In this article we will cover the main ways your FUTURE WOMAN practitioner will approach your PCOS treatment.
Traditionally, PCOS treatment in the UK (via a GP) centres around using the oral contraceptive pill and following some generalised advice around weight loss. More targeted treatment such as Metformin is usually available if you are experiencing infertility as a result of your PCOS and you’re looking to get pregnant.
At FUTURE WOMAN we opt for a more personalised approach to your PCOS treatment, which includes testing, identifying your PCOS type and tailoring your PCOS plan to your test results, PCOS type and unique symptoms.
Step 1: Testing your hormones
The most important part of determining the best PCOS treatment for you, is to test your hormones. This is always where we begin at FUTURE WOMAN. Testing helps to determine the root cause of your hormone imbalance and will reveal your individual hormone picture.
Testing can reveal:
- If there are high androgens levels. Most women with PCOS have an elevation of one or all types of androgens – testosterone from the ovaries, androstenedione from the ovaries and adrenal glands and DHEA-S from the adrenal glands. Androgen metabolites are also important to assess in PCOS.
- If your estrogen is low, normal or high and how well you are metabolising your estrogen down the Phase 1 and Phase 2 pathways.
- If you are ovulating and therefore producing enough progesterone.
This is all crucial information as it can help to dictate which treatment options are then right for you.
Our Advanced Hormone Test and Advanced with Cycle Mapping Hormone Test also look at your adrenal and stress hormones, antioxidant profile, markers of gut and brain inflammation and important nutrient levels such as B6 and B12 to understand if these are a contributing factor to your PCOS symptoms.
Step 2: Determining your PCOS type
Testing can help us determine which type of PCOS you have. There are four different types of PCOS – insulin resistance PCOS, post-pill PCOS, inflammatory PCOS and adrenal PCOS. By determining which type of PCOS you have, we can tailor our supplement, dietary and lifestyle recommendations to you.
Here are some guidelines to the FUTURE WOMAN approach to each PCOS type:
This is the most common type of PCOS, affecting around 70% of PCOS sufferers. Too much insulin speeds up luteinising hormone pulsatility from the pituitary gland (in the brain), which leads to the ovaries producing more androgens. Too much insulin also lowers sex hormone binding globulin (SHBG), which binds to testosterone and other androgens, which results in too much free or unbound testosterone. This results in symptoms such as irregular periods, lack of ovulation, acne, weight gain and more.
If you’re overweight and especially if you have weight gain around the waist or apple-shaped obesity, you likely have the insulin-resistant type of PCOS.
Some key ways we address insulin resistance:
- Reduce processed sugar. Sugar is the main cause of insulin resistance. Glucose leads to imbalanced blood sugar, this in turn then leads to insulin resistance. To add to this, too much fructose can lead to intestinal permeability, oxidative stress, inflammation, and fatty liver and therefore causes damage that leads to insulin resistance. Therefore if you have the insulin-resistant type of PCOS, your first thing to do is give up sugar.
- Avoid too many carbohydrates/starch. Carbohydrates can also lead to blood sugar imbalance (the amount someone can tolerate can vary hugely from person to person depending on factors such as age and genetics). Therefore we recommend a low carbohydrate, high protein breakfast in order to begin to balance your blood sugar and reverse insulin resistance.
Other ways that we address insulin resistance at FUTURE WOMAN include addressing:
- Inflammation, which can impair insulin sensitivity (too much fructose can lead to inflammation).
- Poor sleep/disrupted circadian rhythm.
- Stress/HPA axis dysfunction.
- Environmental toxins can block insulin receptors.
- Medication use – the oral contraceptive pill (which is one of the reasons why the pill often isn’t the best option for PCOS).
- Inactivity and exercise.
Post Pill PCOS
Some women can qualify for a PCOS diagnosis after they come off the pill if their ovulation does not return and they have high androgens (which can be caused after coming off a pill with a low ‘androgen index’). This type of PCOS is usually temporary.
Some key ways we may support post-pill PCOS:
- Supporting the connection between the brain and the ovaries. This is called the hypothalamic-pituitary-ovarian axis (HPO axis). This becomes disconnected and disrupted while on the oral contraceptive pill, therefore supporting this through lifestyle, diet and supplementation is vital. This ensures healthy, balanced hormone levels and the reduction of PCOS symptoms.
- Supporting healthy and regular ovulation. Ovulation is the MAIN event in your menstrual cycle. It is suppressed on the oral contraceptive pill, therefore we work to re-establish regular and healthy ovulation in order to support the production of LH and FSH, which in turn helps to balance estrogen, progesterone and androgen levels. This can be achieved through specific dietary, lifestyle and supplementation.
Although inflammation will play a role in all types of PCOS, with inflammatory PCOS it’s the primary driver. How does inflammation lead to PCOS? Inflammatory cytokines can disrupt hormone receptors and suppress ovulation. It also leads to increased androgens.
At FUTURE WOMAN we look at the root cause of the inflammation and address that – whether it’s a food sensitivity, digestive issues or other cause.
The final type of PCOS is characterised by elevated adrenal androgens (DHEA-S) rather than ovarian androgens. Adrenal PCOS is driven by a dysfunctional HPA axis, which can be the result of stress around the time of puberty.
If adrenal PCOS is picked up in testing (either via our Advanced or Advanced with Cycle Mapping Hormone tests), we would look to address this by:
- Supporting healthy cortisol levels.
- Implementing lifestyle changes to support the adrenal glands.
- Implementing specific nutritional and supplement recommendations to support the nervous system and adrenal glands.
It is important to remember that these are general guidelines, but your health plan is based on your test results or consultation in order to ensure it is individualised and right for you and your body.
SUPPLEMENTATION AND HORMONE THERAPY AS A PCOS TREATMENT
Our personalized protocols for PCOS at FUTURE WOMAN typically include evidence-based supplements. Here are three examples of supplements your practitioner may recommend for your PCOS treatment:
Please note it is incredibly important not to place yourself on any of the supplements mentioned below without talking to your doctor or a FUTURE WOMAN practitioner first to ensure they are safe for you.
Magnesium can help to support all types of PCOS. It supports adrenal gland function, increases insulin sensitivity, and the nervous system, supports hormone detoxification and balance, supports mood, sleep, and more.
The type, quality, and dose of magnesium are important for efficacy and your FUTURE WOMAN practitioner will ensure you have the right type for you.
Myo-inositol has been shown to be beneficial for insulin resistant PCOS. Research has shown that 2-6 grams daily can help to improve FSH signaling and promote regular ovulation, both of which are extremely important in PCOS. It can also help reduce cravings, support healthy egg quality and reduce inflammation.
Zinc supports many of our hormones and hormonal pathways. It can help specifically with PCOS as it helps to support blood sugar balance, helps reduce acne and supports skin health, supports healthy ovarian follicles, supports mood, and importantly it also inhibits the 5 alpha reductase pathway which in turn reduces DHT (a potent androgen). Therefore zinc lowers androgens and can reduce symptoms of PCOS.
PROGESTERONE HORMONE THERAPY
Progesterone is typically low in those with PCOS. This is due to the lack of regular ovulation – without ovulation, there is no progesterone. Many symptoms connected to PCOS can be attributed to low progesterone including anxiety, poor sleep, mood changes, irregular periods, missed periods, and more.
So how could taking progesterone be beneficial for PCOS?
The latest research shows that taking progesterone cyclically can help to address the root cause of PCOS. This is because progesterone can help to slow down the pulsatility of gonadotropin-releasing hormone. This essentially means that it then slows down the release of luteinising hormone and in turn helps to regulate ovulation and cycles. A reminder that in PCOS there is increased gonadotropin-releasing hormone pulsatility and increased LH secretion which causes irregular periods and lack of ovulation. Therefore progesterone can target the root cause of PCOS at the level of the brain.
Progesterone therapy can also be beneficial in helping to stabilise mood, weight, increase insulin sensitivity and reduce androgen levels.
It is important to ensure that this is the correct option for you and your body, so talk to your doctor or health care provider first. Please also note progestins found in hormonal contraception and some hormone therapy are NOT the same as progesterone and will not have the same therapeutic effect.
Key Takeaways for OUR APPROACH to pcos treatment:
- Your PCOS treatment should be personalised to you and your unique hormonal picture.
- Testing your hormones is the best place to start.
- Determining your PCOS type through testing helps to determine the best approach to take for your diet, lifestyle and supplementation plan.
- Research has shown that certain supplements like magnesium, inositol, zinc and/or hormone therapy like body identical progesterone can be helpful in PCOS.
If you are struggling with PCOS or suspect you are struggling with PCOS you can book a FREE 15-minute call with one of our women’s health experts to chat about your symptoms and determine what test may be right for you. .