Do I Really Have PCOS?
PCOS, or “Polycystic Ovarian Syndrome” is often diagnosed whenever a woman has difficult, painful or irregular periods. But do you really have PCOS? And what can you do about difficult periods besides birth control? Whether you have PCOS or some other ovarian cyst symptoms or difficult, heavy or painful period, there are answers.
You can have comfortable, regular periods and feel great!
In this blog, we’ll dig into what PCOS is, what can contribute to PCOS and ovarian cyst symptoms and how to treat PCOS from a Functional medicine perspective.
What is PCOS
PCOS is the combination of three related symptoms:
Polycystic ovaries
Insulin resistance
Androgen excess
If you do not have these three things, then you do not have PCOS. You can have ovarian cyst pain, irregular periods, painful periods and even ruptured ovarian cyst(s) but you need to have insulin resistance and androgen excess for it to be polycystic ovarian syndrome (PCOS).
If you’ve been diagnosed with PCOS, along with a pelvic ultrasound to determine if you have multiple cysts on your ovaries, were you tested for insulin resistance or excess androgens? If you have difficult or painful periods, did anyone check your hormones? If they did test your sex hormones, did they test them at the appropriate time in your menstrual cycle?
Why isn’t PCOS often diagnosed further? Because in conventional medicine, the treatment is the same for all types of difficult, irregular or painful periods: Birth control.
Why do I have PCOS? (or other types of ovarian cyst pain, irregular and/or painful periods)
Off-schedule hormones.
PCOS, cystic ovaries and other types of difficult periods occur because your body’s normally tightly regulated hormone cycles get off-schedule.
The Beautiful, Complex, Female Hormone Cycle.
Women get their periods because of a complex, not fully understood, rise and fall of a cascade of interdependent hormone signaling. One hormone’s rise triggers the next hormone, triggers the next…in a beautiful cascade that leads to the development and selection of just one egg from an ovarian follicle (ovulation), the development of the uterine lining and, if this egg isn’t fertilized, a sudden drop in hormones that leads to the shedding of your uterine lining (your period!).
If the cascade of hormones is off in sequence, all of these things are off schedule. This leads to improper development and selection of a single egg in your ovary’s follicles (=polycystic ovaries); irregular ovulation timing and perhaps painful or off-schedule periods.
About 10% of women develop cysts on their ovaries. They can develop and then disappear and do not alone diagnose PCOS or other menstrual issues. Only when other issues continue to perpetuate dysregulated hormone signally will ovarian cysts persist and can scar and rupture (ouch!).
Why do your hormone schedules get dysregulated?
Hormones are often “collateral damage” from other things in our body being out of balance. So while we will want to focus on correcting hormones to heal from PCOS or other types of ovarian cyst pain or difficult periods, we often have to go to other areas of the body to heal them.
What dysregulates our hormones? Stress, inflammation, gut microbiome dysbiosis, metabolic syndrome and imbalanced nutrients (too much or too little).
Also, the roots of PCOS and other period issues can start in our early life, from a processed/inflammatory diet or undiagnosed food intolerances/allergens, frequent antibiotic use leading to gut microbiome issues, stress, other illnesses or toxin exposures. Some of us may even have inherited predispositions towards excess androgen development or insulin resistance that.
How is PCOS treated?
Birth control. Oral birth control is the preferred method of treatment for period issues in conventional medicine, regardless of any other diagnosis or causes. What if your symptoms don’t respond to your current birth control? Then a different birth control is prescribed, or another, and so on.
How does oral birth control work to mask PCOS and menstrual symptoms? Remember that intricate, complex cascade of hormones required to develop eggs in your ovaries and have a regular period? Birth control over-rides this by providing external hormones (estrogen and/ progesterone) that interrupt this cascade.
If it is investigated further and you are found to be insulin resistant and/or androgen dominant, you may also be put on metformin (lowers blood sugar levels) for insulin resistance and spironolactone (anti-androgen).
Why isn’t birth control, metformin and spironolactone a good enough solution to PCOS or other period issues? It only attempts to mask the irregular hormone cycles or insulin resistance that are causing it. It doesn’t try to address how or why your hormones got out of balance.
And, what do you do if you want to get pregnant?
Or have undesirable side effects from being on birth control (moodiness, low libido, weight gain), metformin (nausea, diarrhea, vomiting) or spironolactone (low potassium levels and blood pressure, stomach pain, diarrhea, irregular menses and symptoms of low androgens: fatigue, low libido…)
The PCOS Triad
To understand if you have PCOS and what to do about it let’s take a deeper dive into the PCOS triad:
1. Ovarian Cysts. Note: Having cysts on your ovaries does not diagnose PCOS alone.
Cysts on ovaries are actually quite common.
You can have ovarian cysts, even quite painful ones, and not have insulin resistance or androgen excess and therefore, not true PCOS.
2. Insulin resistance. Insulin is secreted by our pancreas gland in response to ingesting food. It tells our cells “Hey! Take up this energy!” so the cell can have the energy it needs to do its jobs for our bodies.
Insulin resistance happens when there is too much insulin secreted over a long time (usually due to too much carb/food intake). Eventually, the cells just start ignoring insulin’s signal to take up sugar because they are full already! That leaves both a lot of insulin and sugar floating around in your blood.
High sugar and insulin in your blood is a major driver of all sorts of inflammation in the body, including PCOS and other hormonal imbalances that can make our periods, moods and energy terrible.
Luckily, most of the time this is completely controllable through Functional medicine root-cause treatments based within a solid foundation of balanced diet & lifestyle therapy.
3. Androgen excess. Androgen hormones include the “male” hormone testosterone and DHEA(-S) and “female” hormone estrogen.
Insulin resistance and androgen excess go hand-in-hand, and one can drive the other. Together they can drive cystic ovaries and ruptured cysts as well as many patterns of hormone irregularities that make our periods very painful, heavy, irregular and just downright difficult.
What if it's not PCOS?
You don’t have to have insulin resistance, androgen excess or cystic ovaries to have painful, heavy, irregular or difficult periods. And PCOS and other menstrual issues have a lot of common, other underlying drivers. These can include:
Inflammation (Other than that driven by insulin resistance such as from our diet, gut microbiome or other diseases).
Nutrient insufficiencies or excesses.
Hypothalamus-pituitary dysregulation (the brain and master gland that control our hormones)
Stress (which can drive all sorts of hormone and inflammation dysregulation).
So whether you have true PCOS or some other form of difficult period, we still want to:
Investigate causes of, and resolve, inflammation.
Test for and address nutrient imbalances.
Consider testing and treating HPA- and HPO-axis (hypothalamus-pituitary adrenal/ovary axis) dysregulation.
Identify and resolve stress, both external (your outside world) and internal (your ‘filter’ through which you interpret the world and reactions).
You don't have to live with difficult periods:
PCOS is a specific condition characterized by cystic ovaries, insulin resistance and androgen excess. You can have painful, heavy or irregular periods and even cystic ovaries or ruptured ovarian cysts and not have true PCOS.
In conventional medicine, it doesn’t matter if it is really PCOS or not, because they will just give you birth control anyway.
In Functional medicine, our aim is to treat the root causes of your health issues by understanding how your body works and how you ended up with your unique symptoms.
There is a lot more, better and more holistic solutions for difficult periods than birth control, whether it is PCOS or not.
You don’t have to live with difficult periods.
Have you been diagnosed with PCOS but wonder if you really have it?
Do you have difficult periods and birth control is not a satisfactory answer?
Contact InHealthRVA and start your journey to period-wellness.