PCOS is a complex condition. It can be caused by many things… which means that it can also be overcome via many different strategies. What are the best PCOS treatment options? What are the worst PCOS treatment options?
PCOS treatment options: choosing which is right for you
There are many different causes of PCOS. I describe them in great depth in my program for overcoming PCOS (you can download it here). Briefly, here is a quick list of potential causes of PCOS: diabetes, insulin resistance, being overweight, stress, birth control pill use, hypothyroidism, MTHFR, undereating, and dramatic weight loss.
The best way to decide which PCOS treatment options are right for you are to consider your goals. Ask first: do I wish to eliminate symptoms, or is it crucial for me to become pregnant right away? If fertility is a pressing concern, then you may wish to accelerate your healing protocol and even consider combining diet and exercise with fertility treatments with an OBGYN.
Ask then: do I wish to use solely diet and lifestyle changes (which are the most effective way to overcome PCOS), or am I in a special case in which I might want to also implement some pharmaceutical options such as thyroid or blood sugar medications…. and do I want to take supplements?
Finally, the most important thing that needs to be done to overcome PCOS in almost every case is to figure out what has caused your PCOS. PCOS always arises as a result of some underlying health problem. If you work with a doctor, get bloodwork done, and/or educate yourself about the causes and cures for PCOS, then you can overcome PCOS relatively quickly by going right for the heart of your underlying problem.
Here I discuss all the different PCOS treatment options, so you can learn about them and help calibrate which ones are going to be the most appropriate for you.
PCOS treatment options: Diet
Studies have shown that diet and lifestyle changes are approximately twice as effective in the long-term for PCOS treatment than drugs.
The best thing every woman with PCOS can do is eliminate processed foods from her diet. Focusing on whole foods consisting of fresh fruits and vegetables, healthy fats, and pasture-raised animal products greatly boosts nutrient status and reduces the number of toxic, problematic compounds in the body. This helps streamline metabolism, reduce inflammation, heal the gut, and balance hormones in the right way to overcome PCOS.
Overweight and/or insulin resistant PCOS patients (which I call “type 1 PCOS”), may benefit from a lower carbohydrate diet that helps manage insulin levels. I typically recommend starting at about 100 grams of carbohydrate a day. Elevated insulin levels is one of the most common causes of PCOS, because it increases testosterone levels. Fixing the insulin problems that may be the causative root of your PCOS is a bit more complicated than this, and may involve some serious gut healing, but people seem to have success with this method reducing insulin and testosterone levels.
Underweight and under-fed PCOS patients (“type 2 PCOS”) may benefit from a diet higher in carbohydrates. I recommend several servings of dense carbohydrates like fruits or starches in these case. The body needs carbohydrates in order to feel fed. The female body simply needs to feel fed in order to manufacture adequate amounts of sex hormones.
These PCOS patients also need to eat as much as possible, and be careful not to be restrictive with calories or exercise too much.
Hypothyroidism is another common cause of PCOS. There are many different ways this can be helped with diet, depending on which kind of hypothyroidism it is. Hashimoto’s Thyroiditis is an autoimmune disease that requires an autoimmune-healing diet. My favorite book for this is Sarah Ballantyne’s The Paleo Approach. Hypothyroidism without autoimmunity requires a higher carbohydrate diet, as well as being sure to eat when hungry and stop when full… and perhaps also iodine and selenium supplementation. Seaweed (a few servings a week) and Brazil nuts (2 a day) are great, natural ways to get your iodine and selenium respectively without resorting to supplements.
Sometimes PCOS patients are in hormonal deficit instead of excess. In this case, be sure to eat plenty of fat! At minimum, every woman should eat 1 tbsp of fat with each meal. Fat is crucial for the production of hormones. Good fats to focus on are the monosaturated fats–olive oil, avocado, and macadamia oil–and saturated fat in the form of coconut oil or organic, pasture-raised animal products (if possible) such as eggs and grass-fed beef.
Steer clear of Omega 6 PUFAs. Omega 6 fats are associated with increased testosterone levels in both women and men, in addition to causing excessive inflammation. This means seriously limiting soy, canola, rapeseed, vegetable, and corn oils. Nuts in their natural form are not awesome and should be treats instead of daily staples.
Eat organic meat or wild game, not factory farmed meat, as often as possible. The hormone levels are guaranteed to be natural and to disrupt your system as little as possible.
Eat foods good for the liver, which helps clear excess hormones out of the bloodstream. The best are high in choline, such as eggs and organs.
PCOS treatment options: supplementation
While supplementation can be a great way to supplement a good diet, it should by no means replace a good diet. Supplements are excellent ways to help correct nutrient deficiencies. Nevertheless they are less good at doing so than the vitamins and minerals in their natural forms present in natural foods.
For all mineral supplements, it is incredibly important to use the organic (that is, carbon-based), or chelated forms of any mineral supplements you take. Magnesium oxide, for example, is magnesium in its metal form. Taking it is basically eating crunched up metals. Instead, take a form of magnesium that is “bio-available,” or “chelated,” which means that it is a part of a molecule your body can actually use. These forms will often end in the letters “-ate.” Glyinate, carbonate, and taurate are just a few examples.
Iodine for PCOS
Iodine can be helpful for PCOS for the sake of boosting thyroid function. However – iodine should always be taken in conjunction with selenium. The thyroid gland needs both iodine and selenium to function optimally. Additionally, if you have Hashimoto’s Thyroiditis, you may wish to keep your iodine supplementation limited relative to selenium, since over-doing iodine supplementation with Hashimoto’s can actually damage the thyroid gland and cause a “thyroid storm” which is basically a brief period of extreme symptoms of hyperthyroidism.
Iodine can be taken in kelp form, though I prefer to get my own through consuming seaweed a few times a week or by regular consumption of iodized salt.
Selenium for PCOS
Selenium is crucial for thyroid functioning. Try eating one or two brazil nuts each day– they are an excellent way to meet this need. This is the supplement I recommend if you choose to go the supplement route.
Chromium for PCOS
Chromium helps to encourage the formation of glucose tolerance factor which is a substance released by the liver and which is required to make insulin more efficient. A deficiency of chromium can lead to insulin resistance. Because of this, it is the most widely researched mineral used in the treatment of insulin resistance and weight loss. This is a great supplement for women with insulin resistant PCOS.
B vitamins for PCOS
Vitamins B2, B3, B5 and B6 are particularly useful for controlling weight, and here’s why: Vitamin B2 helps to turn fat, sugar and protein into energy. B3 is a component of the glucose tolerance factor (GTF), which is released every time blood sugar rises, and vitamin B3 helps to keep the levels in balance. Vitamin B5 has been shown to help with weight loss because it helps to control fat metabolism. B6 is also important for maintaining hormone balance and, together with B2 and B3, is necessary for normal thyroid hormone production. Any deficiencies in these vitamins can affect thyroid function and consequently affect the metabolism.
The B vitamins are also essential for the liver to convert your ‘old’ hormones into harmless substances which can then be excreted from the body.
Zinc for PCOS
The world’s soil has been depleted by overfarming, so there is very little natural zinc found in fruits and vegetables. No matter how good your diet, you may not be getting anywhere near the levels of zinc that you need. There are two approaches to this: you can eat whole organic food, which has much more rigorous controls on farming methods, or you can add a good chelated zinc supplement (about 20mg a day, perhaps) to your diet. But why is it so important?
Zinc is an important mineral for appetite control and a deficiency can cause a loss of taste and smell, creating a need for stronger-tasting foods. Zinc is necessary for the correct action of many hormones, including insulin, so it is extremely important in balancing blood sugar. It also functions together with vitamins A and E in the manufacture of thyroid hormone.
Magnesium for PCOS
Magnesium levels have been found to be low in people with diabetes and there is a strong link between magnesium deficiency and insulin resistance. Magnesium is also awesome all around and can be read for reducing inflammation, enhancing sleep and promoting calm.
Here is my favorite magnesium supplement (it’s a flavored beverage powder!) – I do it almost every night before bed.
Co-Enzyme Q10 for PCOS
This is a vitamin-like substance that is contained in nearly every cell of your body. It is important for energy production and normal carbohydrate metabolism. Co-Q10 has also been proved useful in controlling blood sugar levels.
Herbs for PCOS
I’m not generally a very big fan of herbs. Their effects are not well studied – pretty much all of the recommendations people make are based off of tradition and anecdotes. You never know what effect an herb will have on you specifically, so if you choose to use herbal supplementation steps cautiously and start with low doses.
Agnus castus (Vitex/chastetree berry)
Chasteberry anecdotally helps to stimulate and normalise the function of the pituitary gland, which controls the release of LH and FSH, which signal the menstrual cycle. Here is a good brand.
Saw Palmetto (Serenoa repens)
Saw palmetto is an herb that is traditionally considered in light of its success in treating prostate problems caused by an imbalance of hormones (including excess testosterone). It is a small palm tree found in North America and the berries of the tree are used in tinctures or capsule form. Some sparse research has shown that saw palmetto works as an anti-androgen, which can be very helpful for women who have elevated testosterone. Here is a good brand.
Milk Thistle (Silybum marianum)
This is one of the key herbs for the liver. It helps to protect your liver cells against damage and to promote the healing of damaged cells, so improving the general functioning of the liver and all its detoxifying properties.
Spearmint tea also counts. The mechanism is unknown, but spearmint tea has been shown to significantly reduce circulating free testosterone levels in women with hyperandrogenism. This is my favorite spearmint tea.
Exercise for PCOS
Exercise is an excellent way to increase insulin sensitivity and promote metabolic fitness! I talk about this at great length in my book on women’s health and fitness. If you are a “type 1″ PCOS, then incorporating some more sprint and weight-bearing exercises in your life could go a long way. The kind of PCOS I describe as “type 2″ then you may wish to consider exercising less.
Sleep for PCOS
A great deal of healing and hormone production takes place during the night. This is when cortisol levels are low and the body is recharging. This enables the hypothalamus and pituitary glands to send their signals to reproductive tissues uninterrupted. I also talk about sleep at great length in the book on women’s health and fitness. Basically, I recommend a dark, cool room, waking without an alarm, and other tricks for a long, deep, restful sleep.
PCOS treatment option: Optimize thyroid function for PCOS
If you have hypothyroid, or even subclinical hypothyroid, try addressing this issue before getting on different PCOS medications. Hypo- or subclinical hypo- thyroidism os often the underlying cause of reproductive failure. To understand more about hypothyroid and PCOS, see my recent post on PCOS pathology.
PCOS treatment option: Metformin medication
Metformin is a blood sugar lowering drug that several dozen million of Americans take in order to reduce their risk of diabetes. Women with PCOS take it in order to reduce their testosterone levels. It is usually fairly effective at doing so, and at reducing the severity of PCOS symptoms such as acne and facial hair.
Nevertheless, metformin has it’s own complications and problems, which I discuss at great length in the blog post Metformin and PCOS: Everything You Need to Know.
PCOS treatment option: Birth Control Pills
Birth control is effective in “treating” PCOS by increasing either estrogen or progesterone levels, though usually both. It helps regulate hormone fluctuations throughout the month.
However, birth control doesn’t solve the underlying issue. In fact, many women experience even greater dysfunction in their cycles once they go off the pill. As one popular example, some women began taking birth control as teenagers. They continued taking it until they want to have babies, yet once they got off the pill, they found themselves breaking out for the first time in decades and unable to conceive. Birth control pills are great for mitigating PCOS symptoms, but they will never make you more fertile, and they rarely restore hormonal balance.
For more on birth control, it’s varieties and how you can manage your experience with it, see my quick e-guide to birth control, Birth Control Unlocked.
PCOS treatment options: Progestin
Women who don’t menstruate are sometimes proscribed synthetic progesterone (progestin) medications by their doctors in order to induce menstruation. How it works is that these women take progesterone pills for ten day. A week later, as the progesterone levels fall, estrogen levels rise, and the pituitary and ovaries read this as a signal to shed the corpus luteum.
Because amenorrhea (the failure to menstruate) increases the risk for endometrial cancer, amenorrheic women are advised to induce menstruation every few months. Some go years without ill effects, and this depends on each individual’s PCOS pathology and hormone levels. Progesterone also might help jumpstart your system back into more normal health, such that you can take it for a while and then afterwards have achieved enough of a cycle to continue functioning without progesterone. This is a decent option if you are trying to balance your hormones via diet, but are hoping to speed along your progress or conceive quickly.
PCOS treatment options: Anti-androgen medication
Anti-androgens act to block or inhibit testosterone activity in the body. For this reason, they are often proscribed for acne or hirsutism, helping women cope with these nasty issues while they try to sort out the rest of their endocrine health.
Spirionolactone is the most popular anti-androgen proscribed for PCOS. It is normally proscribed for high blood pressure, but it is proscribed off label to help women reduce their androgen levels. It has been shown to be quite successful with mitigating symptoms of PCOS such as acne and facial hair, and has even helped women with PCOS ovulate. In this study, 11 out of 13 women began ovulating after a few months of treatment.
Nevertheless, spironolactone has it’s own problems. In fact, I personally had to check myself into the ER because of spiro. Spiro spares potassium in the kidneys, which can upset elctrolyte balance in the bloodstream. This can cause serious cardiovascular symptoms, and even sudden death. This harmful effect on electrolytes can also cause neurotransmitter problems, insomnia, and anxiety. This is a rare side effect, so simply be on the lookout for any problems if you decide to experiment with spiro. You can read about how spironolactone almost killed me – if you’re interested! – here.
PCOS treatment options: Ovarian Drilling
This is the only surgical intervention for PCOS. Ovarian drilling is exactly what it sounds like—in this course of treatment, a woman lays on a table and a doctor inserts a microdrill through her abdomen and into the ovaries, creating tiny holes. These holes puncture the thick endometrium of amenorrheic women and reduce testosterone production. Ovarian drilling to me seems like a great option, but the complications if something goes wrong include permanent infertility. For this reason, many people leave this option as a last resort.
Ovarian Drilling also fails to address the underlying health problem, which leaves you just as ‘unhealthy’ as you were before. This makes it inferior to diet and lifestyle changes in my opinion.
PCOS is complex! There are many things that can cause PCOS, and many different PCOS treatment options. Some of these options are great for everybody – some may only work for a select few.
I describe the different kinds of PCOS and how to overcome them in even greater depth in my program for PCOS: PCOS Unlocked the Manual. If you are interested, that’s a great program that’s helped literally thousands of women figure out their PCOS and overcome it all on their own with simple dietary changes.
PCOS is complex! But it is not impossible.
What are your thoughts? What have you done for your PCOS treatment options? Which have worked best for you?
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