The Ishbelwell Approach to Managing PCOS

When faced with a PCOS diagnosis, I defied the odds and embarked on a journey to restore my health and mitigate my risk factors. In this article I share the Ishbelwell approach to tackling PCOS through holistic strategies.

When I was diagnosed with PCOS, I was told I would never be able to get pregnant naturally.  I was told I would be obese (and that the reason it took so long for me to be properly diagnosed was because I wasn’t obese).  

I remember leaving the doctor’s office after I was diagnosed with “Frank/Classic” PCOS, and I sat in my car with Dr. Google.  I read all of the statistics.  I called my husband (who at the time was my boyfriend), and I told him that I may never be able to get pregnant unless we were willing to take exceptional measures.   

If you’ve ever been “diagnosed” with something you probably understand how I felt.  

I was in shock, and I had a lot of questions that didn’t have easy answers.  It took me a few days to wrap my mind around the statistics, and to shift from a state of shock to a state of refusal.  

I stubbornly refused to accept that I would live with the laundry list of symptoms PCOS presented me with.  

At the time I was suffering from chronic fatigue, severe constipation, nonexistent menstrual cycle, stubborn weight gain, severe hormonal symptoms like PMS and depression and oh yes, my favorite – facial hair.  I sought out physicians who specialize in hormone imbalances, and I was offered diabetes medication and birth control.  

Here’s where my stubborn refusal kicked into full gear.  I thought to myself  “There is absolutely no way in hell that I’m going to live with these symptoms for the rest of my life.”  

I put my Nutritional Therapy training to work for me, and I doubled-down with more education.  I took courses specifically on gut function and learned how to use stool testing.  When I ran my first GI Map on myself, I had the highest levels of candida I’ve to this day ever seen on a GI Map.  (As an aside, candida is naturally-occuring, however, when it grows out of lab normal range, it can cause significant digestive and endocrine symptoms.) 

At this point in my life I hadn’t gotten in my period on a regular basis in over 7 years. Within one month of starting my gut healing protocol, my period returned and it’s come back month after month all of these years later.

Can you even fathom how incredible that was for me?  It absolutely blew my mind.  

And life just kept getting better from there.  After I finished my gut healing process, I went on to test my hormones.  I discovered that my progesterone levels were very low and my DHEA and testosterone levels were high.  

I presented with a classic PCOS hormone pattern, and I wasn’t ovulating which I knew would set me up for health issues down the road.  (Keep reading below to learn why that is).  

I created a hormone protocol for myself, and within 2 months of following that protocol I started ovulating again.  

I used a Continuous Glucose Monitor which helped me to understand how sensitive my blood sugar balance was to carbohydrates – an absolutely crucial aspect of managing PCOS which I have found is almost always overlooked by most practitioners! 

Navigating PCOS Challenges

Discovering I had PCOS was overwhelming, but I refused to accept its limitations. From fertility concerns to hormonal imbalances to a 50% increased risk for heart disease, cancer and diabetes, I confronted PCOS head-on. I know first-hand how challenging it is to manage a condition that seems to be constantly changing. PCOS requires next-level self-care and daily upkeep which I am more than willing to do because my quality of life depends on it.

Holistic Healing: The Core Priorities

• Gut Function: address the balance between probiotic load and dysbiotic bacteria with an emphasis on eradicating dysbiotic bacteria populations and correcting functional irregularities. 
• Month-long hormone panel: a one day hormone panel is not nearly enough information to understand the female hormone cycle.  
• Diet Deep Dive: understand what foods you’re sensitive to as well as understand what food combinations you need to follow to balance blood sugar. 
• Continuous Glucose Monitor: diabetes is a serious risk for people with PCOS.  Oftentimes, traditional blood sugar markers like the A1C miss crucial blood sugar abnormalities, and this can have a huge affect on quality of life.

1. Gut Function: Uncover the pivotal role of gut health in PCOS management. Restore balance, eradicate dysbiotic bacteria, and correct functional irregularities.
2. Comprehensive Hormone Panel: Move beyond surface-level assessments. Delve into the intricate female hormone cycle to uncover insights crucial for effective PCOS management. A one day hormone panel is not nearly enough information to understand the female hormone cycle which changes every day!
3. Dietary Deep Dive: Custom-tailored dietary approaches are key to offloading gut inflammation and chronic blood sugar imbalances.
4. Continuous Glucose Monitor: Decode the impact of blood sugar on PCOS. Gain insights into managing blood sugar abnormalities for enhanced quality of life. Diabetes is a serious risk for people with PCOS.  Oftentimes, traditional blood sugar markers like the A1C miss crucial blood sugar abnormalities, and this can have a huge affect on quality of life.
5. Functional Blood Chemistry Panel: Most annual physicals involve blood work, but these tests are oftentimes not nuanced enough to shed light on chronic symptoms of blood sugar, liver, hormonal and thyroid imbalances.

What is PCOS?

5-10% of women are affected by PCOS, a complex hormonal disorder with implications for fertility, metabolic health, and more. PCOS is a complicated hormonally-driven condition that involves imbalances in insulin, androgens (testosterone), estrogen, progesterone and other pituitary hormones that drive function from the brain to the sex organs. 

Because PCOS is becoming more and more common, you probably know someone who has it.

“…PCOS is a serious genetic, hormone, metabolic and reproductive disorder that affects women and girls. It is the leading cause of female infertility and a precursor for other serious conditions including obesity, type 2 diabetes, cardiovascular disease and endometrial cancer.” (PCOS Awareness Month)

Symptoms of PCOS: Decoding the Complexity

In 1928 two French doctors – Achard and Thiers – described a condition in which women presented with male features like facial hair and a receding hairline along with type 2 diabetes.  Further studies proved the link between PCOS and type 2 diabetes which was delineated in the groundbreaking article “Diabetes of Bearded Women”.  

Like so many diseases that exclusively impact women, very little research has been dedicated to understanding PCOS. In 2003 the second international conference on PCOS occurred in the Netherlands, and the parameters for diagnosis of PCOS set forth in that conference are still what are used today.  

The Netherlands conference grouped patients into four different phenotypes: 

• Frank / Classic PCOS: chronic anovulation (not ovulating), hyperandrogenism (high testosterone) and polycystic ovaries (cysts around the ovaries). 
• Classic non-polycystic ovary PCOS: chronic anovulation (not ovulating), hyperandrogenism (high testosterone) and normal ovaries.  
• Nonclassic ovulatory PCOS: regular menstrual cycle, hyperandrogenism (high testosterone) and polycystic ovaries (cysts around the ovaries). 
• Nonclassic mild PCOS: chronic anovulation (not ovulating), normal androgens and polycystic ovaries. 

The Frank phenotype is considered the most severe and significantly increases the risk of obesity, type 2 diabetes, cardiovascular disease, high blood pressure and high cholesterol.  

On the other end of the severity scale, Nonclassic Mild PCOS are at the lowest risk for metabolic disease.  

PCOS can present with a range of symptoms and not all women have all of these symptoms: 

Diagnosing PCOS: Navigating Complexity

Pinpointing PCOS isn’t simple, but proactive steps can guide diagnosis. Combine pelvic ultrasound and comprehensive hormone tests for accurate assessment.

Not all women present with all of the symptoms of PCOS, and thus PCOS can be challenging to diagnose but it doesn’t have to be.  

If you suspect you have PCOS, ask your doctor for a pelvic ultrasound to look for ovarian cysts AND a hormone test to measure testosterone levels.  

Keep reading to understand why a blood hormone test will help you to identify whether or not your testosterone levels are high, but it will not provide you with the nuanced information about how other hormones (especially progesterone and estrogen) are impacting the development of PCOS.  

Navigating Health Risks: PCOS and Associated Conditions

From diabetes to heart disease, PCOS can have far-reaching implications. It’s important to empower yourself with knowledge about the potential health risks linked to PCOS so that you can proactively mitigate your risk.

Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:

• More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40. Abnormally high levels of insulin promote the production of androgen hormones (testosterone) and aggravate the ovarian chronic inflammatory response.  
• The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.  A 2010 consensus found the risk was 70 – 95% higher in women with PCOS.  
• Insulin resistance develops in 40% of women with PCOS, and the risk increases with age. 
• Women with PCOS are at greater risk of having high blood pressure.
• Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
• PCOS sufferers can develop sleep apnea. This is when breathing stops for short periods of time during sleep.  Sleep apnea is 30 times more likely in women with PCOS.  
• Non-alcoholic fatty liver disease.  Approximately 30% of women with PCOS have evidence of liver damage. 
• Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.
• Women with PCOS are three times more likely to develop endometrial cancer and two to three times more likely to develop ovarian cancer. 
• PCOS is considered the cause of about 80% of cases of anovulation (not ovulating).  Because of this there is an increased risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer. 

“Women with PCOS should be screened for type 2 diabetes using an oral glucose tolerance test every three to five years.  Measuring fasting glucose alone may miss the diagnosis of up to 80% of prediabetic patients and 50% of diabetic patients.  If cardiovascular risk factors exist, the screening should be done annually so the disease can be diagnosed at an early stage when lifestyle measures such as dietary changes can prevent damage to the body’s major organs.”  (Pateguana, Fung.  The PCOS Plan. Greystone Books, 2020) 

Many women with PCOS choose to be involved with polycystic ovary syndrome support groups to gain support and knowledge from other women going through similar symptoms and situations. Understanding what others are going through can be a great help in managing PCOS.

PCOS, Immunity, and Gut Health: New Perspectives

Emerging research is connecting immune dysfunction to PCOS. The intricate interplay of inflammatory markers, immune function, hormones, and gut health all impact PCOS development and management.

Recent research suggests that PCOS may be in part driven by immune system dysfunction.  Inflammatory markers like C-reactive protein (CRP) and interleukin-17 (IL-17) have been found to be at much higher levels for women with PCOS which can cause a chronic inflammatory state.  

A month-long hormone panel is essential for understanding how estrogen, progesterone, testosterone and other pituitary hormones are influencing PCOS.  Estrogen dominance is a common PCOS pattern, not to mention causes insufferable symptoms like weight gain, PMS and intense mood swings.  A one-day hormone panel is commonly used for testing female hormones, but this approach is insufficient and does not reflect the eb and flow of hormones over the course of a woman’s menstrual cycle.  

Research is showing that both estrogen and gut function impact the development and intensity  of PCOS: 

“During PCOS, immune cells and immune regulatory molecules play critical roles in maintaining metabolic homeostasis and regulating immune responses. Because of oligo/anovulation, patients with PCOS have low progesterone levels. Therefore, low progesterone levels in PCOS overstimulate the immune system, causing it to produce more estrogen, which leads to a variety of autoantibodies.

PCOS is a complex endocrine metabolic syndrome, and its pathological process also shows close association with the changes of intestinal flora. The disorder of intestinal flora in PCOS causes metabolic diseases and affects immune function and gene expression. Intestinal microorganisms can resist pathogen invasion, stimulate intestinal mucosa and humoral immunity, and produce tolerance. Intestinal flora can balance the systemic immune response by inducing a systemic chronic inflammatory response, interfering with insulin receptor function, and increasing androgen and interfering with follicular growth.” (Luan, Zhang, Peng, Li, Liu, Yin, 2022) 

My clients know my mantra very well “Gut health comes first.  Everything else comes after.”   For this reason, I won’t allow new clients to enter my Hormone Healing Program without first completing my Gut Healing Program.  With the majority of my clients, about 50% of hormone-related symptoms significantly decrease or disappear by the end of the Gut Healing Program.  Furthermore, it may surprise you to know that about 50% of my clients who struggle with hormonal imbalances never move on to the Hormone Healing Program because their symptoms were entirely resolved in the Gut Healing Program.  

The PCOS Mindset

If you have PCOS, it’s important that while you are caring for your physical body, you are also caring for your mindset. Managing a chronic condition can be mentally and emotionally hard, and learning how to promote a mindset of curiosity and empowerment will help you to weather the ebbs and flows of the healing journey.

Don’t give up. You’ve got this!