PCOS Crash Course & Care Plan

My heart is always saddened by the struggles I hear women speak about in the office as a nurse practitioner. So often, women are told that our symptoms are “normal.” We aren’t listened to or taken seriously. We’re rushed out the door and put on medications like birth control, metformin or spironolactone. By the end of the visit, we’re more confused than when we walked in, and told, “it’s probably just PCOS, here’s a pill, good luck.”

No one is even able to give us a clear answer about what is actually happening in our body. We’re told we just have to live with it. But that is not the way it’s supposed to be.

So I became determined to get to the root cause of hormone imbalance in women, and why it’s so common to see irregular and painful periods, infertility, low energy, weight gain, acne, and rising rates of depression.

Here is my PCOS (Polycystic Ovarian Syndrome) crash course. Before we begin, remember: every patient is different and shows up with a different story. It’s the job of your practitioner to listen and put the puzzle pieces together to find a care plan meant for you and your body.

First, the basics

As women, we have ovaries that are supposed to ovulate every month. Ovulating means we release an egg from our ovaries, which will either be fertilized or not. If the egg is fertilized, you become pregnant. If it isn’t, the menstrual cycle starts over again.

The release of the egg is called the rupture site, and this is also where progesterone is made. Progesterone helps reduce anxiety, maintains pregnancy, promotes bone development, and lowers the risk of breast cancers. Testosterone is also made in the ovaries; it’s our primary androgen hormone, helping with muscle, bone strength, fertility, energy and fat storage.

If we are not ovulating, we do not produce progesterone.

In other words, when our ovaries have too many cysts (as in PCOS), we don’t ovulate at all, or we ovulate irregularly. We miss the benefits of progesterone, and this is part of why PCOS is connected to infertility.

So why do we get cysts?

Remember that testosterone is made in the ovaries. When your insulin stays too high for too long, your ovaries overproduce testosterone. High insulin also lowers sex hormone binding globulin (SHBG), a protein that binds hormones to make them inactive in the blood. With less SHBG, you have more free, active testosterone circulating, which interferes with follicle (ovary) formation and leads to cysts instead.

You don’t have to have cysts to be diagnosed with PCOS. Symptoms include irregular cycles, weight gain, excess hair, infertility, acne, and depression from the high testosterone levels.

Excessive insulin production causes excess production of testosterone in the ovaries.

So if insulin is the driving factor behind your PCOS, this becomes a metabolic issue, not a gynecological one.

Why does insulin increase in the first place? The root of the answer is inflammation: from high refined-carbohydrate intake, from toxin exposure, from dysbiosis of the gut, and from chronic stress.

So here is what we need to address

Again, every patient is different and shows up with a different story.

1. Diet
2. Toxin exposure
3. Gut imbalances
4. Emotional health

PCOS basic care plan

Diet

This is where we start. We need to cut out the refined sugars, and some you might not think about: cereals, processed oatmeals, white bread, pasta, soda, candy, crackers, those Starbucks/Dunkin vanilla lattes. They’re only spiking your insulin.

We also want to remove the most inflammatory foods: gluten, dairy, soy and corn are the top four offenders. Lean into a phytonutrient-rich, anti-inflammatory way of eating, whole foods, high fiber, high protein and healthy fats. Stabilize your blood sugar first by eating a lower-refined-carb diet. (This could be a whole blog post on its own.)

Toxin exposure

Toxins trigger your immune response. Repeated exposure, from the products we use, the chemicals we clean with, BPA from plastics, can cause chronic immune activation, which causes chronic inflammation, which elevates insulin.

Reduce your exposure by choosing clean products, using glass tupperware and mugs, and supporting your body’s detox pathways. Detoxifying starts simple: stay hydrated so you’re urinating normally, eat enough fiber so you’re having regular bowel movements, and sweat daily through exercise or sauna.

Gut health (dysbiosis)

Abnormal bacteria in the gut release lipopolysaccharides (LPS), which the body identifies as a toxin. These leak into the bloodstream and cause that same immune response, leading to more inflammation. Probiotics, prebiotics, and restoring gut balance all help.

Supplements to consider

(Always talk to your provider before starting anything new.)

• Inositol → helps improve insulin sensitivity
• Vitamin D3 + K2 → needed for insulin stability
• Omega-3s → anti-inflammatory

Emotional health

We are a mind, body and soul being. Emotions are energy-in-motion, and if they aren’t properly addressed, they get stored in the body. Fear in particular tends to be held in the reproductive organs and adrenal glands. Processing your emotions plays a huge part in your physical health.

I hope this breaks PCOS down into terms you can understand, and gives you an idea of where to start. Remember: your body is on your side and wants to help you heal. We just need to give it the right tools. Be kind to your body. <3

Xoxo,
Elyse