Understanding PCOS: Symptoms, Causes & Solutions | Insights from Dr. Felice Gersh

Polycystic Ovary Syndrome (PCOS) is often misunderstood and underestimated, despite being the most common female endocrine disorder affecting reproductive-aged women worldwide. This comprehensive article dives deep into the complexities of PCOS, its foundational causes, symptoms, and effective lifestyle-based solutions. Drawing from the expertise of Dr. Felice Gersh, a dual board-certified OB-GYN and Integrative Medicine specialist, we explore the intricate relationship between estrogen, metabolism, inflammation, and the impact of environmental factors on women’s health.

What is PCOS and Why Does It Matter?

PCOS is a multifaceted syndrome characterized primarily by hormonal imbalances, particularly involving estradiol—the form of estrogen produced by the ovaries. At its core, PCOS reflects a state where a woman’s body functions with insufficient estradiol, affecting not only reproductive health but also the metabolic and immune systems. Every organ in the body contains estrogen receptors, highlighting estrogen’s critical role beyond reproduction. When these receptors are not properly activated due to low estradiol levels, it leads to widespread dysfunction.

Dr. Gersh emphasizes that PCOS is not just a reproductive issue; it’s a systemic metabolic disorder. This is why women with PCOS often experience symptoms that extend far beyond menstrual irregularities, including insulin resistance, chronic inflammation, and increased risk of cardiovascular problems.

The Journey to Understanding PCOS

Dr. Gersh’s personal journey with PCOS began with her own menstrual irregularities during medical school. Despite consulting top specialists who routinely prescribed birth control pills to regulate cycles, she felt something was wrong and was determined to understand the underlying causes. This personal experience fueled her passion for women’s health and shaped her approach to PCOS treatment, focusing on comprehensive care rather than symptom masking.

Her perspective challenges the common medical practice of prescribing oral contraceptives to “regulate” cycles. While birth control pills mask symptoms by shutting down ovarian function and replacing natural hormones with synthetic ones, they do not address the metabolic and inflammatory dysfunctions intrinsic to PCOS.

PCOS: Beyond the Surface Symptoms

Many women first encounter PCOS when they struggle with infertility or irregular menstrual cycles. However, the syndrome manifests with a broad spectrum of symptoms, some of which may be unexpected. Common symptoms include:

• Irregular or absent menstrual cycles

• Elevated androgens leading to symptoms like excessive hair growth (hirsutism), acne, and androgenic alopecia (female pattern baldness)

• Polycystic ovaries visible on ultrasound (though this is not a reliable diagnostic tool in adolescents)

• Chronic low-grade inflammation

• Metabolic issues such as insulin resistance and obesity

• Gingivitis and other signs of oral inflammation

• Mood disorders including anxiety, depression, and ADHD

• 
  

Dr. Gersh highlights that menstrual cycle irregularities are a vital sign of overall female health, much like blood pressure is for cardiovascular health. Disruptions signal that the body is not functioning optimally, and ignoring these signs can lead to serious health consequences.

The Role of Estrogen and Estrogen Receptors in PCOS

Estrogen is not a single hormone but a family of hormones, with estradiol being the predominant and most biologically active form produced by the ovaries. Every organ system contains estrogen receptors, which are diverse and vary in type and density throughout the body. This complexity means that simply supplying synthetic estrogen through birth control pills does not replicate the natural, pulsatile, and balanced effects of ovarian estradiol.

Dr. Gersh explains how estrogen is essential for mitochondrial function—the energy factories within every cell. It helps regulate the creation, utilization, and storage of energy, which is fundamental to life. Without adequate estradiol, mitochondrial function falters, leading to fatigue, poor metabolism, and increased inflammation.

Moreover, estrogen tightly regulates the immune system, balancing inflammatory responses to protect the body without causing excessive damage. In women with PCOS, this regulation is impaired, resulting in a chronic pro-inflammatory state that contributes to cardiovascular risks, insulin resistance, and reproductive challenges.

Environmental Factors and Hormonal Disruption

Exposure to endocrine-disrupting chemicals such as BPA (bisphenol A) and phthalates plays a significant role in the development of PCOS. These chemicals, found in plastics, receipts, and many everyday products, interfere with hormone receptors and disrupt normal endocrine function. In utero exposure to such toxins can alter fetal development, predisposing offspring to PCOS and related metabolic disorders later in life.

These environmental toxins contribute to receptor dysfunction, meaning even if hormones are present, they may not bind or work properly. This receptor insensitivity exacerbates the hormonal imbalances seen in PCOS and makes treatment more complex.

PCOS and the Microbiome Connection

Recent research reveals that PCOS is associated with altered microbiomes—not only in the gut but also in the vagina, skin, and mouth. The microbiome is a complex ecosystem of trillions of microorganisms that play a vital role in immune regulation, inflammation, and hormone metabolism.

Women with PCOS often have dysbiosis, an imbalance of good and bad microbes, leading to inflammation and increased susceptibility to infections such as bacterial vaginosis and yeast infections. The altered gut microbiome can cause “leaky gut,” where toxins leak into the bloodstream, further stimulating systemic inflammation.

Dr. Gersh stresses the importance of nurturing a healthy microbiome through diet, lifestyle, and targeted supplements like probiotics, which may help restore balance and reduce inflammation.

Metabolic Dysfunction and Cardiovascular Risks in PCOS

PCOS is fundamentally a metabolic disorder. Women with PCOS have altered glucose metabolism, insulin resistance, and a heightened inflammatory state that affects their cardiovascular health. Dr. Gersh points out that pregnancy can be particularly challenging for women with PCOS, as the heart must pump twice the blood volume, demanding high mitochondrial energy production, which is compromised in PCOS.

This energy deficit can lead to heart dysfunction, including mild diastolic dysfunction—a condition where the heart becomes stiffer and less able to relax properly. The chronic inflammation and vascular dysfunction in PCOS also increase the risk of hypertension, preeclampsia, and placental complications during pregnancy.

Common Misconceptions: Birth Control Pills and Metformin

While birth control pills are often prescribed to manage PCOS symptoms, Dr. Gersh makes it clear they are not a cure. These synthetic hormones suppress ovarian function and mask symptoms but do not restore metabolic health or resolve inflammation. In fact, birth control pills can exacerbate inflammation and increase the risk of blood clots, especially in women with PCOS who already have a pro-inflammatory state.

Similarly, metformin, a common medication used to improve insulin sensitivity in PCOS, has limitations. Studies show that metformin does not significantly reduce pregnancy-related complications and may have negative long-term effects on children exposed to it in utero, including increased metabolic dysfunction by age four.

Lifestyle Interventions: The Cornerstone of PCOS Management

The good news is that lifestyle modifications form the foundation of effective PCOS management. Dr. Gersh highlights several key areas:

Sleep and Circadian Rhythm

Women with PCOS often suffer from poor sleep quality and disrupted circadian rhythms, which exacerbate hormonal imbalances and metabolic dysfunction. Sleep hygiene practices are vital, including minimizing blue light exposure before bedtime, maintaining a dark and cool sleep environment, and aiming for at least 7-8 hours of quality sleep.

Light exposure in the morning helps reset the body’s internal clock, improving hormonal regulation and metabolic health. Avoiding night shifts or minimizing their impact is also important since circadian disruption mimics many PCOS symptoms.

Nutrition and Diet

A plant-based diet rich in polyphenols, fiber, and phytoestrogens supports gut health, reduces inflammation, and improves estrogen receptor function. Foods such as legumes, nuts, seeds, fruits, and vegetables provide powerful antioxidants and compounds that mimic estrogen’s beneficial effects without the risks of synthetic hormones.

Timing of meals is also crucial. Eating larger meals earlier in the day and minimizing late-night eating aligns with the body’s natural insulin sensitivity rhythms, improving glucose metabolism and reducing insulin resistance.

Exercise and Movement

Regular physical activity, especially high-intensity interval training (HIIT), boosts metabolism, promotes muscle mass, and improves insulin sensitivity. However, because women with PCOS may have joint inflammation or other health challenges, starting gradually and working with a qualified trainer is recommended to avoid injury.

Stress Management and Mind-Body Medicine

Chronic stress worsens hormonal imbalances and inflammation. Techniques such as meditation, guided imagery, progressive relaxation, and bodywork (massage, essential oils) can reduce cortisol levels and improve overall well-being.

Supplements and Targeted Nutrients

Dr. Gersh advocates for a thoughtful, personalized approach to supplementation to avoid the “pitis” (piling on too many pills) phenomenon. Key supplements for PCOS include:

• Myo-inositol:

  Improves ovarian function, estrogen production, and ovulation. It is preferred over d-chiro-inositol, which may block ovulation.

• Berberine:

  A plant alkaloid that acts as an insulin sensitizer and supports cardiovascular health, serving as a natural alternative to metformin.

• N-acetyl cysteine (NAC):

  An antioxidant that improves glucose transport and ovulation.

• Vitamin D:

  Important but should be supplemented cautiously, as it is fat-soluble and can accumulate.

• Coenzyme Q10 and Curcumin:

  Support mitochondrial function and reduce inflammation.

• Probiotics and Gut Support:

  Including glutamine and butyrate to restore gut integrity and reduce leaky gut.

Additionally, a high-quality prenatal vitamin with methylated B vitamins supports metabolic processes and prepares the body for healthy pregnancy.

The Importance of Preconception Health

Women with PCOS face higher rates of infertility and pregnancy complications including miscarriage, gestational diabetes, hypertension, and preeclampsia. Dr. Gersh stresses the importance of preconception counseling and optimizing health before pregnancy to improve outcomes for both mother and child.

Unhealthy maternal environments can lead to epigenetic changes in offspring, increasing risks of obesity, diabetes, ADHD, and even autism. Therefore, addressing PCOS comprehensively before conception is not only vital for fertility but also for the lifelong health of the next generation.

Final Thoughts: Hope and Empowerment

While PCOS presents significant challenges, Dr. Gersh’s insights offer hope grounded in science and integrative care. Understanding the root causes of PCOS, moving beyond symptom masking, and embracing lifestyle changes empowers women to reclaim their health.

PCOS is not a life sentence but a call to action—a complex syndrome requiring a multifaceted approach. With dedication to sleep, nutrition, movement, stress management, and targeted supplementation, women with PCOS can improve their metabolic health, fertility, and quality of life.

For anyone navigating PCOS, remember: defining the problem clearly is the first step toward effective solutions. The journey to health is a labor of love and self-care, and you are not alone.

For more information, watch this youtube video: