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PCOS Treatment Options

April 16, 2012
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What you can do to treat your PCOS

Please refer to my exploration of the causes of PCOS for a description of PCOS pathologies.  What follows is a brief layout of different treatments.   Going through them all, and experimenting and finding what works best, and talking to your doctor and doing your own research is all critical.   This is just what I have found, both on the web and in my body.   Note that the section on diet does not stand alone.  There is more information on the role different foods play in PCOS is in the post to which I just linked.

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Diet

If you are an overweight PCOS patient, I recommend that you eat low carbohydrate (specifically fructose) to decrease insulin and testosterone levels.  Try and stick to glucose and safe starches when you do eat carbohydrates.  These include potatoes, sweet potatoes, yams, and white rice.  Fixing the metabolic syndrome that may be the causative root of your PCOS is a bit more complicated than this, but people seem to have success with this method across the board.  Low carbohydrate diets tend to mitigate insulin signalling problems, which in turn helps with PCOS.

If you are an overweight PCOS patient, also, try fasting.  Fasting, especially for people with overburdened metabolisms who are trying to lose weight, increases insulin sensitivity and helps the weight slide off.

If you are a thin PCOS patient, eat high carbohydrate.  Carbohydrates elicit a greater leptin response than fat.  Leptin is responsible for telling your hypothalamus that you are well fed.  If you are someone who often feels hungry or who recently lost weight, you may want to seriously consider this idea.  If your body thinks it is starving, it will not perform reproductive functions.

Similarly, if you are a thin PCOS patient, do not fast.  Fasting decreases leptin levels.

If you are a hypothyroid PCOS patient, eat a high carbohydrate diet, at least 50 percent of calories, a la Ray PeatChris Kresser and PHD.  This is because glucose is necessary for the conversion of T4 into T3 in the liver.  Without glucose, less T3 is synthesized, such that many cellular functions, such as reproduction, slow down.

Don’t eat fructose.  For overweight PCOS patients, fructose can inhibit leptin signalling and make you hungrier.  Fructose is significantly, insidiously implicated in weight gain.  For thin PCOS patients, fructose directly inhibits the reception of leptin in the hypothalamus.  This is another factor that makes it difficult for the body to perceive whether or not it is being fed.

Don’t eat soy.  Soy is the most potent phytoestrogen.  Not only does soy beget PCOS by hindering the production of true estrogen, but it is also implicated in reproductive cancers.

Don’t eat legumes, which also contain phytoestrogens.  This means all forms of beans and peas.

Don’t eat dairy.  It’s androgenic.   Having too many androgens in the bloodstream is one of the primary drivers of PCOS.

Lower the amount of cruciferous vegetables you eat (if you eat them a lot).  Brassica plants activate an enzyme (cytochrome P450 enzyme CYP1A2) in the liver which clears estrogen out of the body.  Additionally, if cruciferous vegetables are consumed often in the raw form, they act as goitrogens and can decrease thyroid function.

Eat plenty of fat.  Fat is crucial for the production of hormones.   And cholesterol.  Cholesterol is one of the root molecules in endocrine production.  Good fats to focus on are the monosaturated fats–olive oil, avocado, and macadamia oil–and saturated fat in the form of coconut oil or organic animal products.

Steer clear of Omega 6 PUFAs.  Omega 6 fats are associated with increased testosterone levels in both women and men, in addition to causing excessive inflammation.  This means limiting soy, canola, rapeseed, vegetable, and corn oils.  Nuts in their natural form should also be avoided because they are primarily omega 6 fats, and also because they contain phytoestrogens.

Eat grapefruit.  Grapefruit inhibits the enzyme CYP1A2 I mentioned above that clears estrogen out of the body.  This is a nice trick to increase estrogen levels, but note also that it is not a permanent fix, and that the activity of enzyme CYP1A2 is still crucial for your health.

Eat magnesium rich foods to increase insulin sensitivity.

Eat beta carotene containing foods to increase progesterone levels.  The corpus luteum has the highest concentration of beta-carotene of any organ in the body, suggesting that this nutrient plays an important role in reproductive processes.

Eat foods good for the liver.  The best are high in choline, such as eggs and organs.

Eat organic meat or wild game, not factory farmed meat, as often as possible.  The hormone levels are guaranteed to be natural and to disrupt your system as little as possible.

Drink spearmint tea.  It’s fairly highly regarded as a testosterone blocker.

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Supplement

Honestly, in my personal experience, I have rarely witnessed benefits from supplements.   In fact, the biggest changes I experience are usually negative and from overdoses, probably because I eat a rich enough diet already.  So if you eat a range of vegetable and animal products, supplementation should not be too much of an issue.    If you want to supplement for general health, I recommend checking out the Jaminet’s list of supplementation in their book, or which can be figured out over at their blog.   Please use the organic (that is, carbon-based), chelated forms of any mineral supplements you take.  Magnesium oxide, for example, is something you do not want to take because it’s basically eating crunched up metals.  Instead, take a form of magnesium that is “bio-available,” or “chelated,” which means that it is a part of a molecule your body can actually use.

Supplementation to correct specific deficiencies, however, can be very helpful.  If you’re worried specifically about your ovaries and your fertility, here is a list of supplements I have witnessed being efficacious:

Iodine
On his podcast, Robb Wolf  recommends that women with PCOS or androgen-dominant type symptoms try to boost their thyroid functioning with iodine supplementation.  His clients are apparently satisfied and ‘healed’ by taking iodine.  If you really suspect your thyroid in your pathology, however, I recommend getting your blood tested for levels of TSH, T3, and T4 at least before proceeding.   Iodine can help with hypothyroid, especially if its an iodine deficiency causing the problem, but iodine can also hinder thyroid functioning in clinical hypothyroid cases, especially if the underlying problem is the autoimmune disease Hashimoto’s thyroiditis rather than a simple iodine deficiency.

Chromium 
Chromium helps to encourage the formation of glucose tolerance factor which is a substance released by the liver and which is required to make insulin more efficient. A deficiency of chromium can lead to insulin resistance.  Because of this, it is the most widely researched mineral used in the treatment of overweight.

Selenium
Selenium is crucial for thyroid functioning.  Try eating one or two brazil nuts each day– they are supposed to be better supplements than the pills themselves.

B vitamins
Vitamins B2, B3, B5 and B6 are particularly useful for controlling weight, and here’s why: Vitamin B2 helps to turn fat, sugar and protein into energy. B3 is a component of the glucose tolerance factor (GTF), which is released every time blood sugar rises, and vitamin B3 helps to keep the levels in balance. Vitamin B5 has been shown to help with weight loss because it helps to control fat metabolism. B6 is also important for maintaining hormone balance and, together with B2 and B3, is necessary for normal thyroid hormone production. Any deficiencies in these vitamins can affect thyroid function and consequently affect the metabolism.

The B vitamins are also essential for the liver to convert your ‘old’ hormones into harmless substances which can then be excreted from the body.

Zinc
Unfortunately, because our soil has been depleted by overfarming, there is very little natural zinc found in our food. Furthermore, processing and refining strip out what little might be remaining. So no matter how good your diet, you may not be getting anywhere near the levels of zinc that you need. There are two approaches to this: you can eat whole organic food, which has much more rigorous controls on farming methods, or you can add a zinc supplement to your diet. But why is it so important?

Zinc is an important mineral for appetite control and a deficiency can cause a loss of taste and smell, creating a need for stronger-tasting foods.  Zinc is necessary for the correct action of many hormones, including insulin, so it is extremely important in balancing blood sugar. It also functions together with vitamins A and E in the manufacture of thyroid hormone.

Magnesium
Magnesium levels have been found to be low in people with diabetes and there is a strong link between magnesium deficiency and insulin resistance.

Co-Enzyme Q10
This is a vitamin-like substance that is contained in nearly every cell of your body. It is important for energy production and normal carbohydrate metabolism.  Co-Q10 has also been proved useful in controlling blood sugar levels.

Boron?
Word of mouth recommends taking boron, or eating apples, which contain boron, to boost estrogen levels, but I can’t find any scientific research endorsing this is a solid idea.

Herbs 

Agnus castus (Vitex/chastetree berry)
Chasteberry anecdotally helps to stimulate and normalise the function of the pituitary gland, which controls the release of LH and FSH, which signal the menstrual cycle.

Saw Palmetto (Serenoa repens) 
Saw palmetto is an herb that is traditionally considered in light of its success in treating prostate problems caused by an imbalance of hormones (including excess testosterone). It is a small palm tree found in North America and the berries of the tree are used in tinctures or capsule form.  Research has shown that saw palmetto works as an anti-androgen, which can be very helpful given the high levels of testosterone in PCOS.

Milk Thistle (Silybum marianum)
This is one of the key herbs for the liver. It helps to protect your liver cells against damage and to promote the healing of damaged cells, so improving the general functioning of the liver and all its detoxifying properties.

Spearmint tea also counts.  The mechanism is unknown, but spearmint tea has been shown to significantly reduce circulating free testosterone levels in women with hyperandrogenism.

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Exercise

Exercise is an excellent way to increase insulin sensitivity and promote metabolic fitness.

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Sleep

A great deal of healing and hormone production takes place.  During the night, when cortisol levels are low, and when the body is recharging, enables the hypothalamus and pituitary glands to send their signals to reproductive tissues uninterrupted.

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Optimize thyroid function

If you have hypothyroid, or even subclinical hypothyroid, try addressing this issue before getting on different PCOS medications.  Hypo- or subclinical hypo- thyroidism os often the underlying cause of reproductive failure.  To understand more about hypothyroid and PCOS, see my recent post on PCOS pathology.   

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Blood sugar medication: Metformin

Metformin is for many people a wonder drug.  Most everyone on the standard American diet I believe could take the drug and see an improvement in metabolism.  Metformin prevents the uptake of sugars in the gut, and it improves the efficiency of the insulin response, thereby creating greater insulin sensitivity and reduced testosterone levels.  Metformin is great for overweight women with PCOS who also tend to be insulin resistant.  Metformin is usually used to treat diabetes.

Metformin has also been shown to decrease testosterone levels even in PCOS patients who don’t test positive for insulin resistance.  Metformin may directly impede the production of testosterone in the ovaries.   Personally, I am a lean woman who doesn’t test positive for insulin resistance.  I took metformin for six days and ovulated for the first time in a year.

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Birth control pills

Yaz, Yasmin, and Ortho-try-cyclen are popular choices.  But there’s a lot out there on birth control and I will write about the various options and implications of them all as soon as I can.  Birth control is effective in “treating” PCOS by increasing either estrogen or progesterone levels, though usually both.  However, birth control doesn’t solve the underlying issue.  In fact, many women experience even greater dysfunction in their cycles once they go off the pill.   As one popular example, some women began taking birth control as teenagers.  They continued taking it until they want to have babies, yet once they got off the pill, they found themselves breaking out for the first time in decades and unable to conceive.    Birth control pills are great for mitigating PCOS symptoms, but they will never make you more fertile, and they rarely restore hormonal balance.

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Progesterone

Women who don’t menstruate are proscribed progesterone medications by their doctors in order to induce menstruation.   How it works is that these women take progesterone pills for ten day.  A week later, as the progesterone levels fall, estrogen levels rise, and the pituitary and ovaries read this as a signal to shed the corpus luteum.

Because amenorrhea increases the risk for endometrial cancer, amenorrheic women are advised to induce menstruation every few months.   Some go years without ill effects, and this depends on each individual’s PCOS pathology and hormone levels.  Progesterone also might help jumpstart your system back into more normal health, such that you can take it for a while and then afterwards have achieved enough of a cycle to continue functioning without progesterone. This is a good thing to do if you are trying to balance your  hormones via a more natural method, such as eliminating soy from your diet or losing weight.

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Antiandrogens

 These are my favorite medications, mostly because they have served as a great crutch while I work on the rest of my issues.  Metformin is technically one of these, but other good options are spironolactone and flutamide.  Spironolactone is the safer and more efficacious of the two, so almost everyone pursues this option first.

Antiandrogens act to block or inhibit testosterone activity in the body.  For this reason, they are often proscribed for acne or hirsutism, helping women cope with these nasty issues while they try to sort out the rest of their endocrine health.

Spirionolactone, in particular, is interesting.  It is normally proscribed for high blood pressure, but it is proscribed off label to help women reduce their testosterone levels.  Spiro is shaped very similarly to testosterone, so it sits in receptor sites and blocks activity.  This is why it’s so effective against acne.  Additionally, it helps prevent testosterone production itself by inhibiting 17α-hydroxylase and 17,20-desmolase, which are enzymes in the testosterone biosynthesis pathway.

With Spiro, estrogen levels increase via enhancing the peripheral conversion of testosterone to estradiol and by displacing estradiol from sex hormone-binding globulin (SHBG).  Spiro actually decreases serum testosterone and increases serum estrogen levels.  I really can’t speak more highly of it.  The one great issue is that it creates birth defects, since testosterone is completely blocked, so Spiro absolutely cannot be taken during pregnancy.

Perhaps most importantly, Spiro has an excellent success rate with getting women to ovulate.   In this study, 11 out of 13 women began ovulating after a few months of treatment.

Spiro decreases testosterone activity in the body.  For this reason, it is an excellent treatment for hyperandrogenic symptoms such as hair loss and hormonal acne.

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Ovarian Drilling

        Ovarian drilling is exactly what it sounds like—in this course of treatment, a woman lays on a table and a doctor inserts a microdrill through her abdomen and into the ovaries, creating tiny holes.  These holes puncture the thick endometrium of amenorrheic women and reduce testosterone production.  Ovarian drilling to me seems like a great option, but the complications if something goes wrong include permanent infertility.  For this reason, many people leave this option as a last resort.

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For more information on PCOS, I would direct you first to Pubmed, to the Journal of Endocrinology, and also to some PCOS support forums such as soulcysters.net or www.hormonehelpny.com.

A final relevant point is that OB/GYNs are decent doctors for PCOS, but the best specialist to see is a reproductive endocrinologist.   This is my personal area of expertise, but I cannot provide you with the full range of testing that certified reproductive endocrinologists can.

I’ve read a lot about PCOS, but not everything, and this is really a summary of everything, more or less, that I’ve discovered.  In any case, my hope is you’ll hop on google and figure out how to tailor my starting points to your own needs.  That has been my greatest lesson with PCOS.    It’s all about experimentation, your own body, diligence, and patience.   

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For more information on PCOS, why you have it, and how to overcome it, check out PCOS Unlocked: The Manual, the multi-media resource I created in order to share all the PCOS information and experience I’ve amassed in my brain, and apply it to solving the unique case of your PCOS.

Here!

 

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Managing director of Paleo for Women and author of Sexy by Nature.

30 Comments

  1. So glad I found your site – wealth of information here that I’m looking forward to reading! This article in particular is very useful to me. I appreciate how comprehensive your treatment options are. Thanks!

    • Hah, yes, I should go back and edit them. Today I am feeling much less charitable about medical treatment options as I was when I wrote that article. :)

  2. I love all of your suggestions above, and have been eating a paleo type diet for about a year and have seen some positive changes. I am kinda confused about whether I fall into a “thin” or “overweight” model of PCOS… I am 5’6″ and 135 lbs… which I figure is pretty “normal.” What does someone with an “average” weight do for PCOS – practice fasting/low carb to control insulin or eat carbs and not fast? Perhaps I need to keep experimenting with myself.. at this point I follow a pretty moderate approach, no fasting and pretty moderate carbs for a paleo diet (which is probably still pretty low carb compared to a standard american diet).

    • Hi Kristin,
      I would recommend first and foremost getting your blood tested and such to see where you lie. Perhaps– I will definitely write a post on this soon. but when I say “thin” or “overweight” PCOS it has as much to do with hormone levels in the blood as it does with weight status. Your diet sounds good. If you test for insulin resistance, and if you have the typical PCOS LH/FSH ratio inversion, this is an indicator that you produce too much testosterone via insulin effects, so you would definitely want to pursue fixing that problem, whatever that would entail for you. Low carb in that case may be something you want to play with, though I recommend listening both to your body and to your doctor far and above me in that regard.
      My recommendation in moving forward is to stick with paleo meals–absent dairy– two – four meals each day, whichever you feel comfortable with, without any grazing in between. That should help sharpen insulin sensitivity if you are not already doing that. Exercise, too, sprint exercise, a few times each week will also help with insulin sensitivity.
      Stress reduction and the elimination of phytoestrogens–soy, nuts, seeds–and the improvement of sleep quality are also powerful usual suspects to try and get into line.

  3. There’s lots of great information here. When you say not to eat dairy, are you mainly talking about pasteurized, factory farmed dairy, or is all dairy androgenic? Would you recommend sufferers of PCOS stay away from all dairy, even grass fed, raw, fermented, etc? Thanks

  4. This is so helpful! I can’t believe i missed this when I first came to your site yesterday. It should have been the first thing I read! Anyway it is very clear and super helpful. I would say from personal experience that taking iodine is about the worst thing you can do for an auto-immune thyroid problem. I have Hashimoto’s and taking iodine will definitely make your symptoms worse. I’m glad to have clear, definite answers for diet though. I eat a grain and sugar-free diet, but now I am going to cut out fructose. I guess I’ll have to cut back on the raw cabbage salads, though. Either way it will be worth it to get better! Thanks again for all your info and good work.

  5. What do you mean by fructose? Do you include fruit in this category or do you mean added sugar?
    Also I’m not entirely sure what legumes include ;D (beans and peas, I guess, anything else?)

    I’m pretty sure I have PCOS. My doctor mentioned early on that I was at risk when I was a lot younger, and now I have all the symptoms. I’m 5’2, 145 :( and menstruate very rarely (maybe once or twice a year). I can’t really afford many of the supplements and my diet depends on what my parents buy (it took me so long to convince them to supply me with enough meat to do a Primal diet), so organic, grass fed is not even a possibility, despite my pleading (nor is it widely available where I live).
    What would you recommend?

    I’ve been Primal and VLC and even zero carb at one point, on and off, and I keep losing and gaining the same 20-15lbs. But it seems each time I need a loooooooong recovery period for my body to start losing weight (the first time I went Primal it took me 6 month to lose 10lbs).
    It seems like diets only work when they’re new. If I try the same one again, it just doesn’t work. It’s so frustrating! :(

    I really love your blog, by the way! So I’m reading all of it from the beginning. I was apprehensive at first, because right now loving my body, my face, my self doesn’t seem feasible :(. But your story really sounds like mine, the PCOS, the acne, the overweight. So I really consider you as a role model!

  6. What kind of low-carb vegetables do you recommend? When I think of low-carb meals, I think of meat/seafood, fat, and green leafy (cruciferous) vegetables. What do you suggest, instead, for those in the overweight PCOS camp?

    Thanks!

    • all of them. :) literally. they’re all fair game. When I recommend people go on an insulin-sensitizing diet, I do not mean that they go to zero carbohydrate. I mean that they eat lowish/reasonable carbohydrate. Some potatoes certainly will not be bad for you, and ALL varieties of vegetables are fair, healthy game.

      • Thanks! Should make for fun trips to the farmers market!

        So I take it that grapefruit is low enough in carbs and fructose for those who are overweight?

        Also, I notice that you don’t mention fish oil supplements. What’s your opinion of them?

        I recently discovered your blog and it’s fantastic! Thank you for what you are doing!

  7. Do you have any specific research on the dairy/androgen issue? I was discussing your recommendations with my husband and he does not understand how androgens being present in the milk would transfer to being in the human bloodstream. All his research and schooling in nutrition indicates that since a hormone is only a cholesterol your body will process it as a saturated fat (same concept as eating dietary cholesterol does NOT correlate with blood cholesterol). Your blog posts have generated several conversations about PCOS and diet but this is one of the big points he cannot understand based on his knowledge of the topic.

    • Thank you, Rachel. I agree with you that this is one of the weaker points of my arguments, but I still stand by it, based on anecdote, theory, and some evidence. It is based, first, on anecdotes, finding that even small amounts of dairy for women who have PCOS and/or high testosterone or DHEA-S levels leads to acne. In addition to the anecdotes, which of course wouldn’t support a “hormone in dairy theory,” theories/speculation based on the presence of natural hormone levels in dairy as well as on growth hormone injections float widely in homeopathic dermatological circles. To back that up in a totally “I’m busy and doing my best” sort of way I just googled “hormones dairy” and came up with an article from Harvard Gazette with a milk researcher, http://news.harvard.edu/gazette/2006/12.07/11-dairy.html. A more scientific approach is found in this article, which is old but refers to the potential for IGF, estrogen, progesterone, etc, to interact with the human body in such a way as to promote cancer. http://www.sciencedirect.com/science/article/pii/S0306987797901109 I would argue that if these hormones can promote cancer, they can do other things as well.

      Secondarily, I am not sure I agree with your assertion that hormones are processed as a saturated fat. What of the case of xenoestrogens? Those are ingested hormones and they seem to play a significant role in both rodent and human fertility models, in a wide variety of studies.

  8. Are you taking clients? Can you point me to someone who is? I need more help with this.

  9. Hi Stefani,

    I have a question. You said that an overweight PCOS patient should eat a low car diet but a hypothyroid PCOS patient should eat a high carb diet. What if I am an overweight hypothyroid PCOS patient? What do I do?

    • Is fasting still safe for me?

    • low-ish carb should be just fine for you :) 50-150 g / day is a healthy range I think

  10. My issue is a little different. I have PCOS, but I have high estrogen, high DHEAS, low 17-OH progesterone, and low cortisol. Testosterone (free and total) is normal, as is regular progesterone. I’m not overweight (anymore. Was on the chubby side most my life. Lost weight several years ago. Have kept it off since, and have been following a paleo-ish diet for several months). My fasting glucose and insulin are both normal. It’s rather hard to decipher what my diet and supplementation might ideally look like, especially on the carb front! Any thoughts?

  11. Hello thankyou for this great site ,I was wondering wether or not HGH ingection will help with pcos .I have it but I am on the lean side I am 5’7 and 52 kg I have a hard time keeping weight on and I also have excess hair this started really possing a problem after I was ingected with depo provera my symptoms got worse they seem to drop off when I am pregnate and both pregnacies have been boy’s .I was able to grow my nails my skin cleared up and my hormones feelt great and then about three mths after bebies were born I developed post natel and post pardom depression.I was wodering if it would help this rolercoaster is getting a bit ridiculas .thanks again for your time

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  13. A low-carb diet is generally used to lose weight. Some low-carb diets say that they have health benefits beyond weight loss, such as reducing risk factors associated with heart disease, certain cancers, diabetes and metabolic syndrome. .*.,

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  14. Stefani, I can’t thank you enough for your thoughts re complex carbohydrates and no fasting for thin-pcos, non-insulin resistant women. ***Please*** try to get this point out to as many women as possible! My body seemed to think it was starving, even though my calorie intake was very high. Adding back carbs, something very few seem to advocate, is so simple, yet effective.

    • I am doing what I can, Lynne! I know — I am super passionate about this as well. I am glad its working for you, thank you so much for sharing.

  15. Hi Stefani, my niece is thin, very depressed now since she ahas all the symptoms, so what kind of diet do you recommend? How about the paleo or primal? I read you said for thin, high carbs, but these diets say no carbs, and they claim to cure pcos with their diets, so very conflicting! please explain!

    • Depending on the type of PCOS your niece has, I would recommend a different take on carbohydrates. If she struggles with being overweight and/or insulin resistance, I recommend a paleo diet with reasonably limited carbohydrate intake. If, on the other hand, she is quite thin and exercises a lot, I recommend keeping carbohydrates in the moderate range. This is because limiting carbohydrates can help improve insulin signalling and reduce testosterone levels, so its great for women who have excess hormones, but women who have historically starved themselves or been too stressed need more of that “I’m fed” signal from carbohydrate intake.

      • Thanks Stefani, but why do people who have done the primal and paleo claim the diet helped them so much and no carbs? I guess they were all overweight. Yes my niece is now below weight, very stressed out and sad, so I am trying to help. So I suggest her doing the paleo, with addition of which carbs do you suggest?

  16. Hi Stefani,
    I bought your manual this summer and was ready to tackle my PCOS but now I am slightly confused! I’m 5’4″, 135 lbs with 19% BF, chronically low blood pressure, and no insulin resistance at all. I have been doing Paleo for about a year with vast improvements in acne and bodyfat%. My extreme facial hirsutism, which causes lots of ingrowns and hyperpigmentation, is slowly being tackled with this new lifestyle and electrolysis treatments. Moreover, my cysts are all gone! However, my testosterone is high. And that is the only abnormality I have. No problems with estrogen, LH, FSH, progesterone, T3, T4, or TSH. I take NAC and spearmint tea and iodine to hopefully help my ingrown facial hair and testosterone but it is very slow going. I was diagnosed, interestingly, with PCOS after losing about 50 lbs. That’s when the facial hair issue first began and what made me get an ovarian ultrasound for PCOS diagnosis. My question is: I am a “normal weight” PCOS patient with no metabolic/hormonal issues besides high testosterone. I don’t fit neatly into any of the PCOS subcategories outlined in your manual. What is the ideal macronutrient ratio and exercise plan for me? (I currently eat 50% fat, 30% protein, 20% carb with at least 25 g of fiber, and workout 5-6 times a week: usually 5-6x a week body-part specific lifting with 4x a week steady state cardio, or 3-5x a week HIIT if I can’t make it to the gym). i’m currently a 2nd year medical student, hoping to go into primary care, so I would definitely love to be as educated on PCOS not only for myself, but for my future patients.

    • Hi Janelle, please feel free to respond to this comment @ stefaniruper@paleoforwomen.com. I have one question: has your DHEA-S been tested? I would guess – but of course this is a big guess – that your DHEA-S may also be elevated. In women who exhibit PCOS after weight loss, this is often the case. That’s because the male hormones have leapt up in response to stress, and particularly DHEA-S, as it is a stress hormone in and of itself.

      With how much you work out, I am not sure that even making sure you eat 20 percent carb is enough. It seems to me as though your body is in a bit of panic — much like mine was — as it is adjusting to your new body fat levels, but more importantly as you experience perhaps a fair amount of stress as a result of your high amount of exercise. Being a med student, I am inclined to think you live under a fair amount of psychological stress and sleep deprivation as well, which exacerbates that problem, and I’d drop you square in the category of type II PCOS, from this incredible distance and with so little information, of course, being the important caveats.

      Anyway – Please let me know what you think via email. I am super happy to keep talking about this and working through it with you.

  17. love this its def helpful…was diagnosed with pcos when was 13 am 25 now and me and my husband want kids ive lost 70lbs in the past 6 months all my blood work is normal except my testosterone is to high so i dont mestrate my endo dr put me on 750 mg metformin 2x daily havent really been noticing diff i excersise daily bout an hr so my question is what kind of diet shld i be doing…oh and i take a prenatal too any info wld be great

  18. I am doing what I can, Lynne! I know — I am super passionate about this as well. I am glad its working for you, thank you so much for sharing. friv 2

  19. A lot of the Do’s & Don’ts you mentioned are accurate, but what you said about legumes and and cruciferous vegetables is the exact opposite of what is true.

    Other than soy–which is terrible for you, like you said–beans are actually very beneficial to managing estrogen levels and so are cruciferous vegetables. Broccoli for example is well known for being one of the most beneficial vegetables for managing pcos symptoms.

    I’m not sure where you’re getting your info, but there is a book called “The Anti-Estrogenic Diet” by Ori Hofmekler that you should read. It’s incredibly informative and he references many scientific studies for proof of this.

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