1670 ROUTE 34 N. 3R FLOOR SUITE 3C WALL • NJ 07727
1670 ROUTE 34 N. 3R FLOOR SUITE 3C WALL • NJ 07727

Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS): Understanding the Basics

Polycystic Ovary Syndrome, commonly referred to as PCOS, is a prevalent and multifaceted endocrine disorder affecting women of reproductive age worldwide. Characterized by a variety of symptoms such as irregular periods, excessive body hair, weight gain, and infertility, PCOS is more than just an ovarian condition; it represents a complex metabolic, hormonal, and insulin-related anomaly. The diagnosis of PCOS often involves various tests, including pelvic ultrasounds and blood work, aimed at detecting ovarian cysts and hormonal imbalances. Traditional treatments for PCOS typically involve lifestyle changes and medications like birth control pills and diabetes drugs, focusing largely on symptom management

A Metabolically Directed Approach to PCOS

Diving deeper into the treatment of PCOS, a metabolically directed approach offers a unique and comprehensive perspective. This approach, grounded in understanding the root metabolic causes of PCOS, shifts focus from merely treating symptoms to addressing the underlying factors contributing to the syndrome. Key elements include managing insulin resistance, inflammation, and hormonal imbalances through diet and lifestyle modifications. By embracing this holistic strategy, individuals can achieve a more effective and sustainable management of PCOS, potentially reducing long-term health risks associated with the condition such as type 2 diabetes and heart disease.

Symptoms of PCOS

  •  Irregular periods, missed periods, very light periodS
  •  Excess body hair
  •  Weight gain
  •  Male-pattern baldness
  •  Oily skin and acne
  •  Infertility
  •  Ovaries that are enlarged
  •  Cystic ovaries

Diganostic Tests

  • Pelvic ultrasound – to determine presence of ovarian cysts
  • Blood work – checking for elevated testosterone levels, estrogen levels, blood sugar levels, HgA1c, Insulin levels

Conventional Treatment for PCOS

  • “healthy diet”
  •  Birth control pills – to treat symptoms of painful cycles, and acne
  • Diabetes medication – to lower insulin levels
  • Spironolactone – to block high testosterone levels
  • Other drugs to treat other symptoms

Office on Women's Health (.gov)

There is no cure for PCOS, but you can manage the symptoms of PCOS. You and your doctor will work on a treatment plan based on your symptoms, your plans for having children, and your risk of long-term health problems such as diabetes and heart disease” Feb 22, 2021

The Mayo Clinic

The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may lower the risk of long-term complications such as type 2 diabetes and heart disease”

Root Causes of PCOS

A high carbohydrate, high sugar, low cholesterol, low saturated fat diet and chronic snacking (Edibolic Stress) This unhealthy diet increases your insulin secretion while simultaneously increasing insulin resistance Chronic inflammation secondary to chronic stressors including environmental illness (CIRS, mold) also increases insulin resistance High insulin and inflammation stimulate aromatase activity transforming testosterone and androstenedione into estrogen Therefore, most women with PCOS have high estrogen and high

Hippocrates 2,500 Years Ago

  • “All Disease begins in the Gut”
  • Every time you eat or drink, you are either enhancing your health or promoting disease

Root Causes of PCOS

Aromatase Transforms Androgens into Estrogens and Visa Versa

  • Aromatase activity is increased by excess insulin levels
  • Aromatase activity is increased by chronic inflammation
  • Therefore, a metabolically directed approach to treatment of PCOS includes a relatively low carbohydrate diet and treatment for chronic inflammation

Elevated Aromatase Activity Increases Production of Estrogens

There are Several Forms of Estrogen

  • The most potent Estradiol (2 alcohols)
  • The least potent Estriol (3 alcohols)
  • Intermediate potency Estrone (1 alcohol and 1 ketone)
  • These estrogens are then metabolized by various enzymes to produce estrogenic intermediates
  • The 4 hydroxy and the 16 hydroxy estrogens cause proliferation of estrogen sensitive tissues and are causative in PCOS

Some forms of Estrogen are more Potent than Others Diindolylmethane (DIM) can lower the Potency of Estrogen

Diindolylmethane (DIM)

  •  Diindolylmethane (DIM) is a natural compound that is found in cruciferous vegetables like broccoli, cabbage, cauliflower, and brussel sprouts. DIM has been found to have a wide range of potential health benefits.

Catechol O Methyl Transferase

  • COMT
  • An important enzyme that transfers methyl groups from one substance to another
  • Important for the metabolizing of hormones and neurotransmittors
  • Needed for the proper detoxification of estrogens
  • Adequate methyl groups need to be available for this transfer
  • Therefore, inadequate availablility of methyl groups

Specific Estrogens (Catechols) can be Metabolized by Catechol O Methyl Transferase (COMT) to Safer Metabolites


  • An important process in your liver
  •  Processes carbohydrates, therefore a high carbohydrate, high sugar diet can raise your estrogen
  • Helps detoxify both estrogen and testosterone
  • Dysbiosis (imbalanced bowel flora) increases glucuronidase levels which impede glucuronidationleadingtoelevatedestrogen

Estrogens can be Detoxifed by your Liver Through a Process Known as Glucuronidation


  •  What is the function of glucuronidation?
  •  The human body uses glucuronidation to make a large variety of substances more water-soluble, and, in this way, allow for their subsequent elimination from the body through urine or feces (via bile from the liver). Hormones are glucuronidated to allow for easier transport around the body.
  • Glucuronidation-Wikipedia

Progesterone Balances Estrogen

  • Many women have simultaneously high estrogen and low progesterone
  • This is known as Estrogen Dominance
  • Estrogen Dominance is contributing factor to developing PCOS

Estrogen Dominance Contributes to PCOS


  •  “All things are poison, and nothing is without poison; the dosage alone makes it so a thing is not a poison”
  • “The dose makes the poison”

Metabolic Imbalances Contributing to PCOS

  • Excess Alkalinity – contributes to insulin resistance
  • Parasympathetic imbalance contributes to excess insulin secretion
  • Ketogenic imbalance contributes to excess alkalinity and insulin resistance
  • Glucogenic imbalance depletes glucuronidation leading to increased estrogen

Thyroid Involvement in PCOS

  • Elevated Insulin and elevated estrogen, commonly seen in PCOS will contribute to Reverse T3 Syndrome
  • Reverse T3 syndrome leads to a functional hypothyroidism consequently exacerbating the weight gain, insulin resistance and fatigue seen in PCOS

Diet Myths

  • Myth -“Eating multiple small meals will boost your metabolism”
  • Fact – every time you eat, your pancreas secretes insulin
  • Myth – Saturated fat causes heart disease and obesity
  • Fact – Consuming saturated fats increases your metabolism and reduces inflammation

PCOS Overview

PCOS Treatment Summary

To learn more about Michael Rothman MD contact us today by giving us a call at (732) 268-7663, emailing us at [email protected] or by requesting an appointment online.

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