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Understanding Hormonal Health: Unraveling the Mystery of PCOS 🧠
Discover the impact of Polycystic Ovarian Syndrome on women's health and how to navigate it. (10min read)
Hormonal health, especially PCOS, affects many women, causing irregular cycles, acne, and weight issues.
PCOS diagnosis is complex due to its various symptoms.
Lifestyle changes can manage PCOS, including a balanced diet, calming exercises, and strength training.
PCOS is linked to higher rates of mental health issues such as anxiety, depression, and disordered eating.
Hello everyone, Cody here.
Today, I'm stepping aside to give room to an exceptional guest writer, Kelli, a seasoned dietitian, and personal trainer with a passion for women's health.
Kelli brings a wealth of knowledge and personal experience in dealing with hormonal imbalances and their impact on women's lives.
She's here to shed light on a prevalent but often misunderstood condition - Polycystic Ovarian Syndrome (PCOS).
Many women struggle with the symptoms of PCOS, such as irregular cycles, acne, and difficulty losing weight, often feeling like they're fighting a losing battle.
In today's blog, Kelli aims to demystify PCOS, breaking down its diagnosis, the associated health risks, and most importantly, sharing effective strategies for managing this condition through lifestyle changes.
Over to you, Kelli!
Why Should You Care About Hormones?
As a dietitian and personal trainer, I’m always chatting with women about food, fitness & hormones.
Recently, I met a dermatologist at a mutual friend’s wedding, so of course I started talking with her about health.
Polycystic Ovarian Syndrome (PCOS) came up and she expressed an idea that kind of blew my mind... She said, “It’s almost like all women have some level of PCOS.”
The amount of women experiencing irregular cycles, acne & struggling to lose excess body weight suggests there are a lot of hormonal issues happening.
I frequently hear my clients express their frustrations with feeling like:
“I’m doing what I can to be “healthy” but I’m not feeling better.”
“It feels like such a fight to just exist as a woman right now.”
“I get 8 hours of sleep but still wake up exhausted”
“I don’t even feel hungry, I just eat to survive.”
These are all red flags to me that we need to nourish our hormones and look deeper than just eating the right amount of calories.
Hormones influence every function in our body from thoughts to energy to fertility.
I believe they can provide a great source of inner guidance, allowing us to take charge of our health.
What is Polycystic Ovarian Syndrome (PCOS)?
Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder affecting 10-20% of women in their 20s and 30s according to recent studies.
It can develop in the early teen years and is a lifelong condition, but many of the symptoms can be managed and even reversed.
Both the environment & genetics play a part in how PCOS presents itself.
There is an increased risk of gestational diabetes, pregnancy-related hypertension, preeclampsia, and infant hypoglycemia in women who present with PCOS (Mustaniemi S, et al., 2018).
The success of treatments varies from person to person but medications, acupuncture, nutrition & lifestyle habits have all been shown to improve different PCOS biomarkers.
Before we discuss some of the ins and outs of PCOS, let’s define a few important terms:
Hormones: Chemical messengers that coordinate different functions in the body. There are hormone receptors all throughout the body, not just on our sexual organs.
Insulin: The hormone that allows glucose (the source of cellular energy) into cells.
Insulin Resistance: When cells slowly over time stop responding to the insulin.
The pancreas will respond by secreting more and more insulin until it hits a point of burnout.
It is then (AFTER a long period of insulin resistance) that blood sugars start to rise and pre-diabetes presents.
Androgens: Hormones that are often higher in women with PCOS. They interact with insulin and impact skin, hair & fertility.
History & Diagnosis
PCOS was first defined in 1935 and was not yet well understood.
There were a variety of symptoms seen in women, but determining how to diagnose it was (and still is) controversial.
In 2003 the European Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine created the Rotterdam Criteria to expand the "phenotypic expression", or a variety of symptoms that could represent PCOS.
Wondering what a phenotype is?
Think of it like this: Your genotype is like the ingredients list in a recipe—it's the specific set of genes you inherit from your parents.
Now, the phenotype is like the final dish that's cooked up from that recipe—it's all the visible and measurable characteristics you end up with, like your height, eye color, or even the risk of getting certain diseases.
The same ingredients (genes) can result in different dishes (phenotypes) depending on how they're mixed together and the environment they're cooked in, just like how your genes interact with environmental factors to make you, you!
Rotterdam Criteria PCOS Phenotypes
That being said, in 2006, the Androgen Excess Society, a PCOS research and advocacy task force, rethought the PCOS diagnosis criteria and created the idea of 4 specific types of PCOS based on the different phenotypes that can present.
According to the Rotterdam Criteria, a woman has PCOS if she presents with at least 2 of the following physical symptoms:
Menstrual dysfunction: This can be any type of irregular cycle, meaning longer than about 35 days apart. However, even women with regular cycles (as defined as 28-35 days) can be anovulatory, meaning they don’t always ovulate.
Clinical and/or biochemical signs of hyperandrogenism: These include irregular hair growth (especially on the face & neck) as well as high lab values (testosterone is one commonly checked).
12 or more immature follicles in one ovary OR ovarian enlargement: The “immature follicles” and ovarian enlargement are also kind of a gray area.
We know that in women with PCOS, the follicles begin but don’t complete development. The underdeveloped follicles can appear as small cysts (but aren’t the same as an ovarian cyst which is usually much larger).
Other conditions such as impaired thyroid or adrenal glands, environmental toxin exposure, and nutrient deficiencies can also impact the development of follicles.
PCOS Phenotypes based on Rotterdam Criteria:
Phenotype A: You have hyperandrogenism, menstrual/ovulatory dysfunction & polycystic ovaries.
Phenotype B: You have hyperandrogenism & menstrual/ovulatory dysfunction
Phenotype C: You have polycystic ovaries & hyperandrogenism
Phenotype D: You have polycystic ovaries & menstrual/ovulatory dysfunction
In general, Phenotype A tends to be the most common. This is what I see in about 50 to 75% of cases. Phenotypes B, C, and D are less common, accounting for about 20 to 30% of total cases according to a reproductive science journal article by Clark, N., et. al, in 2014.
While weight gain is a common symptom associated with PCOS (especially phenotype A), there are women with smaller bodies who present with PCOS, most commonly in phenotypes B, C, and D.
There may be less metabolic dysfunction and fewer long-term risks like diabetes and cardiovascular disease in these three phenotypes.
So, as you can probably see, there’s quite a bit of gray space that can create confusion.
Especially with the increased use of hormonal birth control (HBC), which is thought to “treat” symptoms of PCOS like acne & irregular periods in young women.
Synthetic hormones in HBC can lower androgens while being taken (J. Vrbíková , D. Cibula., 2005).
However, these imbalances may remain when the HBC is stopped. There’s still much to be learned about the additional pros & cons of HBC.
Increased systemic inflammation & nutrient deficiencies may be risks PCOS women already have and HBC may be adding fuel to the already burning flame (Divani AA, et. al., 2015).
PCOS is the cause of 90-95% of anovulatory infertility in women (Dennet CC, Simon, J., 2015).
HBC does have some potential to help women get pregnant due to lowered androgens. Some will get pregnant immediately after they quit HBC but then may find their PCOS symptoms coming back later in life if the root causes aren’t addressed.
I recommend supporting the root causes of an individual's PCOS for not only improved fertility but long-term health.
Is There Hope?!
So, what can we do to decrease our risk of developing PCOS or reverse symptoms? Is that even possible?
The answer is yes.
And to do this we need to learn to manipulate the hormone insulin.
A phenomenon called insulin resistance occurs in many people with PCOS regardless of body size.
Insulin resistance can be measured by a few different biomarkers including fasting insulin and fasting blood sugar.
Unfortunately, these labs aren’t always drawn in young women as a preventative measure.
While larger-bodied individuals are more likely to present with PCOS, smaller-bodied individuals can also have PCOS.
In fact, many successful athletes present with PCOS because increased androgen levels can improve muscle strength!
So, whether you have been tested for insulin resistance or not, if you are a woman, listen up.
Studies have found nutrition changes to be one of the most powerful ways to impact hormones like:
Nutrition can impact our metabolic markers like cholesterol, triglycerides & blood sugar as well.
All of which impact fertility, menstrual cycles, and overall how we feel
So, by starting with the foundational changes to our lifestyle, we can see major improvements in PCOS and other symptoms of hormone imbalance.
Top 5 Changes You Can Make to Improve Your Metabolic Health
Change 1: Macronutrients
Learn the 3 different macronutrients & how to eat a balance of them.
Eating enough protein is the first goal. I recommend a minimum of 80 grams of protein per day divided into 3 feedings.
This can include meals, snacks, shakes, whatever you need to do - just keep in mind your body can only use approximately 30-45 grams at a time.
Change 2: Calming Your Sympathetic Nervous System
If you’re reading this blog, I know you already know this, but when your sympathetic nervous system or the Fight/Flight system is always on, it can have some nasty effects.
Calming your Sympathetic Nervous System, and activating your Parasympathetic Nervous System are key when trying to improve your metabolic health.
Deep belly breathing, meditation, acupuncture, yoga, spending time in nature, humming, etc, are all great ways to do this!
Cody has written some great blogs on this topic, one of my favorites is: The Vagus Nerve & It’s Superpowers
Change 3: Reduce Food Related Stress
Stop stressing so much about avoiding foods.
While we do want to limit sugar and refined carbohydrates because they will cause the most abrupt spike in our blood sugar (not great for insulin resistance), we can still consume these in the right portions and pair them with a balanced meal containing protein & fat.
Most meals can be fit into a ratio of approximately 30-45 grams of protein, 30-40 grams of fat, and 20-40 grams of carbohydrates.
On the high end that’s 700 calories, low end 470 calories (if you’re scared to eat that much at once we have some work to do).
I find so many women unintentionally under eating & not realizing their brains & metabolism are suffering from being in an under-fed state.
It’s kind of a puzzle at first, but it becomes a habit over time to build out your day of meals around this formula.
Here are a few example meals:
Craving Pizza & Chocolate?
2 Trader Joe’s cauliflower thin crusts (8 g carbs, 6 g fats), 3 oz cheddar cheese (20 g protein, 28 g fat), 2 oz shredded chicken (17 g protein), 4 tbsp tomato sauce (3 g carbs)
Mini dark chocolate bar (9 g carbs, 5 g fats).
Grand total: 20 g carbs, 39 g fats, 37 g protein.
3 corn tortillas (28 g carbs), 4 oz ground beef (29 g protein, 18 g fats), ¼ cup guac (4 g fats, 2 g carbs), romaine & salsa (3 g carbs).
Grand total: 33 g carbs, 22 g fats, 29 g protein.
Change 4: Strength Training
Learn to lift weights, start with machines if you need to!
Machines require less stabilization from your joints and ligaments but start to build the “muscle memory” to use free weights like dumbbells and barbells.
If you’re intimidated by the gym, reach out to a personal trainer (like me) for an at-home routine to start targeting your major muscle groups and building muscle.
Exercises to start with include balancing on one leg, chair squats (squatting til your bottom hits a chair then standing up), holding a lunge position, modified planks, and push-ups.
Start adding dumbbells & more complex movements once you can do all of these with your body weight.
Change 5: Nutrients > Calories
Look deeper than just calories.
Learn which vitamins & minerals are important for supporting hormones.
A few common nutrients I see women with PCOS lacking via blood work and dietary assessment are vitamin D, A, zinc, iron, and inositol.
Fiber (not a vitamin but a compound in plant-based foods) can also impact hormones, especially estrogen, by modulating the gut microbiota.
Inositol, a b-vitamin, is one of the best supplements for supporting blood sugar, ovulation & overall hormone balance.
I like Ovasitol by Theralogix (grab it in my supplement dispensary for 20% off).
Performance Lab Women’s Multi is also a great option for a multivitamin to fill in some gaps your diet may not hit.
You’re Not in This Alone
Book a free call to learn about my one on one virtual coaching program Hustle & Hormones where I help women create (& stick to) the habits that really impact their hormones.
And help them stop wasting time researching, extreme dieting, criticizing their bodies & forcing themselves to go on runs.
Yes, I said it, you can skip the run & still lose weight!
I’d like to thank Kelli again for stepping in today and sharing some of her expertise with this community!
If you or someone you know would like to connect with her further, here are the best places to reach her:
Kelli’s Website: avonutrition.life
I hope you see that addressing PCOS is a complex but achievable goal.
Despite the impact on both physical and mental health, remember, you have the power to influence your hormonal health positively.
Simple lifestyle changes, a balanced diet, and stress management can lead to significant improvements.
You are not alone in this journey. Leveraging the help of professionals like Kelli can pave the way toward a holistic and integrated approach to managing PCOS.
Your hormonal health matters - let's empower ourselves to understand it and take control.
Until next time… Live Heroically 🧠
Cooney, LG., Dokras, A. (2017). Depression and Anxiety in Polycystic Ovary Syndrome: Etiology and Treatment. Curr Psychiatry Rep. 19(11):83. doi: 10.1007/s11920-017-0834-2. PMID: 28929349.
Divani AA, et. al. (2015). Effect of oral and vaginal hormonal contraceptives on inflammatory blood biomarkers. Mediators Inflamm. 2015:379501. doi: 10.1155/2015/379501. Epub 2015 Mar 16. PMID: 25861161.
J. Vrbíková , D. Cibula. (2005). Combined oral contraceptives in the treatment of polycystic ovary syndrome. Human Reproduction Update. 11:3, 277-291. doi.org/10.1093/humupd/dmi005.
Mustaniemi S, et al. (2018). Polycystic Ovary Syndrome and Risk Factors for Gestational Diabetes. Endocr Connect. 7(7):859–69. doi: 10.1530/EC-18-0076