Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal health issues in women, affecting an estimated 1 in 10 women of reproductive age. Polycystic Ovarian Syndrome (PCOS) is a condition caused by significant imbalances to the endocrine system in women. One of the biggest concerns with PCOS is that it is widely under-diagnosed due to the wide discrepancy in diagnostic criteria. Its approximated that roughly 7 million women experience symptoms of this condition in the US alone, yet only half of these women are accurately diagnosed!

The first step to treating PCOS is understanding how it occurs. Two major hormones, estrogen and progesterone, control a women's menstrual cycles. While estrogen tends to elevate throughout the full cycle, progesterone only occurs in the second half, known as your luteal phase. It's produced from the lutein cells in the ovaries after ovulation. In women with PCOS, ovulation is often a struggle (for a number of reasons, which I'll talk about in a moment), leading to rippening of an egg (or multiple eggs) that do not release, ultimately remaining as cysts on the ovaries. As a result, progesterone production suffers, menstrual cycles become irregular, and the hormone disruption follows. 

As you can see, PCOS is a complex disorder that presents itself as a group of symptoms resulting from hormonal imbalances -- usually an excess of androgens like testosterone, low progesterone, and high levels of insulin. These symptoms include:
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  • Irregular menstrual cycles. Typically, women with PCOS will have long cycles (often longer than 35 days), missed periods, or have no period at all. Some women may have shorter cycles. 
  • Ovarian cysts.
  • Hirsutism, which is abnormal hair growth on the chin, face, and other areas usually seen on men but not on women.
  • Male-pattern hair loss on the scalp.
  • Acne on the face, chest, and upper back. It may be cystic acne.
  • Darkening of skin on neck creases, under the arms, under the breasts, and in the groin.
  • Skin tags
  • Weight gain and difficulty losing weight.

However, not all PCOS is a result of high insulin, not all PCOS presents with cysts on the ovaries, and not all cysts on the ovaries results in hormone disruption (sorry, what did she just say? Insert a naturopathic doctor's help here).

For a long time, the root cause to PCOS was believed to be a result of an overproduction of male hormones, called androgens. In more recent years, research has confirmed PCOS is correlated to a desensitization in insulin production within the body, which in turn leads to increased production of these androgenic hormones, acne formation, and difficulty managing weight. Secondly, not all PCOS stems from the ovaries. Adrenal glands, which sit above our kidney's and help us respond to stress stimuli, also make up a large portion of our steroid hormone known as DHEA. This precursor hormone directly coverts into testosterone and estrogen. That means that high stress and overproduction of DHEA can create polycystic ovarian syndrome without blaming the ovaries. Read more about adrenal function and fatigue here.

Assessment for PCOS

The most important thing to remember is that while PCOS may physically manifest with cysts on the ovaries, it is ultimately a hormonal syndrome. While symptoms are a great place to start, this syndrome can also be tested for via ultrasound and particular hormonal markers. ​
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​The following lab markers should be tested in PCOS to help understand the root of the problem, your likelihood of fertility, and your course of treatment. All these markers will be ordered by Dr. Holmberg, ND.
  • FSH (day 3 of the cycle, if cycling)
  • LH (day 3 of the cycle, if cycling) 
  • Estradiol (day 11-13 of a 28 d cycle, if cycling) 
  • Progesterone (day 21 of a 28 d cycle, or 7 days post-ovulation if cycling) 
  • Cortisol 
  • Free testosterone, total testosterone
  • Prolactin 
  • DHT – dihydrotestosterone 
  • SHBG – sex hormone binding globulin 
  • HbA1C, fasting glucose, fasting insulin
  • DHEAS
  • Ferritin
  • TSH, free T4, free T3
  • 25-hydroxy Vitamin D​​

Furthermore, more thorough testing can also show us comparisons of both estrogen and testosterone metabolites and the activity levels of their respective enzymes, which help to further understand the cause of your PCOS and narrow down treatment options. 
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Treatment of PCOS

Goals of treatment include understanding the mechanism as to why PCOS is occurring, and implementing the proper diet, lifestyle, and supplement routine to correct the hormonal imbalanced uncovered. Some patients may be anovulatory, so supporting healthy ovulation becomes the goal. Other patients may be resistant to insulin, so emphases is placed on the diet and supporting the re-sensitization of your cells to insulin and sugar so weight will be better managed, acne will resolved, and moods will balance. Inflammation support is always at the core of every treatment plan. ​
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No two people are the same. PCOS can present differently in everyone, and is therefore treated differently in everyone.
​If you think you may have PCOS, or have been diagnosed with PCOS and wish to look at other alternatives to a birth control pill, please use the link below to connect with Dr. Holmberg, ND or call the office at 647 351 7282

Hormones

Acne
Adrenal Fatigue
Anxiety/Depression
BHRT
Discontinuing Birth Control
Fibroids
Irregular Periods
​Infertility
Menopause
Premenstrual Syndrome
Polycystic Ovarian Syndrome
Thyroid Disorders
Weight Gain
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Digestion

Crohns & Colitis
Constipation
Food Sensitivities
Gas & Bloating
Heartburn
Irritable Bowel Syndrome
Leaky Gut Syndrome
SIBO

immune

Allergies
Autoimmunity
Eczema
Frequent Colds & Flu