I am a dietitian who works with women to help balance their hormones naturally with diet and lifestyle changes. Many women come to me with a PCOS diagnosis feeling overwhelmed and not sure where to start.  So let’s start here!

What is PCOS?

PCOS is polycystic ovary syndrome. This condition affects about 10% of women of reproductive age. Many women with this condition experience some or all of the following symptoms:

• Irregular periods
• Weight gain
• Blood sugar disturbances
• Excessive carbohydrate cravings
• Excessive hair growth on face or other parts of the body (hirsutism)
• Hair loss from head
• Skin tags
• Acanthosis nigricans (dark discoloration of skin typical seen in armpits, neck, and groin) 

Clinically, PCOS is diagnosed using the Rotterdam criteria where you must meet 2 of the 3 criteria to have a PCOS diagnosis: elevated androgens, ovulatory dysfunction, and/or polycystic ovaries.

 Furthermore, PCOS is broken down into 4 “types”:

Type A: Elevated androgen levels (testosterone, DHEA, DHEA-S, DHT), anovulation, polycystic appearing ovaries (appears like a string of pearls). This is the most common presentation 

Type B: Elevated androgen levels, anovulation, have normal ovaries

These two types are deemed more “classic” presentation 

Type C: signs of elevated androgens, polycystic appearing ovaries, regular periods 

Type D: anovulation, polycystic appearing ovaries, don’t have high androgen levels

These two types are deemed more “non-classic” presentation 

When working with clients, I don’t categorize based on type of PCOS. Instead, I take a look at what could be exacerbating their PCOS symptoms. 

What Drives PCOS? 

1. Insulin Resistance: 

What does that mean? Simply put, when we eat food, our glucose level rises and that pushes on a “doorbell” that surrounds our cells. Your cell nucleus inside hears the doorbell, looks outside and sees the glucose at the door and calls your pancreas. Your pancreas then knows to secrete a certain amount of insulin and that comes along and opens up the door allowing the glucose to go in and the door shuts. This is in an ideal situation. 

In women with PCOS, intrinsic insulin resistance-doors are resistant to opening because the doorbell is “defective”. The cell nucleus then doesn’t hear the signal which leads to the pancreas secreting more insulin to knock the door down. Your cells are now low in glucose (energy) and your blood sugar levels go up. Your cells are starving despite the fact that there is a lot of glucose available. This situation leads to those crazy carbohydrate cravings! 

Symptoms Include: blood sugar spikes and crashes, carbohydrate cravings, difficulty losing weight, decreased energy, skin tags, acanthosis nigricans

What You Can Do About It: Pair a carbohydrate source with protein and fat, don’t skip meals, include fiber with meals and snacks (goal 30g per day), always eat breakfast, try to add in some light exercise. 

Testing: fasting glucose, fasting insulin, hemoglobin A1C 

2. Inflammation

Inflammation is your body’s natural response to injury, infection, or internal disturbance . When your body is in a state of inflammation, inflammatory compounds are released that cause an inflammatory response in the body. Causes of inflammation are: chronic or acute injury, an infection, gut imbalances, or even intense exercise. Inflammation can cause higher androgen production and insulin resistance.

Symptoms Include: bloating, IBS like symptoms, skin conditions such as eczema and psoriasis, difficulties losing weight, allergies, asthma, chronic fatigue

What You Can Do About It: Address gut health, incorporate antioxidants into your diet, address vitamin and mineral deficiencies, incorporate certain supplements (under guidance of registered dietitian). 

Testing: hs-CRP 

3. Lifestyle Choices

A diet high in processed foods, sugar, and  fat but low in protein, healthy fats, fiber and exercise can cause insulin resistance and inflammation to worsen as well as cause gut microbiome disturbances. The gut microbiome plays a huge role in how our body functions. We know that gut microbiome diversity can play a role with blood sugar balance, weight, metabolism, inflammation, digestion and absorption and mood. Recent studies have shown that women with PCOS have a less diverse gut microbiome than women without PCOS. 

Symptoms Include: gut disturbances such as bloating, diarrhea, constipation, heartburn, gas, acne/skin issues, insulin resistance, inflammation, weight gain, sugar cravings 

What You Can Do About It: Incorporate more gut healing foods (bananas, artichokes, asparagus, oats, barely, beans, lentils, berries, sweet potato to name a few and fermented foods such as sauerkraut, yogurt, kimchi, miso, kombucha, try to aim for for 30g of fiber a day, make sure you have protein, healthy fat and fiber with each meal, chew food thoroughly, eat slower, and practice mindful eating 

Testing for GI disturbances: stool testing, H pylori, allergy testing, lactose testing, SIBO

4. Hormone Imbalances/ Birth Control Induced Hormone Dysfunction

Most women with PCOS suffer from hormonal imbalances. Commonly, women will have elevated androgens which include: Testosterone which is mainly produced by the ovaries, DHEA which mainly comes from the adrenals. Elevated DHEA is likely a result of stress and also in some cases, a result of genetic factors, and DHT which is even more potent than testosterone! 

Furthermore, other hormones can be imbalanced such as estrogen, progesterone, cortisol, and thyroid. Women who recently came off of hormonal birth control can experience hormonal imbalances and irregular cycles as the body readjusts.

Symptoms Include: anovulation, irregular cycles, hirsutism, acne, depression, anxiety, hair loss, weight gain

What You Can Do About It: Get testing done! Be sure to include testosterone, estrogen, progesterone, DHEA, DHEA-S, FSH/LH, prolactin, cortisol, and full thyroid panel.

Testing: Wait at least 3 months for full hormone blood panel testing from the time you come off hormonal birth control. 

Every woman’s PCOS will not be the same and there is no “one standard” approach with PCOS! 

Want to take charge of your PCOS once and for all? Email me to book a 15 minute discovery call at amanda@realyounutrition.com 

For appointments, please call 516-344-5542. Most insurances are accepted!