What is PCOS?

PCOS stands for Polycystic Ovary Syndrome. Some experts believe it should be re-named as the “polycystic” part implies multiple cysts on the ovaries, which now are known not to be true cysts!

PCOS is an endocrine (hormonal) disorder characterized by infrequent or absent periods, multiple follicles on the ovaries and high levels of androgens (such as testosterone and DHEA-S), which for some people leads to excess facial and body hair, hair thinning or male pattern baldness and acne. Many PCOS patients have insulin resistance, which means that your body isn’t able to properly absorb and process sugars and other carbohydrates, which leads to weight gain and can result in a diabetes diagnosis. Other complications include depression, self-esteem challenges, type 2 Diabetes, high cholesterol, heart disease and difficulty becoming pregnant.

It’s important to know that there is a wide range of severity of the condition- some patients with PCOS have only slightly irregular periods as the only obvious symptom, while others may have never before gotten a period on their own and have every other symptom such as unwanted weight gain, excess body hair and acne.

PCOS can’t be diagnosed by just one symptom or test alone, but instead doctors look for the presence of several signs and symptoms together. Not all PCOS patients have acne, excess body hair or obesity, but all will have irregular or absent periods. AMH (Anti-Mullerian Hormone) is a newly recommended blood test which can take the place of performing an ultrasound of the ovaries. Many times a woman is first diagnosed with PCOS because she is unable to become pregnant due to lack of consistent ovulation.

The usual treatment for PCOS includes hormonal birth control pills to artificially “regulate” cycles and reduce androgens, a drug called Metformin for insulin resistance and statins for high cholesterol. Many women are also given Spironolactone to reduce androgen levels. For women trying to become pregnant, treatment includes drugs to induce ovulation such as Letrozole, Clomid or injectible gonadotropins.

How Can I Manage PCOS (Aside from Medications)?

While the condition can’t be cured, there’s a lot you can do (aside from or in addition to medications) to manage and reduce symptoms of PCOS- including acupuncture, herbs and dietary adjustments.

• For PCOS patients with unwanted weight gain and higher levels of adipose (fat) tissue, a 5-10% reduction in weight can dramatically help regulate cycles. Because so many of these people have some degree of insulin resistance, one of the most important things you can do is to adopt a generally healthy diet emphasizing foods with a low glycemic index. This means foods which don’t raise your blood sugar rapidly- such as plenty of whole grains, vegetables, protein and healthy fats. We recommend working with a registered dietician on making these dietary changes.
• Not all PCOS patients should adhere to the above recommendations- for those who have a leaner body type, weight loss could make things worse. However, the recommendation to follow a generally healthy diet is still extremely important and can make a huge difference for these people. We recommend checking out this link and working with a registered dietician who can help as you’re implementing the changes.
• My patients typically receive acupuncture every other week, and most take herbal medicine as well. Each patient is given a different treatment protocol to correspond with their unique symptoms and history. In my clinical experience I have seen that for most patients in the mild to moderate range of PCOS symptoms, periods do start to happen with more regularity and we end up seeing a downstream effect with decreased acne and improvement in other symptoms.
• There are SO many supplements out there to sift through! The one supplement that has the strongest evidence for helping PCOS patients is inositol. It comes in 2 forms- D-Chiro Inositol and Myo-Inositol. The studies that show a benefit from taking this supplement had people take it in a 40:1 ratio of Myo-Inositol to D-Chiro Inositol.
• Regular exercise is helpful to all PCOS patients- there is no one “type” of exercise that has been shown to be more beneficial than others. 150-300 minutes weekly of moderate intensity exercise is recommended for everyone (which works out to about 30 minutes daily), not just PCOS patients.
• Since higher levels of anxiety and depression are more prevalent among people with PCOS, seeking out mental health care is vital. Support groups, individual therapy and prioritizing your everyday social network are key. I feel this is another area where acupuncture treatment can be very helpful- patients report treatments are deeply relaxing and they feel more connected to and at peace with their bodies.

Our Recommended Resources (as of article publication in October 2024):

Published in 2023, the Monash University International PCOS Guidelines are THE gold standard currently. These guidelines are respected and shared by multiple organizations including ESHRE, ASRM, RCOG and the NIH. This is the link for the more detailed information with some medical language included, and the above link is easier to read for the general public.

Monash University PCOS Program has also created an app called AskPCOS (click the link above and see the top section for download links).

BDA (British Dietetic Association) guide to dietary recommendations for PCOS