PCOS is a common but often undiagnosed condition. Polycystic Ovary Syndrome (PCOS) affects about 8 to 13% of premenopausal women worldwide, yet many remain undiagnosed. It can affect every aspect of a woman’s life, not just physically but also emotionally and mentally. Typical symptoms include absent or irregular menstrual cycles, symptoms of excess androgens such as acne, increased body and facial hair growth (hirsutism), scalp hair loss, insulin resistance, and difficulty becoming pregnant.
Symptoms often begin during puberty; however, some women do not develop any symptoms until early adulthood. PCOS can be tricky to diagnose, partly because symptoms can overlap with other health conditions. To diagnose, doctors commonly look for at least two of the following to be present: irregular ovulation, high androgen levels (symptoms or blood tests), or cystic ovaries seen on ultrasound. Cystic ovaries look on ultrasound like small follicles grow around the periphery of the ovary. None of these small follicles grow to a size that would result in ovulation. As a result, the levels of estrogen, progesterone, LH, and FSH become imbalanced. Androgens, including testosterone, are primarily produced by the ovaries and the adrenal glands. In women with PCOS high androgens may be driven by high levels of LH but also increased levels of insulin.
PCOS does not only affect sex steroid hormones, but elevated levels of cortisol are also common. The latter can be linked to high insulin but also to perceived stress triggered by a dysregulated HPA-axis. Not surprising then that affected women do not only report physical symptoms but often suffer from depression, anxiety, cravings, and irritability as well.
This is where root cause medicine looks for underlying emotional trauma, nutrient deficiencies, causes of stress, and imbalances in the gut microbiome. The holistic approach to healing then addresses the spiritual, emotional, mental, and physical layers of a person.
Natural medicine emphasizes gut health and provides guidance on how to restore a healthy gut microbiome as a first step in reducing inflammation. Why start in the gut when we are talking about PCOS?
The gut-brain axis is a two-way communication system between the gut and the brain, linked by the Vagus nerve, hormones, and neurotransmitters like serotonin, most of which is made in the gut. Blood sugar, insulin, and cortisol imbalances as seen in PCOS lead to cravings. Eating processed foods, sugary snacks, and simple carbs, feeds the bad bacteria in the gut. When harmful bacteria outnumber helpful ones in the gut, it’s called dysbiosis. This imbalance triggers inflammation and weakens the gut lining, leading to a condition known as leaky gut. The gut is called ‘leaky’ when larger molecules including undigested foods and toxins can ‘leak’ through the weakened lining directly into the bloodstream, further fueling systemic inflammation. That is why chronic low-grade inflammation contributes to irregular periods, weight gain, and acne. Gut dysbiosis and chronic inflammation not only affect a person’s energy metabolism and ability to detox but can also disrupt the production of important neurotransmitters including serotonin. Imbalanced neurotransmitters are one of the reasons why women with PCOS are prone to experiencing anxiety, depression, and brain fog.
Again, in PCOS,
- inflammation,
- stress, and
- blood sugar imbalance
affect the gut microbiome and thus
- the gut-brain-axis,
- mental well-being, and
- hormonal regulation all at once.
In PCOS,
- inflammation linked to poor gut health, and the gut microbiome needs to be addressed first,
- high insulin is another common factor that requires lifestyle choices, nutrition, and sleep to be upgraded by detoxing the liver and supporting proper methylation in the liver,
- high cortisol indicates that the adrenals are working overtime, thus adaptogenic herbs can support adrenal function, energy healing and hypnotherapy help reset HPA-axis-signaling, and stress management skills need to be upgraded, and
- with proper diet and nutrient supply, exercise, emotional healing, and mental wellbeing, hormones can be rebalanced, and androgens can be lowered. Temporary PCOS as induced by taking hormonal birth control pills can be reversed completely.
- The holistic approach to PCOS addresses the whole person and improves all metabolic pathways.
Potential Genetic Predisposition to Developing PCOS
Females with PCOS and obesity are at particularly high risk for (non-alcoholic) fatty liver and should be screened for signs of increases in liver fat and fibrosis. The underlying cause is a mutation in the MTHFR gene. The DUTCH Complete Test provides helpful initial insights into the liver’s methylation capacity. If methylation is inhibited, hormones cannot be properly detoxed. This further contributes to imbalances in estrogen and androgen levels. This is why supporting liver health, and in particular, a woman’s capacity to methylate is important and needs to go together with addressing gut health.
Testing for the MTHFR gene mutation is simple and inexpensive and can be used as a foundation for targeted nutritional recommendations, or further therapies, respectively.
The DUTCH Complete Test is also my go-to tool to help women improve fertility.
Holistic Approaches for Supporting Wellbeing in Women with PCOS
Here are a few simple yet effective diet and lifestyle strategies that can help the body to self-regulate, reduce inflammation, and balance blood sugar levels.
Prioritize a Healthy Diet
· Fiber-Rich Foods: quinoa, legumes (lentils, black beans, chickpeas), oats, spelt, and chia seeds, avocado, carrots, fruits (e.g., berries, apples), and vegetables (e.g., broccoli, leafy greens, sweet potatoes)
Fiber feeds the beneficial gut microbiota and regulates blood sugar levels.
· Fermented Foods: organic plain Greek yogurt or Skyr, kefir, kimchi, sauerkraut, kombucha, kvass, and miso.
· Healthy Fats: avocados, nuts, seeds (e.g., chia, flax), and extra virgin olive oil. Omega-3 fatty acids help maintain steady blood sugar levels by improving how the body uses insulin.
· Anti-inflammatory Spices and Herbs: besides the fruits and vegetables listed above, eat more turmeric, ginger, garlic, culinary herbs, and colorful vegetables (e.g., beets, butternut squash, spirulina).
· Complex Carbohydrates: sweet potatoes, whole grains, chia, root vegetables, quinoa
· No Empty Carbs: Avoid refined sugars, sugary drinks, and processed snacks that can spike blood sugar, worsen inflammation, and may contain chemicals that negatively affect gut health and hormone balance.
· Hydrate with Purpose: drink plenty of water and include anti-inflammatory teas like green tea or chamomile to support overall health.
· Make the vegetables your entrée. It is easy to add lean, organic protein, and some complex carbs, but base your meals on the vegetables to get enough fiber, plant-based nutrients, and antioxidants. Eat a small salad every day. Eat a piece of fresh, whole fruit or berries every day. Stay away from store-bought juices, sodas, energy drinks, and alcohol!
Sample Meal Plan
· Breakfast: Greek yogurt with organic berries and chia seeds, 12 oz of lemon water, and green tea
· Lunch: grilled wild-caught salmon on a bed of butter lettuce or mixed spring greens with olive oil, basil and fresh lemon dressing
· Dinner: quinoa, leeks, and lima bean “stir fry” with tamari, garlic, ginger and onions, and crispy roasted Brussel sprouts
· Hydration: spring water, filtered water, sparkling mineral water, and herbal tea served hot or iced (spearmint tea has been shown to support healthy hormones in PCOS; ginger tea for gut health and healthy inflammation balance; ashwagandha and Tulsi tea for adrenal support and a healthy stress response, lemon balm tea for gut and mood support).
Exercise
· Reduces insulin resistance and balances blood sugar levels.
· Stay away from strenuous, cardio/HIIT exercise to not trigger cortisol. Moderate exercise promotes menstrual regularity and more balanced dopamine levels.
· Helps reach and/or maintain a healthy weight.
· Enhances a diverse microbial environment to benefit gut health, and prevents candida overgrowth (which is often linked to blood sugar issues).
· Regular exercise reduces systemic inflammation, which in turn improves gut health and reduces symptoms of dysbiosis.
· Stimulates endorphin release, thus alleviating anxiety and depression.
· Improves stress response by lowering cortisol levels and promoting relaxation.
Stress Management
Mindfulness, meditation, yoga, or deep breathing support relaxation and healthy cortisol levels.
Prioritize your peace: set aside time regularly for activities that bring joy and relaxation.
Sleep is sacred: make restful sleep non-negotiable. Set boundaries around your time, especially if you’re up late with work or social events. Create a soothing ambience in your bedroom where you feel safe and able to tune out any distractions including TV and social media.
Consider professional support: holistic health coaching, counseling, and energy healing offer strategies to eliminate chronic stressors and stay on track with healthy habits.
Take baby steps from different angles: combine mindfulness with dietary changes, healthy sleep, and regular movement and/or yoga to optimize overall wellbeing.
Supplements
Probiotics: choose products that contain Akkermansia and B. Rhamnosus.
Folate (B9): stay away from folic acid and choose products that contain methyl folate instead. This vitamin is especially important for those with a confirmed MTHFR gene mutation.
B-Complex: B vitamins are important for healthy hormones, liver function, the nervous system, and the brain.
Magnesium: besides being necessary for over 300 biochemical functions in the body, it helps regulate blood sugar, is required for the production of progesterone and estrogen, reduces inflammation, and calms the nervous system. Magnesium is well absorbed through the skin, making Epsom salt baths a great self-care option.
Omega-3 Fatty Acids: support brain health and reduce inflammation.
N-acetylcysteine (NAC): NAC is a precursor to glutathione, the body’s major antioxidant. It improves ovulation and fertility in women with PCOS, potentially by improving insulin sensitivity and reducing oxidative stress.
Myo-Inositol: improves how the body uses insulin. It also lowers luteinizing hormone (LH), thus balancing hormone levels, and making menstrual cycles more regular.
SAMe: improves methylation, reduces inflammation, and reduces anxiety and depression in patients with confirmed MTHFR gene mutation.
Consult a healthcare provider before starting any new supplements to ensure they align with your individual health needs, are taken at the appropriate dosage, and don’t interfere with any medications you take.
This article is intended for educational purposes only and should not be used as a substitute for medical advice.
