Syndromes are collections of symptoms that frequently co-occur and typically do not have a clear known cause. Without a clear cause, getting treatment can be as difficult as getting a proper diagnosis. Also, treatment for syndromes often include lifestyle changes, which can be overwhelming to tackle alone. Fortunately, holistic health coaches can be helpful allies in the path to recovery for one such syndrome: Polycystic Ovarian Syndrome (PCOS).
PCOS is a complex and widespread hormonal, metabolic and reproductive disorder that causes a long list of health and well-being impairments. It is the leading cause of female infertility and it can lead to other serious conditions including severe anxiety and depression, obesity and endometrial cancer, type two diabetes, liver disease, and cardiovascular disease.
Simply put, PCOS happens when a female body produces too many male hormones, called androgens, and not enough female hormones, called estrogens. The excess androgens cause a female’s ovaries to prevent eggs from maturing. Instead, the eggs form into hardened, cyst-like structures. Typically, the ovaries of a woman with PCOS are also enlarged. The hormonal imbalance from the syndrome causes all kinds of symptoms because of how influential our hormones and their balance is to our mental, physical, and emotional health.
The good news in all of this is that research is increasing, doctors are working towards a more unified diagnosis, and the first recommended treatment is lifestyle change, which means that working with a holistic health coach is a natural fit for someone recently diagnosed with PCOS.
How is PCOS Diagnosed?
Without a known direct cause, PCOS is difficult to diagnose. Doctors often disagree about what symptoms need to be observed, which is partly why so many women go undiagnosed and mistreated; an estimated 50% to 70% of women living with it, don’t know they have it.
Eventually, a simple urine test might be all that is needed to make a diagnosis and take the first step towards treatment. Until then, doctors will first rule out other possible conditions. Then they will perform the following recommended protocol for doctors diagnosing PCOS:
- Take a full family history. Because PCOS has a genetic component, knowing your menstrual cycle within the context of other women in your family and their PCOS symptoms helps your doctor diagnose PCOS.
- Conduct a complete physical exam. Perhaps even less appealing than your routine gynecological wellness exam, your doctor will perform a more comprehensive exam to look for symptoms like extra hair growth, acne, and other signs of high androgens. Your doctor will also capture baseline biometrics, like your blood pressure, waist circumference, and your body mass index (BMI).
- Take blood samples. Your doctor will want to know your blood levels of androgens, cholesterol, and sugar because PCOS impacts each of these levels in different ways.
- Complete a pelvic exam or ultrasound to examine your ovaries. During your pelvic exam, your doctor will insert two fingers into your vagina and press on your belly to feel for cysts on your ovaries. To better visualize the cysts, your doctor might recommend an ultrasound, which can also show how thick the lining of your uterus is.
Doctors look for women to exhibit the following three features:
- menstrual irregularities, like light or skipped periods that result from long-term lack of ovulation,
- high levels of androgens, which often present as excess facial hair and acne, and
- multiple cysts of a specific size on one or both of the ovaries.
Not all women present with all three features. Additionally, some women with PCOS also have insulin resistance. As a result, PCOS can be divided into five different types:
- Type 1: all three features are present (irregular or no menstruation, high androgens, and polycystic ovaries)
- Type 2: high androgens and absent or irregular ovulation, but no polycystic ovaries
- Type 3: high androgens and polycystic ovaries, but still ovulate or have regular menstruation
- Type 4: polycystic ovaries and irregular or no ovulation, but normal range levels of androgens
- Type 5: insulin-resistance in addition to one or more of the three features
Possible PCOS Treatments
Because the cause of PCOS is unknown, there is no boilerplate treatment. Instead, treatment tends to focus on a women’s goals and needs: does she want to get pregnant? Does she want to have regular menstruation cycles? Does she want to stop excess hair growth?
Typical drugs to treat PCOS symptoms include: Clomiphene, Letrozole, Metformin, and Gonadotropins to cause ovulation, birth control pills or IUDs, spironolactone, or eflornithine to address excessive hair growth, and either combination birth control pills or progestin-only pills to help regulate menstrual cycles.
No matter what a woman seeks from her PCOS treatment, the number one consistently recommended first step is lifestyle change. From the Mayo Clinic to WebMD to the PCOS Awareness Association, and even the National Health Institute in the United Kingdom, doctors will first recommend lifestyle change, and then discuss possible pharmacological treatments for specific needs.
Specifically, doctors recommend diet and exercise for weight loss, which research shows makes a positive impact in the management of PCOS symptoms and lowers the risk of diabetes and heart disease. If you or your clients have been diagnosed with PCOS, controlling symptoms through diet and exercise is possible, and can be a safe and adequate alternative to pharmacological solutions.
PCOS Treatment Myths
You are stuck with it because we don’t understand the cause. False. You can treat the symptoms, and doing so is a must because PCOS has such a profound impact on your health and well being. PCOS puts you at greater risk for many other diseases and conditions, and it causes depression and anxiety. You don’t have to just live with it.
PCOS can be fixed easily with birth control. False. Women with PCOS experience irregular periods because they are not ovulating. Without regularly shedding the lining of your uterus (which is what happens when an egg is released and doesn’t get fertilized), it can thicken and put you at risk for other diseases like endometrial cancer. While some birth control methods can help thin the lining of your uterus, they will not help correct ovulation, and some women experience an increase in symptoms because of using birth control.
You don’t have to treat PCOS unless you want to get pregnant. False. Although some women are told not to treat PCOS until they want to get pregnant, your female reproductive health is not limited to the ability to reproduce. You don’t have to be at a greater risk for cancer and diabetes, have excess male-patterned hair, acne, or endure any of the emotional struggles that come with these symptoms just because you are not interested in reproducing.
Lifestyle changes don’t make a real impact. False. Lifestyle change is the number one recommended course of action for treating PCOS. Sure, making these changes are good for anyone and also decrease your risk of other things like heart disease and diabetes, but these changes are an effective way to treat PCOS.
You have to take drugs. False. Not only is the pharmacology of currently recommended prescriptions being called into question and some medications are refuted with research, but again: lifestyle change is the number one preferred treatment. The key to diminishing symptoms is to feed your body what it needs, from the right amounts of rest and exercise to foods that nourish it adequately.
PCOS Treatment with the Help of a Holistic Health Coach
A combination of diet and exercise effectively treats PCOS symptoms, though diet alone can help improve the hormonal symptoms. Targeting weight loss as a goal is still a better approach because decreasing body fat by as little as 5% can drastically improve PCOS symptoms. With so many diet options available, choosing the right one can be daunting. Working with a certified holistic health coach can help take out some of the guesswork and get you closer to fine-tuning your PCOS-friendly lifestyle faster.
Holistic health coaches are perfectly suited to assist with the lifestyle changes used to treat PCOS. Whether helping themselves or clients diagnosed with PCOS, holistic health coaches will consider emotional, mental, and physical health needs to provide the support that makes maintaining a new lifestyle possible. Effective holistic health coaches consider individual personalities, lifestyles, and existing habits. Not everyone can clear their schedules easily for workouts or quickly adapt to new diets. A good coach knows how to work with you to achieve your goals while holding you comfortably accountable.
Different diet trends, like keto, paleo, plant-based, low-FODMAPS, etc. each have aspects that could fit for PCOS treatment. For example, keto will avoid carbs, paleo will cut out milk, plant-based usually also means more whole foods, and low-FODMAPS will aid digestion and cut inflammation. But these diets can all feel like diets, which means they are high stressors at the start, and are not actually what’s required to treat PCOS effectively. Women can eat the foods high in FODMAPS, like avocado, brussels sprouts, bell peppers, and melons, and having a low, steady supply of carbs is preferable to avoiding them all together, even for a short period of time, which means keto could be highly restrictive without high benefit. A better approach is to use experimentation, like elimination diets, to remove and add in foods and determine your individual dietary needs.
Because women with PCOS do not all experience the same symptoms, and their bodies each behave differently, holistic health coaches can provide a general set of recommendations based on PCOS type, and then work with their clients to test out and fine-tune their lifestyle behaviors. For example, a woman with insulin-resistant type 5 will need to address glucose levels and sugar intake immediately, but that might not be as pressing of a concern for types 1-4 without insulin resistance. She might want to focus on other needs first, and then cut down on sugar intake.
Recent research supports a eucaloric diet low in carbohydrates because it effectively reduces adipose deposits. Furthermore, not reducing carbohydrates will promote the repartitioning of lean mass to fat mass. Other research provides additional support for the efficacy of lowering carbohydrates, but more specifically calls for lowering starches in addition to eliminating dairy, which can be a hidden sugar contribution to a diet and cause inflammatory responses.
Eating for overall endocrine health, as if you were diabetic or as if you were hypoglycemic, seems to be an effective approach for women with PCOS. So too does eating an anti-inflammatory diet. These approaches work because high androgens are a key causal factor for PCOS, and their levels are tied to insulin levels, which are influenced by our glucose levels. Eating and exercising to maintain healthy insulin and steady glucose in addition to reducing the inflammation that promotes enlarged ovaries and poor digestion, all contribute to a diet that combats PCOS symptoms. Not coincidentally, these habits also help limit weight gain and induce weight loss. They are also not fad or short-term diets, but whole lifestyle changes that can be maintained for a lifetime of health.
Depending on a woman’s individual needs, her diet can be altered to include more or less of certain foods, like lean meats, healthy fats, or carbohydrates. Think low glycemic index foods and limiting fruits to low-fructose, whole fruits in small quantities. Fewer apples, bananas, and boxed cereals, and more berries, currants, melons, lentils and beans.
Lean or plant based proteins are a welcome component of a PCOS diet, and should not be avoided. They provide bioavailable micronutrients and a complete amino acid profile. Aim to eat a healthy amount of proteins in every meal, as opposed to eating one meal that maxes out on them and leaving all the carbs in another meal. Think of a typical oatmeal for breakfast and a chicken breast for dinner routine. Instead, add almonds or chia seeds to your oatmeal and eat a smaller portion of your choice of lean, organic protein with a side of low-starchy vegetable like broccoli.
Excluding sugar is likely the number one best dietary restriction for a woman with PCOS (and probably for all of us, right?), but too much restriction or calorie counting can add to the stress of the syndrome. That’s why the fad diets and ultra-restricted diets don’t usually fit well for women with PCOS. If the stress of eliminating a food is greater than having it in your diet, work with your health coach to gradually reduce your intake. Go from three cups of coffee a day to two, then to one, rather than three a day to none.
A diet that focuses on balancing macros by including a little bit of carbs, lean protein, and healthy fats at every meal works well to help stave off cravings, promote slow and steady digestion, and curb appetite. Sounds like traditional diet wisdom, but perhaps the most effective trend is to buck the trends. Overall, a key element of treating PCOS naturally is to recognize that how and when you eat is just as important as what you eat. Listen to your body and with the guidance of your holistic health coach, eat a balanced diet of small meals throughout the day.
Balanced exercise is just as important. Stress is a serious factor in PCOS treatment, and overly fatiguing your body causes more stress than benefit. Incorporating strength training and bodyweight resistance training can help increase muscle mass without causing debilitating fatigue.
With the right amount of it, exercise can help combat the depression that PCOS causes for some women. It can also help you sleep better, which is a significant contribution to stress management. Stress is killer, literally. And with PCOS, its effects can be amplified. Working with your health coach to reduce stress and change habits without adding to your stress is key to successfully showing your PCOS symptoms the door.
PCOS impacts your whole self: your mind, your body, and your wellbeing. Working with a holistic health coach to combat PCOS symptoms will address all your needs. You don’t have to want to get pregnant, but if you do, your holistic health coach can help with that too. You can work to create customized eating and exercise habits that are easy for you to maintain and help you achieve optimal health throughout your life.
The true value of a holistic health coach’s skills and knowledge in treating PCOS effectively is his or her ability to fine tune an adapt the plan to meet each woman’s individual needs while providing the guidance and support to create change without adding stress to your life.