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September marks PCOS awareness month: an opportunity to shine a light on the challenges that countless women all over the world face.As a qualified naturopath with a special interest in women’s health, it’s a condition I see often amongst my clients; along with many other complex reproductive health issues and reasons for irregular periods, including the less-talked-about hypothalamic amenorrhoea (HA). So, I want to take the opportunity this month to build awareness and to unravel both conditions.
Both PCOS and HA have one thing in common: they share the same hallmark of irregular menstrual cycles. And, in turn, they both contribute to imbalanced hormones, and both impact a woman’s sense of health and wellbeing.
PCOS is characterised by hormonal imbalances causing excessive androgen production (which often triggers symptoms including acne and excessive hair growth), irregular cycles or amenorrhea (the absence of periods), and/or the presence of polycystic ovaries (ovaries with the appearance of numerous small follicles). PCOS can present very differently from person to person but is usually diagnosed when at least two of these three boxes are checked off by blood testing and ultrasound imaging. However, PCOS often commonly presents with other characteristics, including insulin resistance, weight gain, and fertility struggles. It is believed that the hormonal imbalances causing PCOS can be the result of a multitude of hormonal, genetic and even environmental factors.
On the other hand, HA occurs due to a disrupted hypothalamic-pituitary-ovarian (or HPO) axis. The HPO axis plays a crucial role in managing the body’s female reproductive system and its hormones – the hypothalamus and pituitary gland in the brain signal the ovaries to produce sex hormones, encourage ovulation and prepare the lining of the uterus for potential pregnancy, and to regulate the entire menstrual cycle. Disruptions to the HPO axis cause irregular periods and/or amenorrhea, and usually involve high levels of stress, excessive amounts of exercise, low body weight, undereating or malnourishment, or a combination of all the above. HA is often a little trickier to diagnose – it’s usually confirmed by ruling out any other potential cause of amenorrhoea, like PCOS, but also through carefully considering a person’s diet, lifestyle and stress levels.
Due to the potential interplay of factors, like hormonal imbalances, it’s absolutely possible for some women to experience both PCOS and HA simultaneously – at least for a time.
As HA occurs as the result of a dysfunctional HPO axis (usually due to stress, over-exercising or under-eating), it can often be resolved or reversed through identifying and addressing these factors holistically in order to prevent HA recurring – however the timeline can obviously vary depending on the person and their situation, overall health, lifestyle, nutrition, exercise and stress management.
On the other hand, PCOS is a chronic condition – while its symptoms can be significantly improved and managed really effectively, PCOS is not typically able to be fully “resolved”.
As a qualified naturopath and herbal medicine practitioner, I’ve witnessed the power of holistic health for addressing the multifaceted nature of both PCOS and HA. Like my colleagues here at Floralia, I have a wide range of tools in my toolkit for addressing each woman’s unique case and needs, and for providing individualised, holistic support.
If you’re struggling with irregular periods and think something like PCOS or HA could be a possibility, or you’ve had either diagnosed previously, here’s some of the ways I’d approach your case naturopathically.
As with any health complaint, it’s important for me to understand what’s going on, but, most importantly, why. It’s why all of my initial consults involve so much questioning! Then, pathology, imaging and functional testing can all be useful in filling in the gaps.
I will often refer my clients suffering with irregular periods for blood testing and/or pelvic ultrasound imaging, looking for hormone imbalances (including androgens and insulin), nutrient deficiencies, inflammation, polycystic ovaries, and more.
Functional testing, like the comprehensive DUTCH hormone test, can help us to piece together even more puzzle pieces if/when appropriate, as here we’re able to gain some insight into not just reproductive and stress hormone levels, but also hormone metabolism, metabolic function, nutritional status, detoxification pathways, and more.
Once we’re armed with the background information we need, we can start to tackle things in a holistic and truly personalised way!
Diet and nutrition are, and always have been a cornerstone of holistic medicine.
“Let thy food be thy medicine” — Hippocrates
A balanced and nutrient-dense diet is key in promoting and supporting hormonal and reproductive health. Across the board, I recommend women eat a diet consisting of:
It’s also important that we work specifically to your unique needs. For example, in the case of PCOS, I recommend all of the above, but also less dairy product consumption, to avoid ingestion of additional androgens. And, in the case of HA, we also want to take into account overall intake of food, nutrient absorption, and mindful eating.
As over-exercising is a common contributor to HA, but regular exercise is something we all know is beneficial for our overall health (and particularly in cases of PCOS where weight gain and/or insulin resistance are in the picture!), it’s again important to consider your own body’s needs and capabilities.
I love recommending intuitive movement and enjoyable exercise to my clients generally.
When it comes to balancing hormones and supporting the reproductive system, there are a long list of tools available to us! Considering your unique case, we can work with a huge range of specific herbs, nutrients, and diet + lifestyle recommendations to get things back into balance and to support hormonal harmony.
A commitment to a healthy reproductive system and hormonal balance – with the guidance of a qualified practitioner – will support you through PCOS or HA, but also through puberty, through a post-pill journey, through a fertility journey, and through menopause and beyond.
From my experience as a practitioner, this is perhaps the biggest key when it comes to treating and managing female health conditions! And particularly when it comes to HA.
We now know a little more about the HPO axis, and how our brain and reproductive organs communicate with one-another. It makes sense then that, if we’re in a state of ‘fight or flight’ or ‘survival mode’ more often than not, our bodies aren’t going to feel safe enough to reproduce (or support our menstrual cycle or reproductive hormone balance).
There’s also usually a lot of stress and anxiety that comes with a PCOS or HA diagnosis, or with an irregular cycle generally.
For all of these reasons and more, working on managing stress levels and supporting the nervous system are absolutely paramount.
Luckily, there are a huge amount of handy tools in a naturopathic toolbox for nervous system support, including herbs (like HPA-regulating rehmannia, anti-anxiety passionflower, adaptogenic ashwagandha), nutrients (like magnesium and GABA), lifestyle recommendations (including vagal nerve activating tips, sleep support, and advice around healthy morning + evening routines), and even referrals (to a counsellor, psychologist, kinesiologist, or other supportive practitioner).
Identifying the root cause of your pain can be an invaluable step towards getting you feeling better, and period pain-free!
Naturopath Emily Bathgate, offers natural, holistic and evidence-based treatments for a range of skin + hormonal health conditions, addressing underlying causes and setting you up for ongoing health and wellness.
