PCOS (Polycystic Ovary Syndrome): How to Recognize It?

Have you been diagnosed with PCOS (Polycystic Ovary Syndrome)? How was it diagnosed?
First of all, it’s important to clarify that PCOS cannot be diagnosed with just an ultrasound. The presence of ovarian cysts does not always equate to a PCOS diagnosis. According to the Rotterdam criteria, two out of these three symptoms are required:

• Irregular menstrual cycles
• Excess male hormones (androgens)
• The presence of multiple cysts in the ovaries

Since only two out of three are needed (though you might have all three), this means PCOS can have varying aspects and symptoms depending on the individual.

Signs and Symptoms to Watch Out For

• Irregular cycles or long menstrual cycles
• Difficulty getting pregnant or infertility
• Struggling to lose weight
• Acne and/or oily skin
• Hair loss
• Hirsutism (excessive growth of body or facial hair)
• Mood issues such as anxiety or irritability (or even depression)
• Insulin resistance (yes, we’re dealing with insulin again)
• Food cravings, especially for sweets

You might not experience all these symptoms, but if you check off several and haven’t been able to pinpoint the cause of your health issues, it might be worth investigating PCOS with your gynaecologist.

The Diagnostic Criteria

As mentioned earlier, to receive a PCOS diagnosis, you need two out of three criteria:

• Anovulation or irregular periods
• Elevated androgens (testosterone or DHEA)
• Polycystic ovaries visible via ultrasound

Since PCOS manifests differently in each person, understanding which criteria you meet can help identify the root cause of your PCOS.

What Type of PCOS Do You Have?

Understanding your personal history and identifying the root cause of your PCOS is the first step. This allows me to create a tailored “healing plan” (nutrition and supplementation), customized to your body.

What Drives Your Symptoms?

There are several underlying causes that might drive PCOS symptoms:

• Insulin resistance
• Inflammation
• Stress-related issues
• PCOS triggered post-pill

Other factors to consider include thyroid problems and/or nutritional deficiencies.

Types of PCOS

1. Insulin-Resistant PCOS
   One of the most common drivers of PCOS. You might have normal blood sugar levels but too much insulin, leading to chronic conditions, weight gain, and increased androgens, which impact ovulation.
2. Inflammatory PCOS
   Signs of chronic inflammation like IBS-like symptoms, fatigue, headaches, or skin issues may indicate inflammation as a key driver of PCOS.
3. Adrenal PCOS
   Often stress-induced, driven by high cortisol levels (the stress hormone). Testing cortisol and possibly androgen levels is crucial here. This case is more complex and requires support from medical specialists like a gynecologist or endocrinologist.
4. Post-Pill PCOS
   Was your cycle regular before starting hormonal contraception? The pill can exacerbate insulin resistance and suppress ovulation, leading to a surge in androgens once stopped.

A Note on Painful Periods

Painful periods are not a diagnostic criterion or symptom of PCOS.
You can have painful periods if you have PCOS, but the root cause of the pain might be different (e.g., endometriosis, inflammation, or hormonal imbalances) and requires further investigation.

The Right Path Can Help You Feel Better

With the right approach, yes, you can feel better! Identifying the root cause of your symptoms and implementing the appropriate diet therapy is key. PCOS symptoms vary greatly among individuals, so understanding your unique drivers is the starting point.

What Is the Best Nutritional Approach for PCOS?

Rather than emphasizing the “best approach,” I prefer to focus on three simple foundations, which are then personalized to each individual.

Nutritional Basics for PCOS

1. Balance blood sugar levels by pairing carbohydrates and sugars with a good source of protein and healthy fats. Extra virgin olive oil, a staple of the Mediterranean diet, is an excellent choice.
2. Incorporate anti-inflammatory foods. Fill your shopping cart with a variety of colourful fruits and vegetables. Check my monthly seasonal fruit and vegetable calendar for inspiration.
3. Vary high-quality proteins, including:
   • Lean meats
   • Fish (rich in healthy omega-3 fats)
   • Eggs from free-range, organic chickens

Don’t forget to use fresh herbs and spices! For example, cinnamon is fantastic for improving insulin sensitivity and balancing blood sugar levels.

What About Supplements?

In some cases, targeted supplements can help correct imbalances or deficiencies in the body. However, supplementation isn’t always necessary and should be tailored to your specific needs.

Here are some supplements I might recommend for PCOS (not all are required):

• Magnesium: Supports many bodily reactions and is often depleted by birth control pills.
• Cinnamon: Helps improve insulin sensitivity and blood sugar levels.
• Chromium: Enhances insulin response and blood sugar control.
• Turmeric: Its active compound, curcumin, has anti-inflammatory properties.
• Inositol: A B vitamin that boosts insulin sensitivity and reduces androgen levels.
• Omega-3: Improves cholesterol markers and insulin sensitivity and reduces inflammation when paired with vitamin D.
• Vitamin D: Regular supplementation improves inflammatory markers. Optimal levels should be between 50-80 ng/ml.

I’ll dedicate a separate article to vitamin D and its importance soon!