Unwanted hair growth, male pattern baldness, thinning hair, irregular menstrual cycles, whether non-existent, inconsistent, too long, or irregular, acne on the face, chest, and back, anger, aggression, easily irritated: ALL consistent with Polycystic Ovarian Syndrome.
And for women experiencing any or all of the above, they know all too well, how unwanted, debilitating, life-changing, and impactful it can all be. Traditionally, being overweight and having blood sugar issues (obesity and insulin resistance), which go hand in hand with Polycystic Ovarian Syndrome, has long been thought of as the ONLY causes. As a result, doctors have been limited to suggesting their generic advice of “diet, exercising and weight loss”, with very little success for the PCOS sufferer.
Worse still, being placed on synthetic hormones, with the hopes of normalizing your menstrual cycle, along with all the unwanted symptoms you’re experiencing. Failing to uncover and address the hidden, underlying causes of PCOS. Can’t tell you how many women I consult with who have been put on hormones, a long time ago mind you, and were never explained or taught the actual physiological breakdowns responsible for your hormone imbalances. Only to be left on hormone replacement without addressing true causes.
And as a result, hundreds of thousands of women continue to suffer. Sometimes for decades. Or longer. With no end in sight. However, the role that excess stress plays, on the adrenal glands, leading to adrenal fatigue, and ultimately contributing to PCOS, is seldom talked about. That is, whether, under consistent, persistent stress from deadlines, education, job demands, an unruly boss, raising a family, ailing parents, financial burdens, chronic pain, a nagging recurring injury, marital woes, the death of a loved one, the list goes on and on.
ALL can adversely lead to Polycystic Ovarian syndrome and the dreaded symptoms associated with it. On top of that, genetics, and the role of nutrigenomics (nutrition and lifestyle, aka “epigenetics”) also play a huge roll in Polycystic Ovarian Syndrome. Yet, I’d be willing to bet (if I were a betting person), that your doctor has not connected these genetic and epigenetic dots to your polycystic ovarian syndrome nightmare. Let alone the immense amount of stress you are under.
In this article, I would like to incorporate brand new information regarding hormones, a new method for testing hormones, and the role genetics, stress, and adrenal fatigue play, with the experiencing of PCOS, and its unwanted symptoms. You see, PCOS is much more than obesity and insulin resistance. And with that, most importantly, I would like to suggest treatment protocols based on all of the above information, and offer PCOS suffering women new hope. So let’s begin, shall we?
The Common Cause and Symptoms Of PCOS:
- Unwanted hair growth, facial hair, chest/nipple/back, etc,
- Thinning hairline, or male pattern baldness,
- Irregular menstrual cycles,
- Too long between monthly periods,
- Too short between monthly periods,
- No monthly cycle,
- Heavy bleeding, depression, mood swings, breast tenderness,
- Androgen excess, temper, aggression, easily irritated,
All symptoms of PCOS. And given that one of the hallmark symptoms is an irregular menstrual cycle, it stands to reason that conceiving, becoming pregnant, frequent miscarriages, are all very common as well. Notice I didn’t mention multiple cysts on the ovaries?
That’s because, with the diagnosis of PCOS, you only need to have two of the following three criteria:
1. Confirmed androgen excess on labs and androgen excess symptoms,
2. Ovulatory dysfunction (absence, too long, too short, weird cycles, etc) and,
3. Multiple cysts on ovaries (PCOM) diagnosed via imaging.
Interesting. Because the term “PCOS” stands for “Polycystic” ovarian syndrome, yet, you don’t actually have to have any ovarian cysts to technically have it. So that would be the first myth that I would say is associated with PCOS. But it is the second myth that can be more detrimental when suffering from these horrific symptoms and not being able to recover effectively. That is, being an overweight, obese, sedentary, pre-diabetic, insulin resistance suffering women, is a necessary requirement for suffering from PCOS. WRONG. Although insulin resistance, blood sugar issues, and obesity are all very common, known causes of the polycystic ovarian syndrome, the infinitely more common, unknown cause of PCOS is STRESS.
Massive, continuous, multi-dimensional, stress. Family life, job, finances, education, are probably the big three and are easily understood and identified by the sufferer. But also falling under the massive, continuous, multi-dimensional category of stress, is “environmental” stress. Things like BPA’s in the plastics that we consume, act as estrogen disruptors. Genetically modified organisms (GMO’s) in the foods you eat every day, like gluten (wheat), soy, corn, and other grains, are not only estrogen disruptors, but they are hidden sources of inflammation production, and therefore stress, in your body.
Pathogens from the environment are also sources of massive stress in your body. Parasites, mold exposures, yeast overgrowth, fungus, viruses, bacteria, mycoplasma, are all impacting your body on some level, to some degree, in some way, shape, or form. Other chemicals, pollutants, toxins, heavy metals, sprays, such as fire retardants, organophosphates, phthalates, arsenic, formaldehyde, etc, are other examples. All hidden sources of stress, very much present in your day to day activity, likely disrupting your hormones directly, and indirectly, through your bodies built in stress mechanisms. So what is one to do?
Well, as it relates to your PCOS symptoms, at least identify and recognize that they are present. That they are impacting your overall stress level. Many health providers simply to do not acknowledge this very simple premise. Next, because your stress “organs” in your body are your adrenal glands, it is an absolute necessity to scrutinize your adrenal gland function, objectively though adrenal gland testing, understand how that relates to your PCOS, and most importantly, determine what you can do naturally to optimize adrenal gland function.
Adrenal Fatigue and PCOS: The Ignored Relationship:
One of the most common questions I get from women that are suffering with the classic symptoms of androgen excess (anger, aggression, hostility, irritability, hair thinning, excess hair growth, acne in unwanted places), menstrual irregularity, is:
Can Polycystic Ovarian Syndrome Be Cured?
My response:
“Not If you aren’t focusing on identifying and correcting your adrenal stress mechanisms”
And whether your endocrinologist believes in adrenal fatigue or not, there is no denying the role the adrenals play in hormone production in the body. You see, the adrenal glands, along with producing the hormone cortisol for stabilizing blood sugar and meeting the demands of balancing stressors in your body, also make 25% of testosterone, 50% of androsterone (which can convert back into testosterone), and 80% of your DHEA. Testosterone is made manufactured from DHEA as well. All are the androgen hormones that when produced in excess, contribute to one of the three main characteristics of PCOS.
Accompanied by aggression, hostility, acne, thinning hair, excess hair in unwanted areas, male pattern baldness, and menstrual irregularities. This is how you can have an adrenally based PCOS without the multiple cystic ovaries, being overweight, or having insulin resistance. Sadly, one of the consequences of assuming this condition is only insulin resistance and obesity based, is the fact that the stress contribution is ignored.
Furthermore, because adrenal fatigue is not thought of as a legitimate diagnosis in western medicine, the consequences are analogous to flushing down the baby with the bathwater, especially as it relates to PCOS. Meaning, although your provider may not believe in adrenal fatigue per se, by ignoring the physiological role the adrenal play in hormone production, they ultimately flush away any attempt for “curing” PCOS. That’s because when you are under continuous high stress, the adrenals are constantly pumping out their hormones. Irregular periods ensues.
As the adrenals continue to be chronically recruited to meet the demands of stress, they pump out hormones that are directly or indirectly produce testosterone, leading to the aggression, hostility, irritably, abnormal hair growth, and acne. And if that wasn’t bad enough, here is where being overweight creates that double whammy. The other 50% of testosterone is made in adipose tissue via androstenedione conversion. In other words, if you happen to be overweight or obese, the excess adipose tissue converts the inactive forms of androgen hormones your adrenals are producing while under stress, into the active, testosterone hormone. Big problems.
This is the traditional mechanism long associated with insulin resistance and PCOS. According to Laura Shoenfeld, MPH, RD on PCOS:
“While insulin resistance and elevated insulin often drive the ovarian production of testosterone, it is the hypothalamus-pituitary-adrenal (HPA) axis that stimulates the production of DHEA/DHEA-S and androstenedione. These hormones can be converted to testosterone by peripheral tissues in the body. This process can occur independently from the ovaries and any involvement with insulin”
This means that a woman with PCOS symptoms could have normally functioning ovaries with no cysts and no insulin resistance, yet still, fit the symptomatic profile of the syndrome. So what can you do about it? Well, I realize that many of you that are reading this article will be going to your traditional medical provider who is in your “insurance network”. That seeing a “functional” medical provider may not be an option, so here is a list of objective tests that you can print out to ask your doctor to run to get a better idea if you are suffering from PCOS:
Objective Traditional Labs To Uncover Polycystic Ovaries (thanks to Carrie Jones ND):
- Fasting glucose/Fasting insulin (Hemoglobin A1c, 2hr glucose-insulin tolerance test)
- Thyroid panel with antibodies
- Prolactin (ideal<20ng/ml)
- FSH/LH
- Cardiac markers: lipids, homocysteine, fibrinogen, CRPhs
- 17, hydroxyprogesterone (>80 ng/dL in follicular phase or >285 ng/dL in luteal phase = suspect Congenital Adrenal Hyperplasia, cortisol will be low too)
- Anti-mullerian hormone (>4ng/ml suspect PCOS)
However, for those of you reading this that are ready, willing and able to have a more in-depth evaluation of your female hormone profile, as well as how much cortisol you are producing on a day to day basis, then the DUTCH test is a probably the best way to evaluate the physiological breakdowns, and some genetic influences, that contribute to PCOS.
Objective Non-Traditional Labs to Uncover Polycystic Ovaries (thanks to Carrie Jones ND):
What’s really great about this test is how in-depth it is. The hormone markers that are measured in the Dutch test are called hormone ‘metabolites’. It’s these metabolites that are an indication of how effectively your body is making and breaking down both sex hormones (estrogen, progesterone, testosterone), AND the adrenal hormones (total DHEA, 24-hour free cortisol, and total metabolized cortisol). Why is that so important?
Well as you can see, although progesterone is not found in the urine, it’s two metabolites (breakdown products) are. And because of that, we can extrapolate progesterone’s total production and the role that that plays with ovulation. When progesterone is low and/or faulty, ovulation will be impacted, and remember, that is one of the hallmark criteria for the diagnosis of Polycystic Ovarian Syndrome.
Next, total DHEA production is measured, which is a combination of DHEAS + Etiocholanolone + Androsterone. These androgenic hormones are mostly made in the adrenals (80%), and the overproduction is directly influenced by stress. The longer the stress is present, the more impact it will have on these metabolites, and depending on whether or not they are high or low, will demonstrate an acute or chronic process respectively. Estrogen and its 8 metabolites are measured (versus 1-3 that are measured in the blood or saliva). The estrogen breakdown into metabolites, and are great to know about because it gives the functional medicine practitioner an idea of phase 1 and phase 2 estrogen metabolism. Understanding the metabolism of estrogen during phase 1, will tell us how if you are breaking down estrogen down the preferential, protective pathway, or whether you are not your are metabolizing estrogen down the proliferative or cancerous route. Both phase 1 and phase 2 can be influenced by genetic mutations such as MTHFR, MTR, MTRR, COMT, MAO, SULT1A, CYP1B1, etc.
Next, the Dutch test measure both totals metabolized cortisol and 24hour free cortisol. When we look at total cortisol output, it really answers the question: “Can you make enough cortisol in the first place, to get you through the day” Because cortisol is driven from the brain, and all the inputs, stress, inflammation, infection, insulin, blood sugar, as mentioned earlier, will ALL cortisol production.
Bringing It All together With The Genetic Relationship:
The word MTHFR is becoming more and more popular with the patients that I consult with. That is, when these individuals consult with me, many times they will say to me: “I have MTHFR, What supplements should I take?” Being a loaded question, I’m always hesitant to make a blanket recommendation without doing an in-depth history with them to uncover their subjective complaints, symptoms, and major concerns. As well as understanding their childhood history, a timeline of health experiences, environmental exposures, review of systems, dietary history, social history, metabolic history, and family predisposition. And the reason I need all that requisite information is because we are simply not the expression of the genetics that we inherit. After the human genome project, we determined that there were approximately 23,000 genes in the human body. Furthermore, with continued research, we are starting to learn the clinical significance of 30-50 of these genes (give or take).
When these genes are functioning optimally, they are able to code for enzymes, that make and break over 250 cellular processes in the body. One of those cellular processes is making and breaking female hormones. So, if these genes necessary for making and breaking female hormones are not working effectively, female hormone production and destruction will be impacted. Here is a list of (some of) the genes (whose explanations are beyond this scope of this post):
- MTHFR
- MTR
- MTRR
- BHMT
- MAT
- PEMT
- GAMT
- COMT
- MAOA
- MAOB
- PNMT
When these genes are not working at optimal capacity, they are delayed and inefficient in doing their job. In this case, making and breaking down hormones. This is where stress comes into play. When we have chronic stress, the need to make energy in the body increases, the need to make hormones increases, the need to breakdown hormones and detoxify increases. As a result, genetic weak links will be exaggerated and exposed. Causing you to fall further and further behind. In Part 2 of PCOS: The Uncommon Relationship To Adrenal Fatigue, I will highlight suggested treatments and a trouble shooting algorithm that will help you unravel the epigenetic and genetic mystery, along with the role and impact stress has.
If you are looking for a functional medicine practitioner to troubleshoot your PCOS nightmare, and are not satisfied with your current approach, I do work with distant patients, click here for more information.