PCOS From a Functional Medicine Lens

This past week has brought a few patients navigating PCOS as well as a few questions in my inbox. Let’s chat about what it is and ideas to help manage it that goes beyond OCP’s, metformin and spironolactone.⁣

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Polycystic ovary syndrome (PCOS) is an endocrine disorder. It is a chronic hyperandrogenic state (male hormones. It affects about one in seven women worldwide, making it one of the most common endocrine disorders in women of reproductive age.

Women may present with: obesity, amenorrhea, oligomenorrhea, infertility, or androgenic features.

PCOS has been associated with chronic inflammation, insulin resistance, and an overall increase in health risks. Common comorbidities include infertility, hypertension, type 2 diabetes, depression, anxiety, sleep apnea, and menstrual irregularities⁣.

Diagnosis of PCOS is controversial and depends on what definition is used. 

Rotterdam Criteria for PCOS diagnosis includes 2 of the 3:⁣

  • Oligo-anovulation

  • Clinical or biochemical evidence of hyperandrogegism

  • Polycystic ovaries on u/s

When diving into PCOS I love having a full hormone profile with something like the DUTCH test.⁣

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Lab Evaluation

  • Female hormone profile: LH, FSH, estradiol, progesterone, prolactin.

    • LH/FSH ratio 2:1-3:1. If having cycles checking on day 3 is recommended.

    • Consider DUTCH test.

  • Androgen profile: free & total testosterone, SHBG, DHEA-S.

  • Metabolic profile: fasting glucose, insulin, HbA1c.

  • Lipid profile: triglycerides, HDL, LDL, VLDL, total cholesterol, ApoA1, ApoB.

  • Thyroid panel: TSH, FT3, FT4, RT3, antibodies.

  • AMH

  • B12

  • Homocysteine

  • CRP

  • 4 point Cortisol⁣

Radiological studies

  • Transabdominal and transvaginal ultrasound.

Supplements ⁣

  • B complex (all B vitamins), preferably activated forms⁣

    • Thiamine⁣

      • plays a key role in the metabolism of carbohydrates and fats. oral contraceptive use puts people at risk for thiamine deficiencyRiboflavin ⁣

    • Niacinamide ⁣

    • Pantothenic acid ⁣

    • Pyridoxine⁣

    • Folate as folinic acid or L-5MTHF ⁣

    • Hydroxo- or methylcobalamin⁣

    • Biotin ⁣

  • ⁣Chromium ⁣

  • Essential fatty acids⁣

  • Magnesium ⁣

  • Alpha lipoic acid ⁣

  • Vitamin E ⁣

  • Zinc ⁣

  • Vitamin D⁣

  • Myo-inositol ⁣

    • may improve insulin resistance⁣

  • D-chiro-inositol

    • helps with hyperandrogegism⁣

  • Selenium

    •  decreases DHEA, CRP and hirsutism⁣

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Herbs

  • Black cohosh⁣

  • Cinnamon⁣

    •  improves insulin sensitivity⁣

  • Licorice⁣

    • anti-androgen⁣

  • Gymnema⁣

    • helps regulate blood sugar⁣

  • Shisandra⁣

    •  helps with phase 1 and 2 liver metabolism⁣

  • Chaste Tree Berry⁣

    • assists with progesterone⁣

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Lifestyle

  • Diet (e.g. mediteranean, adequate protein, minimize glucose spikes)⁣

    •  IF can be helpful, but it has to be done smart, meaning adequate macros/calorie intake stays intact.⁣

    • A continuous glucose monitor may be helpful

  • Exercise⁣

    • find something you love to do and don’t forget to lift those weights!

  • Stress management⁣

    • Movement, music, meditation, heart rhythm variability management, massage, sleep, fun, no news.

Not medical advice, please consult your provider.

Tara Woodland