How to self-diagnose & treat PCOS from a pregnant Functional Medicine Physician with PCOS

Polycystic Ovarian Syndrome is severely misunderstood by mainstream medicine. This is primarily a metabolic disorder that, instead of being treated with Band-Aid options and synthetic hormones, can easily be treated at the root cause of the issue.

For me, PCOS was an elusive diagnosis that was never offered to me when speaking with my OBGYN. This is a pattern that I came to detect myself while in doctorate school. I have since dove in headfirst into finding and treating the REAL reason why I developed PCOS. I have done so with so much success, that now I help other women do the same in my functional medicine practice.

How do you know if you have PCOS?

PCOS has 3 primary diagnostic criteria, you must simply meet 2 of the 3 criteria and it just so happens that 2 of the 3 do not necessarily require testing, meaning you may be able to make the diagnosis yourself (with confidence).

Criteria #1: Elevated androgens (a fancy term for male sex hormones, like testosterone) on lab work OR signs & symptoms of elevated androgens.
Signs & symptoms include: Unwanted hair growth (typically dark & course on upper lip, chin, nipples, or belly button), hair loss or thinning (typically on scalp), cystic acne (especially along jaw line & chin), unwanted weight gain or resistance to weight loss, and sometimes constipation & bloating

Criteria #2: Missing or irregular periods, this is defined as 10 or less periods per year.

*Note, at this point if you have a large list of the symptoms from criteria #1 AND you have irregular cycles, you do not need to go any further, that is classified as PCOS.

Criteria #3: Ultrasound proof of ovarian cysts, defined as 12 or more cysts across both ovaries.
To understand this deeper, the elevated testosterone associated with criteria #1 creates an environment in the body that doesn’t allow for proper maturing of our follicles so instead of ovulating a fully developed egg we end up collecting immature follicles on the outside of the ovary, these follicles (and proof of irregular ovulation & cycles) are then categorized as “cysts” although they are actually “cyst like masses” and really just immature eggs that never got to finish the journey. Most of the time they are unproblematic, and even women without PCOS usually have a cyst like mass on their ovaries at some point in their lifetime. In PCOS immature follicles can become inflamed and grow or rupture which is very painful and typically requires a trip to the ER.

So, even if these criteria do not give you immediate clarification, you should be able to speak to your doctor about exactly what testing would be necessary to investigate further (testosterone, DHT (a different type of testosterone), and potentially a pelvic ultrasound).

Once you have determined if what you are experiencing is for sure PCOS, now we can get to healing!

Step #1: Find the root cause.

Women with PCOS are often told to “lose weight, cut carbs, & go on birth control” which almost NEVER actually solve the problem and in fact can make patients feel like they ARE the problem.

PCOS typically falls into 1 of 4 categories, in mainstream medicine you are first evaluated for the most common category and if you fit into that single one, then you are treated for that type of PCOS only, and only if you do not meet the criteria for the first category do you get to be evaluated for the second most common type, and so on. In my practice this is not how we view root cause – it is absolutely possible that you have driving factors behind your diagnosis that are coming from ALL FOUR categories and that the root cause is multifactorial.

Category #1: Insulin Resistance PCOS
This means the driving force behind your elevated androgens is a blood sugar imbalance, this is likely a portion of the root cause if you have difficulty with weight management. 80% of all PCOS patients have atleast a portion of their symptoms being driven by insulin resistance. Other symptoms associated with insulin resistance that many PCOS patients experience are skin tags, darkening of the skin in folds of neck, armpits, etc., inconsistent energy during the day (cycling between fatigue, joint pain, bloating & feeling like you need to take a nap to then feeling anxious, irritable, shaky, and like you need a Snickers bar), as well as difficulty sleeping through the night (waking between 2-4am).

If you are unsure simply from signs and symptoms if insulin resistance is a root cause for you, ask your doctor to run your fasting glucose & fasting insulin as well hemoglobin A1C on your next blood draw.

Category #2: Adrenal PCOS
This is driven by high cortisol and stress. This type is often called “lean PCOS” because it is the most common root cause for the 20% of patients who have no issues with insulin resistance and tend to have less issues with weight management. These patients typically identify with a high stress event or timeline in association with the onset of their symptoms and irregular cycles.

*Remember, even if you are insulin resistant, you can still have stress as a contributing factor – around here we treat ALL of the causes.

Category #3: Inflammatory PCOS
If you are not showing any signs of insulin resistance and your life has been pretty chill lately, then the next category to explore is inflammation. Inflammation can come from anywhere in the body but this is most commonly associated with inflammatory gut conditions such as IBS, Crohn’s disease, or ulcerative colitis.

Category #4: Post-Pill PCOS
Unfortunately, one of the biggest issues with birth control in our modern society, and a piece of information that is often overlooked or glazed over EVEN if you have a provider that is kind enough to discuss the risks of your birth control with you, is that when we utilize synthetic hormones to prevent ovulation and pregnancy, we ultimately push our body towards a more androgen dominant environment. Depriving the female body of its natural cycle, under the right circumstances, can push our bodies to over produce testosterone & its metabolites creating the perfect conditions for PCOS.

My Story
When I was twenty, living with my boyfriend, I was AWFUL at taking my birth control pills. Skipping days and then taking two at a time on a weekly basis. I made the decision with the help of a random OBGYN at planned parenthood to pursue the Nexplanon implant (the matchstick that goes in your arm). Over the course of the next 8 months, slowly but surely I started to notice symptoms start to pop up. I had no idea at the time that it was related to my birth control and by the time my mentor suggested that might be the case I had completely lost my period, my libido had tanked, I was incredibly moody and distant with my partner, was losing hair at a very rapid rate, steadily gaining weight, and had a full beard of painful cystic acne across my jawline & chin.

After making the connection that it could be related to my birth control, I immediately made an appointment to have it removed and when they went to retrieve the matchstick they found that it had broken in half and had to dig in my arm for nearly a half hour to find the second half.

I made the decision at that point to not pursue any other birth control options and that I would wait to get my period back.

And wait I did. It took TWO YEARS for my cycle to return and even then it was completely abnormal, often times stretching 3-4 months at a time between periods. At this point I was in doctorate school and starting to learn more about human physiology and had recently heard of the term functional medicine. If you are unfamiliar, functional medicine is a type of medicine the prioritizes finding the root cause of the problem through more comprehensive testing that what is typically offered at your PCP and then providing holistic treatment options such as supplement protocols, dietary modifications, and lifestyle modifications.

I sought out a local functional medicine doctor who was willing to give me a discount for being a student. I worked with him for approximately 6 months, not just for my missing cycles but, at the time I was experiencing extreme burn out from the demands of doctorate school and struggling with severe fatigue (like, had to take a nap in my car when I pulled in the driveway before I could gather my books and go into my apartment after classes kinda fatigue). By the end of our time together I had lost nearly 30 lbs, had boundless energy, and my cycle was regular! Needless to say, this was a paradigm shifting, life & career changing experience for me.

This is not where my story with PCOS ends though. Nearly four years later, in early 2021, my dad passed away suddenly from a combination of COVID-19 & medical neglect. Clearly that is a traumatic experience on its own but there were many other complicating and compounding factors on top of his death as well (for another post). At this time I was also struggling with a tiny bit of orthorexia (when you are fearful or shameful to eat certain foods in the name of health or eating clean) and my dietary practices that I felt had maintained my health (basically, low carb paleo) for those 4 beautiful years was becoming too restrictive and a source of great mental burden.

So with the combination of feeling overwhelmed by my lifestyle restrictions and the grief of losing my father, I felt as though I had been saved when I stumbled into the worlds of intuitive & then pro-metabolic eating. It sounded too good to be true, to eat whatever you wanted to heal your relationship with food and then shortly after working to focus on nutrient dense foods that would heal my metabolism while still emphasizing food freedom. Although each of those strategies have merit, in retrospect, the missing piece from those conversations is taking care of your blood sugar.

Even with all of my years as a provider and at that time, having just finished my training to transition from physical chiropractic care to functional medicine, I still did not put together what those dietary changes, although a saving grace for my mental health – to let go of my dietary restrictions during such a hard time during my life, could push my body towards insulin resistance.

I learned the hard way. I gained nearly 40lbs over the course of the year after my dad died, working on body positivity and focusing on healing my relationship with food allowed me to see the weight as safety weight during a time of distress. And if it had just been weight alone, I would likely still feel that way. BUT, remember all of those symptoms that I described from criteria #1 in our PCOS diagnosis (unwanted hair growth, darkening skin folds, cystic acne, etc) – yep, I had them ALL. Oh, and I had only had three total periods in the year after my father passed as well.

I had successfully put my post-pill PCOS in remission for nearly 4 years and within the matter of 12 months relapsed with a combination of insulin resistance & adrenal type PCOS.

The timing could not have been more terrible as my husband (the same partner from way back in the day when I was on the Nexplanon), and I were beginning to talk about starting a family.

After pulling myself up by the bootstraps and dedicating myself to being my own #1 patient, within the following 18 months I had lost 20lbs, re-established a regular (nearly symptom free) period, cleared my acne, and after only 4 month of trying, found myself holding a positive pregnancy test!

The rest of this post is about how I managed to turn my (second) PCOS diagnosis around.

Step #2: Treat the root cause

Step #3: Track your cycle & confirm ovulation