If you've ever experienced heavy periods (or no periods at all), weight gain, or pelvic pain and wondered if you might have polycystic ovarian syndrome (PCOS), allow Robin Berzin, MD, to help you sort things out. The CEO of the functional medicine practice Parsley Health, she's taking a deep dive into PCOS and what it can mean for everything from fertility to skin issues to your weight. Here, the Well+Good Council member looks at the symptoms of PCOS—and how she helps her patients manage them through diet and lifestyle changes.
Polycystic ovarian syndrome (PCOS) is being talked about more now than ever, as women open up about associated fertility struggles, hormonal acne, and difficulty managing weight. The latest estimates show that the disorder affects between 8 to 20 percent of women worldwide. Researchers think it’s caused by a combination of genetic and environmental factors, but so little is still known about the disease, and every woman experiences it differently, making it even harder to properly treat.
What is PCOS?
To be diagnosed with PCOS, patients typically have at least two of the following disorders:
- Elevated androgen (male hormone) levels
- Irregular or absent menstrual cycles
- A polycystic ovary (meaning there are cysts on at least one of your ovaries)
Women with these symptoms are considered to have non-insulin resistant PCOS. Some women will also have high blood sugar in addition to two or more of the above symptoms, which is considered insulin resistant PCOS. Understanding the disorders you have can help you and your doctor target treatments.
What are the symptoms of PCOS?
Symptoms of PCOS vary based on the disorders present in each type of PCOS, but common signs include weight gain, fatigue, unwanted hair growth, thinning hair, acne, infertility, changes in mood, pelvic pain, heavy bleeding, headaches, and sleep issues. Women with PCOS are also at an increased risk for diabetes and cardiovascular disease.
How to deal with PCOS naturally
Treatment options for PCOS often include medication to lower blood sugar, birth control pills, and other hormonal medications. With that said, research shows that managing PCOS through diet and exercise can be just as effective as using an insulin sensitizer medication. At Parsley Health, we use lifestyle modifications as a first defense against symptoms of PCOS. Maintaining a healthy weight is a key factor in symptom management, and if you’re overweight, weight loss of even 5 percent can improve symptoms.
Here are 5 ways you can address your PCOS without relying on medications.
Adopt a low glycemic index (GI) diet
Because insulin resistance affects 50 to 70 percent of women with PCOS, getting blood sugar in check is an important factor in treating the disorder. I advise most of my patients with PCOS to try a low-GI diet. The glycemic index is a way of rating carbohydrate-containing foods based on how quickly they are digested and absorbed. Low-GI foods (like most fruits, non-starchy vegetables, and legumes) are digested slowly, causing less of a spike in blood sugar. A low-GI diet has been shown to improve glucose tolerance and menstrual cycle regularity. Eating protein right before consuming low-GI carbohydrates can also stabilize glucose levels.
Make breakfast the biggest meal of your day
Eating the majority of your daily food intake earlier in the day can increase insulin sensitivity and reduce testosterone levels, thereby increasing ovulation and mitigating some of the symptoms related to elevated male hormones. When two groups of women were asked to eat either a calorie-heavy breakfast and light dinner or a light breakfast and calorie-heavy dinner for 90 days, the group that ate the larger breakfast—around half of their daily caloric intake—saw an improvement in insulin sensitivity and 50 percent decrease in testosterone.
Focus on resistance training
Any type of regular moderate intensity exercise can reduce insulin resistance, improve ovulation, and aid in weight loss for women with PCOS—but resistance training could be the most beneficial. Strength training increases lean muscle mass, which is metabolically active, so it can help you better break down and absorb glucose. Women who performed resistance training three times a week for four months improved reproductive function, decreased androgen levels, and decreased belly fat while increasing their lean muscle mass. I recommend that my Parsley Health patients with PCOS strength train three times a week in addition to doing some form of aerobic exercise twice a week.
Supplement with vitamins D and B8
Many women are deficient in vitamin D, but the numbers are higher in women with PCOS: An estimated 67 to 85 percent of women with PCOS are below optimal levels. Research shows this could exacerbate PCOS symptoms, but initial studies indicate supplementation with vitamin D could help regulate your period. Recent research even found that women with PCOS who were vitamin D deficient when starting fertility treatments were 40 percent less likely to get pregnant.
Vitamin B8, also called inositol, is another helpful supplement for treating PCOS. Inositol plays a role in androgen synthesis and glucose uptake in the ovaries, and supplementation has been shown to increase ovulation, improve insulin resistance, and lower androgens.
Reduce chronic stress through meditation
Stress can be a hormone disruptor in all women, but the effect is more pronounced in women with PCOS. When you’re stressed, your adrenal glands produce cortisol, which elevates those blood sugar levels you’re trying to control through diet and exercise. What’s more, stress also leads to the release of a hormone that stimulates the production of androgens. Excess androgens produced by the adrenal glands are evident in about 25 percent of people with PCOS. To combat chronic stress, I advise my patients to incorporate meditation into their lives. A recent review of nearly 19,000 meditation studies confirmed that mindfulness meditation can significantly lower psychological stress.
There's no single, best way to address polycystic ovarian syndrome for everyone who has it—but the natural approach is an excellent place to start.
Robin Berzin, MD, is the founder and CEO of Parsley Health, an innovative primary care practice with offices in New York, Los Angeles, and San Francisco. Dr. Berzin attended medical school at Columbia University. She is a certified yoga instructor and a meditation teacher.
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