PCOS 101: Ultimate Guide to PCOS Symptoms, Diagnosis and Natural Treatments
- Dr. Tediana Torrens
- Mar 15
- 7 min read
Updated: Apr 17
Polycystic Ovary Syndrome (PCOS) is a complex hormonal disorder that affects millions of women and individuals with a uterus worldwide. Despite its name, PCOS is not solely defined by ovarian cysts; instead, it is characterized by hormonal imbalances, metabolic disturbances, and a range of symptoms that can impact overall health and fertility. This comprehensive guide explores the causes, symptoms, diagnosis, and treatment options for PCOS, integrating both conventional and naturopathic approaches.
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What is PCOS?
PCOS is an endocrine disorder primarily caused by excess androgens (male hormones like testosterone) in women or individuals with a uterus and ovaries. Contrary to popular belief, the "cysts" in PCOS are actually multiple undeveloped follicles in the ovaries, rather than true cysts. Typically, a single follicle develops each month, maturing into an egg that is released during ovulation. With PCOS, many follicles develop at the same time, resulting in the failure of any one follicle to mature properly. Ultimately, this leads to irregular ovulation or anovulation and irregular of missed periods. PCOS affects between 10-20% of individuals of reproductive age.
Causes of PCOS
The exact cause of PCOS is not fully understood, but several contributing factors have been identified. Generally, PCOS is thought to develop in individuals with a genetic predisposition in the context of certain environmental factors.
Genetics
PCOS has a strong hereditary component, with a 70% heritability rate. Put simply, this means that genetics are the majority cause for PCOS. It does not mean that 70% of causes are related to genes.
Specific genes associated with PCOS have been identified, although the exact genetic mutations remain unclear.
Individuals with a first-degree relative (parent or sibling) with PCOS have a significantly higher risk of developing the condition.
Insulin Resistance
Insulin stimulates androgen production. Increased insulin levels, which is characteristic of insulin resistance, can lead to excess testosterone levels.
Androgens, in turn, promote visceral fat accumulation (the fat that develops on organs), which exacerbates insulin resistance.
This cycle can lead to metabolic disturbances, weight gain, and worsening PCOS symptoms.
Insulin stimulates the development of follicles, giving ovaries the characteristic "polycystic" appearance.
Microbiome Imbalance (Dysbiosis)
Imbalances in gut bacteria can increase intestinal permeability ("leaky gut"), allowing inflammatory substances to enter the bloodstream.
Inflammation further exacerbates insulin resistance, metabolic dysfunction and hormone imbalances, perpetuating PCOS symptoms.
Research has demonstrated that women with PCOS have lower gut microbiome diversity , a sign of poor gut health, that typically correlates with metabolic dysfunction.
Stress
Chronic stress elevates cortisol levels, which disrupts sex hormone balance and worsens inflammation.
High cortisol levels also contribute to insulin resistance and weight gain, both of which are closely linked to PCOS.
Weight and Metabolism
Increased childhood and adolescent weight gain, particularly central/visceral fat, is a risk factor for developing PCOS.
Metabolic dysfunction in PCOS leads to difficulties in weight regulation and an increased risk of type 2 diabetes.
Endocrine Disruptors
Chemicals such as bisphenols, parabens, and triclosan (found in plastics, cosmetics, and cleaning products) can interfere with hormone regulation.
While research is still emerging, preliminary studies suggest a potential link between endocrine disruptors and PCOS development.
Using databases like EWG and Skin Deep can help in identifying products that are clean are free of endocrine disruptors.
Lifestyle Factors
Diets high in processed foods, low fiber intake, sedentary behavior, smoking, and alcohol consumption contribute to systemic inflammation and metabolic dysfunction, increasing the risk of PCOS.
Symptoms of PCOS
PCOS symptoms can vary widely, but the most common include:
Irregular or absent periods (amenorrhea/oligomenorrhea)
Hirsutism (excess hair growth on the face, chest, or back)
Acne, particularly on the chin and jawline
Hair thinning or scalp hair loss
Weight gain, especially around the abdomen
Mood changes and irritability
Complications and Associated Conditions
Individuals with PCOS have an increased risk of:
Insulin resistance and type 2 diabetes
Metabolic syndrome (high cholesterol, high blood pressure, high blood sugar - all leading to increased cardiovascular risks)
Infertility due to ovulatory dysfunction
Endometrial hyperplasia and increased risk of endometrial cancer
Diagnosis of PCOS
The Rotterdam Criteria is the most widely used method for diagnosing PCOS. A diagnosis is made if at least two of the following three criteria are met:
Clinical or biochemical signs of androgen excess (such as hirsutism or high testosterone levels)
Irregular menstrual cycles (>35-day cycles or fewer than 9 periods per year)
Polycystic ovaries seen on transvaginal ultrasound ("string of pearls" appearance)
Conditions that Mimic PCOS
Non-Classic Congenital Adrenal Hyperplasia (CAH): Presents with the same symptoms as PCOS, but caused by an enzyme deficiency that results in excess testosterone.
Classic CAH presents with infancy, while non-classic presents in teens or adults.
Adrenal Tumors: Can result in excessive testosterone production.
Thyroid Disorders: Hypothyroidism can cause irregular periods but lacks other PCOS-specific symptoms like hirsutism.
Lab Testing for PCOS
Blood Tests
Testosterone (total and free)
Estrogen, progesterone, and LH/FSH ratios
Estrogen dominance can present with PCOS. This can make periods heavy, painful, and cause other symptoms like headache/migraine, bloating, weight gain.
Fasting insulin and Hgb A1c
Insulin resistance and diabetes commonly occur with PCOS.
Cholesterol (lipid panel)
Cortisol levels (stress hormone evaluation)
Thyroid function tests
GGT
This is a simple way to assess toxic burden, which can help identify if exposure to endocrine disruptors are contributing to the development of PCOS.
Nutrient levels: Vitamin D, B12, iron, omega-3, and zinc
Functional Tests
DUTCH test: Provides comprehensive hormone analysis and cortisol patterns.
Comprehensive stool testing: Assesses gut health, dysbiosis, and inflammation.
SIBO breath test: Identifies small intestinal bacterial overgrowth, which can contribute to PCOS.
Conventional Treatments for PCOS
Birth Control Pills: Regulate menstrual cycles and prevents pregnancy.
Spironolactone: Lowers testosterone and reduces hirsutism and acne. Spironolactone can cause birth defects if taken during pregnancy. This is why it is important to be taking some type of birth control.
Metformin: Improves insulin sensitivity and may promote weight loss.
Natural Approaches to Managing PCOS
Dietary Changes
Mediterranean diet: Rich in whole foods, fiber, and lean proteins, low in processed foods. This diet is naturally anti-inflammatory and a crucial foundation in PCOS treatment.
Low-glycemic index foods: Help stabilize blood sugar levels and reduce insulin spikes.
Exercise
Aerobic exercise: Improves insulin resistance and overall metabolic health.
Strength training and yoga: May support hormone balance and stress reduction. High intensity interval training is also helpful in improving insulin resistance.
Sleep Hygiene and Stress Management
Improving sleep quality enhances insulin sensitivity and hormonal balance.
Mindfulness practices, meditation, and therapy can help lower cortisol levels.
Supplements and Herbal Medicine
Spearmint tea: Reduces testosterone levels when consumed daily.
Vitex (Chaste Tree Berry): Regulates menstrual cycles, reduces PMS, and improves fertility.
Inositol: Supports insulin sensitivity and menstrual regularity.
Omega-3 fatty acids: Reduce inflammation and improve metabolic health.
Other Recommendations:
Lowering Testosterone: Spearmint, Saw palmetto, Tribulus
Balancing Estrogen and Progesterone: Vitex, Flax seeds, Resveratrol
Managing Insulin Resistance: Inositol, Berberine, Cinnamon
Improves Fertility: Chamomile, Aloe vera, Inositol, Melatonin, CoQ10, Omega-3, Vitamin D
Final Thoughts
PCOS is a multifaceted condition that requires a personalized, holistic approach to treatment. Whether opting for conventional, natural, or integrative therapies, managing PCOS effectively involves addressing hormonal balance, metabolic health, and lifestyle factors. If you suspect you have PCOS or need support in managing it, schedule a consultation to explore the best treatment plan for your needs.
Disclaimer
The information provided in this blog and throughout the website is intended for educational purposes only and should not be considered, or used as a substitute for, medical advice. The content is not meant to diagnose, treat, or cure any medical condition. This blog does not constitute the practice of any medical, nursing or other professional health care advice, diagnosis or treatment. Always consult with a qualified healthcare provider before making any changes to your health regimen or starting new treatments, and never disregard professional medical advice or delay seeking care because of something that you have read on this blog, website or in any linked materials. Your individual needs and circumstances should be evaluated by a medical professional to ensure safe and appropriate care. If you are experiencing a medical emergency, please call 911 or call for emergency medical help on the nearest telephone immediately.
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