You know how drug commercials are always suggesting fun icebreakers to try on your doctor? Like, “Hey doc, what’s up with,” oh, I don’t know, “Nexplanon?” In general, it’s safe to assume if your doctor doesn’t bring something up first, you probably don’t have to worry about it. But I don’t know if I ever would have gotten diagnosed with PCOS if I didn’t bring it up with my doctor. It’s a mercurial condition that’s sometimes defined by painful ovarian cysts and sometimes not—you might experience anything from out of whack hormone levels to missed periods to infertility without developing ovarian cysts. “The origins of PCOS are poorly understood and symptoms can be varied,” explains my current gynecologist, Dr. Elizabeth Poynor. She’s an expert on PCOS, which is how I ended up in her Upper East Side office that feels more like a pied-à-terre than a clinic. After undergrad at Princeton, medical school at Columbia, and a residency at the University of Pennsylvania, she took a big job at the Memorial Sloan-Kettering Cancer Center doing gynecologic oncology and pelvic surgery. Then, she left—her current practice specializes in providing thoughtful, empathetic care to women suffering from difficult-to-treat gynecological issues.
In the cab ride from 81st street all the way downtown, I cried on the phone to my mom. For the first time, I went to see a doctor and it felt like they were actually seeing me—I felt listened to, understood, and that my symptoms could be mitigated rather than just dealt with. Namely, an intense nausea I’d wake up with, and feel waves of throughout the day. (It’s a cruel trick when a body that doesn’t really ovulate on its own starts mimicking what, in a Hollywood cliché, would be the first sign of pregnancy.) Still, I was hesitant about Dr. Poynor’s extensive PCOS protocol at first. We both agreed that my current birth control was “optimized” (Dr. Poynor’s word for when something has maximal benefits and minimal bad side effects), but the rest of my instructions were very supplement-forward, and expensive. Plus, it was a lot of pills—too many to fit in my geriatrically charming day-of-the-week pill organizer.
“More holistic and natural approaches towards PCOS try to help achieve hormone balance through direct actions on the ovaries, metabolism and inflammation,” she explains to me. It’s part of why her practice includes a nutritionist, who Dr. Poynor recommends all of her PCOS patients see in addition to regular check-ins with herself. “More traditional allopathic approaches, such as the oral contraceptive pill, do not treat the root cause of PCOS.” She’s constantly researching new PCOS solutions, and she’s read enough studies that support targeted supplements. With the right mix, your ovaries can actually achieve a more balanced production of hormones—and, therefore, lessen some PCOS symptoms that can affect your day-to-day life. After several months of consistently following her instructions, not only am I not nauseous, but also have more energy and a revved-up metabolism. Many of these supplements increase fertility and, well, I’ll be the first to tell you I’m not looking for a baby right now. But for women with PCOS, fertility just means balance overall—when your pesky ovaries are working right, a lot of other symptoms go away. Here’s what worked for me.
Inositols are carbohydrates that help determine how your body processes sugar. You make them naturally, and they’re also found in whole grains, beans, nuts and citrus fruits. “As a dietary supplement,” says Dr. Poynor, “inositols can help with excess hair growth, acne, and PMS symptoms that come with PCOS.” So basically, everything. There are nine types of inositols, but Dr. Poynor says myo-inositol is the most popular. “A high percentage of women with PCOS who take myo-inositol will establish regular periods and show evidence of ovulation,” she explains. In other words: it helps get you back on track. I take myo-inositol daily as a powder that I mix into a cup of ginger tea (good for nausea, too!) in the morning and at night.
I pair it with another inositol, d-chiro-inositol. “Women with PCOS appear to benefit most from a combination of myo-inositol and D-chiro-inositol in a ratio of 40:1.” Dr. Poynor adds that while many other combinations exist, they’re still undergoing clinical investigation.
Maybe you’ve heard of its cousin, folate, before? Folate is a B vitamin that helps your body make genetic material and divide cells. You can get it from your diet (peanuts, asparagus, and oranges are all good sources) but the National Institutes of Heath also recommends a supplement, specifically for women. Methylfolate is a form of folate that your body can process more easily, and in combination with myo-inositol, it’s been shown to help regulate menstrual cycles.
It’s possible that after a long March following an even longer winter spent mainly indoors, your vitamin D levels might be lower than usual. But if you have PCOS, you might also have a natural vitamin D deficiency—which could be making your symptoms worse. “Vitamin D directly impacts ovaries and plays an important role in progesterone production,” says Dr. Poynor. “And low vitamin D levels have been associated with insulin resistance.” You might have heard the term insulin resistance before in the context of diabetes, and while insulin resistance can evolve into diabetes, in PCOS patients it’s a signal for your body to make more testosterone. Male hormones contribute to some of the more uncomfortable PCOS side effects like unwanted hair and acne. Aside from balancing your natural vitamin D levels, a supplement might also help mitigate these symptoms, too.
“There is some evidence that omega-3 intake can lower androgen levels in women with PCOS,” says Dr. Poynor, “but it’s also helpful in lowering inflammation and, like vitamin D, decreasing insulin resistance.” You might be able to get enough omega 3 from food alone (many fish are high in it), so take that into consideration before going for a supplement solution.
NAC acts as an antioxidant, and studies have shown it has promising results in treating PCOS—in fact, they’re comparable to the prescription medication metformin. “Supplementation with NAC can decrease excess hair, free testosterone, and menstrual irregularity,” says Dr. Poynor. It also might improve your chances at ovulation, or even pregnancy, if you’re into that.
This pill is called Nutrient 950, but really it’s just a very strong multivitamin—much stronger than some of the beauty industry supplements you’ve seen all over Instagram. “Just to comment on two of the most important ingredients in this vitamin, beta carotene is another antioxidant,” says Dr. Poynor, to help balance the oxidative stress central in PCOS patients. “And it also has a lot of magnesium, because low levels of magnesium have been associated with low insulin sensitivity,” she adds. Just for reference, Nutrient 950 has 70mg more magnesium than Ritual’s multi for women, and 1,800mg more beta carotene than The Nue Co’s Skin Filter. It’s got a lot of other good stuff, too.
Of course, there’s a lot of other stuff you can do, too. Dr. Poynor recommends adding a probiotic called Bifidobacterium lactis to further help reduce inflammation in the body, so I take Seed, which fits the bill. I also have (mostly) cut out processed sugar and try to work out at least three days a week. But that’s about as much as I can take as a lifestyle change at this point—if these things don’t work, you can work in other homeopathic remedies such as DIM, white peony, and licorice root, according to Dr. Poynor. You can also reduce your carbohydrate intake, eat raw, and follow an anti-inflammatory diet which… I’m not willing to do. PCOS symptoms are a tricky thing to solve. Have something that works for you? I want to hear about it in the comments.
Photo via ITG