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PCOS: A Step-by-Step Guide


PCOS, or polycystic ovarian syndrome, can be a confusing diagnosis.


It is a common condition that is often misunderstood by mainstream medicine, and the wrong treatment leads to further problems down the line. However, with some simple detective work, you can start making sense of your situation.


Here is a basic, step-by-step guide to PCOS and the questions you need to ask to get your periods back once and for all.


Beautiful Peony - Paeonia lactiflora


Step 1: Do you have irregular periods? They may have stopped altogether or even come more frequently with no clear pattern.


If the answer is yes, and an ultrasound finding has shown multiple cysts on your ovaries, you may have been diagnosed with PCOS. But - newsflash - you may not have PCOS.


Young women and teenagers often have a higher number of developing ovarian follicles, and this can normalise before the age of 30. Ultrasound is now not recommended for the diagnosis of PCOS within 8 years of the start of periods.


Equally, a clear ultrasound doesn’t mean that you don’t have PCOS. Basically, forget about the ultrasound. A real PCOS diagnosis depends on a few other important things.



Vitex agnus castus or Chasteberry

Step 2: Do you have elevated male hormones on a blood test or symptoms of androgen excess like excess body/facial hair or male-pattern hair loss?


Male hormones include testosterone, DHEA, DHEA-S and androstenedione. It is also important to test prolactin as high prolactin levels inhibit ovulation.


If your answer is no, you do not have PCOS. You may have a condition called hypothalamic amenorrhoea, which means you’re not eating enough carbohydrate to be able to ovulate. Test your LH (luteinising hormone) levels on the 2nd or 3rd day of your cycle to make sure - they should be low in relation to your FSH (follicle-stimulating hormone).


Alternatively, your diet may be too low in zinc or iodine, or too high in soy, and this is preventing you from ovulating normally. This is common with vegan and vegetarian diets - the answer is to supplement or modify your diet accordingly.


If your answer is yes to the above question, you need to identify the type of PCOS you have. There are 4 main types - let’s start with the most common.


If you do not have elevated male hormones on a blood test or any symptoms of androgen excess, you do not have PCOS

Step 3: Do you have insulin resistance? This is measured by either a fasting insulin blood test or a glucose tolerance test with insulin.


You don’t need to be overweight to be insulin resistant, but it helps. It means that constant high blood sugar levels have caused your body to become less sensitive to the hormone insulin, leading to inflammation and hormone imbalance.


If your answer is yes, you have insulin resistant PCOS, and you need to give up sugar and fructose. Eat a maximum of 3 pieces of fruit per day with no desserts, sugary drinks or snacks. Get some good sleep, exercise, and take magnesium. Stick at it for 6-9 months.


If your answer is no, move onto Step 4.


Barberry or Berberis vulgaris

Step 4: Have you recently stopped taking hormonal contraception - the Pill or implant? If so, you may be experiencing post-pill PCOS - a temporary state of ovarian dysfunction which does normalise with time.


Your system can take 12 months or longer to rebalance, so you may want to help your hormones along naturally. You’ll need to check your LH, FSH and prolactin levels.

If your LH is high in relation to your FSH, take Peony & Liquorice. By acting on the aromatase enzyme, these herbs support healthy ovulation, improve progesterone levels and increase the conversion of androgens to oestrogen.


If your prolactin is high, take Vitex agnus-castus under the supervision of a herbalist. At the right dose, Vitex promotes ovulation by encouraging the secretion of dopamine from your pituitary gland (in the brain), which in turn reduces prolactin.


Don’t take these herbs too soon or for too long - wait at least 3 months before stopping the Pill, then take for at least 3 months and stop after 6-9 months.


If this isn’t you, move onto Step 5.


Your system can take 12 months or more to rebalance after stopping the oral contraceptive pill

Step 5: Do you have symptoms of immune dysfunction, like recurrent infections, headaches, joint pain or skin conditions? Are you tired all the time? You could have elevated thyroid antibodies or coeliac disease, vitamin D deficiency or leaky gut syndrome.


If so, you may have inflammatory PCOS. You’ll need to get help with some blood, urine or stool tests, and eliminate key inflammatory foods from your diet such as wheat, dairy and sugar.


Eat fermented foods, take turmeric and barberry, make bone broth. Think about stress reduction, and reduce your exposure to environmental hormone-disrupting toxins like plastics and pesticides.


Rhodiola rosea - one of my favourite adrenal adaptogens

Step 6: If your blood work shows high adrenal androgens (DHEA-S) but normal ovarian androgens (testosterone and androstenedione) then you have Adrenal PCOS.


This happens in about 20% of women with PCOS, and I’ve seen it in my practice. Your adrenal glands make up to 50% of your total male hormones, and the hormone DHEA-S is a measure of these androgens - if it’s high, it means your adrenals are overworking.


This can be due to the genetic condition congenital adrenal hyperplasia, high prolactin levels, or chronic stress - especially stress around the time of puberty.


Treat this with stress reduction practices or a change of lifestyle, take Rhodiola, Liquorice and phosphatidylserine, and reduce your exposure to environmental toxins.


All this can be difficult to do on your own so do seek help from a good practitioner. PCOS is not a lifetime diagnosis - it can be overcome with time, the right herbs and the appropriate lifestyle changes.



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