The Most Effective PCOS Treatment | The Diving Dietitian
Illustration of Polycystic Ovarian Syndrome by @duvet_days on Instagram.
PCOS is a complex condition that affects the endocrine, metabolic and reproductive systems. It currently affects up to 10-20% of womxn (inclusive of those with non-binary gender identities) in the reproductive age [1, 2, 3].
The most widely used diagnostic criteria requires at least two of the following [1, 2, 3]:
Irregular or missing periods
Hyperandrogenism (high male hormones)
Confirmed via high testosterone, androstenedione, DHT or DHEA-S in blood tests; or
Symptoms such as excess hair growth, hair loss or acne
Immature follicles on the ovaries (aka “polycystic ovaries”)
Confirmed via ultrasound
Your doctor must also be excluded before PCOS diagnosis. Due to the broad impacts and multi-facets of PCOS, symptoms vary from person to person and can range from mild to severe.
Although PCOS has no cure, symptoms can definitely be managed and reduced so much to “reverse” PCOS. PCOS treatment can be complex since no one PCOS case is the same, hence why it is beneficial to have individualised treatment for each case.
Effective PCOS treatment not only reduces current side-effects, but also prevents future complications including [2, 3]:
type 2 diabetes
cardiovascular disease
metabolic syndrome
fatty liver disease
infertility
endometrial cancer
Medication treatment for PCOS shows short-term relief in symptoms but may cause unwanted side-effects during use and after.
Conventional treatment of PCOS focuses on weight loss and medications such as the Oral Contraceptive Pill (OCP), Accutane, Spironolactone and Metformin.
The ineffectiveness of the weight-centric treatment in PCOS needs its whole own blog post. You can become familiar with the evidence in Our Philosophy page. Further, you can ready why weight and BMI is a poor indicator of health on my Instagram post HERE.
While the medications may see quick, short-term relief in PCOS symptoms, there are concerns with the side-effects of long-term use. Further, since these medications tend to simply suppress symptoms rather than treat them, many people with PCOS who come off the Pill, Spironolactone or Accutane experience a dreaded rebound effect of their symptoms.
Finding the root cause of your PCOS helps to direct a treatment that is specific to your unique case.
The start of any effective, long-term PCOS treatment includes identifying the root cause.
The root cause is the main driver of hyperandrogenism, which results in many of the frustrating symptoms people with PCOS experience. Addressing the root cause at the heart of treatment, we can effectively relieve symptoms and prevent future complications of PCOS, while minimising the need and side-effects of medications.
Let’s have a look at the four root causes of PCOS.
Disclaimer: This article is for informational and educational purposes only. It should not be used to diagnose or for treatment of PCOS. Please seek help from a medical doctor or accredited dietitian before starting any treatment.
Lightheadedness or dizziness can be a symptom of hypoglycaemia (low blood sugar), which is a sign of insulin resistance.
Insulin resistance
About 70% of people with PCOS have insulin resistance [2], so there’s a high likelihood this could be your root cause.
Insulin is a hormone that helps our body use sugar (broken down from carbohydrates) to be used as energy or stored as glycogen. If you have insulin resistance, your insulin’s ability to use sugar is impaired. Insulin resistance in PCOS causes excess androgens in the body.
Some symptoms you may experience with insulin resistance include:
o carb cravings (especially late at night)
o brain fog
o random onset of thirst
o lightheadedness or dizziness
o dark patches around the joints
o weight gain (especially around the abdominal area)
Left untreated, insulin resistance can develop into type 2 diabetes, cardiovascular disease, heart attack or stroke. Be alerted, not alarmed.
By understanding how nutrition and lifestyle affect insulin, you can manage insulin resistance and even reverse it in the long run!
Download my 6 Natural Ways to Balance Your Hormones guide HERE for nutrition and lifestyle strategies to manage insulin and other hormones.
Chronic digestive problems like bloating is common in inflammatory PCOS.
Inflammation
Most people with PCOS have chronic, low-grade inflammation [6].
Prolonged inflammation can contribute to insulin resistance and cause damage to various organs, DNA and tissue over time.
Some symptoms of inflammation include:
o Chronic digestive problems like bloating, gas, diarrhoea, constipation, reflux or indigestion
o Skin conditions such as eczema or psoriasis
o Achy joints
o Pain in body like back pain, neck pain, knee pain or headaches
o Asthma or allergies
o Prolonged fatigue and lethargy
Increasing anti-inflammatory foods such as fruits, green leafy vegetables, tomatoes, legumes, nuts, seeds, fatty fish, extra virgin olive oil and whole grains can help to reduce inflammation. Learn more about anti-inflammatory foods HERE.
Excess androgens from the adrenals are often triggered by prolonged stress and contributes to PCOS.
Adrenal
The adrenals are glands that sit on top of our kidneys. Glands produce hormones and the adrenals produce hormones including: cortisol (stress hormone), adrenaline (fight-or-flight hormone) and DHEA-S (androgen and precursor to testosterone).
About 10-30% of people with PCOS have excess adrenal androgens [4, 7].
Excess adrenal androgens are often caused by chronically high stress levels. Managing stress is a big focus if this is your root cause (I know, almost impossible in the world we live in today).
You may have adrenal androgen excess if you:
o Have prolonged stress
o Have anxiety and depression
o Have chronic digestive problems like bloating, gas, diarrhoea, constipation, reflux or indigestion
o Experience dizziness when standing too quick
o Have restrictive eating (currently or in the past)
o Are overexercising (currently or in the past)
o Feel tired but wired before bed
We identify your sources of stress and explore effective and helpful stress management strategies that work for you in PCOS Body Freedom.
Coming off the Pill can cause rebound testosterone levels and a delay in menstrual regularity, qualifying you for a PCOS diagnosis.
Post-pill
The Oral Contraceptive Pill suppresses your natural hormones, oestrogen and progesterone, that is needed for your menstrual cycle and ovulation [4, 5], hence it’s such an effective contraceptive. It also suppresses your testosterone levels, which is why you see relief from many symptoms such as acne and excess hair growth.
In one study, 60% of people stopped taking the Pill after 6 months due to unwanted side effects [9].
Side effects and future complications from the Pill include [4, 5]:
o anxiety and depression
o nausea
o low libido
o micronutrient deficiencies
o impaired gut health
o increased risk of blood clots
o increased risk of insulin resistance
o increased risk of high blood pressure
o increased risk of bone weakness and fracture
o increased risk of some cancers, such as brain, liver and breast cancer
The longer you are on the Pill and thereby suppressing your testosterone, the more likely coming off the Pill can trigger your testosterone to rebound and cause erratic symptoms. It can also take a while to restore the communication between your brain and ovaries, hence many people experience a delay in getting their periods. You may experience these symptoms for up to 1-2 years after coming off the Pill, thereby qualifying for PCOS diagnosis during that time.
If you don’t identify with the other root causes and you were diagnosed with PCOS after coming off the Pill, this may be your root cause.
The symptoms (and your PCOS) will likely reverse, however the ghastly symptoms may be frustrating in the meantime.
You can optimise your nutrition and lifestyle at least 1 month before coming off the Pill to ease that transition, but it’s never too late to investigate what’s going on inside you and use natural methods to restore balance to your hormones and your body.
Some special considerations include:
Hypothyroidism presents with similar symptoms to PCOS, hence it can often be overlooked.
Thyroid disorder
The thyroid is a gland that sits around the throat and neck area that produces important thyroid hormones that control many metabolic processes, such as weight, body temperature and blood pressure.
Thyroid disorder occurs in 25% of people with PCOS [8].
Hypothyroidism is the most common thyroid disorder in people with PCOS.
In hypothyroidism, the thyroid gland is under active and doesn’t produce enough thyroid hormones. Hashimoto’s is common type of autoimmune hypothyroidism where the immune system attacks the thyroid gland causing it to be under active.
Some common symptoms of hypothyroidism:
o Prolonged fatigue + low energy
o Weight gain
o Anxiety or depression
o Low body temperature or getting cold easily
o Hair loss, especially at the outer brow area
o Brittle nails
o Dry, flaky skin
o Muscle weakness
o Impaired memory or concentration
Hypothyroidism symptoms are similar to that of PCOS, so it can be difficult to identify. However blood tests can confirm hypothyroidism. Make sure to test TSH, T4, T3, TAB and TBO. Thyroid disorder has a strong genetic link so it can be helpful to check your family medical history.
Hypothyroidism must be treated with medical and nutritional supervision and is highly individualised.
If you don’t seem to identify with any of the previous root causes, your PCOS root cause may be a hidden cause.
Hidden causes
Other causes include:
o Vitamin D deficiency
o Zinc deficiency
o B vitamins deficiency
o Iodine deficiency
o High prolactin
o Low calorie/carb intake
Combined root causes
Most people with PCOS have a combination of root causes. This is why it can help to work with an accredited dietitian or health professional who understands the complexities of PCOS and the nuances of effective treatment.
You and your PCOS are unique and you deserve individualised and targeted treatment that is suited to your body and your lifestyle. You don’t need to rely on medications that may leave you worse for wear later down the track. Become empowered to manage your PCOS by understanding your root cause and the hormones that are involved.
Freedom from pesky PCOS symptoms is possible without harmful and restrictive dieting and treatment options.
Still not sure what your root cause is? Take this 5-minute quiz!
CLICK HERE to take this ‘What’s Your Root Cause?’ quiz to see what your root cause may be.
PCOS Body Freedom is a 6 month group coaching program that helps you conquer your PCOS and find food freedom. Want to learn more? Book a free 15 minute discovery call with me.
Got an idea of what your root cause may be but not sure what next steps to take?
I can help you.
Hi, I’m Amanda, PCOS & Non-Diet Dietitian.
I’m passionate about helping womxn conquer their PCOS and restrictive eating habits through a unique intuitive eating and hormone balancing nutrition approach.
I believe a holistic approach to health and healthcare is the best way to approach PCOS treatment because you are a complex human being and a narrow-minded approach on nutrition and exercise simply won’t cut it.
I would love to help and empower you with the knowledge and confidence to take control of your PCOS, food freedom and health.
That’s why I created PCOS Body Freedom.
My 6 month program, PCOS Body Freedom, is a truly transformational and empowering experience. We tailor my tried-and-true 5-step framework to help you find long-term relief from your PCOS symptoms while breaking the restrict-binge cycle using a unique root cause, holistic healthy habit approach so you can feel more energised, confident and free in your body.
We leave the guesswork, harmful and uncomfortable dieting practices behind. You get to know and work with your body to identify and manage your triggers naturally, with or without medication. In 6 months, you feel knowledgeable and empowered to manage your PCOS beyond the program and find peace with food and your body.
Are you ready for a life-changing and empowering experience?
References
The International PCOS Network. (2018). Translation and implementation of the Australian‐led PCOS guideline: clinical summary and translation resources from the International Evidence‐based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. The Medical Journal of Australia, 209(57), S3-S8. doi: 10.5694/mja18.00656
Boekmans, F.J., Knauff, E. A. H., Valkenburg, O., Laven, J.S., Eijkemans, M. J. & Fauser, B. C. J. M. (2006). PCOS according to the Rotterdam consensus criteria: change in prevalence among WHO‐II anovulation and association with metabolic factors. An International Journal of Obstetrics and Glynaecology, 113(10), 1210-1217. doi: 10.1111/j.1471-0528.2006.01008.x
Diamanti-Kandarakis, E. & Panidis, D.(2007). Unravelling the phenotypic map of polycystic ovary syndrome (PCOS): a prospective study of 634 women with PCOS. Clinical Endocrinology, 67(5), 735-742. doi:10.1111/j.1365-2265.2007.02954.x
PCOS Society (India) (2018). Consensus Statement on the Use of Oral Contraceptive Pills in Polycystic Ovarian Syndrome Women in India. Journal of human reproductive sciences, 11(2), 96–118. https://doi.org/10.4103/jhrs.JHRS_72_18
Roach, R. E., Helmerhorst, F. M., Lijfering, W. M., Stijnen, T., Algra, A., & Dekkers, O. M. (2015). Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. The Cochrane database of systematic reviews, 2015(8), CD011054. https://doi.org/10.1002/14651858.CD011054.pub2
González F. (2012). Inflammation in Polycystic Ovary Syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids, 77(4), 300–305. https://doi.org/10.1016/j.steroids.2011.12.003
Kumar, A., Woods, K. S., Bartolucci, A. A., & Azziz, R. (2005). Prevalence of adrenal androgen excess in patients with the polycystic ovary syndrome (PCOS). Clinical endocrinology, 62(6), 644–649. https://doi.org/10.1111/j.1365-2265.2005.02256.
Singla, R., Gupta, Y., Khemani, M., & Aggarwal, S. (2015). Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian journal of endocrinology and metabolism, 19(1), 25–29. https://doi.org/10.4103/2230-8210.146860
Westhoff, C. L., Heartwell, S., Edwards, S., Zieman, M., Stuart, G., Cwiak, C., Davis, A., Robilotto, T., Cushman, L., & Kalmuss, D. (2007). Oral contraceptive discontinuation: do side effects matter?. American journal of obstetrics and gynecology, 196(4), 412.e1–412.e7. https://doi.org/10.1016/j.ajog.2006.12.015