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.

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

Step 1
Do you have irregular periods? If the answer is yes, and an ultrasound finding has shown multiple ovarian cysts, you may have been diagnosed with PCOS. But! 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 eight 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.

Step 2
Do you have elevated male hormones on a blood test combined with excess body or facial hair and/or male-pattern hair loss?

If your answer is no, you do not have PCOS. You may have ‘hypothalamic amenorrhoea’, which means you’re not eating enough carbohydrate to be able to ovulate. Test your LH (luteinising hormone) levels to make sure – they will 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, preventing normal ovulation. This is common with vegan and vegetarian diets.

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

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 three pieces of fruit per day with no desserts, sugary drinks or snacks. Get good sleep, exercise, and take magnesium and myoinositol. Stick at it for 6-9 months.

If your answer is no, move onto Step 4.

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. Check your LH and prolactin levels – if your LH is high, take peony and liquorice; if your prolactin is high, take vitex agnus castus.

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

If this isn’t you, move onto Step 5.

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 thyroid 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 such as wheat, dairy and sugar. Think about stress reduction, and reduce your exposure to environmental hormone-disrupting toxins like plastics and pesticides.

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 is most commonly due to chronic stress – especially stress around the time of puberty.

Treat with stress reduction practices or a change of lifestyle, along with rhodiola, liquorice and phosphatidylserine.

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 and the appropriate lifestyle changes.

By Poppy Burr
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Poppy is a degree-qualified medical herbalist practicing from Aljezur and Praia da Luz. She offers holistic consultations and personalised treatment plans using plant-based medicine.
More info at poppytheherbalist.com, or call on 969 091 683.