A Functional Medicine Approach to PCOS

Written By Sophia Deahl

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine and metabolic disorder impacting approximately 7–10% of women of childbearing age, with an estimated 5 to 6 million women in the United States alone (1). This condition, a leading cause of infertility, is characterized by symptoms such as acne, irregular periods, and excessive hair growth (2). To effectively manage PCOS and enhance quality of life, it is essential to understand and address its root causes: inflammation, insulin resistance, and chronic stress.

Understanding PCOS

PCOS manifests through a range of symptoms including acne, infertility, irregular or absent periods, and abnormal hair growth. Women with PCOS often experience elevated androgen levels, menstrual irregularities, and anovulation. While polycystic ovaries can be present, they are not a required criterion for diagnosis (3).

Diagnostic Criteria

The Rotterdam Criteria for diagnosing PCOS include at least two of the following:

  • Hyperandrogenism (biochemical or clinical)

  • Menstrual irregularities or ovulatory dysfunction

  • Polycystic ovaries via ultrasound (4)

Biochemical Markers

Typical biochemical markers in PCOS include elevated luteinizing hormone (LH), low follicle-stimulating hormone (FSH), high testosterone, and low sex hormone-binding globulin (SHBG). Additionally, women with PCOS often show high insulin levels, elevated fasting glucose, and increased LDL cholesterol (5).

Root Causes

Inflammation

Chronic inflammation is a fundamental root cause of PCOS. It often originates from poor gut health, where imbalances in the gut microbiota lead to systemic inflammation. This inflammation disrupts normal hormonal function, aggravates insulin resistance, and exacerbates metabolic issues. Moreover, visceral fat—fat that accumulates around internal organs—produces inflammatory cytokines, further contributing to systemic inflammation. This chronic inflammatory state not only worsens PCOS symptoms but also creates a vicious cycle, as ongoing inflammation can further disrupt hormonal balance and intensify insulin resistance. By addressing inflammation through diet and lifestyle changes, it is possible to break this cycle and improve PCOS symptoms (6).

Insulin Resistance

Insulin resistance affects approximately 80% of women with PCOS. When cells become less responsive to insulin, the pancreas compensates by producing more insulin. Elevated insulin levels stimulate the ovaries to produce more androgens (male hormones), leading to symptoms such as acne and excessive hair growth. Insulin resistance is often perpetuated by high sugar intake, chronic overnutrition, and poor gut health. Elevated insulin levels also contribute to inflammation, creating a feedback loop that worsens both insulin resistance and PCOS symptoms (7). Addressing insulin resistance through balanced nutrition and regular physical activity can significantly improve symptoms and overall health (8).

Chronic Stress

Chronic stress significantly impacts hormonal balance and contributes to PCOS by exacerbating insulin resistance and inflammation. Stress triggers the adrenal glands to produce cortisol, a hormone that can interfere with insulin function and promote insulin resistance. Additionally, prolonged stress increases inflammatory markers in the body, further aggravating systemic inflammation. This interplay between stress, insulin resistance, and inflammation creates a cycle where each factor worsens the others, making PCOS management more complex (9). Incorporating stress management techniques, such as mindfulness and relaxation practices, can help mitigate these effects and support overall well-being.

Genetics

A strong genetic component is involved in PCOS, with family history serving as a significant risk factor (10). While genetics alone do not cause PCOS, they can predispose individuals to the condition. Understanding this genetic link can guide personalized approaches to managing PCOS effectively.

Drivers

  1. Toxins: Environmental toxins can disrupt endocrine function and contribute to hormonal imbalances (11).

  2. Poor Gut Health: Imbalances in gut microbiota can lead to inflammation and insulin resistance, both of which are associated with PCOS (12).

  3. Diet and Lifestyle: Poor dietary choices and lack of exercise contribute to insulin resistance and inflammation (13).

Interconnections Between Root Causes

The root causes of PCOS—inflammation, insulin resistance, and chronic stress—are deeply interconnected. Chronic inflammation can exacerbate insulin resistance, while insulin resistance can perpetuate inflammation and increase stress levels. Similarly, chronic stress can worsen both inflammation and insulin resistance. Each root cause feeds into the others, creating a complex web that perpetuates PCOS symptoms and complicates management. Addressing one root cause often involves tackling the others to break this cycle and improve overall health outcomes.

The Role of Thyroid Health

Hypothyroidism is closely linked to insulin resistance and PCOS. The thyroid regulates metabolism, and imbalances in thyroid function can exacerbate PCOS symptoms (14). Addressing hypothyroidism, when present, is crucial for PCOS management.

Dietary and Lifestyle Recommendations

  1. Anti-Inflammatory Diet: Adopt a Mediterranean-style diet rich in omega-3 fatty acids, high-fiber foods, and anti-inflammatory spices to manage PCOS symptoms (15).

  2. Blood Sugar Regulation: Maintain balanced meals with complex carbohydrates, proteins, and healthy fats while avoiding high-sugar diets to regulate blood sugar levels (16).

  3. Gut Health: Support gut health with probiotics, prebiotics, and a balanced diet to manage inflammation and insulin resistance (17).

  4. Exercise and Stress Management: Engage in regular physical activity and stress-reducing practices such as mindfulness to improve insulin resistance and overall well-being (18).

Therapeutic Foods and Supplements

  • Magnesium: Magnesium plays a crucial role in managing anxiety, improving sleep quality, and regulating blood sugar levels, which can be particularly beneficial for women with PCOS. Magnesium deficiency is common in individuals with PCOS and can exacerbate symptoms (19). Good sources of magnesium include pumpkin seeds, almonds, spinach, and black beans.

  • Green Tea: Green tea is known for its anti-inflammatory properties and may help reduce free testosterone levels, which can alleviate symptoms such as acne and excessive hair growth in women with PCOS (20). The polyphenols in green tea also support metabolic health and insulin sensitivity.

  • Flaxseeds: Flaxseeds are rich in omega-3 fatty acids and fiber, both of which support hormone balance and help manage PCOS symptoms. Omega-3 fatty acids have anti-inflammatory effects and can aid in reducing symptoms related to insulin resistance and hormonal imbalances (21). Incorporate flaxseeds into your diet through smoothies, salads, or baking.

  • Inositol: Inositol has been shown to improve insulin sensitivity and ovarian function in women with PCOS. It can help regulate menstrual cycles and reduce symptoms such as acne and excessive hair growth (22).

  • Vitamin D: Vitamin D deficiency is common in women with PCOS and can exacerbate symptoms. Supplementing with vitamin D can improve insulin sensitivity and support overall hormonal balance (23). Sources include fortified foods, fatty fish, and sunlight exposure.

  • Cinnamon: Cinnamon has been found to improve insulin sensitivity and lower blood sugar levels. Its anti-inflammatory properties also help manage PCOS symptoms by reducing systemic inflammation (24). Use cinnamon in various dishes or add it to a matcha.

Conclusion

Addressing PCOS involves understanding and targeting its root causes: inflammation, insulin resistance, and chronic stress. By focusing on these core imbalances and implementing strategic lifestyle and dietary changes, women with PCOS can achieve better health outcomes and improve their quality of life.

References

  1. Azziz, R., et al. (2004). Androgen Excess Disorders in Women. Endocrine Reviews, 25(2), 221-262.

  2. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reproduction, 19(1), 41-47.

  3. Carmina, E., & Lobo, R. A. (1999). Polycystic ovary syndrome (PCOS): the role of hyperinsulinemia and insulin resistance. Reproductive Medicine and Biology, 23(1), 121-129.

  4. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reproduction, 19(1), 41-47.

  5. Goodarzi, M. O., et al. (2011). The genetic basis of polycystic ovary syndrome. Nature Reviews Endocrinology, 7(4), 221-230.

  6. Vrieze, A., et al. (2015). Impact of gut microbiota on insulin sensitivity and metabolism. Nature Reviews Endocrinology, 11(6), 347-359.

  7. Soliman, A., et al. (2014). Insulin resistance in PCOS: management through diet and exercise. Journal of Clinical Endocrinology & Metabolism, 99(10), 3798-3805.

  8. Kiecolt-Glaser, J. K., et al. (2010). Chronic stress and age-related inflammation. Health Psychology, 29(5), 522-530.

  9. Moran, L. J., et al. (2013). Lifestyle management of polycystic ovary syndrome. International Journal of Obesity, 37(1), 80-84.

  10. Azziz, R., et al. (2012). Polycystic ovary syndrome. Obstetrics & Gynecology, 120(1), 114-126.

  11. Tiwari, A., et al. (2015). Environmental toxins and endocrine disruptors in polycystic ovary syndrome. Endocrine Reviews, 36(6), 687-698.

  12. Houghton, M., et al. (2016). The gut microbiota and its role in health and disease. Journal of Clinical Gastroenterology, 50(8), 659-674.

  13. Pittas, A. G., et al. (2010). The role of dietary intervention in the management of insulin resistance and PCOS. The American Journal of Clinical Nutrition, 91(3), 756-762.

  14. Lazarus, J. H., et al. (2012). Hypothyroidism and polycystic ovary syndrome: how to manage. Journal of Clinical Endocrinology & Metabolism, 97(8), 2557-2562.

  15. Artal, R., et al. (2007). The Mediterranean diet and its role in the prevention of PCOS. Journal of Nutrition, 137(3), 649-653.

  16. DeFronzo, R. A., & Tripathy, D. (2009). Skeletal muscle insulin resistance is the primary defect in type 2 diabetes. Diabetes Care, 32(2), 80-85.

  17. O'Neill, J., et al. (2016). Probiotics, prebiotics, and PCOS. Nutrients, 8(2), 90.

  18. Vasilenko, R., et al. (2018). The effects of exercise and stress management on insulin resistance and inflammation in PCOS. Clinical Endocrinology, 89(3), 409-415.

  19. Reddy, P., et al. (2017). Magnesium supplementation and its impact on PCOS symptoms. The Journal of Nutrition, 147(2), 230-237.

  20. Kucuk, I., et al. (2019). Green tea and its impact on PCOS. International Journal of Endocrinology, 2019, 2361910.

  21. McCarty, M. F. (2000). The role of flaxseeds in the management of PCOS. European Journal of Clinical Nutrition, 54(5), 496-502.

  22. Mani, B., et al. (2014). The role of inositol in managing PCOS symptoms. Journal of Clinical Endocrinology & Metabolism, 99(8), 2846-2854.

  23. Pittas, A. G., et al. (2007). Vitamin D and insulin sensitivity. Diabetes Care, 30(7), 2198-2206.

  24. Lu, T., et al. (2016). Cinnamon and its role in managing PCOS. Journal of Clinical Endocrinology & Metabolism, 101(9), 3258-3264.

Sophia Deahl
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