The PCOS Solution, Your guide to clear skin, regular periods and fertility
By Josephine Cabrall
Edited by Jessica Lloyd
Illustrations by Jessica Thomas
Chapter 1 – PCOS Explained
Something’s not right
Being diagnosed with polycystic ovarian syndrome (PCOS) can be confusing – you may have been told it’s about cysts, excess male hormones or a lack of ovulation. All you really know is that something’s not right.
It might be showing up as acne that persists well beyond your teenage years, facial hair growth, irregular periods, weight gain, or maybe you’ve decided it’s time to have a baby and the pregnancy test is negative month after month.
In the medical world, there is no cure for PCOS. The solutions presented are drugs that control the symptoms (until you stop taking them) or drugs that help you to conceive, while the underlying problem remains.
But there is another choice – treat the underlying cause. You can change the hormonal imbalance that underlies PCOS. You can have clear skin, regular periods and be fertile, without drugs. This book is your guide to doing just that.
What is PCOS? Fundamentally, PCOS is a hormonal imbalance that leads to the overproduction of male hormones – androgens. Androgens are called ‘male’ hormones because they are a group of hormones responsible for the stimulation of male characteristics such as beards and baldness.
Women normally produce androgens from the ovaries and adrenal glands in small amounts, which is healthy and necessary for libido, motivation and prevention of bone loss. In PCOS, androgen production is increased.
If there are too many androgens in a woman, they find their way to her pores, stimulating oil production, acne, dandruff, hair loss and coarse hair growth on the face, belly, chest or back.
Androgens can also interfere with ovulation (the release of an egg from your ovaries), make your period irregular, and because of those things, make it difficult to fall pregnant.
But I thought PCOS was caused by cysts?
With PCOS, your ovaries will often have a bumpy, cystic appearance when you have a scan. This is how PCOS originally got its name:
poly (many) cystic (cysts) ovarian (ovaries) syndrome
But guess what? The ‘cysts’ are actually immature follicles – little blister-like structures on your ovaries containing eggs. Women normally have a number of developing follicles on their ovaries at any one time, but when there are more than 12 immature follicles per ovary, they are termed ‘polycystic ovaries’.
Polycystic ovaries are one of the hallmarks of PCOS and are what often shows up during a scan, but confusingly, you needn’t have polycystic ovaries on your scan to be diagnosed with the syndrome.
So really the name ‘polycystic ovarian syndrome’ is a little misleading and the syndrome should probably be called something else.
Two of the three criteria below are enough for a diagnosis of PCOS:
- Infrequent or absent menstrual periods
- Signs and symptoms of excess androgens (male-pattern hair growth, acne, hair loss, high androgens on a blood test)
- The appearance of more than 12 cysts on both ovaries under ultrasound
Signs and symptoms of PCOS
PCOS is not a disease. It’s a syndrome, which means a set of signs and symptoms that are related to each other. This is why the experience of having PCOS is different for everyone.
A ‘sign’ is something we can see, and a ‘symptom’ is something you can feel. Below is a full list of signs and symptoms related to PCOS. Remember, you don’t have to have all the symptoms to be diagnosed with the syndrome.
- Infrequent periods – periods are 35 days or more apart
- Absent periods – no period for three months or longer
- Irregular cycle length – the length between periods varies by eight days or more each cycle
- Hirsutism (male-pattern hair growth) – on the chest, back, chin, upper lip, abdomen, upper arms, inner thighs and pubic region
- Hair loss – thinning hair or male-pattern hair loss
- Dandruff
- Acne and oily skin
- Anxiety, stress, depression
- Sugar cravings
- Difficulty losing weight
- Acanthosis nigricans (skin pigmentation) – areas of thicker, darker skin with a velvety texture that tend to occur in body folds such as the neck, underarm and groin
- Infertility caused by infrequent ovulation
- Severe premenstrual syndrome (PMS)
- Ovaries that have a cystic appearance when viewed via ultrasound (12 or more immature follicles on each ovary)
Long-term risks of PCOS
PCOS can lead to other, more serious conditions if left untreated, such as diabetes, obesity, heart disease and certain cancers. You may have already experienced some of these.What has gone wrong with my body?To understand what has gone wrong with our hormones in PCOS we first need to understand how a menstrual cycle normally occurs and what hormones govern this.
A normal menstrual cycle
The menstrual cycle is the series of events between each period. It has four phases:
- Menstruation – your period
- Follicular phase – the pre-ovulation phase
- Ovulation – egg release
- The luteal phase – the post-ovulatory phase
During your period the lining of your uterus is shed and menstrual blood flows out through your vagina. The menstrual cycle starts with your period. The first day of bleeding is known as day 1 of your cycle.
During this phase, follicles (those little blisters containing eggs that we talked about earlier) begin growing and developing in your ovaries. There are usually between six and eight, and they are competing for ovulation.
Each follicle wants to be the one that pops out the egg at ovulation time – they are in a race. The growth of the follicles is stimulated by a hormone called follicle-stimulating hormone (FSH), which comes from a small gland in your brain – the pituitary gland.
As the follicles race for ovulation, they produce a hormone called oestrogen. As they grow, oestrogen and FSH levels increase. Eventually one follicle starts winning the race and becomes bigger than all the rest. It is called the dominant follicle. It gets really big while the other competing follicles shrink away and are absorbed by the ovary.
When the dominant follicle is nearly ready to pop out the egg, oestrogen levels get so high that they trigger the pituitary gland to send out a different hormone – luteinising hormone (LH). The egg pops out from the dominant follicle in response to a surge of LH from your pituitary gland. In a normal 24–35 day cycle, ovulation can occur anywhere from day 7 to day 24 (7–24 days after the first day of your period).
Ovulation can only happen once in a cycle. Something starts to happen at the site where the egg popped out. As it heals over, a tiny little gland begins to rapidly form. This gland is called the corpus luteum. The job of the corpus luteum is to produce the hormone progesterone.
Progesterone has many beneficial effects. It promotes scalp hair growth, boosts metabolism, prepares the lining of your uterus for a potential pregnancy, and protects against premenstrual symptoms such as breast tenderness, fluid retention, anxiety and stress.
You notice life without progesterone – it’s not as good. The post-ovulatory (luteal) phase lasts 11–17 days (unless you are pregnant). If you aren’t pregnant, the corpus luteum shrinks away at the end of the luteal phase.
Without the corpus luteum, progesterone levels fall and you get another period. The cycle is complete and a new one begins. With normal menstrual cycles, we ovulate and bleed at regular intervals, completing a cycle every 24–35 days.
Your hormones work in concert over the menstrual cycle with each having its time to shine, but if the timing of the hormones is out, the cycle is interrupted and things don’t unfold in the same way. This is what happens in PCOS.
The PCOS cycle
With PCOS, you don’t ovulate regularly, which means you don’t get periods at regular intervals. The normal course of events is interrupted by androgens. During the pre-ovulation phase (follicular phase) many follicles start developing (12 or more on each ovary) and essentially get ‘stuck’ at an immature stage of development. This may cause the pre-ovulation phase to go on for a long time.
During this time we can get episodes of bleeding that are not true periods, but simply the shedding of the uterine lining when it becomes too thick. This can be confusing – it may feel like your period is really unpredictable, but really these bursts of bleeding are like overflow.
Aside from wreaking havoc with your skin and hair, some of the excess androgens are converted to oestrogen, causing oestrogen levels to rise. All this oestrogen causes the pituitary gland in our brain to decrease its production of FSH.
Remember that the job of FSH is to stimulate follicle development. When there isn’t enough FSH, follicle development stops and you get many small follicles on the ovaries, but none of them are big enough to be popped for the release of an egg. All these small follicles give your ovaries a cystic appearance. This means it might take months before you ovulate. All this time, you remain stuck in the pre-ovulatory phase.
Remember LH, the hormone responsible for triggering the egg to pop out? With PCOS, LH keeps trying to get an egg to pop out but with all these small follicles and no dominant follicle, it can’t happen.
Without ovulation, there is no corpus luteum gland and we do not produce enough progesterone. Normally, after ovulation occurs, the rise in progesterone causes LH to drop but with no ovulation, LH persists. This is where the plot thickens. LH stimulates androgen production from the ovaries. So the constant, moderate-high levels of LH stimulate the ovaries to produce androgens, continuing the cycle.
Does having PCOS mean I can’t have children?
No. Just because you don’t ovulate frequently doesn’t mean you don’t ovulate at all. The frequency of ovulation is different for every woman with PCOS, but it does occur, which means you do have some chance of conceiving.
The treatment section of this book aims to improve those chances by regulating your hormones so that you ovulate more frequently. Where do all these androgens come from? To understand how to fix PCOS we first need to understand how things got out of balance.
It’s all about insulin
We don’t know exactly what causes hormones to get out of balance and cause PCOS symptoms, but it is known that insulin – your blood-sugar regulating hormone – is the major driver. This may be surprising. To understand how this works, we first need to look at what insulin normally does.
What insulin does
Insulin is the hormone produced by the pancreas, responsible for regulating the amount of glucose (sugar) in our blood.
When we eat that burger, piece of fruit or chocolate bar, the carbohydrates they contain are converted into glucose in the small intestine or the liver and enter the blood. This triggers insulin to be released from the pancreas. Insulin lets glucose into our cells. Insulin is like a key that fits into a lock, opening the door for glucose to enter our cells and be used for energy.
Insulin in PCOS
In PCOS, the insulin keys have trouble unlocking doors. It’s like the villagers board up their doors and jam up their locks so the glucose army can’t open them with their insulin key. This is known as insulin resistance.
To combat this, the army general (your pancreas) sends out more keys (insulin) to in an attempt to get those cell doors unlocked and get the glucose inside. This is how insulin resistance causes moderate-high levels of insulin to be constantly present in the bloodstream.
Here is where the androgen problems start. Insulin can also unlock doors on our ovaries and trigger the release of more androgens than is normal (particularly if you are genetically susceptible to this). So a lot of insulin in the blood also means a lot of androgens in the blood.
The result is hirsutism, acne, erratic ovulation and irregular periods: the symptoms of PCOS. As explained earlier, once excess androgen production begins, it continues due to constant moderate-high levels of LH and constant moderate-high levels of insulin, perpetuating the cycle.
Chapter 2 – Why me?
Why do I have PCOS?
You may be wondering what caused PCOS to happen in the first place. We don’t really know the answer to why women get PCOS but it is thought that PCOS and insulin resistance are genetic, since there is a strong familial link associated with the syndrome.
There appears to be multiple genes at play in PCOS. These genes affect things like the synthesis and secretion of hormones, and the sensitivity of our body to these hormones. So you might think it is out of your hands but it’s how we handle these genetic tendencies that really matters.
There are factors that exacerbate them and factors that ameliorate them. It is possible to live a normal, healthy life even if you have genetic tendencies toward PCOS.
While we don’t know the answer to why women get PCOS, we do know a lot about what makes it worse. By controlling the exacerbating factors, you can greatly limit your tendency towards PCOS and alleviate or even eradicate the symptoms.
Diet
The type of food we eat affects the amount of insulin we release. Some foods are digested and absorbed quickly, causing a great rush of glucose into the bloodstream. These are known as high glycaemic index (GI) foods.
Other foods are absorbed more gradually, causing a slow and steady release of glucose into the blood. These are known as low-GI foods. Accordingly, high-GI foods cause a big insulin response and low-GI foods cause a small one.
Glycaemic load (GL) refers to the load of glucose dumped into your bloodstream by a certain food. The GI of a food combined with the amount of carbohydrate the food contains determines its GL. Basically, GL is a number that guides us as to how quickly a food will spike our blood sugar.
Low-GL foods (foods that contain a low amount of carbohydrate and release glucose into the blood more slowly) cause the least insulin response and are the best for PCOS (because less insulin keys are needed to open the cell locks when we have less glucose released at once). This means food is one of the best tools we can utilise to start solving PCOS, since less glucose means less insulin.
Refined grains and sugar tend to have the highest GL. Refined grains are those that have had the germ and bran removed (e.g. white rice, white flour, cornmeal), but even grinding a whole grain into flour is a form of refining and may lower its GL. Sugar refers to any syrup or granulated sugar that has been extracted from its plant origin, including honey.
This GL foods list will give you an idea of the GL of commonly eaten foods. Under 10 is considered low GL, 11-19 moderate GL and over 20 is considered high GL. The treatment section of this book offers further guidance.
It’s not just glycaemic load that matters
You might notice that dairy has a rather low GL and think that it is good for insulin levels, but that is not the case. Dairy contains casein: a protein that stimulates insulin secretion.
Low-fat or full-fat dairy?
Research shows that consuming full-fat dairy is likely to be less harmful to ovulation and fertility than low-fat dairy. It is not known why but it may be because high-fat dairy contains less casein. It could also be the way the fat extraction process affects the milk.
Dairy also contains insulin-like growth factor 1 (IGF-1). IGF-1 boosts insulin activity in the ovaries, which unlocks more doors in the ovaries, leading to increased androgen release. IGF-1 is particularly high in cows injected with recombinant bovine growth hormone: a common practice in conventional dairy farming globally, though it is not allowed in every country.
Vitamins, minerals and antioxidants are also important for reducing insulin resistance. These nutrients help keep the locks oiled and functioning so that the insulin key can easily fit the lock, and smoothly open the door for glucose.
Including a variety of unprocessed foods is the key to getting the complete range of vitamins, minerals and antioxidants needed for optimal control of insulin. This is why having a healthy diet really does matter.
Weight
Being overweight, especially around the waist, causes insulin resistance (even if you don’t have PCOS) because fat cells release molecules that mess with insulin sensitivity. This means that being overweight increases insulin levels even more, worsening PCOS signs and symptoms.
In short, being overweight is bad news for PCOS. Furthermore, insulin promotes fat storage, resulting in weight gain. So the higher levels of insulin in PCOS mean it’s harder to lose weight, perpetuating the cycle.
Do I need to lose weight?
Body mass index (BMI) and body fat percentage are good measures to guide you on how much fat loss to aim for. You can calculate your BMI below and your body-fat percentage using certain digital bathroom scales (make sure the scales have this feature when you buy them).
For best results with PCOS, aim for a BMI between 18.5 and 25 and a body fat percentage of 22–35 per cent. Don’t go lower than this, since losing too much fat can make your period stop – nature’s way of saying we don’t have the energy stores to carry a baby.
Those of you outside the normal BMI range may not be able to reach a BMI below 25 or a body-fat percentage below 35 per cent, but losing even 5–10 per cent of your current weight will have a positive impact on your PCOS symptoms.
Losing weight isn’t easy, and more so in women with PCOS, so the treatment section of this book will help you reach your goal as painlessly as possible.
Exercise
Exercising is an important part of weight loss, but even if you don’t need to lose weight, exercise is great for PCOS. Exercise decreases insulin resistance – reduces the villagers boarding up their doors – by increasing the energy (glucose) requirement of your muscles and reducing the amount of fat you have.
Active muscle cells are hungry for glucose and they welcome it in. They don’t resist insulin and have plenty of locks ready for the insulin keys. In a nutshell, working your muscles means less insulin resistance, and therefore less insulin. Less insulin means less androgens and less PCOS. The optimal amount of exercise is discussed later.
Vitamin-D deficiency
Vitamin-D deficiency has been linked with insulin resistance. Research shows that correcting vitamin-D levels reduces insulin and blood glucose, and furthermore, there is a growing body of scientific evidence linking vitamin-D deficiency to PCOS.
Research indicates that optimal levels of vitamin D in women with PCOS reduces hirsutism, regulates periods, reduces inflammation, and improves follicle development. See your doctor to get your vitamin-D levels tested and work out whether you need supplementation for deficiency.
Getting adequate sunshine exposure on your skin is crucial for supporting vitamin D levels and avoiding deficiency. To work out how much sun exposure you need, see the support section.
Smoking and vaping
Nicotine causes an adrenaline rush that makes your heart beat faster, your blood pressure rise and your breathing accelerate, as imperceptible as that may be to you at the time. This all requires energy, so stored glucose is released from the liver and muscle cells, triggering an insulin release.
At the same time, those insulin-sensitive muscle cells we talked about earlier start boarding up their doors and resisting insulin. The repeated use of nicotine contributes to insulin resistance and results in more insulin in the blood, thus smoking causes the production of more androgens and exacerbates PCOS symptoms.
Smoking also increases production of the stress hormone, cortisol. Cortisol impairs insulin sensitivity, as we will learn next.
Stress
Stress is bad news for PCOS. Stress triggers our adrenal glands to release cortisol. Cortisol enables our body to deal with stressful situations, but it also causes insulin resistance.
Similar to cigarettes, cortisol increases glucose release from liver and muscle cells to give us a burst of energy to run away from trouble, face a perceived threat or stay awake during dangerous times. At the same time, insulin resistance in these tissues is increased.
This is all well and good if we only get stressed occasionally, but when we are stressed every day, it can quickly get out of hand.
If you tend to deal with stress by eating carbs or sweet things, you’re in for a double whammy of androgen stimulation. If you are chronically stressed, you are more likely to have chronic insulin resistance, more androgens and worse PCOS symptoms. See the support section for tips on how to actively manage your stress response.
Inflammation
Research shows that women with PCOS show signs of increased inflammation in the body. It’s not the kind of inflammation you can see or feel though, like a sprained ankle or infected cut. Researchers only know it’s there because of certain markers they can find in the blood, which are signposts that inflammation is occurring.
Inflammatory markers clog up our locks and impair the ability of insulin to open cell doors, thus more glucose is left in the blood, triggering more insulin production.
In this way, inflammatory markers contribute to androgen production and PCOS. Seeing a familiar theme? Inflammatory markers are released by the immune system in response to substances perceived as a threat to our health.
It is not known exactly what triggers the immune system to have an increased inflammatory response in women with PCOS, but generally it is thought that inflammation may be related to gut health, sugary foods and genetic susceptibility.
Chapter 3 – The PCOS Solution
As explained earlier, insulin is the major driver of PCOS. Now that you know how much insulin contributes to androgen production and PCOS, it should make sense that keeping insulin in check is the key to breaking the cycle behind PCOS.
Insulin can be kept in check in two ways:
Decreasing the amount of glucose dumped into your bloodstream every time you eat Decreasing insulin resistance. This is kind of like un-boarding the doors, and unclogging and oiling the locks.The next three parts are your guide to doing both of these things.
PART 1: Eat yourself well
Changing what you eat is the most powerful way to manage insulin. There is no magic bullet. No easy fix. You will need to change your diet as a whole and keep to your new way of eating, but to what extent is going to be different for each of you.
Changing your eating habits over the long term can be really challenging since life often gets in the way. For most, it is a work in progress. Don’t feel bad about this – accept that you may be stuck with PCOS, but that you get to choose what it looks like. Initially, the closer you can follow the guidelines, the better the results.
You will know when your blood-sugar is right – no more highs and lows, no more shakiness and anxiety between meals. You will know when you are happy with your skin, and the return of a regular period will confirm that you are ovulating regularly.
Over time, you will start to know where you can bend the rules and what causes your symptoms return. Remember – each of you has your own version of PCOS, so what level of treatment will work is unique to you.
How to keep insulin in check with food
The most effective way to reduce your insulin response is to eat foods that result in the slow and steady release of glucose into your bloodstream. This means following these rules:
- Eat mostly low-GL foods
Glycaemic load (GL) is the amount of carbohydrate in a food, multiplied by its glycaemic index (how fast the food releases sugar into your blood stream).
Eating a low-GL diet means eating mostly foods with a GL of 10 or lower, eating moderately of foods with a GL of 11-19 and very little of foods with a GL over 20. If you like to delve right into things, see the list of the GL of common foods1, however, to simplify things you can just refer to diagram 4 (coming up) for the best and worst foods for PCOS and don’t worry about all the numbers at all – it’s been done for you.
Tip
When you do eat moderate- and high-GL foods, keep them in smaller amounts and mix them with low-GL foods.
For example, if you were to eat some potato chips, it is far better to have a small amount and combine them with a plate full of veggies than to have them alone.
- Completely cut out sugar and refined carbohydrates (all white carbs)
- Limit inflammatory foods
This fits in with your low-GL eating because sugar and white carbohydrates tend to have the highest GL. You will get the best results if you stay well away from these foods. You can have the occasional treat once you have achieved the results you are after, but it will be much harder getting these results if you eat sugar and white carbohydrates along the way.
The most inflammatory types of dairy are those containing the A1 variant of the protein casein (which means most conventional dairy products). A1 casein leads to the production of casomorphin, an inflammatory, opiate-like substance that makes dairy addictive.
Dairy products containing the A2 variant of casein do not have this effect and include buffalo, sheep, goat and Jersey-cow milk products. Omega-3 fats (from fish, walnuts, chia seeds and flaxseeds) are anti-inflammatory so we should aim to eat more of these to balance out our omega-6 fats (vegetable oils) and saturated fats (meat and dairy fats), which are inflammatory.
Steer clear of trans fats (from margarine, food fried at high temperatures, most packaged cakes/cookies, many processed foods and fast foods) as these are highly inflammatory. Refined sugars and carbohydrates are also inflammatory.
When they spike your blood sugar and insulin rises, your body reacts with an inflammatory response. So there is even more reason to avoid them.
Inflammatory
- Too much meat, dairy and vegetable oils
- Margarine
- Food fried at high temperatures
- Deep fried food and fast food
- Processed foods, packaged cakes and cookies
- Sugar and refined carbohydrates
Anti-inflammatory
- Fish
- Flaxseed
- Walnuts
- Chia seeds
- Vegetables
- Fruit – in moderation
- Culinary herbs and spices – e.g. turmeric, cinnamon, parsley, basil
- Eat ‘good’ fats, protein and plant fibre with every meal
Sources of good fats include avocado, raw nuts and seeds (unsalted, not roasted), coconut milk, coconut yoghurt, coconut oil, olive oil, fatty fish (e.g. salmon, sardines, tuna, anchovies), eggs, organic butter (in moderation) and ghee.
Although butter is technically a dairy product, it is mostly fat, so it does not contain much insulin-like growth factor or casein, thus it is not inflammatory, especially in small amounts.
Eat organic butter where possible to avoid recombinant growth hormone. Sources of protein include fish, seafood, chicken, lean beef and lamb, raw nuts (Brazil, almond, walnut, cashew, hazelnut, coconut), raw seeds (pumpkin, sunflower, sesame, flaxseed, chia seed), eggs, small amounts of dairy from sheep, buffalo, Jersey cow and goat milk.
Vegetarians and vegans can get their protein from legumes (beans, peas, chickpeas and lentils), whole grains (brown rice, oats, farro, barley, spelt, freekeh, millet, quinoa, buckwheat and amaranth). Eat quinoa frequently because it has a higher protein content than most other whole grains.
Is quinoa a grain?
Technically, quinoa, buckwheat and amaranth are not grains but seeds. They are often referred to as grains or ‘pseudo-grains’ because they are used in a similar way to a grain and have a similar nutritional profile.
You will note that some foods appear on both the protein and the fat lists. These foods are giving you good fats and protein in one hit, which makes them great for snacks.
Sources of plant fibre – get this mainly in the form of veggies, with some fruit (2 pieces per day). There are plenty of interesting ways to cook veggies and make them taste great.
Get a good cookbook or take advantage of the many free recipes online. You can even include veggies with breakfast. Adding an egg to leftover dinners is a great way to do this.
Your secret weapon
Planning ahead is going to be the key to changing your diet and keeping PCOS under control. Having a food plan is your secret weapon for success, because it stops you reaching for sugary treats or getting caught with nothing to eat.
Planning ahead also means you can select recipes and meals that appeal to you, yet fit within the guidelines. This ensures you look forward to meals and enjoy what you eat – delicious food is something none of us should have to give up.
Support
If you are not sure how to go about getting started then you might want to try the two-week detox in the support section designed to get you seeing results fast. The support section also has plenty of ideas about how to plan ahead and eat well when you don’t have much time, including recipes.
PART 2: Get moving
What sort of exercise to do
A combination of aerobic exercise and resistance training gets the best results for reducing insulin resistance and maintaining a healthy weight.
Resistance training
Resistance training includes anything that involves moving your limbs against a form of resistance. The resistance can be your own body weight (e.g. push-ups, yoga) or equipment such as bands, weights and exercise balls.
Doing it yourself at home is the most cost-effective way, but at first it can pay to attend classes or get professional help and programs at a gym. Getting started is often the hardest part. For at-home assistance try free training or yoga videos online.
Resistance training is designed to build muscle mass. Increasing muscle mass not only has a positive effect on insulin resistance, it also boosts metabolism, meaning your resting metabolic rate is faster – you burn energy while at rest, promoting fat loss.
Aerobic exercise
Aerobic exercise (or cardio) improves insulin resistance by increasing oxygen supply to muscles, decreasing the fat content of muscle tissue and decreasing overall body-fat content. Don’t go too hard on aerobic exercise if you don’t need to lose weight.
Aerobic exercise refers to any exercise that gets your heart and lungs working. You breathe harder, your heart pumps faster and you work up a sweat. There are many ways to do this and lots of them are actually fun – dancing, walking, hiking, jogging, swimming, sex, aqua aerobics, team sports and cycling. Try things out to find activities you enjoy, or just mix it up.
How much exercise?
Do whatever you can. Start small, make it a habit and keep building on it until you get the results you want. Aim to get your BMI between 18.5 and 25 and your body fat percentage around 20–25 per cent.
For maximum results
If you are ready for a challenge, do one hour of resistance training three times weekly, and on alternate days do 30 minutes of aerobic exercise.
Have one day off per week to give your body a rest. If this is nowhere near your normal amount of exercise, start slowly and work your way up. Not all of us can reach and maintain this level of exercise, so remember that anything is better than nothing – just find a way to move your body as often as you can.
More is not always better
If you push yourself beyond these guidelines, you run the risk of pushing your stress hormones too high, which actually interferes with weight loss and increases insulin, as already discussed.
PART 3: Supplements
Diet is the mainstay of controlling insulin – it is non-negotiable. Supplements won’t work as well without changing your eating habits – it’s like trying to plug up a leak with chewing gum.
Supplements can, however, help you change your diet by reducing sugar cravings and they will help to reduce your symptoms quicker than diet alone. Most people will find these supplements at their local health-food store, chemist or online.
Not all supplements are alike
Be aware that the quality of supplements varies from brand to brand. Generally, you get what you pay for – a cheap price usually means that cheap, poor-quality ingredients have been used.
Do your research, and when buying online only buy from reputable sources. If in doubt, contact the company to obtain information on the quality of their product.
Inositol
What it does
Inositol reduces acne and hirsutism, regulates the menstrual cycle and improves ovulation rates.
How it works
Inositol increases your sensitivity to insulin so you don’t need to make as much. It’s a way to oil the locks, making them function better so that cell doors swing wide open and let glucose in.
Cautions
It is thought that caffeine may block the absorption of inositol, so it’s best to separate doses by two hours.
What form to take
There are two forms of inositol available as a supplement: myo-inositol and D-chiro-inositol. Both have shown great results in reducing symptoms of PCOS in clinical trials.
How much to take
Dosage is important. Myo-inositol is effective at a dosage of 2–4g per day and D-chiro-inositol at 1–1.5g per day. Some supplements you will find have both forms in them. This is okay – just follow the dose instructions on the bottle.
How long to take it
6–12 months.
Magnesium
What it does
Magnesium reduces the symptoms of PCOS by reducing insulin-stimulated androgen production.
How it works
Magnesium increases your sensitivity to insulin so you don’t need to make as much. It is a way to oil the locks and make them function better.
Cautions Some forms of magnesium (e.g. magnesium oxide, magnesium citrate), while not harmful, may give you loose or watery bowel movements because your body can’t fully absorb them. This can, however, be useful as a short-term treatment for constipation.
What form to take
Magnesium bisglycinate, magnesium amino acid chelate or magnesium diglycinate are best absorbed and will help you get the dose you need without watery bowel movements.
How much to take
Take 300mg of magnesium twice daily (reduce to once if your bowel is sensitive). Take it well after a meal, as it may cause indigestion when taken straight before or with a meal. Magnesium is relaxing and aids sleep, so it’s helpful to take it mid-afternoon and before bed
How long to take it
6–12 months.
Cinnamon
What it does do?
Cinnamon reduces the symptoms of PCOS by helping to reduce insulin-stimulated androgens.
How it works
Cinnamon works in a similar way to the previous two supplements – it increases your sensitivity to insulin by making the locks function better.
Cautions
Some people are allergic to cinnamon. If you experience an allergy to cinnamon seek medical advice immediately.
What form to take
Cinnamon can be taken in capsule or tablet form or used in cooking. Cassia cinnamon has the most research, but Ceylon cinnamon (also known as Cinnamomum zeylanicum or Cinnamomum verum) also works well and tastes the best in cooking.
How much to take
In food – two teaspoons per day. This can be hard to achieve, so just to throw cinnamon into cooking wherever possible, like chia pudding, porridge, muesli, herbal tea or chai tea, and savoury cooking.
In tablet or capsule form take 1–2g three times daily. You can take this in addition to cinnamon in food if you like, but go for the lower dose if you are eating two teaspoons per day already.
How long to take it Use it in your cooking forever if you like. Take the capsules or tablets for 6–12 months.
Licorice and peony
What it does
This herbal combination regulates the menstrual cycle, improves fertility and reduces the symptoms of PCOS.
How it works There is evidence that licorice and peony block enzymes that are involved in the production of testosterone (an androgen), thus reducing its synthesis. Peony is also thought to boost progesterone post-ovulation. This is great for reducing PMS, which is often worse in women with PCOS.
Cautions Whilst this herbal medicine is generally safe definitely do not take it if you have high blood pressure, are on fertility drugs, digoxin, corticosteroid drugs or blood pressure medication, or if you are pregnant
What form to take Make sure you get white peony (Latin name Paeonia lactiflora). There are two forms of licorice that work: Glycyrrhiza glabra and Glycyrrhiza uralensis.
How much to take
The ideal dose is about 1g of licorice and 2.5g of peony, twice daily. You may have trouble finding a formula that gives this exact dose or that has only licorice and peony in it, without other herbs. In these cases just follow the directions on the label.
How long to take it
Licorice is not for long-term use because over a long period of time it might start to slightly raise your blood pressure. Take it for up to eight consecutive months and get your blood pressure checked monthly along the way.
Tribulus
What it does
Tribulus can be used to kick-start your period when you haven’t had one for three months or more.
How it works
Tribulus increases FSH, which helps a single follicle to win the race and grow big, in preparation to pop out an egg. It is also thought that tribulus may have an LH-like effect, able to trigger the egg to pop out. Menstruation always follows ovulation, so this is how it brings your period back.
Cautions
Tribulus is not to be taken in pregnancy or long-term. Tribulus may also increase libido (probably considered a bonus for most of us!).
What form to take
Look for preparations containing the fruit or leaf, not the root. The Latin name for tribulus is Tribulus terrestris so make sure this is what is in your supplement.
How much to take
Take tribulus intermittently: 2–5g daily on waking for two weeks on and two weeks off.
How long to take it Take it for a maximum of three rounds, two weeks on, two weeks off being one round.
THE RESULTS
How long will this take to work?
This varies from person to person and is not a quick fix, though this treatment strategy can work very quickly in some women. Diet and exercise makes the difference in the long term; the supplements just speed things up.
We are all individuals with a different set of circumstances affecting our health and this will impact the results, but nonetheless, here is what you could expect.
In as little as two weeks you will start to notice weight loss and more stable energy levels throughout the day – no more low blood-sugar. You’ll also feel less anxious.
Generally, most people will notice a big difference in PCOS symptoms within three months – your skin will be clearer, your periods will be falling into a more regular pattern, and you will be ovulating more frequently, which means more chances to get pregnant if that is your goal.
Conversely, if you have been slack about birth control, now is the time to be more diligent. After 6–8 months most will have a regular 24–35-day cycle and see significant improvements in acne. Some will notice a reduction in male-pattern hair growth, but this doesn’t always happen.
The support section has ideas to help you keep unwanted hair under control in other ways. After one year, you will begin to find your sweet spot – what works for you to keep your symptoms in check.
The maintenance level of diet and exercise will vary from person to person, and you will start to see where bending the rules causes your symptoms to return.
How long to wait before seeking further help
Some of us will need further help from a professional. If you are not seeing results there may be other things going on for you that are beyond the scope of this book.
To continue natural treatment, consult a naturopath for further guidance if:
- you haven’t had a period for six months or more
- you don’t have regular periods after 12 months
- you haven’t seen a significant improvement in acne after four months
- you just can’t stay away from sugary foods no matter how hard you try
- you’d just like some extra support and guidance
Wait, why don’t I just take the pill or other drugs to fix my hormones?
The combined oral contraceptive pill (COCP), also known as ‘the pill’, is often touted as the answer to ‘fixing’ the hormonal imbalances of PCOS because it lowers androgens and forces your body to have a monthly bleed. This is actually a pill-withdrawal bleed, not a true period caused by ovulation.
The pill doesn’t ‘fix’ your natural hormones, it turns them off and replaces them with synthetic ones. This doesn’t solve the underlying cause of your PCOS woes and when you come off it your symptoms will return.
The work will have to be done at some point if you want to truly be free of PCOS. For more information on the contraceptive pill side effects and alternative contraceptive methods, see the support section.
If you are trying to get pregnant, clomiphene or other ovulation-inducing drugs may be prescribed. This might be a good solution to conceiving for many of us, but it doesn’t always work, and again, it doesn’t treat the underlying cause of your PCOS – you still have to change your diet to do that.
If your insulin resistance is severe, you may be prescribed the diabetic drug metformin to increase your insulin sensitivity and control PCOS symptoms. The downside is many people get digestive problems on this drug such as gas, nausea, diarrhoea and loss of appetite. It is also pretty hard on your liver and kidneys, which is why you are instructed not to drink much alcohol while on this drug.
Each of us has a unique life and there are some circumstances where drugs are necessary. The key here is being fully informed of your options so that later, if things aren’t working out, you know why, but more importantly, you know what to do about it.
Get as much information as you can before deciding what the best course of action for you is, whether it is drugs, natural treatments, or a combination of the two.
Chapter 4 – Fertility and PCOS
Even while following the treatment plan in this book, your periods may take a while to become regular. In the meantime, if conception is your goal, you can make the most of each chance you have to become pregnant by learning how to tell exactly when you are ovulating.
It is a common misconception that we ovulate on ‘day 14’ of our cycle. The truth is, this may vary from woman to woman and cycle to cycle, especially if your cycle isn’t the classic 28 days long or is irregular, as in the case of many women with PCOS. As explained earlier, a true period (menstrual bleed) occurs 11–17 days after ovulation.
If we don’t ovulate for long periods of time, the lining of our uterus may grow so much it can no longer sustain itself, causing it to shed due to sheer mass. This is known as ‘oestrogen breakthrough bleeding’, because it is oestrogen that causes the lining of the uterus to grow.
This bleeding is not caused by ovulation and is not a true menstrual bleed. So how do we tell the difference? The best way is to learn how to identify ovulation.
How to identify ovulation
Fertility awareness
Research shows that the most accurate way to identify ovulation is by recording your cycle using the Fertility Awareness Method (FAM). You may have heard about FAM (sometimes called cycle charting or tracking) or even tried it before.
There are many smartphone apps and online resources available that make it seem complicated and difficult.
The truth is, it’s very simple. You don’t have to worry about cervical positions, temperatures or ovulation microscopes or strips. Scientific studies show that the most accurate sign of ovulation is cervical fluid.
What is cervical fluid?
Cervical fluid is the mucous (you know, the stuff you see on your underwear) produced by the cervix. The cervix is the opening to the uterus, governing what gets in and out, and thus it is the gateway to our fertility.
The cervix is composed of different types of cells that each secrete different types of fluids in response to hormones throughout our cycle. The most accurate way to observe cervical fluid is actually by sensation, not sight.
Our vulva (the outside parts of your genitals) is extremely sensitive and can detect the tiniest drop of moisture, therefore the sensations at the vulva can tell us what the cervix is doing.
The stages of the cycle with relation to the FAM
- Menstruation
- Pre-ovulatory infertile phase
- Fertile phase and ovulation
- Post-ovulatory non-fertile phase
During this stage, the cervix is open and menstrual blood flows freely out. During this time you would feel wetness at the vulva if using pads and dryness if using tampons or a menstrual cup. Next, cervical cells produce a thick, sticky fluid that plugs up the cervix. No sperm can enter the uterus.
During this time you feel dry or slightly moist at the vulva. Several days prior to ovulation, the sticky mucous plug dissolves and the cervix opens, so that sperm can swim up through the uterus to find the egg and fertilise it.
During this time fertile cervical fluid is produced: a watery, wet, slippery or stretchy mucous that assists sperm to travel toward the egg. It’s like a sperm superhighway. At the vulva, you feel moist, then wet, then slippery as ovulation approaches. You may even see a stretchy clear mucous that looks like egg white on your underwear or when you wipe after using the bathroom.
Any day you feel or see these types of mucous is a great day to try to conceive. The cervix is once again plugged with thick, sticky fluid that sperm cannot penetrate and you feel dry or slightly moist at the vulva. This continues until your period arrives.
Sometimes, a few days before menstruation, you will sense a bit more moisture and see an increase in mucous as the plug dissolves in preparation for your period. This mucous is thick, sticky and crumbly, unlike fertile cervical mucous.
With PCOS, you don’t always experience a clear cycle as outlined above. Especially if there is a long time between periods. Recording your daily observations is a great way to get around this problem and see clearly when you are fertile.
See the support section for a detailed guide of how to observe cervical mucous, record your cycle and pinpoint ovulation for the best chance of conceiving.
Chapter 5 – Conclusion
Hello new life!
By now you should have a thorough understanding of what was once an ovarian mystery, and be armed with all the tools you need to keep PCOS out of your life. You no longer have to feel that you have a life sentence of acne, chin hairs and trouble falling pregnant.
Insulin resistance can be stopped so that regular ovulation and clear skin return to your life. You now have the knowledge you need to find a way to eat, exercise and supplement that works, to alleviate your symptoms. This isn’t always easy to keep up. It’s likely to be more of a lifelong journey, but you may find you discover lots of wonderful things along the way.
For example, the treatments outlined her will not only help your PCOS, they will help you to have more energy and feel well. Getting real results does take commitment, but you don’t have to go it alone.
If you have any specific questions or difficulties, book in with an experienced practitioner for guidance. – we are here to help.
References
- 1.Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values: 2002,. The American Journal of Clinical Nutrition. Published online July 2002:5-56. doi:10.1093/ajcn/76.1.5
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