PCOS: A Lifestyle Disorder
Polycystic ovary syndrome (PCOS) is a disorder that encompasses a variety of metabolic and hormone-related symptoms. It affects anywhere from 5-20% of reproductive-age women, depending on the source and diagnostic criteria being used, and is the most common cause of female infertility in the United States. PCOS is a syndrome meaning it consists of a constellation of symptoms and patients tend to fall on a spectrum, with significant inter-individual variation in presentation.
The syndrome is characterized by excess androgens (like testosterone), ovulatory dysfunction, and polycystic ovaries, though only 2 out of 3 of these criteria need to be present for a diagnosis1. Based on these diagnostic criteria, known as the Rotterdam criteria, a woman does not actually have to have polycystic ovaries to be diagnosed with PCOS, making the name “polycystic ovary syndrome” a bit confusing.
Symptoms of PCOS include1:
- Menstrual disturbances
- Weight gain
- Hair loss
- Sleep issues
- Acanthosis nigricans
- Body image disorders
A Lifestyle Disorder
Although genetics do play a small role (less than 10%)2 in PCOS, environmental factors and lifestyle heavily influence the development of the syndrome. It’s thought that certain environmental factors influence genes in those with susceptible genomic variants resulting in the PCOS phenotype1.
Metabolic features are present in a large percentage of those with PCOS, including obesity, insulin resistance, hyperlipidemia, and hyperandrogenism. The syndrome comes with an increased risk of developing type 2 diabetes, non-alcoholic fatty liver disease (NAFLD), cardiovascular disease, pregnancy complications, and cancer. Many of these metabolic features and conditions can be reversed through lifestyle-based treatments1.
Insulin: the main culprit
Insulin, a hormone secreted by the pancreas, is important for regulating blood sugar levels in the body. When blood sugar is high, say after eating a starchy meal, insulin is released which tells cells to pull excess sugar out of the bloodstream to store inside the cell for later use. If cells stop responding to insulin, known as insulin resistance, blood sugar remains high and even more insulin is released, resulting in high insulin levels (hyperinsulinemia).
Insulin resistance (IR) is a hallmark characteristic of PCOS and is found in 50-80% of PCOS females3. High insulin in the ovaries stimulates ovarian androgen production and reduces serum sex hormone-binding globulin (SHBG) levels, resulting in high testosterone. To compound the problem, 30–70% of females with PCOS are also obese which perpetuates IR and androgen excess4. Common physical signs of IR include increased belly fat, skin tags, acanthosis nigricans, and difficulty losing weight5.
Focusing on reversing insulin resistance through nutrition and exercise can have profound results, even more than medication. There are also supplements that have insulin-sensitizing effects that have been found to be helpful in PCOS including myo-inositol, berberine, alpha lipoic acid, and cinnamon.
Chronic low-grade inflammation is a pervasive factor for those with PCOS and is linked closely to many of the other main features of the syndrome including insulin resistance, obesity, and cardiovascular disease. A study found that those with PCOS (both obese and non-obese) have higher levels of inflammatory cytokines6. C-reactive protein (CRP), a marker of inflammation that has been found to be reliable in PCOS7, can be used to determine the level of inflammation in the body. It’s imperative to address all the different causes of inflammation in PCOS including diet, food sensitivities, central adiposity, insulin resistance, and digestive health. There are also certain supplements that can help with inflammation including resveratrol, omega-3s, curcumin, and vitamin D5.
The role of endocrine disrupting chemicals (EDCs)
EDCs are chemicals that act similarly to or interfere with natural hormones in the body4 and are ubiquitous in today’s world. There are over 80,000 chemicals registered for use in the US and over 1,500 new chemicals introduced every year. Of those, almost 1,000 are known EDCs though that number may actually be much higher since most chemicals aren’t tested for adverse health effects4. Common EDCs include phthalates, parabens, bisphenol A (BPA), and pesticides and pollutants such as dioxin and polychlorinated biphenyls (PCBs)8. We are exposed to these through cosmetics, household cleaning products, food, pesticides, fabrics treated with flame retardants, and personal care products.
PCOS women have been found to have significantly higher BPA levels compared to controls9, and metabolism and excretion of BPA may be impaired in PCOS. Furthermore, many chemicals in the environment have been found to act as obesogens, causing the development and accumulation of fat cells in the body4, which exacerbates PCOS pathology.
Because of the nature of the way EDCs behave in the body, it is strongly advised to avoid or greatly limit exposure to these chemicals if you have PCOS or any other endocrine or metabolic disease. There are more and more companies today providing products that are free of many of these harmful chemicals. It is important to educate yourself on the topic and know what to look for. The Environmental Working Group provides valuable resources to help you make informed choices and live a healthy life in a healthy environment.
It’s apparent that many factors are at play in the pathogenesis of PCOS, adding to the complexity of the condition. Fortunately, addressing the foundations of health (sleep, nutrition, physical activity, stress management, community) along with a few other targeted interventions can dramatically improve or reverse PCOS symptoms. Part 2 of this blog post (coming soon!) will discuss the functional medicine approach to PCOS.
Our pharmacists at PharmToTable specialize in functional medicine using a lifestyle-based approach and we also have health coaches on our team who can help you make changes towards improving your health. We’d be honored to help you on the journey of improving PCOS or other endocrine or metabolic condition. Book an appointment or schedule a free 15-minute discovery call today!
Written by Megan Morrison, PharmD
- Parker, J. (2020). Understanding the Pathogenesis of Polycystic Ovary Syndrome: Transgenerational evolutionary adaptation to lifestyle and the environment. Journal of the Australasian College of Nutritional and Environmental Medicine, 39(4), 18–26.
- Parker J, O’Brien C, Hawrelak J, Gersh FL. Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment. Int J Environ Res Public Health. 2022;19(3):1336. Published 2022 Jan 25. doi:10.3390/ijerph19031336
- Piazza MJ, Urbanetz AA. Environmental toxins and the impact of other endocrine disrupting chemicals in women’s reproductive health. JBRA Assist Reprod. 2019;23(2):154-164. Published 2019 Apr 30. doi:10.5935/1518-0557.20190016
- Barrett ES, Sobolewski M. Polycystic ovary syndrome: do endocrine-disrupting chemicals play a role?. Semin Reprod Med. 2014;32(3):166-176. doi:10.1055/s-0034-1371088
- McCulloch F. 8 steps to reverse your PCOS. Greenleaf Book Group Press; 2016.
- Abraham Gnanadass S, Divakar Prabhu Y, Valsala Gopalakrishnan A. Association of metabolic and inflammatory markers with polycystic ovarian syndrome (PCOS): an update. Arch Gynecol Obstet. 2021;303(3):631-643. doi:10.1007/s00404-020-05951-2
- González F. Inflammation in Polycystic Ovary Syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids. 2012;77(4):300-305. doi:10.1016/j.steroids.2011.12.003
- Patel S. Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy. J Steroid Biochem Mol Biol. 2018;182:27-36. doi:10.1016/j.jsbmb.2018.04.008
- Kandaraki E, Chatzigeorgiou A, Livadas S, Palioura E, Economou F, Koutsilieris M, Palimeri S, Panidis D, Diamanti-Kandarakis E. Endocrine disruptors and polycystic ovary syndrome (PCOS): elevated serum levels of bisphenol A in women with PCOS. J Clin Endocrinol Metab. 2011 Mar;96(3):E480-4. doi: 10.1210/jc.2010-1658.