I see a lot of women with a diagnosis of PCOS in my practice. Polycystic ovarian syndrome is an interesting diagnosis in that, because it’s a syndrome, there are multiple ways that a woman can end up with this diagnosis. Symptoms, lab tests, imaging or a variety of these can be what leads this diagnosis which one in ten women have been given. Women must have two of three of the following conditions to be considered for this diagnosis: irregular or absent periods, high levels of androgens (ie testosterone) and/or visualization of cystic ovaries. So while PCOS mentions polycystic ovaries in its name, some women have this diagnosis without knowing if they have cysts on their ovaries or not. This is key for how naturopathic medicine can help women with a diagnosis of PCOS. Cystic ovaries aside, PCOS involves hormonal imbalances.

Even without a diagnosis of PCOS, many women are dealing with hormonal imbalances. Severe PMS symptoms or hot flashes, fibroids, and migraines can all be related to hormone imbalances. Women with PCOS may have difficulty losing weight, have facial hair or acne, and may suffer from infertility. Other women, however, end up with the diagnosis of PCOS with little in the way of troubling symptoms. Which can make this condition all the more confusing for women who have it. No two women with PCOS are the same which is related to the complexities of our cycling hormones!

As I often tell my patients, an imbalance in one hormone can impact all of your other hormones. If your estrogen and progesterone are imbalanced, it is important that you also carefully check the health of your thyroid and consider how your adrenal glands are doing with their production of cortisol.

In addition to the communication among hormones, PCOS, can also be related to metabolic syndrome and the development of high levels of insulin related to insulin resistance. Women who have been overweight and then were diagnosed with PCOS may also be told that they are pre-diabetic or at risk of diabetes. In fact, those with a family history of diabetes, may be at higher risk for PCOS.

If you’ve been diagnosed with PCOS, you may feel unclear about what contributed to your development of this syndrome and what it means for your long term health. Women who are planning future pregnancies may be especially concerned about what this diagnosis means for their fertility.

Depending on the results of lab work and imaging, Women diagnosed with PCOS are often started on metformin. Labs done to determine if PCOS was present likely included some basic hormones, including testosterone. Testing hormones in the blood is a snapshot of one day in the complex cycling of hormone in a woman’s body. Blood work to look at hormones is best done at two points during the month (around day 3 and around day 22) so as to capture a view of the follicular and luteal phases of the cycle. This twice a month approach, however, if often not done and diagnoses may be made on one set of labs.

Because hormones are so complex in how they cycle and are also so critical to understanding the full story of a woman’s health, I use urine test to look at a wide range of different hormones. Urine tests offer a slightly broader view than what blood work can, though I often look at some markers in the blood in addition to the urine test. Having as complete a picture as possible is very helpful in correcting hormone imbalances. Seeing the big picture of the body’s various hormones and how the hormone pathways are functioning helps to determine how best to lower androgens and support regular ovulation in women who have PCOS. In addition to looking at hormones, it is also important to check Vitamin D levels since Vitamin D is technically a hormone (not actually a vitamin) as well!

Until these lab tests are run, however, we can always start with the basics of regulating hormones and optimizing insulin sensitivity. Incorporating ground flax seeds (two tablespoons daily) into the diet can help your body to recycle its hormones more efficiency, helping to keep any one hormone from piling up. Similarly, a certain form of calcium, called Calcium-d-glucarate can have the same effect so can also be started with any sign of hormone imbalance. Chromium and Inositol are two nutrients that can help to regulate insulin activity so are often part of a PCOS protocol.

Exercise is also a critical part of optimizing insulin sensitivity and managing weight. Our fat cells can hold onto our hormones so considering body composition may be an important part of understanding PCOS. And insulin resistance responds very quickly to regular exercise.

There are also a wide variety of botanical medicines that can be beneficial for PCOS and hormone imbalances. Last week I taught a class through the Chappaqua Continuing Education program in which we made herbal teas and tinctures. The class was a great opportunity to share some botanical medicines in an area where tea and herb shops are sparse. Luckily there are many herbal supplements available to us which are formulated for very specific conditions but it’s always nice to see the herbs in their whole form to get a better sense of how helpful certain herbs can be for the treatment of different conditions.

If you have PCOS or another type of hormone imbalance, I believe it’s important to be able to see the big picture. I see so many women who do not have a clear understanding of what their hormones are doing or how their hormones are contributing to the symptoms that they are having. I believe it’s important to take a comprehensive look at hormones so that your treatment of your hormonal imbalance makes sense to you. You deserve to understand your body!