Today’s post is all about a subject that I have become very well versed in over the years. I was diagnosed with PCOS in 2014 after coming off hormonal birth control and experiencing 60+ day cycles and irregular bleeding throughout my cycle.
It’s interesting to look back on that day in my OBGYN’s office, because it really did change the trajectory of my life. I can only be thankful that this is my journey. It all led me to this very moment -- here in my cute little office slash yoga studio slash zen den -- writing, doing work I love more than I can say, empowering people through education/food/sustainable choices/life/love/mind/body/spirit healing and experiencing life to its absolute fullest thanks to the life that I have built for myself! Check out the unabridged version of my PCOS story and hormone healing journey here.
So with that I have to say: PCOS, thank you!!!
Thank you for leading me down this path.
Thank you for revealing to me my greatest power.
Thank you for putting me in touch with all of the great teachers and experts who have shaped my knowledge base and inspired so much positive change in my life that I now get to share with my clients.
My goal today is to diffuse some of the confusion around this condition and hopefully help you to dispel any grief or anger you may have if you’ve been diagnosed with PCOS, and maybe even inspire you a little bit. Wherever you are on your journey, whatever your hormones are doing at this moment in time, I'm glad you found this post floating the waves of the internet ethers hah! Thank you for being here with me today!
PCOS, also known as Polycystic Ovarian Syndrome is a condition in which a woman experiences anovulatory cycles (lack of ovulation) and also high levels of androgens (male hormones), including:
- Dihydrotestosterone (DHT)
- Dehydroepiandrosterone (DHEA)
- Dehydroepiandrosterone Sulfate (DHEA-S)
The anovulatory aspect of PCOS results in an overproduction in the androgens.
It’s normal for women to have SOME androgens, as we need them for mood, libido, bone and heart health. However when they are present in concentrations that are too high, symptoms result (specific symptoms described further down in this post)
PCOS cannot be diagnosed with an ultrasound alone, according to Dr. Lara Briden. In order to receive an accurate diagnosis of PCOS, a woman needs to meet the following criteria:
- Ovarian dysfunction and/or polycystic ovaries as seen on ultrasound
- High androgens on a blood test OR symptoms of high androgens (facial hair, hair loss, body hair, acne)
- Other reasons for high androgens have been ruled out
This is criteria from The Androgen Excess and PCOS Society (AE-PCOS), and encompasses the two main aspects of PCOS:
- failure to ovulate on a regular basis and
- androgen excess
Diagnosing PCOS can be a challenge, because it’s really a group of symptoms as opposed to a defined disease. Where some of the confusion lies is in the fact that a woman can have PCOS WITHOUT polycystic ovaries. And on the flip side, a woman can have polycystic ovaries WITHOUT having PCOS. Clear as mud right?
The term “polycystic” came from poly, meaning many, and cystic meaning cysts. Roughly translated, it means “lots of cysts” on the ovary. Healthy ovaries contain many many follicles and once a month, one follicle gets selected to grow/swell extra large (by way of a harmonious symphony of hormones like FSH, LH and estrogen), and eventually burst and release a healthy viable ovum that will be the “egg” that you ovulate that month.
During the process where the dominant follicle is selected, swells and becomes larger than the rest, what happens is the rest of the follicles are naturally suppressed for the rest of the cycle.
These follicles are essentially small, normal “cysts”. In a normal, healthy women with normal ovarian function, these little follicles grow and are reabsorbed by the ovary. So you can see how there is confusion around the word “cyst”, because it actually refers to a totally normal and healthy ovarian function in a woman who ovulates regularly.
Now. In the case of a woman who does NOT ovulate regularly (as in the case with PCOS) here is what happens on the level of the ovary:
The ovary has many follicles, however when a woman does not progress to ovulation, she does NOT form the dominant follicle, and therefore the other follicles do NOT get suppressed. So what happens is all of these follicles just keep growing little bit by little bit, and what you have is a large number of small, undeveloped follicles that create the “polycystic” appearance on ultrasound.
Polycystic ovaries are not specific to PCOS. Teenagers have more ovarian follicles than women in their 20s and 30s, so presence of polycystic ovaries is a natural part of puberty. A woman may experience polycystic ovaries after coming off the birth control pill, because hormonal birth control suppresses normal hormonal function and it can take some time for the body to recalibrate. This study found that 25% of healthy women had polycystic ovaries on imaging.
So this reason is why an ultrasound solely cannot diagnose PCOS. You also need to have presence of androgen excess ruled out by other causes.
Blood tests to assess for androgen excess
Dehydroepiandrosterone sulfate (DHEA-S)
*If your doctor measures total testosterone, make sure she measures sex hormone binding globulin (SHBG), which is a protein that binds to testosterone and estrogen. This is typically low in women with PCOS. I remember it as the sex hormone binding goblin because it binds up testosterone and hijacks our libido. Just a fun little memory aid for you there haha!*
**For all of my coaching clients, I recommend obtaining a full hormonal blood panel in order to get a really good picture of what is happening on the level of your hormones. The more information and insight we have on what is happening inside of you, the better equipped we are to identify the root cause of what is causing your PCOS and course correct accordingly. This would include:***
Luteinizing Hormone (LH)
Follicle Stimulating Hormone (FSH)
Anti-Mullerian Hormone (AMH)
Progesterone (if you suspect you are ovulating, this would need to be drawn 7 days post ovulation)
***if you suspect you have insulin-resistant PCOS, I would include the following labs as well:***
Hemoglobin A1C (HgbA1C)
HOMA-IR Index (Insulin Resistance Index)
Symptoms of androgen excess include
FACIAL HAIR/BODY HAIR
The presence of facial and body hair in women is also known as hirsutism. It’s usually long and dark and may occur on the cheeks, chin, nipples and belly.
Hormonal acne most noted around the chin region is often a sign of androgen excess if you are an adult. Teenage acne is common and is not a good indicator of androgen excess.
HAIR LOSS/THINNING HAIR
This is also known as androgenetic alopecia or female pattern hair loss that is progressive in nature and is caused by the presence of male hormones (some researchers say this type of hair loss is due to a sensitivity to male hormones)
Weight gain is common in “insulin resistant PCOS” due to the metabolic nature of insulin resistance. When there is too much insulin circulating in your blood stream due to blood sugar handling dysfunction, symptoms of metabolic dysfunction result, which include weight gain, heart disease, osteoporosis, and eventually diabetes.
IRREGULAR MENSTRUAL CYCLES
A true period happens 11-14 days after ovulation. If you have an anovulatory cycle, this means you did not ovulate, and therefore the bleed you experience is truly a breakthrough bleed as opposed to a real period. No matter what, when a woman ovulates, 11-14 days later she will experience a period. If you are not ovulating, your period may be delayed or absent all together. This is an irregular cycle. This is very characteristic of PCOS.
PCOS is the leading cause of infertility among women because ovulation either doesn’t happen or it happens irregularly. Very simply stated: if we don’t ovulate, we can’t get pregnant.
There is also an increased risk for diabetes and heart disease in the long-term if you have PCOS due to the inflammatory nature of the condition as well as the chronic decreased exposure to the hormone progesterone, which the body only makes if it ovulates. Progesterone is highly protective and has benefits on every tissue in the body. Check out this post here on the benefits of progesterone and why its essential to longevity and vitality. Given the anovulatory aspect of PCOS, we simply do not get this pulse of progesterone in the latter half of our cycle if we do not ovulate, and this has major implications for long-term health over all.
Allopathic Treatments for PCOS
HORMONAL BIRTH CONTROL
Medical doctors will tell you that hormonal birth control "regulates" your cycle and your hormones. This is technically true because by taking the pill every day, your body's natural hormones are manipulated (and with some hormonal contraceptives, suppressed entirely) by the pill and you will have a predictable bleed every month. This is not a true period, but a "breakthrough bleed" or a "pill bleed". Neither of these are true periods. Hormonal birth control suppresses androgens and may help with symptoms of androgen excess (see above). Hormonal birth control is not without its risks, however, and in my personal opinion after years of research, the risk far outweigh the benefits. The pill worsens insulin resistance (one of the main drivers of PCOS), causes micronutrient depletion (antioxidants, B vitamins, selenium and zinc are all depleted by the pill), completely disrupts the conversation from the brain to the ovaries and further confuses the endocrine system as a whole, disrupts our gut microbiome because it acts like an antibiotic in the gut, causes intestinal permeability (a condition in which large undigested proteins, molecules and toxins make their way through the intestinal lining and into the bloodstream where they aggravate the immune system because they are seen as foreign invaders), increases the likelihood you will develop an autoimmune disorder, increases challenges with liver detoxification, and negatively impacts the body's ability to synthesize thyroid hormones. Also, when you decide to get off the pill when you're ready to have a baby, your underlying hormonal imbalances that led to PCOS in the first place will still be there. Nothing will have been corrected in all the years you spent on birth control. This has MAJOR implications for fertility. I do not suggest this "treatment" for women with PCOS.
Spironolactone is a potassium sparing diuretic that has been found to suppress androgens and thereby improves symptoms of androgen excess such as facial hair, body hair, thinning hair, and hormonal acne. Spironolactone alters the hypothalamic-pituitary adrenal axis (HPA axis), the way in which our brains communicate with our adrenal glands to create the appropriate hormonal cascade we need every day to experience hormonal harmony. It also prevents healthy ovulation in some women. Upon stopping spironolactone, many women experience rebound acne that is much worse than it was prior to being this medication. Again, this option does not address the root cause of the androgen excess.
Metformin is a widely known medication for the treatment of diabetes. It's works by the following mechanisms of action: it decreases blood glucose by inhibiting gluconeogenesis in the liver, it decreases intestinal absorption of glucose, and increases insulin sensitivity by increasing peripheral glucose uptake and utilization. Metformin actually decreases insulin resistance which is a key driver for PCOS, so this makes sense to me why it is an unlabeled use for PCOS. Metformin is still a pharmaceutical drug and carries side effects such as digestive distress (heartburn, stomach pain, nausea, vomiting, bloating, gas) and may cause vitamin B12 depletion. I think this option can be good in the short term, but I believe its much more effective to teach clients how to stabilize their blood sugar through FOOD and better eating habits. Your body doesn't have a metformin shortage, after all. It just needs to recalibrate through better food and lifestyle choices.
The problem with these conventional approaches is that none of them address the root cause of your symptoms. It's radical thinking in the allopathic world that things like food, nutrition, and lifestyle choices can reverse disease. This is a large part of why I left the allopathic paradigm in favor of preventative health care, education, and empowerment through food and lifestyle. It's incredible to witness someone take charge of their health, experience the power of food and nutrition, do their research, get in tune with their inner wisdom, and decide that THEY ARE GOING TO HEAL. It's the whole reason I do what I do and why I am so passionate about this work.
My Personal Journey With PCOS
I opted not to take the pharmaceutical route for my PCOS, because I knew deep down that I could heal. I had zero knowledge of PCOS prior to my diagnosis, but subscribing to the narrative that my 25 year old body had failed me and I was essentially handed a bad genetic hand in the ovarian department just didn't sit well with me. It didn't sit with me AT ALL actually, because I knew that it could be done. I didn't know how I would do it when I left that doctor's office, but dammit if I wasn't going to find out! My last two transvaginal ultrasounds revealed two completely normal, healthy looking ovaries with a dominant follicle indicating ovulation. My lab work over the past 3 years revealed normal hormone functioning across the board. My husband and I went on to conceive in 2021 and sadly miscarried at 10.5 weeks, but we viewed this as a huge win because WE CAN GET PREGNANT. No assisted reproductive technology, no injectable drugs, no meds to force my body to ovulate. This experience showed me that HEALING. IS. POSSIBLE. And this is why I make the choices I make daily -- because when I do, my body rewards me.
I make decisions daily to support my ovulation and manage my PCOS, because I have found over the years that I am extremely susceptible to stress and suffer from severe adrenal fatigue. If I drop the ball, if I abandon my healthy girl habits, if I allow my stress to run amok, if I don't get adequate sleep regularly, if I experience an assault of toxins and don't take steps to mitigate those effects, my hormonal health really suffers. It was only through all these years of fine tuning and honing in on my body's specific, unique, bio-individual needs that I have been able to reverse my condition and restore hormonal harmony. My personal journey with PCOS involved only natural approaches including:
Whole food nutrition
My nutrition approach includes a variety of seasonal whole fruits and vegetables, and very little processed food. I consider anything from a package and anything that contains ingredients I can't pronounce to be a processed food. I eat a combination of protein/fats/carbohydrates at every meal. I eat pasture raised and grass fed meats and eggs, organ meat, raw dairy, full fat Greek yogurt, grass-fed butter, tallow and ghee, sprouted whole grains, legumes, and soaked nuts and seeds. I cook 80-85% of the food me and my husband eat, and the rest of the time I don't sweat it. I indulge on occasion and don't ever feel restricted by food.
My daily de-stressing habits are non-negotiable and have moved the needle of hormonal health more than anything else. I recently quit my 6 figure nursing job due to the impact the stress was taking on me. I have strict boundaries on what I consume in terms of media (so that is to say that I consume absolutely ZERO mainstream media lol), what I look at on social media platforms, who I give access to my energy, and who I spend my time with. Boundaries have been huge in helping me manage my stress. I incorporate meditation, prayer, breathwork, alone time, time in nature, grounding/earthing, play, laughter, reading, baths, music, journaling, and gratitude regularly, and this has enhanced my hormonal health and wellbeing tremendously.
Focusing on my adrenals
When I started working with my functional nutritionist, we uncovered that I was in severe adrenal fatigue. I was beyond "adrenal dysfunction"; my adrenals had full on tuckered out and were essentially fried. The adrenal glands are our organs that secrete the stress hormones cortisol, norepinephrine and adrenaline. The adrenals keep us alive when we need to run away from an axe murderer and don't have time to stop for a smoothie. They are the glands that communicate to our body that we are safe or that we aren't. My adrenals were so fried that my body was literally prioritizing survival over regular periods and regular ovulation. I support my adrenals now by doing only low intensity workouts like hiking and walking plus weights and resistance training. I eat high quality salt daily, nourish with whole food vitamin C, get outside for morning sun, and apply heat to them in the evenings to increase circulation.
I get 8.5-9 hours of sleep every single night and am in bed by 9:30pm most nights. This is a non-negotiable for me and is something I refuse to skimp on ever. College Emily who pulled all-nighters and used to pride herself on being able to stay awake for 24+ hours is judging me hard for my very grandma-esque style of commitment to her bed time routine hah! But Hormonal Harmony Emily doesn't GAF because she's happy, balanced, healthy, and THRIVING. (And she has forgiven College Emily for her bad habits that definitely contributed to the fried little adrenals lol)
I detoxify daily due to the constant barrage of chemicals, heavy metals, pesticides, and other poisons that exist in our environments. Check out this post on my favorite ways to detoxify.
Reducing my exposure to endocrine disrupting toxins
I have done a whole body and whole house makeover in order to reduce my exposure to toxins. I no longer use beauty care products or make up with toxic ingredients. See this post for toxic chemicals that are often lurking in your make up bag. I make my own cleaning supplies (toilet bowl cleaner, all-purpose spray, floor wash, stain remover, etc) with vinegar and essential oils, and I use almost zero plastic. I only eat organic produce and sustainably raised animal products without antibiotics, growth hormones, and lots of access to sunlight and fresh air. It's an entire process to change your practices, so I wouldn't recommend making all these changes in one day. You'll likely get frustrated and abandon ship and feel defeated. Do things little by little, knowing they are positively impacting your health.
Optimizing my gut health
This specific approach is unique to me, as I had a GI Map done to reveal what exactly was going on with my gut. Yours will look totally different so you really need to know what's going on in your gut before you start throwing supplements in there. The big things I did were remove gluten 100%, add a spore based probiotic, add a supplement specific for healing intestinal permeability, incorporate fructooligosaccharides to feed my beneficial bacteria, eradicate my H. Pylori infection, and eat a diversity of seasonal fruits and veggies. Gut health is a daily thing, and there are many supplements and practices that I cycle in and out of in order to achieve optimal balance.
Embodying my divine feminine energy
Feminine energy is the energy of being, of stillness, of tranquility, of nurturance, of creativity, of allowing, of receiving. We live in a very masculine world where we are constantly expected to do do do and produce produce produce and tenaciously pursue what we want. One is not better or worse than the other, but its in achieving balance of our feminine and masculine energies as women that we can have the best possible experience in our cycling bodies. I truly believe that the manifestation of PCOS in my body came from an energetic state of living too much in my masculine energy. This disconnection from the feminine created somewhat of a dissociation with my female body. Getting back in touch with this sensual, flowing, receiving side of myself has helped me to heal emotionally and energetically.
Aligning my life with my menstrual cycle
During each phase of my cycle, I lean into the energetic themes that characterize each phase, and I fully embrace the beauty of each of them. I eat follicular foods in my follicular phase, and menstrual foods in my menstrual phase. I create, communicate, and work in congruence with my cycle phases. Its a relationship I have with my body and my hormones that I cherish more than I can say. Menstrual cycle alignment has helped me step into my power as a woman and experience more happiness, more energy, and more pleasure in all aspects of my life.
Using organic herbs and high quality whole food based supplements to fill in the gaps
I utilize herbs daily to help with my adrenal health and with managing my stress. I use them in tea form, capsule form and tinctures. I often create my own teas because I love the freedom to connect with the plants and see what resonates with me in that particular moment. I do use some supplements daily, and I only ever use reputable brands with Good Manufacturing Process (GMP) certification and without excipients or fillers or crap. Supplements are meant to SUPPLEMENT. Never would I take a supplement without first attempting to get it in food form. Our food is horribly depleted in nutrients due to current farming practices, NPK fertilizers and pesticides, so sometimes supplements are necessary no matter how diligent you are with your diet.
There was no "one thing", no "magic bullet", no "quick fix", no one supplement, no one herb, no one specific diet or way of eating, not one single individual thing that did it for me.
It was a combination of numerous things, trial and error, being my own guinea pig, learning, unlearning, reading all the things, attending summits, learning from experts, tuning into podcasts on the daily, getting in touch with my intuition, being present in my body, being present WITH my symptoms, and tending to my emotional/spiritual/subconscious/unseen layers that were in dire need of healing as well. We can only heal the physical body so far until eventually the emotions and the unconscious patterns beg you to pay attention and tell the truth.
With all of my natural approaches, I did still however receive regular lab work every 2 years. I also received transvaginal ultrasounds when I felt shifts in my body or when I would go through periods of anovulation. I have utilized the DUTCH test and the HTMA tests to hone my mineral status and assess my hormone metabolites. I received guidance from my functional nutritionist, acupuncturist, naturopath and OBGYN, and have regular follow ups with these individuals in order for me to have the most holistic approach to my medical care as possible. I think medical doctors are important people to have in your health care corner, and I certainly recommend to all of my clients that they involve their doctor in their approach to wellness.
I whole-heartedly believe that YOU are the driver of your health train. YOU are leading the charge. YOU know your body better than any practitioner. And I believe that it is from this place of empowerment that true mind/body/spirit healing happens and sustains.
PCOS is a complicated condition that is very nuanced and not easy to diagnose. If you suspect you have PCOS, talk to your doctor and request the aforementioned lab work. Request a transvaginal ultrasound. Start being a detective and getting to the bottom of your symptoms. Be a good historian. Go back in your history and identify onset of symptoms, patterns, habits, etc. Start paying attention to your cycle. There is so much information there.
And if you are a woman who has been diagnosed with PCOS, know that you have many options to manage it. Even the pharmaceutical route has its place, and only you can make that decision for how you wish to proceed.
One final note:
You are not your diagnosis. You are not a victim. You are not meant to suffer. You are not meant to live at the mercy of your hormonal imbalance. Your body WANTS TO HEAL. It is ALWAYS trying heal. Have you ever had a paper cut? All you have to do is watch the healing commence before your very eyes. It like ... KNOWS WHAT TO DO to heal your tissue in the most effective, path of least resistance kind of way. This is the body's innate intelligence. It is always trying to come back into a state of balance, of ease, of flow, of homeostasis. When we support the body holistically by feeding it well, resting it well, hydrating it well, reducing the toxic onslaught, and living in alignment with our joy and our truth, this kind of healing is inevitable.
My Hormone Healing Secrets 6-Week Course is open for enrollment and is an amazing tool to get you started on your own hormonal healing journey!
If you feel like you need more 1:1 support, we can always book a free discovery call to see if we would be a good fit to work together.
Now I want to hear from you! Tell me about your experience with PCOS in the comments. Or you can email me at [email protected] if you prefer!
All my love to you today!!
Yours In Abundant Health