Cracking The PCOS Code: Understanding, Managing, & Thriving Naturally
Polycystic Ovarian Syndrome (PCOS) affects an estimated 5–15% of women, but here’s the wild part—up to 70% of those with it don’t even know they have it. Crazy, right? In the U.S. alone, around 5–6 million women are navigating life with PCOS, yet it remains one of the most under-diagnosed conditions. Why? Because diagnosing PCOS is tricky—there’s no single test for it. Instead, it’s identified based on a collection of symptoms that can look completely different from one woman to the next.
What’s less commonly known is that there are four distinct types of PCOS—a revelation I discovered while reading The Period Repair Manual by Dr. Lara Briden. This book was a total game-changer for me, helping me get my cycle back on track and becoming my go-to resource throughout my PCOS journey. Let’s break them down:
Insulin-Resistant PCOS: this is the most common form that occurs from high-levels of insulin in the body. Increased insulin levels can inhibit ovulation and cause the ovaries to produce more testosterone. Key symptoms include: high blood-sugar, weight gain and/or difficulty losing weight, cravings for sweets / carbs.
Inflammatory PCOS: the cause of this form of PCOS is largely unknown; however, chronic inflammation is the most prominent symptom. Persistent, low-grade inflammation disrupts normal hormonal processes and triggers an increase in androgens (male-dominant sex hormones), resulting in symptoms like unwanted facial hair, hair thinning (on head), acne, and irregular or missed periods. Key symptoms include: fatigue, skin issues (like acne, eczema, psoriasis), digestive issues, and elevated inflammatory markers (like C-Reactive protein)
Adrenal PCOS: occurs when the adrenal glands (instead of the ovaries) overproduce certain hormones, particularly DHEA (an androgen) which is released in response to stress. Key symptoms include: high levels of DHEA-S without a corresponding increase in testosterone, hirsutism (excessive hair growth), fatigue, and chronic stress and anxiety.
Post-Pill PCOS: this is a temporary form of PCOS that can develop after discontinuing hormonal birth control, particularly birth control pills that suppress ovulation. It occurs because the body takes time to re-establish its natural hormonal balance – this is exactly what happened to me and why it took me 3.5 years being off hormonal birth control to get my cycle back. Key symptoms include: irregular or absent periods, acne flare-ups (particularly around the chin and jawline), hair thinning on head and/or hirsutism in other places, weight changes, and mood disturbances (anxiety, depression, etc.)
As you can see, the symptoms across these four types often overlap, making it challenging to determine which one you might have. That’s why a thorough diagnostic approach is crucial! This includes evaluating symptoms, conducting blood tests, and using imaging like ultrasounds. Most OBGYNs rely on the Rotterdam Criteria, which require at least two of the following:
Irregular or absent ovulation
Signs: Cycles longer than 35 days or fewer than 8 periods per year
Cause: Ovulatory dysfunction, where the ovaries do not release an egg regularly.
Elevated Androgens aka hyperandrogenism
Excess hair growth (hirsutism), especially on the face, chest, back, or abdomen.
Acne (particularly around the chin and jawline) and oily skin.
Male-pattern hair thinning or hair loss (aka androgenic alopecia).
Blood testing required to look for elevated levels of androgens (e.g., testosterone, DHEA-S).
Polycystic ovaries on ultrasound
What to look for: multiple small cysts (follicles) on the ovaries, typically more than 12 follicles per ovary or an ovary volume >10 mL.
Important note: the presence of polycystic ovaries alone is not enough for a PCOS diagnosis. It must be accompanied by other symptoms.
Understanding PCOS can be incredibly confusing and getting a diagnosis is often a challenge. To top it off, many women who do receive a diagnosis aren’t armed with proper education on the condition nor a plan to effectively manage it. The truth is – you can manage and even reverse PCOS naturally through lifestyle! And I’ll tell you how.
Starting with nutrition (shocker!) – what you eat can vastly improve and even eliminate your symptoms. As we know, food is medicine. Women with PCOS should focus on an anti-inflammatory whole-foods based diet. I would recommend:
Incorporating tons of anti-inflammatory foods like leafy greens, cruciferous veggies, antioxidant-rich fruits like berries, omega-3 rich foods like nuts, avocados, and salmon, and lots of healing spices like garlic, ginger, and turmeric. Go crazy with these - they work wonders!
Balancing blood sugar by eating at regular intervals (every 3-4 hours works well for most). Ensure you are having a balanced, satiating meal that includes lean protein, healthy fats, and fiber-rich, low-glycemic carbohydrates.
I love to reference what I call the plate method: fill half your plate with veggies, a quarter with lean protein, and a quarter with a complex carb and add 1-2 TBSP healthy fat. This could look like some chicken breast or salmon, roasted veggies, sweet potato, and some avocado, olive oil, or nuts on top.
Focusing on low-glycemic, high-fiber carbohydrates like legumes, fruits and veggies, potatoes, quinoa, brown rice, lentils, etc. and avoiding high-glycemic carbohydrates – typically anything made with refined sugars and flours (cane sugar/white sugar, white flours, etc.).
Supplementing appropriately! Vitamin D, Magnesium, Inositol, Omega-3s, Berberine, and DIM are some supplements that can be beneficial in managing PCOS and eliminating uncomfortable symptoms. Always work with a knowledgeable provider who can do testing and make recommendations based on what supplements will be best for you and your unique symptoms.
Movement is also medicine! And engaging in a variety of different forms of movement can be hugely beneficial for women with PCOS. You can even “cycle sync” your workouts, aligning your higher intensity workouts (your HIIT classes, running, intense/heavy weight training, etc.) with the first half of your cycle (follicular and ovulatory phases) and your lower-intensity workouts (pilates, yoga, walking) with the second half (luteal and menstrual phases).
Even just 30 minutes of more movement / day can be life-changing
Strength training is key because building muscle mass is essential for improving insulin sensitivity
Yoga & Pilates help improve stress and, in turn, can improve hormone regulation
And lastly, stress management, sleep, and nervous system regulation are essential in managing PCOS, just as they are in managing any chronic condition.
Develop some sort of mindfulness practice - whether that be daily walks, journaling, meditation, breath work – whatever brings you joy and grounds you.
Prioritize sleep! Practice good sleep hygiene by developing a stellar bedtime routine and aiming for at least 7 hrs/night (8-9 if you’re an overachiever like me) of quality sleep.
Spark joy - spend time with people who light you up, engage in hobbies that make you feel your best and put you at ease, do more of what brings you joy and less of what doesn’t.
Rest - listen to your body, slow down, and rest when it asks you to. Give yourself permission to rest - you are deserving of it and your healing is dependent on it.
PCOS is complex, but with the right education, tools and support from knowledgeable providers, you can take control of your hormone health, minimize uncomfortable symptoms, and truly thrive.
Xoxo,
Rach
