PCOS and How To Manage It

Living with PCOS is a big part of who I am, even when I’m not trying to get pregnant. Which is most of the time. Prior to receiving a formal diagnosis, it consumed me in a very real, raw, and exhausting way. Before I understood the underlying metabolic dysregulation of PCOS, I was operating in reactionary mode. My day-to-day life was a constant battle of too much caffeine to battle my constant fatigue and post-meal energy slumps. Popping Motrin to manage headaches and pelvic pain. Eating every 2-3 hours to keep the hangry monster suppressed. Eventually, I turned to the pill to relieve my symptoms and “regulate” my cycle. However, the fatigue, foggy brain, and weight gain continued to tailspin. I’m not alone in my journey. Approximately 10% of women suffer from PCOS.

What is PCOS?

Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by reproductive and metabolic disturbances. Androgen excess is a hallmark of PCOS, driving many of the physical features like excess facial and body hair, acne, thinning hair on the scalp, and weight gain around the midsection. Metabolic dysfunction has a direct effect on hormone balance and reproduction. Many women with PCOS experience irregular menstrual cycles, painful periods, and infertility. The main culprit behind metabolic dysfunction is called insulin resistance. Insulin resistance affects about 80% of all women with PCOS. The classification of “lean PCOS” doesn’t mean you are out of the woods regarding insulin resistance.

What is Insulin Resistance? 

Let’s begin with insulin. Insulin is a hormone produced by your pancreas that allows your cells to use glucose (aka sugar) for energy production. Your cells contain insulin receptors and insulin acts as the “key” that unlocks the receptors to allow glucose to enter into your cells and provide energy. With insulin resistance, there is an issue with the lock and key. Glucose has a hard time entering the cells. This causes a couple of issues.

The two main problems caused by insulin resistance are elevated blood glucose levels and poor energy production within the cells. 

The first issue on the table is elevated blood glucose levels. Too much sugar is circulating in your bloodstream. The second issue is poor energy production within the cells. A cell is the basic unit of life and it needs a good source of constant energy to perform its very important tasks. 

Let’s start by looking at the issue of elevated blood glucose levels. This is sometimes called pre-diabetes. Women with unmanaged PCOS are at higher risk for developing diabetes. You might be thinking, what does this have to do with my ovaries? Well, in addition to being at risk for diabetes, as a woman, your ovaries need a lot of energy to function properly. The ovaries have a lot of insulin receptors. The ovaries are the female reproductive glands that are responsible for releasing an egg each menstrual cycle. They make the female hormones estrogen and progesterone which play many important roles in not only reproduction but your overall well-being. Ovulation is an intense event. Your ovaries need a lot of energy to ovulate well. If the insulin receptors on your ovaries aren’t able to properly take in glucose and convert it to energy, your ovaries get exhausted. This is occurring at a cellular level.

The take-home message to this crash course in insulin resistance is that in women with PCOS, glucose energy has a hard time getting into the ovaries. The ovaries get tired and cranky. You become tired. Your ovaries can no longer properly manage the important tasks of ovulation and hormonal balance. Women are designed to ovulate well. If ovulation is off, it’s likely you are experiencing other symptoms like infertility, irregular menstrual cycles, mood swings, fatigue, and more.

What’s a Cyster to do?

As a fellow ‘cyster’ (that’s street slang for a woman with PCOS), blood sugar regulation is a top priority for balancing my cycles and feeling my best. Women with PCOS need to work a little harder to balance their blood sugar. The first step is to accept this reality. 

A few days after a sweet tooth binge or a few glasses of wine, my girlfriends (those unicorns with the perfect cycles) only have pleasant memories of the indulgence while I can hardly get out of bed. This leaves me feeling frustrated and asking “Why me?” 

Can you relate? It all comes back to insulin resistance. And insulin resistance doesn’t happen overnight, it’s the result of excess sugar over a lifetime. I grew up in the era of low fat, high-sugar processed foods. In my childhood, candy and sodas were perfectly acceptable snacks. In college, I lived on microwavable dinners and low-fat (high sugar) yogurt. I didn’t realize that the food I ate was laying a poor foundation for future health. There is truth to the ol’ adage “you are what you eat.”

It wasn’t until I started diving into health and nutrition that I began to understand just how taxing my diet was on my blood sugar and hormonal health. I felt awful, suffered from irregular cycles, chronic fatigue, brain fog, and severe acne. The sugar highs and subsequent crashes really screwed up my hormones and made the insulin receptors on my cells tired and cranky. It got really bad. 

Common symptoms of unbalanced blood sugar are: 

✿ Energy highs followed by a crash

✿ Mood swings, anxiety, and feeling on edge

✿ Sugar and/or caffeine cravings

✿ Feeling hungry within an hour of eating a meal

✿ Sleep issues

✿ Waking up feeling exhausted

✿ A fasting glucose level over 100 mg/dL

Crawling out of the hole of insulin resistance is a daunting task. The first step is to break the cycle of the blood sugar roller coaster. Each spike in insulin (from consuming too much sugar) results in a drop in blood sugar, resulting in craving more sugar. It’s a vicious cycle. 

Where to begin?

If your blood sugar is imbalanced, or you suspect insulin resistance, or you have PCOS, here are four simple tips for crafting your meals to balance your blood sugar. 

✿ Eat animal protein or fatty fish with each meal. Ideally from pastured grass-fed and finished ruminants, free-range poultry, and well-sourced fish low in metal toxicity.

✿ Include healthy fats in each meal (ie: avocado, olive oil, nuts, well-sourced animal fat).

✿ Prioritize vegetables as your carbohydrate source. Over time, those highly processed junk foods that skyrocket blood sugar levels will start to be less appealing. It takes time to break sugar addiction and cravings.

✿ Monitor your fasting and post-meal blood glucose levels with an at-home glucometer kit. 

Start with breakfast. Here are a few of my go-to breakfasts. The trick to this menu is having a dinner plan. I almost always repurpose the previous evening’s dinner to a delicious breakfast concoction. I’m not about to cook up a brisket or whip up a freshly cooked entree first thing in the morning. Although, I must admit, a pan-seared steak before noon is definitely in the playing cards at my house. If I’m not particularly hungry on any given morning I listen to my body and opt for a fat coffee (better known as bulletproof coffee) to fuel my body.

Here are a few of my favorites:

✿ Leftovers Deluxe: Think dinner for breakfast. Last night’s protein and roasted veggies warmed in a skillet with a side of kimchi (because I love kimchi and probiotics are essential for PCOS)

✿ Steak & Eggs: Brisket, over-easy eggs, and roasted bok choy. If you’ve never tried bok choy - you’ve got to! It’s an overlooked but absolutely delicious, cute little cabbage variety.

✿ Breakfast Brussels: Eggs with grilled brussel sprouts and a sprinkle of parmesan.

✿ Fat Coffee: Espresso, full-fat cream, vanilla extract, monk fruit extract, MCT oil, coconut oil, or ghee. It sounds gross but tastes delicious. Trust me. Note: start easy on the oil if you are new to this supplement.  

I am sharing this with you because I know perfectly well that these are not “traditional” breakfast plates. My kids are constantly commenting on the strange concoctions I am putting together for my morning fuel. I know, however, that what I eat for breakfast either makes or breaks my day. 

Jumping off the blood sugar roller coaster is possible and tracking your progress is critical for your overall success and long-term commitment to managing insulin resistance. Charting your cycle is a great way to measure your progress. As your blood sugar becomes balanced, your cycles will regulate, PMS will resolve, and you’ll begin to feel like your old self.

Managing PCOS takes a multifactorial approach. Starting with diet and nutrition will move the needle in the right direction to start your healing journey. Working with a health coach who specializes in PCOS management and who will support you in your journey will take you from suffering from PCOS to thriving with PCOS.

 Written by: Melissa Buchan, CYC Founder and Fertility Coach