THE blog

If you’re currently trying to conceive, you may have seen information around the internet about prioritizing non-toxic skincare and products – why?

What Are EDC’s?

The reason for prioritizing non-toxic products for fertility is to reduce the number of chemicals and endocrine disrupters you’re using on your body, which can impact your hormone health and reproductive health.

Some known endocrine disrupting hormones are:

• Pesticides – like glyphosate
• Phthalates – found in so many skincare products
• PCBs and Dioxins
• BPA Plastic
• Chemical retardants
• Perfluorochemicals found in clothes

Honestly, it can get very overwhelming pretty quickly when you start to think about the sheer volume of chemicals found in our skincare, makeup, cleaning products (even baby products!!)

Below I wanted to share some of my favorite non-toxic skincare brands to help you see that there are so many amazing companies producing clean products that won’t mess with your hormones or impact your chances of conceiving.

My Favorite Non-Toxic Brands for Fertility

• Tata Harper – I love their face masks and toners
• Ilia – beautiful bronzers and highlighters
• Kosas – pretty much all my makeup is from this brand. Super high quality
• Follain – I used to work for this company and learned soo much about clean beauty. Awesome resources and beautiful products.
• Credo – they have stores across the US and they carry so many different brands. One of my favorite stores to visit when I’m in NYC, Boston, or San Francisco.
• Primally Pure – their deodorant is amazing!

There you have it! I know there are so many more amazing brands out there, so if there’s one you know and love, let me know in the comments or DM on Instagram!

Looking for More Support?

We cover environmental toxins in DEPTH inside of my program – Nourishing Fertility. To learn more and snag $100 off the course, check out our FREE masterclass here.

 

 One of my favorite parts about working in functional nutrition is that I get to take a deeper dive into the root causes of health issues. Fertility is something that is so interconnected to every system in the body, that we sometimes forget that something that may seem totally unrelated, could actually be the root of everything else. That’s why I’m excited to talk about how gut health specifically impacts fertility. 

he gut impacts your entire body – from modulating risk for chronic diseases like heart disease, diabetes, and cancer, to impacting your mood, anxiety and depression. There is A LOT of research happening these days around gut health, and there’s more coming out every day about how the gut microbiome impacts fertility. 

What is the Microbiome?

So first, let’s talk about what the gut microbiome actually is. The gut microbiome is essentially all the bacteria that live inside your digestive system, specifically the large intestine. In the gut there are 100 trillion bacteria cells – more cells than our body’s own cells! 

While there can certainly be bad bacteria that cause infections and disease, there’s also a whole host of beneficial bacteria that work hard to digest and absorb our food, signal neurotransmitters to our brains, fight inflammation and boost immunity.

The microbiome impacts:

• Energy levels 
• Mood, stress and brain health
• Digestive health 
• Immune function
• Skin health 
• Inflammation 
• Weight 
• Hormones 

Keeping our microbiome happy is essential for almost everything else happening in the body! The problem is, for many of us our gut balance between good bacteria and bad bacteria is way off. Whether you’re having obvious digestive symptoms (gas, bloating, constipation, diarrhea, etc.), or something else is going on in your body – you likely need to take a closer look into the health of your microbiome. 

5 Ways Gut Health Impacts Fertility 

One of the most clear connections between the health of your microbiome and fertility, is through the regulation of sex hormones, namely estrogen. 

Gut Health and Hormone Balance 

Estrogen is a hormone that the body makes, uses and then needs to get rid of. It goes through three phases of detoxification to be able to remove it from the body. The last step in the process is controlled by the gut microbiome.

There’s an enzyme in your large intestine called Beta glucuronidase, and it’s responsible for unpacking estrogen and allowing to it be re-circulated and re-absorbed in the body. 

When you have high levels of B-glucuronidase, it’s usually a sign that you likely have excess estrogen in your body (estrogen dominance) and may have even experienced some of these symptoms, like menstrual cycle problems, painful periods, heavy bleeding, etc. 

Signs of Estrogen Dominance:

1. Mood swings/mood instability
2. Water retention
3. Difficulty losing body fat
4. Acne and skin issues
5. Irregular periods or anovulatory cycles
6. Painful cycles
7. Low sex drive
8. Difficulty building lean muscle mass
9. Poor recovery from exercise
10. Sleep issues

When our bodies can’t eliminate excess estrogen through the GI tract it actually impairs fertility because it throws off the ratio between estrogen and progesterone, and ultimately causes a higher risk for miscarriage.

 
Remember, any dysbiosis prior to pregnancy is also going to worsen during pregnancy, so it’s a good idea to work on your gut health prior to conceiving. 

According to a recent review, without a healthy microbiome, estrogen metabolism and function becomes impaired and can lead to a number of health consequences including endometriosis, PCOS, endometrial hyperplasia, and infertility. 

Authors of this review concluded that treating the gut microbiome to modulate estrogen levels should be considered as a new future treatment for estrogen-mediated diseases including infertility. 

Gut Health and Weight 

The gut microbiome has been associated with higher pre-pregnancy weight as well as more weight gain during pregnancy. We know that excess weight impacts fertility, and researchers have found that those who are overweight have a different microbiome, with different types of bacterial strains than their normal weight counterparts. 

There’s evidence that higher calorie diets rich in sugar and processed foods actually skew the balance of microbes. In fact, a recent study showed that the diversity of these microbes can be influenced by diet within just 24 hours! 

Diets based in fruits, vegetables and plenty of fiber support the microbiome, whereas the Standard American Diet (SAD) has been shown to be detrimental to the microbiome. 

Gut Health and Thyroid 

As mentioned earlier, when there is an imbalance in the microbiome, it impacts immunologic and metabolic functions. A study in 2015 found that hypo- and hyper-thyroidism was associated to small intestinal bacterial overgrowth (SIBO), and another study in 2019 found an association between dysbiosis and thyroid cancer and thyroid nodules. 

Since your thyroid health is so important for not only all metabolic function, but also fertility, it’s important to take this into consideration. 

An under-active thyroid can impact fertility in a few different ways: 

1. Decreased cellular energy – meaning less mitochondria (your cell’s powerhouse) on ovarian cells, causing irregular or absent cycles. 
2. Increased prolactin – which suppresses ovulation by blocking the release of FSH 
3. Decreased insulin sensitivity – more insulin in the blood increases androgens, which can disrupt ovulation and is especially detrimental for women with PCOS 

Gut Health and Inflammation 

You don’t need to have inflammatory bowel disease to have inflammation in the gut, or your gut causing inflammation in other parts of the body. For example, if you have intestinal permeability (aka “leaky gut”), there could be bacterial products entering the blood stream, causing your immune system to attack them and cause chronic inflammation. 

Since inflammation is linked to so many chronic diseases and infertility, this is an important link to consider. 

Gut Health and Pregnancy Complications 

Research has shown the poor gut health was associated with higher risk of preeclampsia, gestational diabetes, and preterm birth. The microbiome has also been looked at for infant health and studies have shown a connection between imbalances in the microbiome with increased risk of eczema, asthma, and allergies. A healthy microbiome will also contribute to your baby’s immune function, inflammation, and healthy weight throughout their life. 

How Do I know if I need Help with my Gut Health and Fertility? 

So by now I’m sure you’re convinced that gut health plays a major role in fertility. But how do you know if taking a daily probiotic is enough? Ask yourself:

• Have I been suffering with digestive issues for years (this is just my new “normal”)
• Do I often fluctuate between feeling constipated or having loose stools?
• Are there foods that I avoid because I can’t tolerate them?
• Do I have frequent acid reflux? 
• Do I have signs of estrogen dominance? (heavy period, PMS, excess weight and weight loss resistance, etc.) 

If you answered yes to any of these questions or you just feel that it’s time to take a closer look into your gut health, then set up a free discovery call with me to see how functional nutrition can help you on your fertility journey. 

And let me know in the comments below what was surprising for you about this blog post! 

References

1. https://www.ncbi.nlm.nih.gov/pubmed/28778332
2. https://www.ncbi.nlm.nih.gov/pubmed/25564410
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216449/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137456/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845518/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701523/
7. https://www.ncbi.nlm.nih.gov/pubmed/28388917
8. https://www.ncbi.nlm.nih.gov/pubmed/30584647
9. https://link.springer.com/article/10.1007%2Fs12020-014-0509-2
10. https://www.ncbi.nlm.nih.gov/pubmed/32070720
11. https://www.ncbi.nlm.nih.gov/pubmed/32064643
12. https://www.ncbi.nlm.nih.gov/pubmed/32063084

 

One of the best ways to start prepping for pregnancy and optimizing your fertility, is to become more aware of your sex hormones like estrogen, progesterone, and testosterone. If you’ve been tracking your cycle for a while now, you may know that there are two distinct phases of the cycle – your follicular phase and your luteal phase.

Many women experience issues in their luteal phase, which is connected to the hormone progesterone. In this blog, we’ll cover in depth what progesterone is, how to measure it, and what you can do to improve progesterone levels naturally.

What is Progesterone?

Progesterone is a steroid hormone made from cholesterol, and is made from luteine cells in the uterus. These cells will make progesterone until the placenta is strong enough to make progesterone on it’s own, and will continue to do so for the rest of pregnancy.

We make progesterone for about 2 weeks during the luteal phase after ovulation.

The follicle turns into the corpus luteum (aka yellow body), which is what makes progesterone. Your body does not make progesterone in the first half of your cycle.

The first half of your cycle (your follicular phase) is where estrogen is released. You need that rise in estrogen to ovulate, and then progesterone kicks in.

So why is this important for fertility?

Progesterone is your pro-gestation hormone. It helps grow a baby in your uterus and thrive there. When progesterone is made, it’s made for the first 8-10 weeks from the corpus luteum, at which point the placenta should be strong enough to take over.

However, for some women their corpous luteum is not strong enough to make progesterone last for 8-10 weeks, which often leads to early pregnancy loss. Having a healthy amount of progesterone plays a large factor in preventing miscarriage.

The problem is, many fertility clinics will test progesterone from a blood draw on one day of the cycle, but the levels of progesterone can change dramatically throughout the day (and month). Additionally, many women don’t know that they need to check their progesterone levels in the second half of the cycle – this is KEY!

One way to check progesterone levels at home is by using progesterone test strips, like the Proov test strips – which will tell you if you have healthy levels of progesterone after ovulation.

In addition to helping to prevent miscarriage, progesterone is important for priming the uterine lining for implantation.

When should levels be measured for progesterone?

If you’re working with a fertility clinic, it’s important that you check your progesterone levels in the second half of your cycle. Remember, you don’t make progesterone in the first half of your cycle.

Ideally, you would check progesterone levels 5-7 days after ovulation. If you ovulate on day 14, then you want it on day 19-21 to measure, before the start of your period.

While a serum test can be helpful, a DUTCH test provides more information because it measures progesterone at 4 different points throughout the day and takes the average.

[If you’re interested in taking the DUTCH test and having your labs interpreted by me, schedule a call below to chat!]

Because progesterone will be vastly different at different times of the day, it’s best to get a reading at different parts of the day for the most accurate picture of your progesterone levels.

Additionally, progesterone can be made on certain days but then can putter out very quickly. Some signs of low progesterone could be tender breasts, PMS symptoms, and heavy periods.

What are Optimum Serum Levels of Progesterone?

Ideally, serum levels are above 10. Lower numbers are indicative of a weak corpus luteum, and if your levels are extremely low, it could be that you’re not ovulating at all, and rather progesterone is being made from the adrenals glands, and not the ovaries at all.

SIGNS OF LOW PROGESTERONE:

1. PMS – mood changes, bloating, tender breasts
2. Heavy periods, clotting, worse endometriosis symptoms
3. Insomnia and stress or anxiety before period (progesterone impacts GABA, a neurotransmitter that calms things down)
4. Spotting before period (losing the uterine lining that you’re supposed to maintain)
5. Short luteal phase (should be 12-14 days ideally, anything shorter can be a sign of low progesterone)

Suggested Reading: How to Find Your Fertile Window

Remember, hormones are not just about reproduction – hormones impact the cardiovascular system, brain health, immune system, gut health, and essentially every system in the body!

What You Can Do to Increase Progesterone

Okay, so now that we know progesterone is important, and perhaps you’ve noticed signs of low progesterone either from a test, or symptoms mentioned above – what can you do about it?

1. Manage your stress levels

When you have a lot of stress, whether or not it’s real stress or perceived stress – your body will react in the same way.

Cortisol, epinephrine and norepinephrine will feed back to the brain and let your brain know that there’s a lot of stress here.

The brain will then decrease signaling of estrogen and progesterone. Women will first lose progesterone, which will cause you to not ovulate. If the stress is strong enough, then it will down regulate FSH and estrogen, and you will have amenorrhea and skip cycles completely.

This is your body’s way of protecting you. If you’re being chased by a tiger (stress), it’s probably not a good time to make a baby. So working on self care, and anything to support your body like good sleep, healthy relationships, regular movement, etc. is going to be helpful in managing stress, but also in making enough progesterone.

Of course, if you’re trying to conceive or in the middle of fertility treatments, you’re likely very stressed. It’s not helpful for me to tell you that you just need to stop stressing, but understanding the biochemistry behind how stress impacts ovulation and progesterone can give you a better understanding of how your lifestyle choices are impacting fertility.

2. Work on Your Gut Health

Your immune system starts in the gut, and any inflammation happening there will negatively impact progesterone production as well.

Whether you are taking a comprehensive stool test, or just taking the 5R approach to gut health – taking care of your digestion will help balance out your hormones in the long run.

3. Stop Under-Eating and Over-Exercising

As a reminder, all steroid hormones are made from cholesterol. If you have very low levels of cholesterol you may be not be able to make sex hormones like estrogen and progesterone.

Additionally, leptin (a hormone made from fat tissue) is a big sign for fertility -it will tell your brain if you have enough fat on you to actually carry a pregnancy term.

If you’re a marathon runner, extreme athlete, have an active eating disorder, or just really cutting calories and over-excerising and have a very low body fat percentage, your cycles will stop or skip in order for your body to reduce your chances of getting pregnant.

HOW TO BALANCE PROGESTERONE THROUGHOUT THE CYCLE

If you’re having troubles with your progesterone levels or have a short luteal phase, it may be tempting to JUST focus on the second half of your cycle.

The truth is that you need to support your cycle all month long to help with luteal phase defects.

In the follicular phase, your brain makes FSH to make estrogen. One follicle is chosen to release an egg, and you need to have estrogen elevated for 40-50 hours, to get an LH surge which triggers ovulation, which is what triggers corpus luteum, which triggers progesterone production.

You can’t just focus on progesterone, because there is a domino effect between all of these hormones.

Low progesterone is also a sign of low follicular health or poor egg quality. Giving progesterone as a medication does not address the root problem. While there is no adverse effect of taking progesterone, working on diet and lifestyle changes will benefit you in the long run.

That’s why working on your hormone health for at least 3 months before conceiving will be important in order to work on egg quality, progesterone, and address the root cause issues.

Natural Therapies to Increase Progesterone Levels

1. Supplements that Help with Brain Health: Omega 3 fats, Gingko, Rosemary, Maca, Cordyceps – are all great for brain health. We want good signaling from the brain to the ovaries (HPO axis) Trying to get the brain back on track with neuron signaling. Maca, Cordyceps, Lion’s Mane (great for focus), and Chaga medicinal mushrooms.
   
2. Antioxidants play a huge role on the ovaries. Melatonin, lutein foods like beta-carotene, vitamin C, selenium, and zinc can be extremely helpful to the ovaries.
   
3. Vitex / Chaste Tree is a very common herb used to improve both estrogen and progesterone levels. Vitex has been shown to increase LH, and subsequent progesterone levels in women with luteal phase defects. This herb is not necessarily fast acting, but taken every day for 3 months has shown improvements in women in several studies.

Looking for More?

If you’re looking for more support, functional lab testing, and nutrition counseling to help you conceive, let’s schedule a free 30 minute discovery call!

I work with women in their 20s, 30s, and 40s trying to conceive – whether you have PCOS, endometriosis, or unexplained infertility, we will work together to get to the root issue and improve your chances of becoming pregnant.

I hope you learned something from this blog post, and let me know what questions you have below!

Want to know how to boost your fertility diet?

Then you need to learn about Choline! Choline is just as important in helping to prevent neural tube defects as the well known vitamin folate, but unfortunately, it’s not as well known or spoken about. ⁠If you’re looking for some choline rich foods for fertility, then read on!

Choline also plays an important role in:⁠

1. Supporting the transfer of nutrients across the placenta⁠ to ensure your baby receives the nutrients it needs
2. Fetal brain development⁠
3. May assist in reducing the chances of your baby developing chronic diseases later in life ⁠

What’s the data?

The research that has been done over the past 20 years, outlines very clearly the benefits of choline when it comes to both overall health during pregnancy and the development of our babies brain.

Studies on animal models have shown that Choline plays a key role in enhancing brain function and also serves to protect the brain and its various elements as it develops.

Human studies on the other hand have shown that taking Choline in doses higher than what is currently recommended by various health bodies, has multiple benefits, including:

• Enhancing the function of the placenta
• May reduce the risk of preeclampsia
• Improves brain development in the infant
• Boosts reaction times in the infant
• Enhances an infants visual memory

Why haven’t you heard of Choline before?

Unfortunately, the research around Choline is relatively new in scientific terms (by this I mean the research has only really been looking into this topic for the past 20 years), and it’s not a well known supplement when it comes to fertility (well outside of the dietetic community anyway!).

The evidence while not well known, is really promising and it is well worth aiming to include more sources of choline in your diet if you are trying to conceive or pregnant.

So where do you find Choline?

Choline is found in the highest amounts in animal products. ⁠

⁠
Top Choline Rich Foods for Fertility:⁠

• Eggs
• Salmon
• Beef
• Chicken
• Dairy products
• Soybeans

Like many other nutrients, our choline needs increase dramatically during pregnancy with some studies suggesting that our choline needs may be almost double what is currently recommended by the guidelines.

Should I supplement Choline?

Unfortunately, many of us don’t currently get our choline needs from food alone, and in these cases a supplement may be of benefit to support a healthy pregnancy. Not all prenatal supplements contain Choline, and some also don’t contain enough to provide you with all the benefits. Some of my favorite prenatals that include adequate choline are FullWell Prenatal and Needed.

If you’re already taking a prenatal that doesn’t have choline, consider supplementing or assessing your diet to see if you meet the choline requirements for adequate fertility and pregnancy. You can find more fertility supportive supplements in my fertility dispensary here. Remember, it’s important to ensure that you work with a professional when selecting the right prenatal supplements for you!
⁠

Looking for More Support?

Looking for more 1-on-1 support on your fertility journey? Apply for a free 20 minute strategy call today. I can help you regulate your cycles, ovulate, and have a healthy pregnancy using my proven functional nutrition method. I look forward to speaking with you!

References: 

1. Blusztajn, Jan Krzysztof, and Tiffany J. Mellott. “Neuroprotective actions of perinatal choline nutrition.” Clinical chemistry and laboratory medicine 3 (2013): 591-599.
2. Kwan, Sze Ting Cecilia, et al. “Maternal choline supplementation during pregnancy improves placental vascularization and modulates placental nutrient supply in a sexually dimorphic manner.” Placenta 45 (2016): 130. ; Jiang, Xinyin, et al. “A higher maternal choline intake among third-trimester pregnant women lowers placental and circulating
3. Boeke, Caroline E., et al. “Choline intake during pregnancy and child cognition at age 7 years.” American journal of epidemiology 12 (2012): 1338-1347.
4. What Is Choline? An Essential Nutrient With Many Benefits (healthline.com)

Like many of my clients and readers, I was given hormonal birth control with absolutely no discussion on the side effects of the pill. I was handed the pill and never really thought twice about it. I just knew it gave me a “regular” period and would help me protect against an unwanted pregnancy. It was only in my THIRTIES that I discovered how the pill depletes certain nutrients, affects mood, weight, and so much more. If you’re curious about which nutrients are depleted on hormonal birth control, then keep reading on.

8 Nutrients depleted on hormonal birth control and how they impact fertility: 

Zinc

Found in foods such as eggs, seafood, meat, nuts, seeds, beans and whole grains. Zinc plays an important role in both egg and sperm health.

Magnesium

Found in foods such as avocado, banana, seafood, green leafy vegetables, nuts and seeds. Magnesium plays an important role in sleep, bone health and our muscles ability to relax.

Vitamin C

Found in foods such as oranges, broccoli, kiwi fruit and guava. Vitamin C is a valuable antioxidant that keeps our eggs and sperm protected from oxidative stress caused by free radicals.

Folate

Found in green leafy vegetables and fortified breads and cereals. Folate is essential when trying to conceive and helps to prevent the formation of neural tube defects in early pregnancy.

Selenium

Found in foods such as Brazil nuts, meats and seafood. Selenium plays a valuable role in our thyroid function and helps to prevent sperm from mutating or becoming damaged.

Vitamin B2

Found in eggs, meats and dairy products. Vitamin B2 is a common nutrient depleted when on the pill and is often the culprit behind those pesky headaches!

Vitamin B6

Found in foods like breads and cereals. Vitamin B6 is commonly depleted in those taking the pill. It plays an important role in fertility and the luteal phase of the menstrual cycle.

Vitamin B12

Found in foods such as fish, beef, and fortified cereals. B12 is essential for healthy cell formation, a must when trying to conceive.

 

Ideally you would want to ensure that these levels are checked and corrected where necessary before you start thinking about conceiving to ensure a healthy baby and pregnancy. You can start a prenatal, a few months before coming off the pill to help with the transition of coming off. 

Wondering what else you can do to support your body when coming off the pill?

Let’s face it, coming off the pill can be a scary thought and can lead to some not so nice side-effects including:

• Post-pill amenorrhea
• Painful, heavy periods
• Irregular cycles that are hard to predict
• Acne
• Headaches or migraines
• Changes in weight (loss or gain)
• Changes to mood
• Digestive upset (IBS like symptoms)
• Breast tenderness

Supporting your body through nutrition can be a great way to make the transition easier.

Try these 9 tips to support your body when coming off the pill

1. Aim to have at least 1 bowel movement each day to facilitate the removal of excess estrogen in the body.
2. Eat plenty of cruciferous vegetables to lower estrogen levels – try eating 1 cup of bok or pak choy, broccoli, cabbage, cauliflower, arugula and Brussel sprouts each day!
3. Eat regularly – aim to eat every 2-3 hours to support blood sugar and hormone balance. Putting your body under too much stress can increase the stress hormone cortisol.
4. Eat enough fibre to encourage regular bowel movements – aim to eat between 3-6 cups of colourful, leafy vegetables each day.
5. Eat lean protein to support your detox pathways – try turkey, chicken, pork, beef, and seafood.
6. Include plenty of healthy fats to support hormone creation – try extra-virgin olive oil, avocado, nuts and seeds.
7. Stay hydrated by drinking plenty of water – aim for at least 8 cups per day.
8. Try to avoid highly processed foods – think sugary foods, fast foods and refined oils.
9. Avoid alcohol if you can! Alcohol is also removed via our liver, so give it a break if you can.

References:

1. How Birth Control Pills Affect Your Nutritional Needs – Scientific American
2. Oral contraceptives and changes in nutritional requirements – PubMed (nih.gov)

Looking for more support with your fertility? Book your free 30 minute 1:1 strategy call with me to learn how I can support you using functional nutrition, specialty lab testing, and targeted supplements. Can’t wait to speak to you! 

What is PCOS?

PCOS or Polycystic ovary syndrome is a medical condition that impacts a woman’s hormone levels. Keep reading to learn everything you’ve wanted to know about PCOS.

Those with PCOS typically produce more of the male sex hormones which can lead to:

• Hormonal imbalances
• Skipped or irregular menstrual periods
• Difficulties falling pregnant
• Cysts on your ovaries

Polycystic ovarian syndrome can also cause a range of symptoms including:

• Excess hair growth (particularly on the face and body)
• Changes in body shape
• Acne
• Balding or excess hair loss

Different types of PCOS

There are four main types of PCOS that we commonly see.

⁠1. Insulin resistant PCOS⁠

⁠This is the most common type of PCOS. We can determine that you have insulin resistant PCOS by looking at your circulating insulin levels.⁠

2️. Pill-induced PCOS⁠

⁠Unfortunately, birth control can mask PCOS and may cause symptoms once we stop taking it. When we cease birth control, there is a flood of androgens which while temporary which can cause a range of symptoms associated with PCOS.⁠

3️. Inflammatory PCOS⁠

⁠Chronic inflammation in our body can see our ovaries produce too much testosterone, which we know is a common issue in PCOS!⁠

⁠4. Adrenal PCOS⁠

⁠If our bodies respond to stress in an abnormal way, we can see adrenal PCOS as a result. It is not as common, only making up around 10% of all PCOS cases. This diagnosis will see high levels of DHEAS (an androgen produced in the adrenal glands) and normal levels of other androgens.⁠

How PCOS is diagnosed

A PCOS diagnosis is typically made by your medical team if you have at least two out of these three symptoms:

1. Elevated androgen levels
2. An irregular menstrual cycle
3. Cysts on your ovaries

Your doctor may also:

• Conduct a pelvic exam to check the health of your reproductive organs
• Do an ultrasound to look for abnormal follicles or cysts on your ovaries
• Take your blood to test your hormones and a variety of other health indicators

Helpful PCOS labs to request

In your quest to learn everything you’ve wanted to know about your PCOS, it’s important to consider labs! There are several helpful labs that you can ask your doctor to request if you suspect you have PCOS or if you want to gain a clearer picture of how well you are currently managing your PCOS.

There are several hormones which may be contributing to your PCOS and are responsible for your symptoms including:

• Testosterone
• Estrogen
• Progesterone
• LH
• FSH
• Prolactin
• DHEA

It’s also helpful to understand your blood sugar levels and whether insulin resistance is an issue for you. You can ask your doctor to check your:

• Fasting glucose
• HbA1c
• Fasting insulin

Inflammation can be common in those with PCOS and thankfully with dietary and lifestyle changes, we can reduce this if we know it is an issue. As your doctor to check your:

• CRP
• Homocysteine

Metformin (a commonly prescribed PCOS medication) can cause B12 deficiencies, so ensure that you doctor screens for this in your bloods also!

How does PCOS impact your cycle?

There are two main ways in which PCOS impacts upon your menstrual cycle.

1. Women with PCOS typically don’t ovulate or ovulate infrequently. This prevents the uterine lining from shedding each month like we would typically expect. As a result, this can cause irregular menstrual cycles.
2. As a result of the above, the uterine lining doesn’t shed as often, becomes thicker and can cause heavier bleeding than normal when you do get a menstrual bleed.

What does PCOS mean in terms of fertility?

Given that PCOS disrupts your ability to have a normal menstrual cycle, it can also potentially impact upon your ability to get pregnant. It is estimated that between 70-80% of women diagnosed with PCOS struggle with infertility at some point.

The changes in hormone levels can also increase your risk of complications arising during your pregnancy including:

• Premature birth
• Miscarriage
• Gestational diabetes
• Pre-eclampsia

Thankfully dietary and lifestyle changes considerably improve your chances of conception and having a healthy pregnancy and healthy baby!

Things that can make your PCOS worse

• Working long hours and not taking regular breaks
• Inadequate water intake
• Inadequate daily movement or exercise
• Not eating enough fibre
• Poor sleep duration and quality
• Drinking too many caffeinated beverages
• Not eating enough healthy fats in your diet
• Not eating regularly – skipping meals and snacks can wreak havoc on your blood sugar and insulin levels
• Exposure to endocrine disrupting chemicals
• Not eating balanced meals
• Consuming too many processed foods

How best to support your PCOS

The good news is that there are many aspects of your lifestyle that can be altered that can significantly improve the free androgen index (FAI), in addition to your weight and BMI.

Aim to balance your blood sugar levels and manage your insulin resistance

• Consuming low-glycaemic index foods (see guide here for more info)
• Eat regularly (every 3-4 hours)
• Consume balanced meals (incorporate protein, healthy fats and fibre-filled carbohydrates into each meal and snack)

Consider supplements

• Talk to your healthcare profession about how dietary supplements may be able to assist in the management of your PCOS (see more on supplements for PCOS below)

Manage your stress

• Adopt strategies to better manage your stress
• Try moving your body, meditating, and journaling

Drink enough water

• Aim for at least 8 glasses of water each day

Get plenty of sleep

• Aim for 7-8 hours sleep each night

Avoid endocrine disrupting chemicals

• Avoid BPA, phthalates, dioxins, copper and chromium are just some of the many endocrine disrupting chemicals we are exposed to each day.

Endocrine disrupting chemicals are found in:

• food
• personal care products
• cosmetics
• pharmaceuticals
• pesticides
• plastics
• water
• soil

Learn more about endocrine disruptors here.

Some commonly used supplements include:

Magnesium

The research on magnesium supplementation is not concrete at present. Some studies suggest that magnesium may play a role in improving insulin resistance due to its links to glucose metabolism.

Inositol

Inositol is often combined with metformin and can help to enhance:

• Insulin function and manage insulin resistance
• Move glucose into our cells faster helping to keep our blood sugar levels more stable

Berberine

Berberine is known for having several functions including:

• Helping to reduce inflammation
• Increase insulin sensitivity
• Encouraging ovulation each cycle (in turn improving fertility)

N-Acetyl Cysteine (NAC)

NAC is an antioxidant compound which reduces the number of free radicals that can damage cells in our body.

NAC is associated with:

• Improved chances of conceiving
• More regular ovulation

Enjoyed learning everything you’ve wanted to know about PCOS and keen to learn more?

References:

1. Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice (nih.gov)
2. Pregnancy complications in women with polycystic ovary syndrome | Human Reproduction Update | Oxford Academic (oup.com)
3. Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, and Treatment (healthline.com)