It’s hard enough to get a diagnosis of PCOS–and, once you do, it’s common to wonder how to treat PCOS naturally, so you can feel better. We spoke with functional medicine physician, wellness strategist, and hormone expert Felecia Sumner, D.O., to get answers.
Dr. Sumner, you treat and coach women through all hormone conditions, but you have a particular passion for making a difference in PCOS. Why?
What sparked my interest in finding ways to treat, and especially natural ways to help PCOS, was personal experience. I never showed the common telltale signs most doctors associate with PCOS. I wasn’t overweight, didn’t struggle with infertility, didn’t experience hair loss, and acne wasn’t an issue. However, after my second pregnancy, I experienced significant fatigue and brain fog. I was bloated, had some chin hairs, and my periods were irregular but it wasn’t anything especially noteworthy, as I was breastfeeding at the time.
When I mentioned these things to my physician, she drew labs but nothing really came of them. Gratefully, I was entering the world of functional medicine at the time. I ordered my own labs and took a wider scope in what types of markers were looked at. From there, I could see I was dealing with post-birth control and adrenal PCOS, while also developing insulin resistance.
From there, I really immersed myself in research on how to treat PCOS naturally, and I was able to reverse many of my markers and symptoms in less than a year. Once I dove into the research, I noticed in clinical practice that the prevalence of women with PCOS went beyond the statistics of 1 out of every 8 women. Listening to patients made me realize that nearly 1 out of 5 of the women I was seeing was dealing with PCOS. It opened my eyes as a physician to really sift through the slew of symptoms my patients were experiencing, consider them in an out-of-the-box way, and put them together.
You’ve said before that a PCOS diagnosis is not an answer in and of itself. What do you mean by that?
Right, so PCOS is really a label. It’s an important one for us to recognize when women suffer with its symptoms. But with any condition, addressing the personal underlying dynamics of what’s contributing to PCOS is much more powerful. When we do that, we can have much more impact than when we just look at the label, or diagnosis, alone.
Why do you think a lot of women suffer with PCOS symptoms but wait years for a diagnosis?
We use the Rotterdam Criteria in conventional medicine to diagnose PCOS. So, according to the criteria, someone should have 2 of the following: abnormal or no ovulation, hyperandrogenism (excess androgen hormones), and/or ovaries with an excessive amount of cysts at ultrasound. Having some ovarian cysts is actually very common and normal. They happen during the follicular phase, and you need them to ovulate.
But I think the issue with the conventional approach is that we always diagnose things when they’re at the worst. We rarely meet people at the place they’re headed towards. That’s often where we fail. Instead, women are being told everything’s okay because they’re within the lab reference ranges. Unfortunately, they wait and suffer for years until finally their symptoms are “in the red”–a place where their physician for the first time says something about it: Oh, you have PCOS.
For a lot of women, signs happen long before their diagnosis. If we’re paying attention, we’ll notice this. For example, androgen levels may build slowly over time. We can track their rise and know earlier on that these women might have PCOS. Similarly, your doctor may only be checking your blood glucose levels. That’s common but has the potential to be misleading in insulin-resistant PCOS. When you’re insulin-resistant, your blood sugar may look great or even low. But, if you’re constantly feeling hangry, you might really need your fasting insulin levels looked at instead.
If you suspect a patient has PCOS but she doesn’t meet the Rotterdam Criteria, what steps do you take to evaluate her for it?
Certainly, we’d want to look at symptoms of excess androgens. These include hair-growth issues in unwanted places, hair loss from the scalp, and acne. Low libido and mood changes can be an issue. We want to also talk about the menstrual cycle. Are you having cycles? Skipping them? How many? Are you ovulating? There are a number of cycle issues that can happen in PCOS. It doesn’t always look the same way.
In conventional medicine, there’s a general rule that if a patient has missed fewer than three periods, investigating isn’t necessary. But in functional medicine, we want to know right away. If you’ve missed a period, that’s a sign of your body saying that something’s going awry. And I don’t think we should be waiting for you to build up estrogen and lose progesterone to see what’s happening.
What are your preferred methods for testing sex hormones and other labs?
A lot of hormones can be checked through serum (blood). But that’s not my preferred method. I would rather check urine or saliva levels of sex hormones. The reason is that sex hormones are super tiny compared to many of the other hormones that we measure through the blood. Also, when we measure sex hormones (estrogen, progesterone, and testosterone), it’s great that we can understand what the total levels are, but we need to know free levels. Free means unbound and what’s actually available for your body to use. That information is much more valuable than any total.
Why do some women hear their lab results are normal for so long but they feel awful? Or, suddenly their labs become abnormal?
A lot of this has to do with how your physician is interpreting your tests. Many doctors go off of the indicated reference ranges for labs and view them one of two ways accordingly: normal or abnormal. This way of thinking misses a lot. It’s why women hear that their insulin (or other markers) are fine–and then one day they’re pre-diabetic and wondering: how did that happen?
Really, you want someone who will look at things from the standpoint of what’s optimal for your health. If we go back to the insulin example: according to the lab, a “normal” level is between 4 and 25 mIU/L. But an optimal fasting insulin level is less than 6 mIU/L. That’s a big difference. In functional medicine, we don’t want to help you feel “average.” I want to help make you feel amazing. A good example of this is fasting insulin levels.
Would you test micronutrients with PCOS, and what advice can you give on micronutrient testing?
What I might also check if I suspect PCOS are vitamin D levels. Vitamin D is a master hormone. All hormones are chemical messengers. If you’re vitamin D deficient, the mailman is not getting the mail where it needs to go. Looking at micronutrients can also be helpful. I check magnesium with almost everyone. You need magnesium to help absorb vitamin D. And you also need it to relax. Zinc is another extra important one in hormone imbalance. It helps regulate testosterone levels in the body.
Also, of great importance but that gets overlooked in conventional medicine: we really need to specify that we want to check RBC levels of these minerals. That’s because, a lot of times, when you’re deficient, those minerals are drawn out of your red blood cells first. Testing how much is actually in your red blood cells lets you detect deficiencies well before they might show up without this criteria.
PCOS and hypothyroidism are often correlated but not every physician is checking for both. Do you automatically test thyroid levels if you suspect PCOS?
About 95% percent of the time, I check free T3 and free T4 levels, thyroid antibodies, and TSH. Thyroid hormones are so critical to everyday functioning and a common contributor to energy levels and not being able to lose weight. I would never want to miss Hashimoto’s thyroiditis or hypothyroidism in any woman.
What kind of support do you feel like women with PCOS need the most?
If and when you get a PCOS diagnosis, you usually get offered blanket ways to minimize symptoms: metformin or spironolactone or a birth control pill. There’s so much more that’s available, but it depends on what your personal or individual situation and environment are. I mean that to say that, first, there are a few different types of PCOS: adrenal, insulin-resistant, post-birth control, and inflammatory. All of those require different approaches. PCOS really needs highly individualized support. Dynamics are incredibly important.
First, I think we should test don’t guess. PCOS isn’t the most overt condition. We can attribute its symptoms to a lot of different things. I get so much valuable information from DUTCH testing. This testing helps us identify the best ways to modify nutrition, stress management, exercise, and overall lifestyle. If you really want to be well and not just bandaid symptoms, having this type of approach matters.
Accountability and multi-level support are also really important. It’s so common for us, as women, to talk ourselves out of getting the level of help we need or to postpone it by putting everyone else before us. Plus, when we don’t feel well for a long time, we feel defeated. Having people to follow up with us on how we’re doing reminds us that we are worthy of feeling well. Mindset is just as important as any medication or other lifestyle changes in healing PCOS.
Many women get prescribed birth control to “treat” PCOS. What are the general advantages or disadvantages in this?
I liken prescribing birth control for a woman with womanly problems as similar to prescribing pain medication for someone who just had their arm amputated. Yes, we’re addressing the pain of the issue. But what are we doing about the actual problem? Birth control can bandaid symptoms, but we’re not treating it. We still need to address the root cause and repair the dynamic behind it.
Also, even though birth control can mask symptoms of hormone imbalances, it can lead to more problems down the road. Unfortunately, the majority of time, when hormonal birth control is prescribed, we’re not educated on what can happen beyond preventing pregnancy or stopping certain symptoms. Birth control pills tell your body that you don’t need to make these hormones because you’re getting them another way. You end up killing that feedback loop. I’ve seen women who have spent years with fertility issues or birth-control-induced PCOS after taking these contraceptives. And, as for using birth control to relieve symptoms in PCOS, it’s not really ideal. If someone’s dealing with excess estrogen, which is common in PCOS, the last thing I would want to give them is more estrogen.
How does approach differ in trying to relieve PCOS symptoms versus trying to improve PCOS symptoms and also fertility?
A lot of the approaches are generally the same, whether I’m trying to help someone feel their best or also trying to conceive. But individual dynamics are important. For women who are concerned with fertility, I would also test Anti-Müllerian hormone, or AMH. (AMH looks at ovarian reserve.)
I generally see infertility most in women with insulin-resistant PCOS, but that may also be because 80% of women with PCOS have insulin resistance. Adrenal-type PCOS can also be a major issue with infertility. If you’re dealing with a tremendous amount of stress, the last priority that your body has is conceiving a child. Approaching what’s exhausting the adrenal glands and supporting them becomes really important.
You have a program called “Happy Healthy Hormones” and it can help with PCOS. Can you share some info about it?
My 12-week program, Happy Healthy Hormones, is for women who are dealing with PCOS, fibroids, symptoms of estrogen dominance, infertility, or other hormone imbalances. Many of these women haven’t gotten to the root cause of their imbalances from conventional medicine. We start with a 45-minute consult to see if it’s a good fit. This is where we go over symptoms and issues and any labs that have already been done. From there, I give a customized blueprint with recommendations for how to move forward productively.
If a client is a good fit for the 12-week program, we can customize approaches and work together more. The program cost includes DUTCH hormone testing and interpretation. That testing gives us a really clear picture of the dynamics at play. I really enjoy this program because we can really get tremendous results and empower women to feel good about what they’re doing for themselves.
What advice would you give to women wondering how to treat PCOS naturally?
There are a number of things that can help treat PCOS naturally. However, being able to search and find any information you want can make you go down a rabbit hole of things that might work. But the question is: will they help you? One of the best things a woman with PCOS can do is partner with an educated, open-minded provider.
The other thing I would say is to go into appointments with a defined goal. For example, come with a symptom that you want get to the bottom of and focus your practitioner on that goal. Don’t just listen to your blood pressure and glucose levels. Explain that you are more tired than normal or you don’t get a cycle and you want to get to the bottom of it.
It’s also important to figure out your why. Why do you want to be able to feel better? There’s a place where you have to find that power and ownership within yourself and believe you deserve to thrive rather than just survive.
What type of results can a woman expect if she wants to treat PCOS naturally?
The amount of time it takes to feel results depends on a few things, including if you’re using a pharmaceutical or if you treat PCOS naturally. When you decide to take a medication, it’s possible you could see symptom improvements in weeks. But you’re not actually treating your PCOS and the underlying causes have not been fixed. Taking a more holistic approach usually takes longer but that depends on how open people are to change and what support level they have. You’re undoing a lifetime worth of habits that play a role in how your body communicates organ-to-organ. Be patient. It will make a difference.