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:
- 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 www.paleoforwomen.com