Explore PCOS Symptoms, Treatments & Virtual Care with Allara Health
Allara is the first ever virtual chronic care platform for women with Polycystic Ovary Syndrome (PCOS), making expert-led, holistic healthcare accessible online. PCOS is one of the world's most common hormonal disorders, affecting 1 in 10 women of reproductive age.
Felice Ramallo, MSCN, RDN, LD/CDN & Allara Lead Dietitian
Felice’s nutrition philosophy is grounded in mindful or Intuitive Eating, and reducing the burden of weight stigma through a pledge to Health at Every Size (HAES). In short, she aims to help patients eat what makes them happy with a goal of teaching not only what to eat, but how to eat in ways that promote health for a lifetime.
What does PCOS stand for?
Polycystic Ovary Syndrome
What causes PCOS?
PCOS is an endocrine (hormone) condition caused by genetic and environmental factors, many of which are unclear or unknown.
Environmental contributors are less understood, as some people experience their first symptoms of the condition at a seemingly random point in time, and others seem to “develop” it, following a stressful period of time or after stopping hormonal birth control.
Additionally, symptoms can change or go into remission throughout one’s life. In part, this is because inflammation exacerbates the condition. The broad term “inflammation” can be rooted in insulin resistance, hormonal changes (i.e. changing hormonal medications), thyroid disease, mental stress, etc.
Can you get pregnant with PCOS?
Most people with PCOS can get pregnant, even without fertility treatments and intervention.
However, it can take some time to figure out what lifestyle, nutrition, supplement, or medication changes are necessary to promote regular ovulation: the key to getting pregnant.
Whether or not you plan to get pregnant, it is important to address your PCOS. Healthcare for people with periods shouldn’t end at reproduction.
As an endocrine (hormonal) condition, it can affect just about every system in one’s body, increasing the risk for chronic disease and comorbidities including type 2 diabetes, heart disease, stroke, depression, anxiety, etc.; not to mention the unpleasant symptoms of the condition.
What are some ways you can treat PCOS? Are there any solutions and treatments for this?
First-line treatment of PCOS is considered to be lifestyle change.
Lifestyle change could be regulating your sleep schedule, finding the right kind and amount of movement, eating a balanced diet. Supplements can be a great addition to lifestyle treatment.
When lifestyle changes and supplements aren’t enough, medications (like metformin or birth control) can be employed to address underlying contributors to the condition as well.
What are the first signs of PCOS?
They differ for everyone, but common symptoms include:
- Absent or irregular period
- Unexplained weight or rapid gain
- Excess hair growth (hirsutism)
- Thinning hair on scalp
- Acanthosis nigricans (skin darkening particularly along neck creases, under breasts, around the groin area)
- Skin tags
How do doctors diagnose PCOS? What does the process look like after?
PCOS is diagnosed using the following criteria. At least two of the three__ criteria__ are required for most providers to diagnose the condition:
- Labs or clinical markers of hyperandrogenism (high testosterone levels)
- Irregular or absent periods
- Polycystic ovaries
Typically, there isn’t much of a process afterwards. Often, for those not currently trying to get pregnant, oral contraceptive pills are recommended. Other medications may be prescribed as well.
Allara, the first ever all in one virtual care platform for PCOS, handles things differently though. Patients are paired with a medical provider and a registered dietitian to address their PCOS holistically, and from every angle.
Ultimately, different treatments work for different people.
Is PCOS genetic?
Yes, it can be.
The genetic piece is certainly strong, as there is an increased chance of having PCOS if a first-degree menstruator/female relative (like a sister or mother) has the condition. In male relatives, there is a higher incidence of type 2 diabetes.
Although, not everyone with PCOS has a relative with it.
How common is PCOS?
PCOS affects approximately 10-20% of the global menstruator/female population, showing similar rates across all countries and ethnicities: another indicator that it isn’t just environmental or genetic.
Does PCOS cause infertility?
PCOS is the leading cause of infertility in menstruators. Although, not everyone with PCOS has trouble conceiving.
How to lower testosterone levels in menstruators with PCOS?
Elevated testosterone levels are often associated with the general or “global” inflammation that drives PCOS. Getting that under control means testosterone levels are likely to go down. Some of the strategies that may help include:
- learning to balance meals and snacks to improve blood sugar control
- supplementing when appropriate
- getting enough sleep and maintaining a regular sleep schedule
- finding or increasing physical activity that you enjoy
- possibly adding in more rest days or mental health/relaxation breaks
Again, if these do not prove to be enough, medications may be added.
What does metformin do for PCOS?
It sensitizes the body to insulin, meaning less insulin would be necessary to balance blood sugars.
High insulin levels seem to affect ovarian function, and drive some of the inflammation associated with PCOS.
Does PCOS cause hair loss?
It can cause androgenic alopecia, which involves a thinning of the hair on the crown of the head or down one’s hair part.
This is due to the hair follicles reacting (miniaturizing) in response to testosterone. Even in people with the same amount of circulating testosterone, they may find different degrees of hair loss or sometimes, none at all.
Can you develop PCOS after having a child?
PCOS can show up in one’s life at any time. Although, having a child does not “cause” or contribute to development of PCOS.
Notably, there can be early signs of PCOS that show up in pre-pubesence and many symptoms of PCOS persist past menopause.
Is keto a good diet for PCOS?
First things first, there is no single diet or strategy that works best for PCOS. That includes keto or low-carb diets.
In fact, most people with PCOS do best with moderate carbohydrate intake, meaning some grains or starchy vegetables present at most meals and snacks.
Remember how in the 90’s and early 2000’s, fat was demonized as the driver of heart disease and high cholesterol? And then we learned that it was more about getting in nutrient-dense oils like extra virgin olive oil rather than cutting out fat? Well, the same thing is happening to carbohydrates.
Carbs do not singlehandedly cause diabetes or worsen insulin resistance and PCOS. When carbohydrates are eaten with fiber, fat, and protein; they don’t spike blood sugar levels or worsen insulin resistance (or PCOS). Carbohydrate foods are full of so many nutrients that optimize how our bodies operate. Carbs are an essential part of most everyone’s diet, as they help with steady energy throughout the day, improve satisfaction after meals, and even help prevent cravings and binges.
Strategies that improve PCOS in most people are:
- Eating 4-6 small, frequent meals and snacks throughout the day
- Getting a variety of food groups (and all macronutrients + fiber) at as many meals and snacks as possible: we recommend following the PCOS Plate
- Planning ahead: spending an hour or so each week generally planning some meals, snacks, and convenience options to fill in the gaps seems to be the key to success for most people
What are the 4 types of PCOS?
There aren’t medically recognized “types of PCOS” in this sense. Additionally, PCOS is a syndrome, meaning it’s a cluster of symptoms that can change, disappear, or worsen in different periods in one’s life. However, some underlying issues associated with PCOS are often called “types” and targeting them in treatment, will likely improve PCOS presentation. They are as follows:
Insulin-resistant PCOS → This can be treated by improving the body’s blood glucose response and insulin sensitivity.
Post-pill PCOS → This refers to first symptoms showing up after stopping the oral contraceptive pill. However, being on the pill does not cause PCOS.
Inflammatory PCOS → This includes basically any source of inflammation, including IBS or GI conditions, allergies or intolerances, inadequate movement or sleep, thyroid disease, etc. Getting some of those items better managed may help with PCOS.
Adrenal PCOS → This is often associated with elevated DHEA-S, an androgen like testosterone. People with this “type” may benefit from lowering the amount of exercise (or cardio exercise) they are doing, improving their sleep, etc.
Again, these are not medically or scientifically-supported “types.” Although, they are widely used to help better make sense of the condition.
Does birth control help out with PCOS?
Specific birth control pills have been shown to lower androgens, regulate cycles, and generally improve PCOS symptoms.
It is important to note that the pill does not cause or “cure” PCOS. They may be a good treatment option for those not looking to currently conceive.