PCOS: How to Identify and Address Naturally

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Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting millions of women worldwide. Despite its prevalence, PCOS remains widely misunderstood, leading to delays in diagnosis and treatment. In this protocol, we'll delve into the types, symptoms, diagnostic methods associated with PCOS, and natural approaches shedding light on this complex condition.

What is PCOS?

PCOS is a hormonal disorder characterized by imbalances in reproductive hormones, particularly in women of reproductive age. These hormonal imbalances can lead to various symptoms and health issues, including irregular menstrual cycles, ovarian cysts, infertility, and metabolic problems such as insulin resistance and obesity.

Types of PCOS:

1. Classic PCOS: This is the most common type, characterized by irregular menstrual cycles, high levels of androgens (male hormones), and polycystic ovaries on ultrasound.

2. Non-Classic PCOS: Some women may have symptoms of PCOS without meeting all the diagnostic criteria. This type is often referred to as "non-classic" or "atypical" PCOS.

Symptoms of PCOS:

PCOS manifests differently in each individual, but common symptoms include:

• Irregular menstrual cycles or absence of menstruation
• Excessive hair growth (hirsutism), often on the face, chest, or back
• Acne or oily skin
• Weight gain or difficulty losing weight
• Thinning hair or male-pattern baldness
• Difficulty getting pregnant (infertility)
• Darkening of the skin, especially along neck creases, in the groin, and underneath breasts (acanthosis nigricans)

Diagnosis of PCOS:

Diagnosing PCOS can be challenging due to its varied presentation and overlap with other conditions. A healthcare provider will typically conduct a thorough medical history review, physical examination, and various tests, including:

1. Menstrual History: Assessing the regularity and length of menstrual cycles can provide valuable clues.

2. Blood Tests: Measuring your hormone levels:

   1. Elevated total testosterone > 45 ng/dL
   2. Elevated free testosterone > 4.6 pg/ml
   3. Normal or elevated estradiol during luteal phase 56 - 214 pg/ml
   4. Low progesterone in the luteal phase < 2.6 ng/ml
   5. Elevated DHEA-S > 391 ug/dL
   6. 3:1 ratio of LH/FSH
   7. Elevated AMH > 4 ng/ml

Order blood work panels: Hormone Panel - should be done during the luteal phase, about 5-7 days post ovulation.

1. Pelvic Ultrasound: A transvaginal ultrasound may be performed to visualize the ovaries and detect the presence of cysts.

2. Other Tests: Additional tests may be conducted to evaluate insulin resistance, lipid profile, and thyroid function, as these are commonly affected in women with PCOS.

Risk Factors

• Genetic Predisposition: There is evidence suggesting a genetic component to PCOS, with a higher likelihood of developing the condition in individuals with a family history of PCOS. Keep in mind that your genes are influenced by your diet, lifestyle and environment. 

• Insulin Resistance: PCOS is strongly associated with insulin resistance, a condition where cells become less responsive to insulin's effects, leading to elevated insulin levels in the blood. Biomarkers to look for when assessing insulin resistance:

  1. Elevated fasting glucose > 86 mg/dL
  2. Elevated fasting insulin > 5 uIU/ml
  3. Elevated HbA1c > 5.3 %
  4. Elevated triglycerides > 80 mg/dL
  5. Elevated LDL > 100 mg/dL

Order blood work panels: insulin Resistance & Lipid Panel

• Obesity: Excess body weight, particularly central obesity, is a major risk factor for PCOS. Obesity exacerbates insulin resistance and hormonal imbalances, further increasing the risk of developing PCOS and its associated complications.

• Lifestyle Factors: Sedentary lifestyle and poor dietary habits, including consumption of refined carbohydrates and high-sugar foods, may exacerbate insulin resistance and contribute to the development of PCOS.

• Exposure to Environmental Toxins such as heavy metals, BPA, PCHs, PFOAS, Phthalates, etc.
• Mitochondrial Dysfunction: it's very important that you control your light environment before anything else 
• Poor Liver and Gallbladder Health: Refer to the liver and gallbladder pathway
• Hypothyroidism increases the risk of PCOS

Order of Operations

1. As with other hormone imbalances it is important that you fix your circadian rhythm and sleep 
2. Control your exposure to environmental toxins 
   • Invest in a good water filter: Reverse osmosis such as AquaTru (link applies discount automatically), or with a distillation machine such as My Pure Water (code: PAOLA)
   • If mold is present in your environment, invest in a good air filter such as AirDoctor (link applies discount automatically). Consider having it tested and remediated. 
3. Work on your drainage pathways especially liver and gallbladder
4. Address nervous system dysregulation or stored trauma
5. Cultivate your feminine energy especially if you are mostly in your masculine: go getter! 
6. Address insulin resistance if present
7. Address hypothyroidism if present 
8. Lose weight if you are overweight - it's important to work with a practitioner if you have other hormone imbalances impacting weight loss

Supplements 

1. D-Chiro-Inositol: 1,000 mg/day - Consider using DCI supplementation when insulin resistance is a prominent feature of PCOS or when targeting improvements in insulin sensitivity is a primary goal. DCI may be especially beneficial for women with PCOS who have elevated insulin levels or have not responded well to other interventions targeting insulin resistance.
2. Myo-Inositol: 2 g twice a day - MI supplementation may be appropriate for women with PCOS who have menstrual irregularities, ovulatory dysfunction, or fertility issues. It can also be considered for women with PCOS who have insulin resistance, particularly when used in combination with DCI.
3. Vitamin D (with K2): 1,000 to 5,000 IU/day, refer to The Nuances of Vitamin D before supplementing
4. N-Acetylcysteine (NAC): 1,800 mg/day, divided into multiple doses, on an empty stomach
5. L-Carnitine: 3 g/day, divided into multiple doses, on an empty stomach
6. Coenzyme Q10: 60 mg three times per day, taken with meals
7. Omega-3 Fatty Acids (Fish Oil):
   • Equivalent to about 4–6 g/day of fish oil
8. Selenium: 200 μg/day
   • Test your selenium levels first