Primal Fertility Series: PCOS

PCOS and Fertility

PCOS or Polycystic Ovarian Syndrome affects thousands of women in North America. In fact, it’s estimated that approximately 20% of women in North America have cysts on their ovaries and it’s by far, the most common gynaecological ‘complication’ I see in my office each day.

What is PCOS?

PCOS is a complex endocrine condition characterized by a combination of pearl like strands of ovarian cysts, blood sugar dysregulation, hormonal imbalance and irregular or absent menstruation. Women with classic PCOS are overweight or obese and suffer from elevated blood sugars and excess estrogen. Women with a ‘less classic’ version of PCOS, may be normal weight or underweight, suffer from low estrogen and have some hypothalamic  dysfunction. Sounds complicated! That’s because it is! I like to think of PCOS as a hormonal response to a high stress life.

PCOS and the Menstrual Cycle

Let’s break it down….

In healthy women, the hypothalamus produces GnRH (gonadotropin-releasing hormone) which signals to the pituitary to produce LH (luteinizing hormones and FSH (follicle stimulating hormone). The release of GnRH is pulsatile in women with regular menstrual cycles. This normal pulsatile release of GnRh signals some of the follicles in the ovary to begin maturing and for the ovaries to release estrogen and progesterone. This estrogen/progesterone signal is recognized by the pituitary gland. As the follicles begin maturing, they release and increase the hormone estrogen over time. The rising estrogen level signals the pituitary gland to curb release of FSH. This communication allows for ovulation to occur. When you ovulate, you are able to conceive…hurray!

In women with PCOS, cycles are irregular as the hypothalamus loses it’s “rhythm” and becomes either hypersecretory or suppressed leading to an imbalance in FSH/LH and a subsequent imbalance in estrogen/progesterone/testosterone.  This imbalance causes the growing follicle to stay ‘immature’, leading to ovulation failure aka anovulatory cycles. When you don’t ovulate, you are unable to achieve a pregnancy, thus resulting in infertility. Boooo

What is even more of a bummer is that this ‘immature’ follicle continues to make estrogen leading to an imbalance and overall estrogen dominance in the system. This excess estrogen can further disturb the hormonal cycle by converting to testosterone (also called aromatization, which happens when there is too much estrogen in the system). Too much testosterone causes facial hair, hair loss among a host of other issues all of which google will tell you about J

So, what causes PCOS?

Good question! Although you can look up the “causes of PCOS” in any medical textbook, I think the real causes of this complicated hormonal condition are intensely individual and multifaceted but all are linked to some form of STRESS in the body.

Here are some more common causes

Metabolic stress: Insulin Resistance

Women who have PCOS and insulin resistance often suffer from metabolic syndrome and are overweight/obese. This can be a direct result of consuming a ‘Standard American Diet’ (SAD) with too many refined or processed foods. Insulin resistance causes chronic high blood sugar and can wreak havoc with your hormonal system by directly stimulating the production of testosterone. More testosterone essentially inhibits ovulation and affects fertility by contributing to progesterone and estrogen imbalance.



It’s widely recognized amongst the medical community that hypothyroidism is a leading cause of PCOS. In the Paleo community, many women struggle with acquired hypothyroidism and low T3 levels as a result of chronic carbohydrate and overall caloric restriction. Carbohydrates, specifically glucose, are necessary for T4 to T3 conversion in the liver. Without adequate T3, hormonal signalling is thrown off resulting in cystic ovaries.


Some studies demonstrate PCOS to have a genetic link. If your grandmother, mother or sister have it, you’re more likely to have it. There is some great epigenetic research suggesting that exposure to excess androgens during fetal development may predispose you to PCOS in your fertile years. This excess androgen exposure could occur if your mom suffered from PCOS.


Stress disregulates the hypothalamic Pituitary Axis and can trigger a cycle of low sex hormones and elevated cortisol and imbalanced DHEA levels. If it’s persistent, it can cause a woman to stop menstruating and lead to a diagnosis of Hypothalamic Amenorrhea (or amenorrhoea if you’re a Brit).  During the diagnostic process, many of these women will also be given the diagnosis of PCOS after they have a pelvic ultrasound. Women experiencing this ‘stress induced’  PCOS may suffer from many types of stressors including: under-eating (especially restricting carbohydrate sources) and being underweight. These women tend to be classic “A” types and are perfectionists. Many also have stressful occupations. In fact, I most often see these women working in health care.  


It has been found that many women with PCOS also have low-grade inflammation. White blood cells produce substances to fight infection, this is known as inflammatory response. Food allergies, gluten exposure or exposure to environmental toxins, ‘chronic cardio’ or endurance athlethics may all contribute to a chronic inflammatory response.

Profiles of Women with PCOS

Mary has stressful job. She doesn’t sleep properly and is constantly giving to others, ignoring her own needs. Her periods are erratic and she craves sugar and needs caffeine to keep her going.

Susan craves sweets and consumes of large amounts of sugars in her diet. Susan is overweight and has a hard time shedding this unwanted weight, despite following a classic prescription for diet and exercise. She has thinning hair and is starting to develop acne and dark coarse chin hairs.

Carrie has a history of being a vegan/vegetarian for 10 years. She has a diet high in refined soy products, grains and inflammatory vegetable oils. She’s slim but has very little muscle mass. Her friends call her ‘skinny fat’. She has hypoglycemia and suffers from wild mood swings when she goes more than a few hours without eating.

Erica strives to achieve the perfect “0” body. She under eats, over-exercises and restricts carbohydrates in an effort to stay thin.  She’s ‘tired- but –wired” and noticed that her menstral cycles got longer and longer. She now hasn’t had a period in a few months and would like to become pregnant.

Peggy experienced had an accident where she lost her spouse. She was diagnosed with PTSD, has a hard time sleeping, has irregular periods and hypoglycemia.

What’s common in all of these situations?


Stress tells the body that it is not ‘okay’ and interferes with many of our delicate hormonal pathways. A diagnosis of PCOS doesn’t mean you are infertile for life, but it does indicate that some diet and lifestyle changes need to occur.

Meg ‘the Paleo Midwife’s’ suggestions for the treatment of PCOS

Find a care provider that will look beyond the standard treatment of Metformin and Oral Birth Control. These drugs do not address the causes of your PCOS and only serve to treat (without great success) your symptoms. A multi-faceted holistic approach including diet and lifestyle modification combine with targeted supplementation is the best approach. Find a care provider who can offer comprehensive Lab testing, which may include: 

  • Salivary and blood hormone testing. Salivary is a better indicator of how much hormone is in your TISSUE not just floating around in your blood, which is not where it is needed.
  • Pelvic ultrasound
  • IgG allergy testing or a 7-week guided elimination diet. This rules out any hidden metabolic stressors.
  • Iron and micronutrient testing.

Reduce your EMOTIONAL stress: 

My  Midwife friend Kathleen and I taking time to enjoy a sunset and let our bodies relax. 

  • Take a yoga class (not power or hot yoga). I recommend Jivamuti or a gentle restorative practice.
  • Learn to meditate and actually do it. Even 5-15 mins each day can make significant differences to your body’s hormonal pathways.
  • Make a list of things that contribute to your stress and try to find realistic ways of reducing these stressors.
  • Make another list (as you can tell, I like lists) of the things that you are grateful for and help you REDUCE your stress. E.g. your kitty, your family or spending time in nature.

Reduce your METABOLIC stress

If you are overweight:

  • Adopt a clean paleo/primal/ancestral diet. Doing a 21-day sugar detox may be beneficial.
  • Reduce carbohydrate intake to 50-100g/day and/or about 25% of your daily macronutrient percentages.  Ensure your carbohydrate sources are from mostly glucose containing starches/sugars. Excess fructose can contribute to inflammation and insulin resistance. Consider increasing activity levels and include sprints, which have been shown to aid in insulin sensitivity.

If you are underweight:

  • Consider gaining a bit of weight. Ensure you are getting at minimum 1
  • 400-1500 calories/day (increasing 100-200 cals/wk until you are at this level).
  • Include 100-150g starchy carbohydrates/day and reduce exercise, especially ‘chronic cardio’. Try sprinting a few times a week combine with shorter weight bearing activity. The Purely Twins Lori and Michelle have a great little program that’s well priced and very supportive towards healing from PCOS.

SLEEP: 8-10 hrs / night and practice good sleep hygiene.

Want more info?

Send me an email or download Stefani Ruper’s PCOS Unlocked The Manual. This is a great resource I recommend to all of my clients suffering with hormone/fertility issues. She also has a great blog at


The Beautiful Cervix Project

Have you ever wondered what your cervix looks like? Curious about how it changes during your cycles? What's up with cervical mucus? How does it change as your hormone levels fluctuate during your cycle?

Taken from Beautiful Cervix Project

 The Beautiful Cervix Project is an amazing site I discovered this week. It encourages women to  check out their own cervix as it changes and has beautiful photos documenting various women during various times of the month.

Checking out your own cervix is a great way to become more in touch with your own fertility and menstrual cycles. 


Micronutrient needs for Fertility and a healthy Paleo Pregnancy: Sometimes it's the little things that really matter!!

A CaveGirl’s Micronutrient Needs for Fertility and Paleo Pregnancy

While a paleo friendly diet based on whole-foods is critical for any healthy CaveGirl's fertility, there is a tendency out there to focus all of our attention on macronutrients.  That is, the protein, fats and carbs. I'm continually asked, "how many carbs should I eat when pregnant or breastfeeding." While I work on a great answer to that question,  here are some key micronutrients that deserve some attention! These micronutrients are essential for an optimal state of ripe and ready fertility and pregnancy. As the old saying goes, “it's the little things that really matter”, in this case, 'they' couldn't be more right.



B-Vitamins: Important for the prevention of open neural tube defects (spina bifida), energy metabolism, as well as healthy growth & development. Vitamins require healthy stomach acid in order to be properly absorbed, so if you have issues with low stomach acid, you may want to consider something like an HCL supplement. 

Paleo Sources:

  • B12: Highest in animal proteins with the richest sources being found in liver, clams, fish*, beef and grass-fed milk 
  • B9 (folate): Dark leafy greens, asparagus, broccoli, citrus fruits, avocado, nuts/seeds, squash and beets. Folate is the key nutrient we need to protect against neural tube issues, like Spina Bifida. It needs to be in our diets BEFORE getting pregnant so while trying to conceive you need to get in those greens! Want to learn the important difference between folic acid and folate? Check this post out! 

Magnesium: Magnesium helps build strong bones and teeth, regulates insulin and blood-sugar levels, and helps enzymes function properly. It can help reduce anxiety, aid with sleepless nights, constipation and help to prevent painful leg cramps.

Paleo Sources:

  • Bananas, spinach, pumpkin seeds, chard, cashews and almonds
  • You can also apply magnesium oil directly to your skin or find it as a dietary supplement. Natural Calm makes a great product that many people enjoy as a hot drink. Take magnesium in the evenings to help you sleep.

Calcium: Critical for development of little baby bones and nervous systems. A pregnant woman’s dietary calcium needs go up in pregnancy. While babies will always get what they need, they do so at the expense of mom’s bones. If you become calcium deficient in pregnancy it can pre-dispose you to osteopenia (or low bone density) later in life. Some women just choose to supplement with calcium in pregnancy which I don't recommend. Calcium in a pill form isn't well absorbed, can cause constipation and there is no evidence to support supplementing for bone health. Instead, try to get calcium from dietary sources. A smoothie with greens and grassfed yogurt is a pretty spiffy way of getting in your daily calcium! 

Paleo Sources:

  • Grass-fed Dairy, sardines (crunch the bones), collard greens, kale, swiss and rainbow chard
  • Nuts (like Almonds) but is poorly absorbed due to the phalate content of nuts and seeds. If you soak your nuts for 24hrs, it will help. You can also buy pre-soaked and sprouted nuts here
  • Calcium blocks the absorption of iron, so it’s best eaten away from your big iron containing meal or on it’s own.


Vitamin D: Helps you absorb calcium from your diet and it’s important for bone health as well as metabolic and immune function (which is reduced in pregnancy). Babies born to Vit-D deficient mothers may also be predisposed to Type-1 diabetes. You can have your vitamin D levels tested by your Midwife or OB/Gyn. In some places it costs extra, but it's worth the $20-40 investment. It's one of the most common vitamin deficiencies I see in my office. 

Paleo Sources:

  • Egg yolks, fish*, cod liver oil
  • You can also feel free to take a pill
  • Get outside! Sunlight helps us make our own vit-d.

Vitamin K2- Works together with Vit D/Calcium to protect your brain, nervous system and skeletal system. K2 helps to shuttle calcium around the body as well as aiding in gene expression. Some folks claim it helps babies facial structures develop symmetrically…. Therefore vit k2= pretty babies.

The Weston A Price foundation has a pretty comprehensive list of K2 sources found here.  

Paleo Sources:

There are two forms of Vit K2 we can get from our diet:

  • MK-4: found in highest amounts in grassfed butter and egg yolks
  • MK-7: found in fermented foods. Taking a fermented cod liver oil/butter blend would be really your best bet when it comes to getting enough K2

Choline: Helps our baby’s brain develop. Some studies show that it may also reduce the risk of nervous system disfunction and mental illness in our growing little cavemunchkins.

Paleo Sources:

  •  Egg yolks, beef liver and cube steak. Smaller amounts in spinach and potatoes

Zinc:  Pretty darn important for DNA/Gene expression. As Madonna taught us in the ‘80’s, it’s so important to “express yourself”. You're needs for zinc in pregnancy go up and as we are unable to store it in the body, it's important to get it from dietary sources. 

Paleo Sources: 

  •  Oysters, liver, beef, dark meat from poultry, pumpkin seeds (or pumpkin butter), dark chocolate (yessss), lamb and goat

Vitamin A (or if your Canadian, vitamin eh?): Prevention of placental insufficiency, low birthweight babies and preterm birth. Here's a great article by Mary G. Enig about vitamin A and fetal development. 

Paleo Sources:

  • Liver from all animals (including cod liver oil)
  • While yellow/orange coloured vegetables such as sweet potatoes, squash and apricots contain Beta-carotene (the inactive form in vegetables) most of it is not  converted into Vitamin A, which is used by the body. You'd have to eat a whole lot of veggies to get all your vitamin A needed for optimal fertility,  pregnancy, breastfeeding so it's best to supplement your diet with a bit of liver or grass-fed dairy (if tolerated). 

Vitamin C: Aids in immune function and in the absorption of iron from food sources.

Paleo Sources:

  • Citrus, fruits and berries, colourful peppers, cauliflower


Omega- 3 :  Or more specifically DHA. DHA aids in brain and eye development as well as protecting CaveMama from cardiovascular problems in pregnancy. DHA can also prevent mood imbalance during pregnancy and specifically postpartum, so if you're prone to depression or anxiety, DHA in higher doses may be for you. 

Paleo Sources: 

  • Krill oil, fish*, blue green sea algae (for fish allergic)

Iron: As your blood volume expands (by 50%) during pregnancy, your iron stores become naturally diluted making anemia (low iron) the top “complication” in pregnancy. Iron is important for energy levels and most metabolic functions in the body.



Paleo Sources:

  • Liver, red meats, dark turkey, pumpkin seeds
    • If your levels get really low your midwife or OB/Gyn may recommend a supplement. Floridix and Inate Iron Response are the most natural supplements out there and are very well absorbed. Remember to always take your iron away from anything containing calcium and always with something containing vitamin C for optimal absorption.

    * Always choose wild caught fish rather than farmed fish and aim for species that is low on the food chain: think trout, salmon, shrimp, lake fish. Stay tuned for a full post about mercury content in fish/seafood in a future post.



    5 Paleo Powerhouses for a healthy CaveGirl Pregnancy

    "What should I eat?", I hear this almost every day! It can be so confusing navigating all the nutritional advice for pregnancy and optimal fertility. I thought I'd throw in my 2 cents and give you a short list of 5 Paleo Powerhouse foods that are often overlooked in our diets. These foods support your fertile body as your grow a little Cavebaby and can help prepare  you for pregnancy as well as breastfeeding.

     #1 Fermented Cod Liver Oil: Fermentation allows the oil to be separated from its source without heating and without changing the structure of the oil. This optimizes the  nutritional components and keeps all of the beneficial nutrients intact. Fermented cod liver oil is extremely high in fat soluble vitamins A,D,E and K2 (stay tuned for a super informative micronutrient post), all of which are splendidly important for pregnancy and fertility. Does it taste good? Not in the least. There are however certain brands that taste better than others. Green Pastures carries a line of excellent flavoured oils you can buy online if your local store doesn't carry them.  

    #2 Pumpkin Seed Butter: Yes, PSB contains Omega-6 but in the context of a healthy paleo/primal menu, it has it's rightful place. Not only is this little gem high in protein  (10g/serving), it's also high in zinc, multiple forms of beneficial vitamin E, tryptophan, magnesium and iron. All key nutrients for a pregnant Cavemama. Plus it tastes delicous...unlike powerhouse #1 and is has funky green colour, which will totally gross out your friends and family. There is value in that.

    #3 Gelatin: A rich source of amino acids as well as protein, gelatin helps our connective tissues (which are stretching and growing), skin, nails and hair stay healthy and look great. It also helps to support the lining of our guts, aiding in digestion as well as essential liver function. Both of which can be challenged in pregnancy. You can get gelatin by making your own bone broth or by taking a Collagen Hydrolysate powder. I use Great Lakes Brand. It's flavourless and easy to use, either in a recipe (see my recipage for some ideas) or added to a hot liquid, like tea or soup.

    #4 Liver: Sorry folks, but liver is great. Liver is one of the best sources of iron, b-vitamins, zinc and vitamin A. Gram for gram, it contains the riches sources of nutrients  than any other food and it's also super affordable!  I always recommend organic grass-fed liver, as conventionally raised animals may have come into contact with high amounts of hormones, pesticides or toxins, all of which will be present in their meats. 

    I think they even look kinda "fertile".  Mother nature know's her stuff.

    I think they even look kinda "fertile".  Mother nature know's her stuff.

    #5 Avocado: Besides being creamy and absolutely delicious, the avocado is an excellent food for pregnancy and fertility. Avocados have a unique nutrient profile being high in vitamin A, C, E, zinc, ALA omega-3 fats and selenium. What a total gem!  

    No I didn't forget coconut oil or eggs!  I had to choose just 5! They deserves their own please standby !  

    What foods do you consume the most during your pregnancy or while trying to conceive ?