What is PCOS?
(Another post in our ‘What is X?’ series)
Femme a Barbe
Who is that fabulous bearded woman with the quiet smile and the adorable fur baby, you ask? Why, that’s Clementine Delait, one of history’s most famous, and most fabulous, bearded ladies! 1
Clementine was a Victorian-Era Frenchwoman who lived an adventurous life highlighted by a beautifully enormous amount of self-acceptance and self-love. Researchers believe that her striking appearance was likely caused by Polycystic Ovary Syndrome (PCOS), an endocrine condition that affects as many as 9-18% of women today. 1 ,2
As a young woman of 25, Clementine chose to stop shaving her beard and make peace with her natural body. Later in life, after years of infertility, Clementine and her husband adopted a child together, and Clementine was finally able to become a mother. She was an entrepreneur, world-traveler, fur-baby mama, human-baby mama, performer, girl-boss, and much, much more! 1
Clementine will stand forever as an example of resiliency and fabulousness among the PCOS community.
Why All the Clementine Info?
She shows us that PCOS is not new, and that it can affect every aspect of a person’s life. She also shows us that despite it all, individuals with PCOS can live beautiful lives filled with love, acceptance, and fun! (It feels important to open with this in mind.)
So, as we move through this post about PCOS, if it gets to be a little overwhelming, just stop and think about Clementine, France’s most fabulous Femme a Barbe (Bearded Lady), who didn’t let her condition stop her from living the life she wanted. 1
The lesson here? You can be profoundly affected by PCOS and still be a beautiful badass; remember that.
Wait, Does PCOS Cause Beards?
If you’re stuck on that and you don’t know what in the world I’m talking about, then here’s the short answer. Yes, sometimes PCOS can cause women to grow beards, though they aren’t usually as full and luscious as Madame Clementine’s, and most women choose to keep their beards as subtle as possible. (Not always though, and we at Wholesome Story believe that YOU get to decide what you want for your body. No judgment either way.)
We’ll cover more about this potential symptom of PCOS later in the post, so keep reading!
What is PCOS?
For those who don’t know, PCOS is an endocrine disorder, aka a hormonal disorder. In fact, it’s the most prevalent endocrine disorder in women of child-bearing age in the world. As many as 9-18% of women have PCOS and, unfortunately, there is no cure.2
In this post we’ll discuss the diagnostic criteria, symptoms, risks, and treatment options for one of the world’s most common health conditions.
As usual, we’ve provided you with some definitions to review before you dive into the rest of the post. Take a quick peek and make sure you understand each of the terms listed below to ensure you’ll get the most out of your read!
- Androgens - Male sex hormones that are typically present in women in small amounts. 3
- Anovulation (see also, anovulatory) - Occurs when an ovary doesn’t release an egg (ovum) during the menstrual cycle. 4
- Cyst - See Follicle
- Cyster - A PCOS warrior! A.K.A. someone with PCOS.
- Follicles - Fluid-filled sacs with immature eggs in them. 3
- Follicle Stimulating Hormone (FSH) - Secreted by the anterior pituitary gland, this hormone promotes the formation of either ova or sperm depending on the sex of the individual. 5
- Hirsutism - A condition in which hair grows on atypical parts of the body, usually facial hair growing on people assigned female at birth. 6
- Hyperandrogenism - A term that refers to high levels of androgen hormones. 4
- Infertility - Medically, infertility is defined as the inability to conceive after 12 or more months of regular, unprotected sex. 7
- Luteinizing Hormone (LH) - A reproductive hormone that aids in ovulation and pregnancy; it is commonly imbalanced in fertility and menstrual disorders. 8
- Obesity - Having an overall Body Mass Index (BMI) of 30 or greater. (Statistically, those with obesity are prone to more health complications.) 9
- Polycystic Ovarian Syndrome (PCOS) - A medical condition that causes the ovaries to produce abnormally high levels of androgen hormones and multiple small cysts ( immature follicles). 10
- Rotterdam Criteria - The three diagnostic criterion used to determine if a woman has PCOS; they are: irregular periods, high androgen levels, polycystic ovaries. (If a woman has at least two of these things, she can be diagnosed with PCOS.) 11
- Irregular Cycle - Nine or fewer menstrual flows per year and/or a menstrual cycle average of longer than 35 days. 11,12
What are the symptoms?
The symptoms of PCOS can vary from one person to the next and they depend on the severity and type of PCOS. If you have PCOS, you may have experienced some or all of the following symptoms, either at different times or concurrently, depending on your individual case.
Let’s also note that this list of symptoms is not exhaustive. Just because we don’t list a symptom here doesn’t mean that it’s not legitimate, or even common. PCOS affects every aspect of a person’s health and we simply can’t go over every possible effect.
We’ve chosen to cover some of the most common and detrimental symptoms of PCOS. If you have some or all of these symptoms and you haven’t spoken with your doctor about it, then make an appointment today! (And just remember to think of Clementine and her fabulous life if it gets a little overwhelming!)
Your period should come at least semi-regularly and a full cycle should last somewhere between 21 and 35 days. That’s from the start of one period to the next. If you frequently skip periods and/or your periods are very irregular (nine or fewer menstrual flows per year and/or a cycle average longer than 35 days), then you could have PCOS. 3,11,12,13
Abnormal Hair Growth
Some women have more hair than others. Some of us have luscious locks and others have scraggly strands (myself included). Some have hairless arms and legs and others feel like Chewbacca if they skip a day of shaving. So far, so normal.
Women with hirsutism usually pursue medical treatments such as laser hair removal or hormonal therapy to help control their symptoms, but not all are successful with this. Most women with hirsutism pluck, shave, and/or wax religiously, but this can be costly, and even painful. Many women report that natural supplements help with unwanted hair growth, but not all.
We’d also like to note that as social movements in favor of natural body positivity continue to grow, so does acceptance for women keeping their natural body hair…including beards! We’re in favor of you doing whatever you prefer, FYI. So, grow it, or mow it; regardless, we think you’re beautiful!
It’s normal to get zits, and even breakouts, from time to time. What’s not normal is painful, scarring acne that doesn’t respond to typical skincare treatments. This could be a sign that you have hormonal acne, which is common in PCOS. 3,13
It’s estimated that somewhere between 40-80% of women with PCOS have obesity. 3,13 If you’re thinking that overweight/obesity are prevalent everywhere, not just in the PCOS community, then you’re right. What really defines weight gain among women with PCOS is that it can be nearly impossible to fight.
There are many causes of weight gain and many people have trouble losing weight. But, if you’re exercising like crazy, barely eating, and still can’t lose weight or are even continuing to pack on pounds, this can be a sign that your weight problems stem from hormonal imbalances, such as those found in PCOS. 3,13
In PCOS, overweight/obesity is typically tied to insulin resistance, a condition that over 60% of women with PCOS struggle with. In insulin resistance, much of the glucose (energy) from food that a person eats never makes it into the body’s cells, but is instead stored as fat. 14
Someone in a situation like this could eat an entire meal and still feel very hungry. It’s like their body went grocery shopping, put everything in the cupboard, and never took a bite. If the body does this every time they eat, then they end up with an overflowing cupboard of hoarded food (fat tissue), chronically high blood sugar and insulin levels, and very low energy levels.
Cellular energy deprivation like this typically leads to intense cravings for carbohydrates (the body trying desperately to signal that the cells need energy) that are very difficult to resist and usually lead to more weight gain. 15
On a side note, if you’re a larger size and you don’t feel the need to lose weight, then more power to you! It’s your life and your body, and you are beautiful in any and every size.
We get that not every woman is a Fertile Myrtle and that sometimes it takes time and effort to conceive. But, if you have been trying to conceive for quite some time without success, then it’s probably time to talk with your doctor.
(And don’t forget to make sure your partner sees his doctor too! Male-factor infertility is just as prevalent as female-factor, so get those swimmers tested.)
If you want more information about the biology of how PCOS can impact fertility, check out our original blog on PCOS: What is PCOS? (Because People Should Know, and You’re People).
This is the delightful part of the blog where we explain how all those life-altering symptoms can cause medical complications…as if the symptoms weren’t enough on their own.
Approximately 50% of women with PCOS will be diagnosed with Type II diabetes by their 40th birthday. 2 Oh. Joy.
Remember that insulin resistance we mentioned earlier? The condition that makes it so you’re hungry, fatigued, and have a very hard time maintaining a healthy weight? Yeah, this is where that insulin resistance is headed if you don’t head it off.
You see, high levels of testosterone can decrease insulin sensitivity and really get the ball rolling in the Type 2 Diabetes direction. If the ball isn’t stopped, it just rolls right on over into disease territory and before you know it, you’ve got full blown diabetes. 3,13
If you want more information about the biology of how PCOS can lead to Type II Diabetes, check out our original blog on PCOS: What is PCOS? (Because People Should Know, and You’re People).
Depression and/or Anxiety
(There’s something about fertility problems, weight management issues, fatigue, hirsutism, etc. that can really take a toll on a person’s mental health…go figure.)
If you’re feeling depressed and/or anxious, be sure to address the issue. You can talk with your healthcare provider about treatment options such as medication/counseling if necessary/desired, or simply try lifestyle modifications for more minor cases.
Great ways to care for your mental health can include things like, taking time for yourself, meditating, moving your body, and/or spending time with friends and family. The key is to engage in activities that are relaxing and reassuring to you.
This isn’t really that surprising when you consider how PCOS can cause/contribute to issues like cellular energy deprivation, fatigue, weight gain, and bodily dissatisfaction.
One study found that 60% of women with both PCOS and obesity met the criteria for Binge Eating Disorder (BED). 2,15 This is almost certainly tied to the very intense carbohydrate cravings that come with insulin resistance.
And, let’s acknowledge that BED isn’t the only eating disorder women with PCOS are susceptible to. PCOS can cause a struggle to maintain control over one’s body, which can leave a person susceptible to developing an eating disorder in an effort to regain control and/or aesthetic satisfaction. Anorexia, binging and purging, excessive laxative use, and other forms of eating disorders are risks as well. 2,15
Click here to find out how you can get help now if you’re struggling with an eating disorder.
Here is a link to the PCOS Awareness Association’s Crisis Center where you can contact someone for help if you need it.
What does cardiovascular health have to do with PCOS you ask? More than you’d think.
You see, obesity and diabetes are both risk factors for problems like high blood pressure, heart attack, and stroke.
This is because high levels of insulin and glucose in the blood damage our bodies’ delicate blood vessels. Add this to the fact that high carbohydrate diets (such those often eaten by individuals craving energy) can lead to increased LDL cholesterol levels, and you’ve got the perfect storm for creating heart disease. 15
Keep breathing, you’re probably not going to get cancer from your PCOS.
Ok, let’s keep reading.
On average, women have a chance of about 15 in 100,000 of getting endometrial cancer, but women with PCOS have a chance of about 226 in 100,000. 12,16 Translated into percentages, this means that while the average woman has a 0.015% risk in any given year of her life, that risk increases to 0.226% for women with PCOS.
As you can see, while the increase in odds is drastic and undesirable, it’s still not something to freak out about.
However, we strongly recommend you talk with your healthcare provider about your personal risk level (there are factors besides PCOS which can impact your personal risk), and try to find ways to reduce your risk as much as possible.
Well, That Was Depressing
Before we move on to the part of the post where we discuss diagnosis and treatment, let’s take a break for some beautiful affirmations.
See? If Moira and Tina think you’re wonderful, then you MUST be!
OK, back to our regularly scheduled programming….
How is PCOS Diagnosed?
To diagnose PCOS, doctors use the Rotterdam Criteria; a woman must meet at least two of the three listed below to be diagnosed. The Rotterdam Criteria are:
1. Irregular Periods
A woman is considered to have irregular periods if she has nine or fewer menstrual flows per year and/or her menstrual cycle average is longer than 35 days. 11,12 Irregular periods are the norm in women with PCOS.
2. High Androgen Levels
Androgen hormones aren’t typically found in high amounts in women, but PCOS cysters buck this trend. Your doctor may use a blood test to diagnose high androgen levels, or they may use phenotypic criteria (physical symptoms) to diagnose it.
Check out this link to learn about Harnaam, a beautiful, bearded woman making waves on social media. She chose self-acceptance and self-love over self-hatred and self-harm. This photo is from her story in Vogue magazine!
3. Polycystic Ovaries
Although the term makes it sound a bit like a horror show, “polycystic ovaries” isn’t nearly as scary as it sounds. This diagnosis simply means that your ovaries have more immature egg follicles (cysts) in them than is normal. 11,12
(To receive this diagnosis, you must have a transvaginal ultrasound to look at your ovaries. This means that a doctor/technician must use an ultrasound wand, inserted into the vagina, to get the necessary images for diagnosis. We’re just giving you a heads-up so you don’t get blindsided at the doctor’s office, like so many women do.)
20: Each image shows the ovary from a different angle, and each small black dot with a number is a cyst. This ovary has 39 immature follicles!
So, if you meet at least two of the three criteria on this list, your doctor will likely diagnose you with PCOS. Welcome to the cysterhood! (It’s not the best club to be in, but it’s not the worst either. PCOS cysters are a wonderfully supportive bunch.)
If you want more information about the biology of polycystic ovaries or other information about the Rotterdam Critera, check out our original blog on PCOS: What is PCOS? (Because People Should Know, and You’re People).
How is PCOS Treated?
Let’s talk about how to get some help!
Treatment for PCOS is usually determined by the goals of the individual person. For example, treatment options for aiding conception are very different from those that simply target symptoms. Personalized treatment is a must!
If you have PCOS, you likely fall into one of these three categories:
1. You’re trying to conceive but are having difficulty because of your PCOS, and your coworker’s unsolicited conception “advice” isn’t proving helpful.
You want to have a baby, but they’re hard to come by when your ovaries aren’t working properly. If so, your doctor may put you on hormone-modulating meds to help your body create a mature egg for ovulation and hopefully fertilization. 12
2. You’re not trying to make a baby, but you need help with your symptoms because you’re starting to feel like a hangry, pock-marked troll (which you definitely are NOT by the way).
You just want a freaking break from all the weight gain, acne, facial hair, and other lovely symptoms. If so, your doctor may recommend medications and/or supplements to help normalize your hormone levels. This could include Metformin and/or hormonal birth control among other things. 12
3. You feel A-OK, but your doctor says otherwise.
You had no idea anything was amiss until you went to the doctor and they told you that you have PCOS.
If so, your doctor likely wants to treat your PCOS to keep it from escalating and causing health problems like those mentioned earlier in this post. They may recommend lifestyle changes, supplements, and/or medications. 12
Are There Natural Treatments for PCOS?
Um…YES! There are many natural things you can do to help improve your health if you have PCOS. From diets, to sleep patterns, to exercise routines, and even stress management, you can support your body with natural methods.
If you want to pursue Naturopathic care for your PCOS, we recommend contacting a certified ND who specializes in women’s reproductive health. You can use this link to search for NDs in your area.
When it comes to natural ways to help control your PCOS, there’s no better place to start than with what’s on your plate.
In fact, dietary interventions for PCOS are so effective that we’ve written an entire blog post about it, Dietary Interventions for PCOS: One Size Doesn’t Fit All, where we discuss, in detail, the different dieting and fasting options for PCOS, considerations for each option, and suggestions for how to decide which method(s) to try.
If you’re struggling with insulin resistance, then exercise may be your best friend. Studies show that regular exercise, even something as simple as walking, can help reduce insulin resistance and improve metabolic health in women with PCOS. 17
So, if you’re trying to improve your PCOS symptoms with natural methods, give exercise a try! You could try a yoga class, take your dog on a walk, join a pickleball league, or even just turn on your favorite playlist and dance around in your PJ’s!
Managing stress healthfully is an important life skill regardless of medical status. But, for those with chronic health conditions, it’s imperative.
In fact, one study found that individuals with PCOS had a higher prevalence of stress compared to those without the disorder. Furthermore, the researchers concluded that these higher stress levels play a “critical role” in body composition for these individuals. 18
Translation? PCOS makes stress worse, which makes PCOS symptoms worse….go figure. 18
This is your sign to take your stress levels seriously. So, soak in a hot bath, take a vacation, or do whatever it is that makes you feel relaxed and happy.
If you’re reading our blog, then you probably already know about the power of supplements, and you’re probably a fan of them, like we are.
Many women with PCOS find certain supplements to be incredibly beneficial!
Unfortunately, due to FDA regulations, we are not permitted to tell you which supplements may or may not be helpful for your PCOS. Lame, we know.
But, we can tell you to look up Healthline’s article on natural ways to treat PCOS and pay special attention to the supplements they recommend. ;)
The Bottom Line
PCOS is an extremely common condition that can cause a lot of problems, ranging from unwanted hair growth to uncontrollable weight gain, to infertility. To put it bluntly, PCOS makes life hard for a lot of women.
The best treatment options for you will depend greatly on your goals and on your symptom types and severity.
Lifestyle changes can be very effective for many women with PCOS, but it’s important to remember to be kind to yourself. Balancing your lifestyle choices with your emotional and mental health is key.
If you’re struggling with any of the symptoms or conditions associated with PCOS and you haven’t sought help yet, then we’re here to tell you that…you deserve to feel better! Get the help you need to live your best life.
And remember, just like Clementine and Haram, you can live an amazing, adventurous life regardless of your condition(s). You’re BEAUTIFUL, no matter what lies our culture may have told you about your body. And, most importantly, your body is your own, so YOU get to decide what to feed it, how to treat it, and what looks/feels good on it.
In parting, remember that eating healthy, whole foods, and lots of plant foods is one of the simplest, safest, and most effective things we can do to promote good health in our bodies. As with every preventative/restorative measure though, sometimes these changes alone are not enough to help our bodies function the way we want or need them to. If you are struggling with health problems, please contact your doctor or other healthcare provider such as a Naturopathic Doctor, Dietitian, or Mental Health Professional, to see if they can offer appropriate guidance and care. We at Wholesome Story believe that healthy communities require community effort, so we advise you to keep your healthcare community aware and involved in your journey as you pursue better health.
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- Cleveland Clinic medical professional. Hirsutism: What it is, in women, causes, PCOS & treatment. Cleveland Clinic. July 2022. Accessed August 25, 2023. https://my.clevelandclinic.org/health/diseases/14523-hirsutism.
- Mayo Clinic Staff. Infertility. Mayo Clinic. September 1, 2021. Accessed August 25, 2023. https://www.mayoclinic.org/diseases-conditions/infertility/symptoms-causes/syc-20354317#:~:text=Infertility%20is%20defined%20as%20not,of%20factors%20that%20prevent%20pregnancy.
- Cleveland Clinic medical professional. Luteinizing hormone: Levels, function & testing. Cleveland Clinic. August 2022. Accessed August 25, 2023. https://my.clevelandclinic.org/health/body/22255-luteinizing-hormone.
- Cleveland Clinic medical professional. Obesity: Causes, types, prevention & definition. Cleveland Clinic. June 2022. Accessed August 25, 2023. https://my.clevelandclinic.org/health/diseases/11209-weight-control-and-obesity.
- Johns Hopkins Staff. Polycystic ovary syndrome (PCOS). JHM. February 28, 2022. Accessed August 25, 2023. https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos.
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- All gifs obtained from Gify.com; links for each gif are posted below the respective image.
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