A Functional Medicine Approach to PCOS (Polycystic Ovarian Syndrome)
Updated: Jan 16
|| by Mitchell Rasmussen, DC, CFMP and Kate Daugherty, MS, CNS ||
Polycystic Ovarian Syndrome (PCOS) is a complex hormonal disorder that affects millions of women worldwide. It is best characterized by hormonal imbalances, insulin resistance, and ovarian cysts. However, it broadly represents a collection of symptoms such as irregular menstrual cycles, fertility issues, weight gain, and even psychological distress.
While conventional treatments exist, they are non-specific to the TYPE of PCOS and often come with a litany of their own side effects. (re: Conventional medical treatment typically involves hormonal birth control and androgen inhibitors like Spironolactone)
Instead, we'll explore how functional medicine and nutrition can play a vital role in treating PCOS and improving overall well-being from a root-cause perspective.
In our Functional Medicine practice, we spend a lot of time identifying and addressing the underlying factors that contribute to a patient's challenges. With PCOS, this includes assessing potential drivers such as blood sugar dysregulation, gut health, inflammation, adrenal function, nutrient deficiencies, hormone metabolism pathways, and lifestyle exposures. By understanding WHY the symptoms of PCOS are presenting, we can better develop a personalized treatment plan.
With that in mind, we'll explore some of the most common issues and management techniques for Polycystic Ovarian Syndrome.
The Conventional Picture of PCOS
Polycystic Ovarian Syndrome is commonly diagnosed by a gynecologist as a "catch-all" in the presence of irregular cycles and hyperadrogenic symptoms (facial hair, acne, aggression). Contrary to common thought, actual polycystic ovaries are NOT required for diagnosis.
Hormonal Birth Control is the most-prescribed drug treatment for PCOS. It interrupts normal ovulation, so the pearl-like cysts that come from immature eggs are not formed. However, it largely masks the problem. Women who discontinue the pill in hopes of conception often find themselves entrenched in PCOS and infertility despite "treating" it for years.
Concomittantly, spironolactone (a potassium-sparing diuretic) may be prescribed. This drug works by preventing conversion of androgen hormones; thus limiting androgenic symptoms like abnormal facial hair growth, male pattern hair loss, and resistant acne.
Lastly, when insulin resistance is identified as part of the PCOS symptom picture, the drug of choice tends to be Metformin. While not the worst drug (when warranted), there are alternative options including non-pharmaceutical management of blood glucose.
When you go to your PCP or gynecologist complaining of irregular cycles, mood disturbance, abnormal weight gain, and fertility challenges... you can expect to walk away with one of these recommendations. Sadly, the tools available in conventional medicine are time-limited (short appointments) and resource-limited (minimal nutrition or lifestyle guidance).
FM Intervention #3: Supplements and Herbal Support
The Role of Functional Medicine for PCOS
Functional medicine seeks to identify and address the underlying factors that contribute to a person's health conditions. With PCOS, this approach involves three large categories for intervention: nutrition/dietary habits, supplements/herbal support, and lifestyle modification.
In a follow-up post, we'll discuss the most common drivers WE see for Polycystic Ovarian Syndrome. (Spoiler Alert: Insulin Resistance and Stress)!! For now, we'll look at general recommendations in these categories to better illuminate the OVERALL picture of PCOS.
Nutrition Considerations for PCOS
Certain dietary patterns and nutrients can help regulate hormonal imbalances, improve insulin sensitivity, reduce inflammation, and support overall health. We use functional lab testing in our practice to FIRST understand the drivers of your condition. From there, we can be more targeted in dietary advice. If a DUTCH test or Comprehensive Bioscreen is not feasible, we'll make assumptions and start with the basics:
Balance Blood Sugar Levels. - Insulin resistance is a primary driver of PCOS. In order to correct the sex hormone imbalance leading to symptoms (especially in the case of high androgens); we MUST start with blood sugar management. This is as much about HOW you are eating as it is about WHAT you eat. Related Post: Blood Sugar 101
Increase healthy fats. - PCOS is an inflammatory condition. In order to relieve the body burden of inflammation, we can tip the scale in favor of anti-inflammatory fats. This means consuming more fish, nuts, seeds, avocado, and olive oil.
Incorporate anti-inflammatory foods. - In addition to healthy fats, you can boost the anti-inflammatory capacity of your diet by "eating the rainbow". This mantra encourages consumption of a wide variety of phytochemicals from colorful fruits and vegetables. In addition to produce, spices, coffee, and chocolate can all be rich sources of antioxidants helpful in managing the oxidative stress of PCOS.
Add fiber-rich foods. - When it comes to detoxification, fiber is paramount. It binds biotransformed toxins and helps to escort them OUT of the body. This is especially important for hormonal imbalance. Our own hormones can be "toxins" that get recirculated in the body without adequate fiber to bind them! A generous mix of soluble and insoluble fiber is recommended for the management of PCOS.
Use mindful eating strategies. - Increased adipose tissue is a common presentation in PCOS patients. (this may be a chicken or egg conundrum with insulin resistance/adrenal dysfunction which we'll save for another post) Regardless of the cause, practicing mindful eating habits can improve body composition through direct portion control/healthier food choice. Secondarily, the HPA Axis function will be improved with better vagal nerve tone!
Lifestyle Modifications for PCOS
The major lifestyle interventions for PCOS are those that contribute to overall well-being. While these things are not groundbreaking... they are essential to managing the symptoms! The best supplement regime still cannot outweigh the basics.
Regular Physical Activity.
Stress Management.
Adequate Sleep.
Minimized exposure to environmental toxins.
Effective functional medicine care includes guidance in these categories. Too often, we see practitioners relying on supplements without providing coaching and accountability for changing basic habits. We aim to change the narrative on medical care-- it isn't just about giving a "quick fix" pill (natural OR synthetic).
Supplements and Herbal Support for PCOS
After a foundation of good nutrition and optimal lifestyle habits has been established, we can consider certain supplements or herbal formulas to manage the symptoms of PCOS. As with every recommendation, these should be targeted based on YOUR lab results. With Polycystic Ovarian Syndrome, and any hormonal imbalance, we must understand the synthesis and metabolism of hormones. High estrogen, Low progesterone, and High Androgens are all potential hormone imbalances with vastly different supplement protocols! A general "hormone balance" supplement is unlikely to fit YOUR needs.
With that in mind, here are a few of the things we regularly use in our practice for the management of PCOS based on the current research:
Inositol. - In cases of insulin-resistant PCOS, inositol is a useful supplement that helps to manage blood sugar. Inositol works as a second messenger to regulate hormone signaling. There is also significant research to support the use of inositol to promote ovulation and menstrual cycle regularity.
N-Acetyl Cysteine (NAC) / Glutathione. - For inflammatory PCOS, N-AC or Glutathione can provide powerful antioxidant support. These supplements have applications well beyond PCOS and are very safe as they are compounds made endogenously in the body!
Omega-3 Fatty Acids / Fish Oil. - If consuming fish is unrealistic, using a fish oil supplement can provide necessary amounts of the omega-3 fatty acids DHA and EPA. A proper balance of Omega-3:Omega-6 fats is paramount in controlling and resolving inflammation.
Adaptogenic Herbs. - For adrenal PCOS, adaptogenic herbs like rhodiola, maca, ashwaghanda, and holy basil are used to support the brain. These herbs are a stress management "insurance policy" better equipping the system to handle stress.
Probiotics. - Improving gut health can have an indirect effect on PCOS symptoms. Better microbiome balance allows greater nutrient absorption, less inflammatory cytokine production, and increased detoxification capacity for excess hormones. Remember: Strain-specificity is important!!
Honorable Mentions: Berberine, Quercetin, Resveratrol
You'll get the best outcomes from a supplement protocol that is specifically designed for YOUR physiology. However, we'd much rather you have access to high-quality pharmaceutical grade supplements than self-prescribe on amazon. With THAT in mind: Click here to access our FullScript catalog recommendations for PCOS.
Ultimately, Managing PCOS and Hormone Imbalance comes down to managing not only your diet, but your lifestyle. Particularly when risk factors (like genetics) are unavoidable, YOU must take the control to live healthier, happier, and longer. If you need help assessing your baseline and implementing strategies towards better hormone regulation, REACH OUT.
We LOVE using the DUTCH to look in detail at hormone issues. Fasting Insulin is included in our Comprehensive Bioscreen Bloodwork.. the basic foundation of our Functional Medicine Testing.
>>You better believe we're gonna hone in on Sleeping, Pooping, and Blood Sugar Control.
Want a free resource for managing your PCOS with good nutrition? Click here to get Kate's 7-Day PCOS Meal Plan!
CLICK HERE to shop our supplement store - products are also available in our Cherry Creek Clinic.
If you're curious about building a personalized supplementation protocol for controlling and managing your hormones, contact us to book a consultation! (This can be remote).
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Want to work with a functional medicine doctor to run labs and assess nutrient status? Struggling with hormone imbalance, IBS, weight gain, mood changes? Let's look at BIOCHEMISTRY. Read more about Functional Medicine at The Facility here.
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