Polycystic Ovarian Syndrome: Know the Symptoms

Approximately 1 in 10 women of childbearing age in the United States have Polycystic Ovarian Syndrome, or PCOS. Understanding what is going on in the body, why it’s happening and how to make positive changes are key to reducing PCOS symptoms.

The Female Menstrual Cycle

As the name implies, Polycystic Ovarian Syndrome, or PCOS, is a condition in which one or both ovaries have many cysts. To understand why a cyst forms, you first need to understand the female menstrual cycle.

At the start of each menstrual cycle your pituitary gland produces follicle-stimulating hormone (FSH). This hormone is meant to stimulate fluid filled sacs called follicles within your ovaries. These follicles are the houses for your eggs. Each follicle holds one immature egg and each egg is patiently waiting its turn to be released in order to make the journey to your uterus. The release of FSH stimulates roughly 10-20 of your follicles to begin growing and maturing. These growing follicles start to release estrogen, encouraging your uterine lining to thicken and stimulating the pituitary gland to now start producing luteinizing hormone (LH). A spike in LH causes one or two of your maturing follicles, the dominant follicle, to release its egg; this is ovulation.

Once the egg or eggs are released, the follicles stop producing estrogen, estrogen levels drop, and progesterone is allowed to rise. This hormonal change encourages your uterine lining to be more nourished in anticipation of fertilization. If after all that work the egg is not fertilized, progesterone and estrogen levels drop, telling your uterus it’s time to shed that protective lining; this is menstruation.

Polycystic Ovarian Syndrome

In a healthy woman, the dominant follicle releases its egg each month. However, in a woman with PCOS, the mature follicle never gets the signal to release its egg. These unreleased eggs are considered cysts. As more and more mature eggs remain in the ovary, that ovary becomes more cystic; increasing your risk of PCOS. The important thing to understand is that a polycystic ovary is not the cause of PCOS. It is only one of several symptoms that may occur as a result of some underlying cause.

In addition to your body holding on to several unreleased eggs, other common symptoms of PCOS include:

• Irregular periods

• Excessive hair growth on your face and body

• Thinning hair on your scalp

• Acne

• Skin tags

• Darkening of your skin, especially at the nape of the neck

• Gray-white discharge from your breasts

• Excess weight and inability to lose weight

• Sleep apnea

• Pelvic pain

• Depression and anxiety

Causes of PCOS

Although the medical community is still searching for the underlying reason for PCOS, we do know that there are five hormones involved in the development of PCOS symptoms: estrogen, luteinizing hormone, insulin, cortisol and testosterone. Additionally, four probable causes: genetics, environmental factors, increased testosterone, and hypothalamus dysfunction can greatly influence those hormones. Let’s take a look at each hormone and how things can get out of balance.

1. Estrogen: If your body is estrogen dominant, due to environmental factors such as xenoestrogens in your food and environment, progesterone cannot balance the effects of estrogen. This leads to irregular periods, acne, excess weight and mood problems.

2. Luteinizing Hormone: If your hypothalamus is not working properly, it can send high levels of LH to the ovaries, stimulating them to secrete more male hormones. This leads to irregular periods, excessive hair growth, thinning hair, acne and anxiety.

3. Insulin: High insulin levels cause your ovaries to produce more male hormones. This leads to the same symptoms as elevated LH levels.

4. Cortisol: Excessive stress, both mental and physical, increases production of cortisol. Excess cortisol can lead to high insulin levels, irregular periods, excessive hair growth, acne, and weight gain.

5. Testosterone: Elevated male hormones such as testosterone can increase insulin levels, which then stimulates the ovaries to produce more male hormones. This creates a vicious cycle and can lead to many PCOS symptoms.

Understanding Symptoms of PCOS

A healthy body will be able to balance hormones and maintain a regular menstrual cycle. However, once hormones become imbalanced, it can lead to four common PCOS symptoms.

1. Irregular Menstrual Periods: Blood sugar dysregulation from high insulin levels creates excessive LH production. This then blunts the release of a mature egg and can create heavy bleeding or spotting.

2. Excessive Hair Growth and Hair Thinning: Blood sugar dysregulation and high LH levels also increase production of testosterone. This imbalance of male hormones in a female body causes hair on the upper lip, chin, and upper back to become darker and thicker. Excess testosterone also leads to male-pattern baldness in women.

3. Acne: A high level of androgen hormones, such as testosterone, can be caused from blood sugar dysregulation and high LH levels. This excessive testosterone can then stimulate sebum production in skin follicles, leading to blocked pores and acne.

4. Inability to Lose Weight: Estrogen dominance, excessive cortisol production and blood sugar dysregulation all contribute to increased fat storage and the inability to lose weight.

Insulin Resistance and PCOS

As you can see, controlling your blood sugar is very important for hormone balance and reducing PCOS symptoms. In fact, insulin resistance and PCOS are closely related, each influencing your risk of developing the other.

Each time your blood sugar spikes from a high sugar or refined food meal, insulin is released to shuttle excess blood sugar into cells and get things back in balance. The more your diet consists of refined carbohydrates, the more insulin it pumps out. Eventually your cells stop responding to insulin and they become insulin resistant, which keeps your blood sugar up and further increases insulin levels. These high insulin levels then cause your ovaries to secrete more testosterone, doubling up on increasing your risk of PCOS symptoms. As insulin levels continue to increase, PCOS symptoms increase, including weight gain, which creates more insulin resistance and the cycle continues.

Using Diet to Improve PCOS

The following simple dietary principles can help you improve PCOS symptoms and, in turn, balance your hormones and blood sugar as well as reduce insulin resistance.

1. Choose Carbohydrates Wisely: Eliminate sugars and refined carbohydrates which are associated with higher estrogen levels and insulin resistance. Instead, focus on moderate consumption of high fiber, low-glycemic whole food carbohydrates such as quinoa, beans/legumes or sweet potatoes which promote blood sugar regulation and hormone balance.

2. Consume the Right Fats: Eliminate trans fats and reduce unhealthy omega-6 fatty acids from refined oils like canola and generic ‘vegetable’ oils. Instead, focus on consuming more omega-3 fatty acids from low-mercury fish, flax oil, olive oil, avocado, nuts and seeds.

3. Load Up on Vegetables: Leafy greens and cruciferous vegetables such as broccoli, kale and Brussels sprouts have fiber and phytonutrients that help your body eliminate excess hormones and regulate blood sugar.

4. Eat Frequently: Consuming 4-5 smaller meals per day instead of 2-3 bigger meals can help regulate blood sugar.

5. Balance Your Meals: Fat, fiber and protein help balance blood sugar and create a slower release of insulin. Focus on having all three with each meal and snack.

6. Understand Proper Portions: Eating proper portion sizes can assist with maintaining a healthy weight for your body as well as reduce insulin resistance and PCOS symptoms.

Diet isn’t the only way to optimize hormonal health. Exercise, stress management and targeted supplementation are other lifestyle choices to incorporate that will help you regulate blood sugar, improve PCOS symptoms and optimize your health and happiness!

Stephanie Walsh, MNT, CEPC, CPT, CPI