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PCOS

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among persons born female of reproductive age with a 10% prevalence in the United States. PCOS develops as a confluence of both genetic (a gene has been identified) and environmental factors, and it's characterized by high serum androgens (male hormones such as testosterone) and insulin resistance which is present in 75-95% of cases. 

 

Immature follicles, known as “cysts”, can develop on the ovaries due to irregular ovulation impacted by out of whack hormone levels as too much testosterone or high insulin levels can decrease ovulation. This appears as the characteristic "strand of pearls" on ultrasounds. Cystic ovaries have been identified in girls prior to puberty, and some evidence suggest that even female infants can be born with cystic ovaries if there was too much testosterone in the womb. 

 

High androgens can also cause excessive hair growth on the face and body (hirsutism), hair loss from head (alopecia), acne, skin problems, and irregular or absent periods. High insulin levels, which may be a result of a genetically driven insulin receptor dysfunction, can make weight loss more difficult and cause unwanted weight gain in the abdominal area, intense cravings for carbohydrates, and hypoglycemic episodes.

 

Common Signs and Symptoms

 

If you have PCOS, you may have some or all of these concerns:

  • family history of PCOS, especially mother, sister, or grandmother

  • excessive abdominal weight > 35 inches

  • difficulties losing weight despite diet and exercise

  • heavy, irregular (> 40 days or frequent bleeding) or absent periods

  • intensive carbohydrate cravings even after eating meals

  • hypoglycemic episodes or low blood sugar

  • problems with excessive hair growth on face

  • hair loss from head

  • darkly tinted patches of skin on some parts of your body (acanthosis nigricans) 

Messages from the doctor's office

 

A PCOS diagnosis can come packaged with weight stigma at the doctor's office when patients are inaccurately told to "just lose weight" or "don't eat any carbs". These comments are not helpful and create confusion. A weight neutral approach has been found to be equally- if not more- helpful than promoting weight loss. Weight stigma can be very harmful, and eating disorders have a higher prevalence among those with PCOS vs the general population. It is important to understand that the symptoms of PCOS can improve greatly through a weight neutral lens that doesn't push or prioritize weight loss. And weight cycling that comes along with chronic dieting can increase inflammation, making the signs and symptoms of PCOS worse. 

At Bodacious Nutrition, we help you understand and identify the root causes of PCOS- inflammation, insulin resistance, thyroid issues, elevated LH, and nutrient deficiencies- and find a plan to focus on these root causes that doesn't include deprivation or restriction. 

Fertility Concerns

PCOS is often not diagnosed right away, and many women don't know much about it even after diagnosis because doctors are leaving them without enough information. Birth control is often used as the only form of treatment which can mask symptoms until women are ready to get pregnant. When women get off birth control, there can be an increase in androgens (post-pill PCOS) which can make fertility difficult. Elevated insulin can also decrease fertility, and pursuing weight loss at the doctor's recommendation also cause more of a barrier due to concurrent hypothalamic amenorrhea from undereating.  

We work persons with PCOS to manage symptoms or increase fertility through lifestyle changes and nutrition as well as improving the food relationship and body image. It's important to understand the root cause of symptoms and what might be fueling it. It is impacted by the confluence of genetics and environment. 

Bodacious Nutrition dietitian, Joanna, has PCOS. 

She was once told by a gynecologist that she'd have to get on "fertility drugs" to have babies due to the high level of LH to FSH and irregular menses. She didn't start her period until she was 16 years old, and it was never regular. Doctors didn't give her any meaningful information about PCOS or how her body worked, and it wasn't until she became a dietitian and changed her lifestyle habits to support fertility that her period normalized, and she was blessed with her 3 children without fertility support (she knows she is very lucky in this way). 

She loves helping others navigate this often frustrating or confusing diagnosis. 

Other fertility support concerns might include irregular periods or missing periods due to maternal stress, undereating, inadequate nutrient intake, over exercise, or disordered eating. She works with moms to understand what the research tells us about fertility nutrition, reconnect with their bodies, and set up a plan to find a sustainable way of eating during this very special and transformational time. 

The post-partum time is also a crucial point where mom needs more support and may experience body image disturbances or a resurgence of disordered eating. We are here to help. 

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