Inside PCOS: Understanding the Hormonal Puzzle
“PCOS is one of the leading causes of infertility in women and the most common reason for irregular periods,” said Lauren Rubal, M.D., a reproductive endocrinologist from Newport Beach, Calif. According to the National Polycystic Ovary Syndrome Association, one in ten women have PCOS, but half remain undiagnosed.
Recognizing the Symptoms
PCOS symptoms include irregular periods, excess hair, acne, weight gain, insulin resistance, ovarian cysts, anxiety, depression, fatigue, and hair loss. Women may also experience cycles with no mucus or constant mucus, breakthrough bleeding, or cycles longer than 35 days. PCOS can also raise the risk for diabetes, metabolic syndrome, heart disease, and fatty liver. “If a woman isn’t bleeding regularly, cancerous cells in the uterus can develop,” Dr. Rubal warned.
The Hormonal Imbalance Behind PCOS
“PCOS is hard because there’s such a spectrum,” said Dr. Rubal. “It’s very interesting how PCOS presents in different women.” A woman’s hormones depend on each other. When one falls out of balance, others follow. The main hormones involved are androgens, insulin, progesterone, and estrogen. Women with PCOS often have high androgens, which cause acne, unwanted hair, thinning hair, and irregular periods. Insulin resistance leads to higher blood sugar and triggers more androgen production. Low progesterone also adds to irregular cycles and difficulty conceiving.
There is no single cause. PCOS likely has hereditary and environmental factors. A woman’s risk rises if her mother has PCOS, if diabetes runs in the family, or if she is overweight. Because ovulation may not occur regularly, charting fertility can be frustrating for couples practicing Natural Family Planning (NFP). “You’re taught that a healthy cycle has a beautiful pattern,” Dr. Rubal said. “For a woman with PCOS, that may not happen.”
Diagnosing PCOS
PCOS is a diagnosis of exclusion, meaning other causes for irregular cycles must be ruled out first. Dr. Rubal advises women to ask: “Are my cycles longer than 35 days? Do my symptoms bother me?” If both answers are yes, make a doctor’s appointment. “Knowledge is power,” she said. Blood tests can check for excess androgens, and ultrasounds can show a “string of pearls” pattern on the ovaries.
Even with PCOS, pregnancy is very possible. “There are good studies showing that once ovulation occurs, a woman’s chance of conception is nearly normal,” said Dr. Rubal.
The Problem with Birth Control Pills
As a solution for PCOS, most doctors prescribe the pill, which contains synthetic estrogen and progesterone. “These hormones are released constantly, not like in the body’s natural rhythm,” Dr. Rubal said. The pill can cause mood issues, low libido, and increase the risk of blood clots and cancers. It suppresses symptoms rather than healing the root cause. “When she’s ready for a family, she’ll be at square one—or worse,” Dr. Rubal said.
Natural Steps Toward Healing
Diet and lifestyle changes can make a major difference. Dr. Rubal recommends a low-glycemic diet to reduce sugar spikes and insulin resistance. Avoid processed foods, sugars, and refined grains. Eat non-starchy vegetables, moderate fruits, and whole grains. “Even replacing one weekly meal with a vegetarian option helps,” she said. Exercise also restores insulin balance and reduces stress. “Exercise helps soak up that excess sugar,” said Dr. Rubal.
Helpful supplements include inositol, N-acetyl cysteine, and methylfolate. If needed, medications like letrozole or metformin can help restore ovulation. Dr. Rubal encourages using multiple biomarkers to understand fertility signs more clearly.
Tracking your cycle with an app, like the PeakDay app, allows you to share your charts with a medical professional. Even though charts may not be typical, they hold valuable information. This is a great first step in diagnosis and treatment.
A Message of Hope
PCOS can be discouraging, but Dr. Rubal reminds women not to lose heart. “It’s something where I’ve absolutely seen so many women get pregnant, even without medications,” she said. “There’s a lot of different avenues to heal and restore normal cycles. So have hope!”
Condensed from an interview of Dr.Lauren Rubal, a reproductive endocrinologist from Newport Beach, Calif., for Family Foundations magazine.
Did you know that Couple to Couple League has a book combo for PCOS? Food for Fertility and PCOS: Empowering Women to Face Fertility Challenges – Check it out in the store here.
Saint Paul VI Institute’s National Center for Women’s Health (NCWH) has provided services in obstetrics, gynecology, reproductive medicine and surgery for individuals needing regular or high-risk care, all in an environment consistent with Catholic moral principles.
Endnotes from the PCOS Book
1 Rotterdam ESHRE/ASRM-Sponsored Consensus Workshop Group. “Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome” (Fertil. Steril. 2004, 81:19-25).
2 -3 Norman, R., Dewailly, D., Legro, R., et al. “PCOS” (The Lancet 2007).
4 Velija-Asimi, Z., Ascic-Buturovic, B., and Pesto, S. “The role of subclinical hypothyroidism in PCOS” (Medicinski Zurnal 2009, 15:34-35).
5 Singla, R., Gupta, Y., Khemani, M., et al. “Thyroid disorders and polycystic ovary syndrome: An emerging relationship” (Indian Journal of Endocrinology and Metabolism 2015, 19:25ff).
6-7 Sinha, U., Sinharay, K., Longkumer, T., et al. “Thyroid disorders in polycystic ovarian subjects: A tertiary hospital based cross-sectional study from Eastern India” (Indian Journal of Endocrinology and Metabolism 2013, 17:304ff).
8 Norman, R., Dewailly, D., Legro, R., et al. (2007).
9 Moran, L., Pasquali, R., Teede, H., et al. “Treatment of obesity in polycystic ovary syndrome: A position statement of the Androgen Excess and PCOS Society” (Fertil. Steril. 2009, 92:1966-1982).
10-11 Franks, S., Robinson, S., and Willis, D. “Nutrition, insulin, and polycystic ovary syndrome” (Reviews of Reproduction 1996, 1:47-53).
12 Kasin-Karakas, S., Cunningham, W., and Tsodikov, A. “Relation of nutrients and hormones in polycystic ovary syndrome” (Am. J. Clin. 2007, 85:688-694).
13 Liepa, G., Sengapta, A., and Karsies, D. “Polycystic ovary syndrome (PCOS) and other androgen excess-related conditions: Can changes in dietary intake make a difference?” (Nutrition in Clin. Prac. 2008, 23:63–71).
14 Sorensen, L., Soe, M., Halkier, H., et al. “Effects of increased dietary protein- to-carbohydrate rations in women with polycystic ovary syndrome” (Am. J. Cin Nutr., 2012, 95:39-48).
15 Moran, L., Ko, H., Misso, M., et al. “Dietary composition in the treatment of PCOS: A systematic review to inform evidence-based guidelines” (Journal of the Academy of Nutrition and Dietetics 2013, 113:520-545).
16, 19 Chavarro, J., Willett, W., and Skerrett, P. The Fertility Diet (New York: McGraw-Hill 2008, p. 183).
17 Chavarro, J., Rich-Edwards, J., Sosner, B., et al. “Dietary fatty acid intake and the risk of ovulatory infertility” (Am. J. Clin. Nutr. 2007, 85:231-237).
18 Chavarro, J. Personal communication to M. Shannon (Mar. 17, 2008).
20 Gittleman, A. , 2nd ed. (New York: Three Rivers Press, 2008, pp. 14-16).
21, 27 Chavarro, J., Rich-Edwards, J., Rosner, B., and Willett, W. “A prospective study of dairy foods intake and anovulatory infertility” (Human Reprod. 2007).
22 Dhingra, R., Sullivan, L., Jacques, P., et al. “Soft drink consumption and the risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community” (Circulation 2007, 116:480-488).
23 Nettleton, J., Lutsey, P., Wang, Y., et al. “Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the multi-ethnic study of atherosclerosis (MESA)” (2009, Diabetes Care 32:688-694).
24 Roberts, H., Aspartame (NutraSweet): Is It Safe? (Philadelphia: The Charles Press, 1990, pp. 147-150).25 Roberts (1990, pp. 194-195).
26, 43 Suez, J., Korem, T., Zeevi, D., et al. “Artificial sweeteners induce glucose intolerance by altering the gut microbiota” (Nature 2014, 514:181ff).
28 Guzelmeric, K., Alkan, N., Pirimoglu, M., et al. “Chronic inflammation and elevated homocysteine levels are associated with increased body mass index in women with PCOS” (Gynecol. Endocrinol. 2007, 23:505-510).
29 Kilicdag, E., Bagis, T., Tarim, E., et al. “Administration of B-group vitamins reduces circulating homocysteine in PCOS patients treated with metformin: a randomized trial” Human Reprod. 2005, 20:1521-1528)
30 Schachter, M., Raziel, A., Strassburger, D., et al. “Prospective, randomized trial of metformin and vitamins” (Fertil. Steril. 2007, 88:227-230).
31 Constantino, D., Minozzi, G., Minozzi, F., et al. “Metabolic and hormonal effects of myo-inositol on women with PCOS: a double-blind trial” (Eur. Rev. Med. Pharmacol. Sci. 2009, 13:105-110).
32 Pizzo, A., Lagana, A., and Barbaro, L. “Comparisin between effects of myo-inositol and D.chiro-inositol on ovarian function and metabolic facors in women with PCOS” (Gynecol. Endocrinol. 2014, 30:205-208).
33 Genazzani, A., Lanzoni, C., Ricchieri, F., et al. “Myoinositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with PCOS” (Gynecol. Endocrinol. 2008, 24:139-144).
34 D’Anna, R., DiBenedetto, V., Rizzo, P., et al. “Myo-inositol may prevent gestational diabetes in PCOS women” (Gynecol. Endocrinol. 2012, 28:440-442).
35 Hahn, S., Haselhorst, U., Tan, S., et al. “Low serum 2,5 hydroxyvitamin D concentrations are associated with insulin resistance and obesity in women with PCOS” (Exp. Clin. Endocrinol. Diabetes 2006, 114:557-583).
36, 46, 51 Moran, L., Teede, H., and Vincent, A. “Vitamin D is independently associated with depression in overweight women with and without PCOS” (Gynecol. Endocrinol. 2015, 31:179-182).
37 Jamilian, M., and Asemi, Z. “Chromium supplementation and the effects on metabolic staus in women with polycystice ovary syndrome: A randomized, double-blind, placebo-controlled trial” (Ann. Nutr. Metabl. 2015, 67:42-47); Personal communication to M. Shannon (October 12, 1996) Julian Whitaker, M.D. stated that 400 mcg of chromium is safe during pregnancy.
38 Whitaker, J. “Weight Loss is Not Just About Fat” (Health and Healing 1997, 7:5-8).
39 Kasim-Karakas, S., Almario, R., Gregory, L., et al. “Metabolic and endocrine effects of a PUFA rich diet in PCOS (J. Clin. Endocrinol. Metab. 2004, 89:615–620).
40 Mohammadi, E., Rafraf, M. Farzadi, L., et al. “Effects of omega-3 acids supplementation on serum adiponectin levels and some metabolic risk factors in women with polycystic ovary syndrome” (Asia Pac. J. Clin. 2012, 21:511-518). EPA is the abbreviation for eicosapentaenoic acid; DHA is the abbreviation for docosahexanoic acid.
41 Nadjarzadeh, A., Dehghani-Firouzabadi, R., Daneshbodi, H., et al. “Effect of omega-3 supplementation of visfatin, adiponectin, and anthropometric indices in women with PCOS” (J. Reprod. Infertil. 2015, 16:212-220).
42 Saldeen, P., and Saldeen, T. “Women and omega-3 fatty acids” [CME Review Article] (Obstet. Gynecol. Survey 2004, 59:722-730).
44 Tremellen, K., and Pearce, P. “Dysbiosois of gut microbiota (DOGMA)—A novel theory for the development of polycystic ovarian syndrome” (Medical Hypothesis 2012, 79:104-112).
45 Dean, C. “Understanding the Weight Connection” in Crook, W., Dean, C., and Crook, E. The Yeast Connection and Women’s Health (Jackson, TN: Professional Books, 2005, pp.245-252).
47 Randeva, H., Lewandowski, K., Drzewoski, J., et al. “Exercise decreases plasma total homocysteine in overweight young women with polycystic ovary syndrome” (J. Clin. Endocrinol. Metab. 2002, 87:4496-4501).
48 Family Foundations, Sept.-Oct. 2001, p. 25
49 Shomon, M. The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age (New York: Collins, an imprint of HarperCollins, 2006, pp. 33, 37).
50 Lee, J., and Hopkins, V. Dr. John Lee’s Hormone Balance Made Simple (New York: Warner Wellness, 2006, pp. 102-103).
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