A Woman’s Guide to PCOS

Polycystic Ovary Syndrome, or PCOS, affects as many as five million women in the United States and it is one of the most common causes of infertility among women of childbearing age. PCOS symptoms—including weight gain, weight loss resistance, acne, missing or irregular periods, thinning hair on the top of the head and excess hair on the face and chest—can be annoying at best and debilitating at worst.

As if that weren’t enough, PCOS can come with long-term consequences. The condition can set the stage for other chronic conditions, like diabetes, heart disease, high blood pressure, sleep apnea, and stroke. PCOS has also been associated with increased risk of anxiety and depression.

What is PCOS?

PCOS is a hormonal imbalance that affects women of reproductive age. Specifically, the condition is characterized by having too many androgens, or male hormones, in the body, and this imbalance interferes with regular menstrual cycles. Women with PCOS experience missed or irregular periods.

(Don’t let the term “male hormones” mislead you, however. Androgens are produced in both women and men and play subtle but important roles in the female body. It’s only when they become out of balance that they can cause problems.)

How is PCOS diagnosed?

PCOS is diagnosed when high androgens are present and all other possible causes of androgen overload have been ruled out. (Other causes of high androgens can be a history of taking certain types of birth control pills and a condition called congenital adrenal hyperplasia.)

A physician can diagnose PCOS based on several criteria (1) symptoms that indicate higher than normal androgen levels, including acne along the jawline, chest, and back; unwanted hair growth on the chin and/or chest, loss of hair on the head; weight loss resistance; and waist-to-hip ratio (women with PCOS tend to store unwanted weight around the waistline, (2) blood tests, including blood glucose, HbA1c, insulin, and circulating androgens, and (3) physical exam and pelvic exam to look for enlarged ovaries or other signs of increased androgens.

Some doctors may do an ultrasound of the ovaries, but PCOS cannot be definitively diagnosed by ultrasound, as is often reported, because it is normal for ovaries to have ovarian follicles (cysts). Healthy women—especially young women—very often have multiple ovarian follicles at once. That makes an ultrasound finding of multiple cysts meaningless when it comes to diagnosing PCOS.

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What are the symptoms of PCOS?

• Missing or irregular periods (not ovulating regularly)
• Unwanted face and chest hair
• Loss of hair on the head
• Acne (specifically on the jawline, chest, and back)
• Carrying extra weight around the waistline
• Inability to lose weight
• Insulin resistance and dysregulated blood sugar (though not in every case. Most women with PCOS have dysregulated insulin, but not all)

Potential long-term consequences of PCOS

PCOS may have long-term consequences. The condition can set the stage for other chronic conditions like diabetes, heart disease, high blood pressure, sleep apnea, and stroke. PCOS has also been associated with increased risk of anxiety and depression. It is the most common cause of infertility in women.

What causes PCOS?

The exact cause (or causes) are unknown, but researchers believe that genetics play a role and that environmental factors can contribute to the condition. High androgens and dysregulated insulin are almost always involved.

Different Types of PCOS

There are three types of PCOS and knowing which type you have is key to choosing the right treatment protocol. (In mainstream medicine, of course, each type of PCOS is managed with the same suggested treatments, even though these treatments only work for some women some of the time.)

Different types of PCOS also have different symptoms – not all women with PCOS are overweight, for example – and this confusion can delay diagnosis and proper treatment. Irregular cycles and missing period affect all women with PCOS, no matter which type of PCOS is present.

Here are the three different types of PCOS:

Insulin-resistant PCOS – This is the most common PCOS type. High insulin levels interfere with ovulation, causing irregular cycles and other symptoms like weight gain, weight loss resistance, acne, hirsutism, mood swings, and thinning hair on the head. Women with this kind of PCOS usually have blood sugar and insulin levels that suggest diabetes or prediabetes.

Inflammation-based PCOS – This type of PCOS is most often seen in women who are not overweight and who don’t present with the classic symptoms of PCOS. Inflammation can be caused by a variety of factors, including food intolerances, exposure to environmental toxins, chronic viruses and/or chronic low-level injuries, and an over-reliance on sweeteners and high-glycemic foods (a generally poor diet).

Synthetic Hormone-Induced PCOS – This kind of PCOS is common for women who have been on the pill or other hormonal birth control like the implant, shot, or ring, for a long time. They will come off and their periods do not return. The synthetic hormones shut down communication between the pituitary gland and the ovaries in order to prevent pregnancy and it can take work to bring this communication channel back online.

It’s possible to have a combination of these three types of PCOS, or for the root cause of your PCOS to evolve over time.

Why drugs don’t work for PCOS

Two pharmaceutical drugs are often prescribed to women with PCOS. The first is Metformin. It is so commonly prescribed for PCOS that it is worth doing a deep dive on the basics of this drug:

What is Metformin?

Metformin is a first-line medication for those suffering with type 2 diabetes. It is also presented as a treatment for PCOS sufferers who are also overweight or obese. (Not all PCOS sufferers have weight gain as a symptom. Weight gain and weight loss resistance primarily affect women with insulin-resistant PCOS.)

Metformin works by reducing overall insulin levels. Insulin resistance is a condition in which the cells of your body become resistant to the hormone insulin. And when your cells stop hearing insulin’s important chemical message, glucose can no longer enter your cells to be used for energy. Instead, glucose stays in the bloodstream and blood sugar stability goes out the window. This process is associated with diabetes, prediabetes, and insulin-resistant PCOS.

What does poor insulin and blood sugar control have to do with PCOS? Unstable blood sugar interferes with ovulation. Because metformin helps regulate blood sugar it is thought to help ease symptoms of PCOS.

Should I take Metformin?

Most of the research studies that have examined Metformin as a treatment for PCOS show differing and conflicting results. This is probably because Metformin is given to women with a PCOS diagnosis regardless of the kind of PCOS they have. Insulin-resistant PCOS is very common, but it’s not what every woman has.

What can I expect if I take Metformin?

Metformin is not a miracle medication. If you take it, you will not instantly see an end to your symptoms and drop all the weight you have gained. If you have been diagnosed as prediabetic and you want to move away from this diagnosis as quickly as possible, then you could decide to take Metformin. This might be the case if you are hoping to get pregnant. Entering pregnancy with insulin-resistant PCOS and pre-diabetes sets you up for increased risk for gestational diabetes and increased weight gain during pregnancy.

Guidelines if you choose to take Metformin

I recommend these guidelines if you choose to take Metformin.

• Take Metformin as a short-term triage for a pre-diabetes diagnosis
• Know your exit plan from this treatment before starting the drug
• Simultaneously change your diet and lifestyle to improve insulin resistance (including strictly managing your blood sugar levels and sugar intake, and increasing exercise).
• Start the Flo Living protocol. The Flo Living protocol will alleviate symptoms of PCOS long-term and support regular ovulation and regular periods. It will also prevent sugar cravings, manage your blood sugar levels, and help you to lose the weight.

I have worked with many women for whom Metformin has not worked at all. They’ve taken it, experienced the side effects, and seen no improvement in their condition.

The other drug that is often given to women with PCOS is hormonal birth control. The pill is prescribed to help manage symptoms, but it is only a band-aid solution — just like metformin — that ignores root causes. So while things might seem better on the surface, the root causes of your PCOS go unaddressed, and often get worse, which means that when you stop the pill, your symptoms can return with a vengeance. The pill comes with a raft of side effects, too, both short term and long term. The better route is to address PCOS with food and lifestyle changes.

The Birth Control Pill and PCOS

What it does: The hormones in the birth control mask your natural hormonal patterns to prevent ovulation from happening, and therefore prevent pregnancy. The period you experience on the pill is not an acutal period, but rather a “break-through bleed” that occurs from the drop in estrogen. So even though it might be regulating your cycle, once you get off the pill chances are your period will return to the same state is was before.

Side effects:  We’ve spoken about significant side effects of the pill before, but the one side effect most relevant to PCOS is that it increases testosterone uptake, which can make your androgenic symptoms worse. This means if you’re experiencing hirsutism (hair growth in unwanted places), head-hair loss, or acne, it could potentially get worse with the pill.

Alternative solutions:  Re-establish your monthly ovulation and menstruation through restoring key micronutrients and helping your body to eliminate excess estrogen or other hormones that could be impeding your natural flow. Addressing adrenal fatigue and thyroid issues is also key here. And the great news is – all of these can be achieved through your diet and lifestyle!

Emerging Drug Therapies for PCOS

A recent study suggests a pharmaceutical cure for PCOS. Researchers at the French National Institute of Health and Medical Research hypothesized that PCOS might be triggered in utero by overexposure to a specific hormone (called anti-Müllerian hormone). They tested their theory by injecting anti-Müllerian hormone into pregnant mice and observing symptoms in their female offspring.

Indeed, the daughters of the mice injected with anti-Müllerian hormone showed many of the same symptoms as women with PCOS: irregular ovulation, delayed pregnancy, and fewer offspring. Then the researchers treated the symptomatic mice with cetrorelix, a drug that is commonly used during IVF, and the symptoms reversed.

Naturally, the idea that a drug could reverse PCOS generated a lot of excitement. But treatment in humans is a long way off, the side effects and long-term consequences of the drug require more research, and the body’s intricate hormone system is unlikely to be thrown off balance—and brought back into balance—by one single intervention.

But the best news of all? You don’t need drugs to feel better. You can find the answers to easing your symptoms in your home, on your plate, and in your supplement drawer. Best of all, when you make lifestyle and nutrition modifications, you address the root hormonal imbalances that give rise to PCOS, something a drug can’t do.

How to Resolve Your PCOS Symptoms

Whenever I’m working with a client who has been diagnosed with PCOS, the first changes I recommend are food and nutrition. Food is medicine when it comes to PCOS.

One important nutrition piece? Blood sugar and insulin balance. Whether you have insulin-resistant PCOS or another type of PCOS, getting your blood sugar and insulin under control is critically important for regulating ovulation—and the best way to manage blood sugar is with food. A diet high in processed carbs and simple sugars will send your blood sugar and insulin surging. A diet high in healthy fats, phytonutrient-rich vegetables and other complex carbohydrates, and high-quality protein will keep blood sugar stable.

When you eat certain foods makes a difference, too. I call the concept of matching your nutrition with your unique hormonal needs each week “Cycle Syncing®,” and it is one of the most important parts of any diet plan for women with hormone imbalances. If you don’t currently track your cycle and match your food with your shifting hormonal needs, get the MyFlo app and start tracking your 28-day cycle and aligning your food with your hormones.

PCOS and Sex Drive

When it comes to libido, women with PCOS have one of two experiences: they have a relatively high sex drive or a very low sex drive.

Here are the strategies I use in my own life and those I recommend to the women I work with:

If you have low libido with PCOS...

Low libido with PCOS means you likely have low testosterone levels. That said, your testosterone production will still peak when you’re in the ovulation phase. So start by tracking your cycle so that you know when you’re ovulating and can plan ahead. Make the most of that time. Clear your calendar. Plan a few date nights with your partner. Then make sure you focus on the foreplay, because it might take you a little longer to feel ready. Spend some time getting to know what feels good for you and then teach your partner what you need.

You can also work to boost your testosterone levels by taking zinc supplements and making sure you have enough healthy fats in your diet (think avocados!).

If you have high libido with PCOS...

Practice receiving pleasure. It’s not fun or pleasurable to always be the one who is leading, initiating, and dominating in a relationship. It can bring about resentment if you’re never in “receiving” mode in your relationship – being pursued, wooed and adored by your partner. Getting into the mode of receiving pleasure from your partner can boost your mood and health.

You can also work to lower your testosterone levels by taking saw palmetto extract.

10 Natural Remedies for PCOS

PCOS is best addressed with food and lifestyle modifications. Here are my top recommendations for resolving the hormone imbalances associated with PCOS and erasing your symptoms:

(1) Have healthy protein and healthy fat at breakfast. Try to eat breakfast within 30 minutes of waking up to help keep blood sugar steady and keep you feeling full until lunch. Eggs and avocado make a good combo. Consider adding some leafy greens or other veggies so your plate is brimming with inflammation-fighting phytonutrients.

(2) Don’t overdo animal protein. A Harvard study showed that women improved their chances of fertility when they got more of their protein from vegetable sources than animal sources. For the absolute best sources of protein for your hormones, click here. (Spoiler alert: eggs are okay! They appear to be the exception to the rule when it comes to animal protein.)

(3) Embrace the RIGHT kind of carbs. Not all carbs are created equal. While some carbs are notoriously bad for health—think baked goods, white bread, pasta—others are important for hormonal harmony. Most women with PCOS struggle on a low-carb diet, like Atkins or Paleo. I recommend making rice, quinoa, buckwheat, and millet part of your regular diet.

(4) Ditch caffeine. Caffeine is catastrophic for your hormones. Numerous studies link caffeine with impaired fertility (which is a hallmark of PCOS) and general hormonal discord. Research shows that drinking 3 cups of coffee a day (consumed by either men or women) increases the risk of miscarriage by 74%. Coffee depletes B vitamins, which are necessary for healthy ovulation and hormone balance. If you suspect you’re low on B vitamins, you can find the formula I recommend in my Balance Supplement Kit.

(5) Tiptoe around toxins (and try to avoid them altogether). Many of the everyday chemicals we’re exposed to through cleaning products, conventional health and body care products, lawn care products and household pesticides are endocrine disruptors and have negative reproductive, neurological, and immune system effects. The Environmental Working Group lists twelve of the worst endocrine offenders. Read labels on cleaning products carefully or, better yet, make your own products with vinegar, baking soda, and essential oils.

(6) Sync your life to your cycle. When you live your life in accordance with your natural hormonal rhythms, your hormones are happier—and so are you. It’s as simple as that. Sync your life with my MyFLO Period tracker App, the first ever hormone balancing app.

(7) Tend your microbiome. A healthy microbiome, the group of bacteria that lives in your gut, means a healthy estrobolome, the colony of bacteria in the microbiome that help metabolize estrogen. Hormonal healing is impossible if your gut is out of balance. The best way to bring your microbiome into balance is to supplement with probiotics.

(8) Patch up nutrient deficiencies. Micronutrient support is critical for women with PCOS. Our bodies need the B vitamins that can help with mood and progesterone production; the liver support that helps detox estrogen; the magnesium that helps balance the production of progesterone, estrogen and testosterone; the probiotics that help heal the gut; and vitamins D, K1, and K2 to support healthy immune function and regular ovulation. You can find all these supplements together in the Balance Supplement Kit I created specifically to bring hormones back into balance.

(9) Focus on strength training. Some research suggests that resistance training may have a therapeutic effect for women with PCOS.

(10) Get some sleep. Sleep helps pretty much everything, including hormone regulation. Make getting more sleep a priority!

Why Most Women with PCOS Shouldn’t Use Vitex

Vitex increases progesterone levels by increasing LH (luteinizing hormone) levels, and it suppresses prolactin levels – the result is increased ovulatory cycles. This sounds like a perfect scenario for PCOS sufferers, but there’s a problem. Vitex can actually worsen PCOS for some because their LH levels are already high. If you know your LH level is high (if you don’t know – ask for a hormonal panel blood test from your doctor), you should not use Vitex.

If you have PCOS with normal LH levels and high prolactin levels, you might consider using Vitex. You can have your prolactin levels tested by your doctor. This kind of PCOS has a different root cause, usually inflammation from allergens like dairy and gluten or as the result of using the birth control pill. Vitex can help to suppress prolactin levels and increase ovulatory cycles in these cases.

Vitex is a slow-acting herb. You will need to commit to taking it for up to 3 months to see any change in your cycles or improvement of symptoms. Be sure to purchase Vitex from a reputable, long-standing supplement company like Gaia so you know you are getting a potent formulation, without fillers.

Should Women with PCOS Use Progesterone Cream?

The idea behind using natural progesterone cream to treat your PCOS is that you will increase your progesterone levels and rebalance your estrogen levels. You make progesterone after you ovulate, if you ovulate, in the second half of your cycle. If you don’t ovulate regularly, as is common with PCOS, progesterone deficiency can cause many unwanted symptoms. Progesterone cream is one of the ways to help your body deal with this lack of progesterone, but it’s not an ideal treatment and I have some caveats about progesterone cream if you choose to use it as a natural treatment for your PCOS.

If you’re in a place where your PCOS symptoms are acute, natural progesterone cream can offer some immediate relief. If I meet a woman in a critical state with her PCOS-related health issues, then I believe that natural progesterone cream can be a good choice for her, for one to three cycles.

That said, using natural progesterone cream only adds plant-based progesterone to your body (to replace the progesterone your body is lacking). It doesn’t help you create more of your own progesterone, which is ultimately what you want your body to do. This is why Cycle-Syncing™ is so effective because it balances out estrogen and boosts progesterone throughout your cycle.  

The 5 Best Supplements for PCOS

I recommend these supplements to address the root causes of PCOS

Cinnamon – Taking this warming spice as a supplement helps stabilize blood sugar, which is essential for all hormonally-sensitive women, but especially those with PCOS. I recommend New Chapter for a cinnamon supplement, but you can additionally shake cinnamon on oatmeal, eggs, or enjoy cinnamon tea, like Tazo’s Cinnamon Apple Baked.

Magnesium –  Magnesium is vital for hormonal balance, and most women are deficient in this essential micronutrient. Magnesium improves insulin resistance, reduces inflammation, and supports adrenal function — all essential actions for managing PCOS symptoms and treating the root causes of PCOS.

B6 – A condition called estrogen dominance, in which estrogen levels are high relative to progesterone, fuels PCOS. Taking vitamin B6 helps increase progesterone production. I encourage women with PCOS to eat B6-rich foods like bananas, grass-fed beef, and garlic, but a daily supplement is also important.

Selenium – Selenium is essential for supporting liver function. The liver’s job is to help the body detox excess estrogen and environmental estrogens (phytoestrogens). When the liver gets the support it needs, estrogen dominance is less of an issue.

Zinc – This mineral balances testosterone. Whether your testosterone levels are high or low (both possible with PCOS), zinc will have a positive, balancing effect. Studies have shown how beneficial zinc supplementation can be for women suffering with PCOS, with relatively rapid results.

In the FLO Protocol, food comes first. What you eat and when you eat it are the single best ways to heal your hormones and erase the symptoms of PCOS.

After that, taking high-quality, targeted supplements is the best way to help yourself recover lost nutrients and restore hormone balance. Supplements can help undo the havoc caused by caffeine, stress, hormonal birth control, and environmental toxins — and they are especially important when you are trying to heal PCOS. They help support your body and balance your hormones as your body works to restore a new, healthy baseline.  

It’s easy to feel protected by a virtuous diet. But that is often not enough to erase PCOS symptoms. What’s more, you don’t want to take a slapdash approach to supplements, trying one thing you read about in a magazine here or another highly lauded supplement there. Real relief from hormone-related symptoms requires a systemic approach. That’s why I’m proud to be able to offer you the essential micronutrients you need to support hormone health and keep your periods symptom free. I’ve spent years researching the targeted supplements women need to heal their hormones and the result is the Balance Supplements by Flo Living. These supplements take the guesswork out of shopping for high-quality supplements that meet a woman’s unique physiological needs.

Always remember that once you have the right information about how your body really works, you can start making health choices that finally start to work for you! You can do this – the science of your body is on your side!