A step-by-step guide to reverse your PCOS in 6 months.
If you're like me when I decided to get my IUD out after 10+ years of hormonal birth control for my PCOS (polycystic ovary syndrome), starting a hormone-healing journey feels overwhelming. You have probably googled things like "Is PCOS curable?" "treatment for PCOS," and "getting pregnant with PCOS." The results are pretty crippling. PCOS has become this sticker diagnosis that's somehow no big deal because so many women have it but also makes you feel powerless carrying a seemingly lifelong diagnosis with so little conventional research behind it. If you do a quick search, treatment for PCOS is limited to symptom management tools like birth control and metformin, which may help regulate your cycle and blood sugar but don't address the underlying imbalances. PCOS is an inflammatory state that could be classified as an autoimmune disorder and can impact your fertility and long-term health, but the truth is that you can address the root causes. The approach I'm outlining here could help you get started.
It's my nature to go down every rabbit hole, read every book, and buy every supplement. I didn't start with the goal of getting pregnant immediately (spoiler alert), so this isn't the guide to fast-track fertility, but if you are like me at 26, realizing that artificial hormones aren't doing you any favors and wanting to feel healthy and strong mentally and physically regardless of if you want to welcome a baby into the world somewhere down the line, this guide is for you. This has turned out to be a monster of a post, so to keep it somewhat manageable, I will do a deeper dive into each month's goal in a future post series.
I hope this month-by-month guide to reversing your PCOS can help you hone in on two major components of hormone healing: gut health and insulin resistance, and drown out some of the extra noise until you're ready to hear it.
Now that I'm more deeply entrenched in the pro-metabolic nutrition space, my hormone and nutrition journey feels pretty textbook, but when I started, I didn't know where to begin. Hormone healing wasn't something on my radar. The type of gut-healing, counter-culture nutrition that feels so intuitive to me now was not mainstream, and the rabbit hole I went down totally altered my priorities and worldview. I feel compelled to share my story because it is relatable to so many women, and if I can help condense down the lessons I learned into actionable first steps, then maybe it could feel a little less daunting to dive in. I am not a nutritionist or medical professional; I'm simply a consumer of information and feel strongly about women taking empowered steps to own their health.
I was diagnosed with PCOS at 11 or 12 because my cycles were irregular after I got my period. This is totally normal, by the way. I did have elevated testosterone levels despite not presenting any outward symptoms like weight gain or hairiness...I am hairy, but I'm also Ashkenazi, so much of that is genetic. Of course, birth control to the rescue. Despite having to switch brands countless times for side effects like constant nausea and vomiting, migraines, weight gain, depression, anxiety, and moodiness, I stayed on birth control for 10 years before finally switching to an IUD. That transition was the first time I realized that those awful symptoms were not a part of my personality; they were side effects of the magic pill that was supposed to be helping me. While the IUD uses localized hormones, they still circulate through the body, and after a time, most of those symptoms creep back in.
It was not our plan to start a family early in our marriage, but it was time for my IUD to get replaced; I had just been laid off, it was the start of another pandemic winter, and I had time on my hands, so why not try to go off artificial hormones all together?
I read 8 Steps to Reverse Your PCOS by Dr. Fiona McCulloch and Beyond the Pill by Dr. Jolene Brighton. It was the first time I took real responsibility for my own health that went beyond some short spurts of calorie counting and a month of being vegan in college. Fortunately, I'd never really gotten deep into diet culture or developed any deeply rooted disordered eating, so I could welcome the paradigm shifts in what healthy eating looks like more easily than most. I'd been slowly diving deeper into the biohacking world and learned about gluten, blood glucose, mineral balance, and leaky gut. Once I started to dive into women's hormones, it all came together.
I finally understood that what I put into my body had a direct effect on my gut, inflammation, blood glucose, hormones, and, more immediately, on my mood and energy levels every day. I implemented principles from both books and Dr. Ray Peat's style of pro-metabolic eating and remineralization (I'll explain below). As I said earlier, I tend to dive head-first into anything I am passionate about. I had more time on my hands to research and tune in to my body than most of you might. That's why I want to share this information in a digestible (pun intended) and actionable way. Here's how I'd start.
Reverse your PCOS in 6 months.
Month 1: Find your why.
I've seen so many people in my life with health issues far more serious than my own start some protocol or supplement and feel better for a time, then revert back to habits that keep them feeling miserable. I know there are a lot of people out there that will say that it's about how you build new habits, how you stack them, rewire them, etc. I am not the best person to preach consistency or discipline, but I do know that if you find your "why?" and your "why now?" taking ownership of your health and healing your PCOS will change your life long-term. Once you gain control over how you feel, how you show up, and how you view the world, you won't slip backward.
This first month of the journey is the perfect time to stock your pantry with quality basics and put motivating and informative books like Awakening Fertility: The Essential Art of Preparing for Pregnancy by the authors of the First Forty Days (see my post) and Real Food For Pregnancy by Lily Nichols on your nightstand. If you have the capacity to dive deeper into hormone health, listen to podcasts like Freely Rooted and follow accounts like Noelle Kovary on Instagram. I found that tuning in to the pro-metabolic community helped me stay curious and optimistic about my fertility journey, but if an onslaught of new information and considerations feels overwhelming, keep things simple to start off. I'm definitely guilty of feeling like I need to know everything and do every protocol, but no one can do it all.
Month 2: Do an elimination diet.
As I said earlier, PCOS may actually be classified as an autoimmune disorder. It is important to take inflammation seriously and find your personal inflammatory triggers. The best way to do that is an elimination diet. In my definition, that means no gluten, caffeine, refined sugar, grains, nuts and seeds, seed oils, soy, corn, dairy, citrus, or nightshades, and it means buying pasture-raised organic meat and eggs and organic produce. I know there can be a lot of friction to doing this for many people. It feels like you need to go out and spend a bunch of money on new foods like nutritional yeast and coconut aminos, things many of us do not consume regularly, but you really don't have to. The money you save on random snacks and eating out easily covers the added expense of a few higher-quality ingredients, and trust me, you will get used to eating simply faster than you think, and you may even save yourself some valuable time.
My biggest recommendation for people overwhelmed by the potential expense of an elimination diet is not to follow a whole-30 style recipe book or meal plan with lots of new recipes and ingredients but to simplify your eating to the basics and eliminate rather than add new ingredients.
Crafting your protocol
Trust me. I am a person that doesn't like to eat leftovers because it's boring for me to eat the same thing twice, loves a crunchy snack while watching tv, and feels incomplete without dessert after dinner. Heck, I can't even write this blog post without crunching on something. I won't say it's easy to eliminate foods, especially the habits and rituals we create around foods, but it really does start to feel worth it very quickly. If you're feeling stuck and need a recipe, there are tons of Whole 30, AIP, Paleo, and Carnivore recipes and meal plans online, and I learned about new ingredients and techniques from following these. If I had to go back and do an elimination diet all over again, I would keep it simple, rewriting food habits rather than trying to replace them with substitutions. Once you stop craving sugar or caffeine, it really becomes exponentially easier to stay consistent. The options expand significantly as soon as you start re-introducing things like dairy and gluten-free grains.
Going Out to Eat
With these restrictions, it is nearly impossible to go out to eat, but you can prime yourself for success by choosing an elimination window when you don't have many birthdays or holidays. For me, this was early January, but summertime, when foods are simpler and there is easier access to local whole foods, sounds pretty ideal too. When you are out, and it's hard to order or eat what everyone else is eating, try to remind yourself that the restrictions are not permanent. It's not "unfair." You're in the process of better understanding your body and improving your well-being; that opportunity is a privilege. At friends' houses or at events, try your best to stick to the elimination protocol, but more likely than not, you'll have to budge on one or more eliminated groups. Try to limit it to something like white rice, fruit, or non-organic meats, and observe how you feel for the days following. It's not going to break the protocol to be flexible once or twice, but you will likely feel pretty crappy if you bring in gluten, dairy, and soy all at once, for example.
Month 3: Monitor your blood glucose and start reintroducing foods.
With PCOS, and many other hormone imbalances comes insulin resistance. There are many interesting correlations between blood glucose, gut health, inflammation, and hormone balance. You can't compartmentalize the four, but the reintroduction phase after the elimination protocol is an ideal time to tune in to how your body reacts to specific foods and food combinations. Testing your blood glucose is a critical step in understanding inflammatory triggers and learning how to eat for your body.
Many people think that glucose monitors are only accessible with a prescription, but the One Drop Blood Glucose Meter is easily available and is really simple to use. You should ideally test before, 5 minutes after, 30 minutes after, and 2 hours after a few key meals throughout the day. I chose to test more consistently for the first week and then only when I was experimenting with different food combinations and amounts and when reintroducing foods.
Experiment with small modifications
You would be surprised how small modifications to your meal impact your blood glucose levels. Try these little hacks with a lot of science behind them and see how they influence the digestability and reactivity of foods in your body.
Order your macros: the order with the most success for many is cruciferous veggies, protein, fat, then carbs. There are dozens of peer-reviewed studies showing the effects on blood glucose.
Consume something vinegary before meals. My default is raw carrot salad (I'll mention that later) with ACV (apple cider vinegar) and MCT oil before I start on lunch and sometimes dinner.
Try adding fat. When I started taking a few bites of avocado before eating snacks or pairing more fat with carb-heavy foods or desserts, the difference in my blood glucose was dramatic.
Month 4: Introduce supplements and prioritize minerals
The world of supplementation is overwhelming! Read 3 different articles or books, and you'll have a list of 20+ supplements you NEED to take. I hesitated even to include supplements in this guide because the truth is that supplements cannot replace proper nourishment, and many of these generally support hormone health, rather than PCOS specifically.
Too many people, myself included, start with supplements rather than nutirtion, and I'm realizing that it's just another way to outsource responsibility for our own health.
I've tried so many supplements over the last few years, and for my sanity and wallet, I've whittled it down to a critical few. For me, prioritizing whole superfoods like smoked oysters, liver, egg yolk, adrenal cocktails, raw milk, sauerkraut, sourdough, kefir, and yogurt, which contain so many bioavailable minerals or probiotics, is so much more sustainable and effective.
All that being said, I can't say that supplements are not helpful. I've noticed dramatic differences between a few that I continue to take and some that I took in the past to regulate my cycle and my blood glucose at the start of my hormone-healing journey. I know that building food habits is hard, and we sometimes need a small boost to keep us motivated in the meantime. Here is my list of supplements that I've found most effective.
*The supplements listed reflect my most current knowledge of dosage. They are intended to serve as a starting point. Please do your own research as well.
NAC (N-Acetyl Cysteine) is an amino acid that supports the production of glutathione, essential to organ and immune function in the body. My acupuncturist, who has supported hundreds of women in their fertility journeys and typically doesn't recommend starting with supplements, concurred that NAC could have a surprisingly quick effect. I really did feel the effects when coming off hormonal birth control, and I think this has something to do with the extra liver support. If you're interested in going down that rabbit hole, there's a lot of information on organ function and fertility in Awakening Fertility.
Myo & D-Chiro Inositol (formerly known as Vitamin B8) is a sugar that our body produces naturally. Supplementation has been proven effective in increasing insulin sensitivity in women with PCOS specifically and has the added benefit of decreasing anxiety. The Huberman Lab Podcast episode on Fertility gives a deeper dive into how and why inositol works and some of the other uses in men and women. I recommend taking inositol in the evening as it can have mild sedative effects.
Berberine has been proven to be more effective than metformin in women with PCOS in multiple clinical trials without the side-effects. I was hard-pressed to find GI distress, nausea, and loss of appetite reported from official sources, but I know multiple women personally and have seen countless women online dealing with the unintended consequences of the drug. I experienced dramatic improvements in my reactive hyperglycemia and pre-diabetic blood glucose levels while taking Berberine.
Omega-3 fatty acids have been recommended supplements for decades, but only recently has research pinpointed the exact proportion of EPA to DHA (two different types of fatty acid) that regulate mood, combat seasonal depression, reduce inflammation, prevent migraines...the list goes on. I've taken various forms of fish oil for years, but this is the first formulation I noticed a drastic difference from. I reach for a double dose of this before painkillers, my hormonal headaches are significantly milder, and my postpartum brain fog has disappeared. The dosage is at least 1 gram of pure EPA to reap the benefits.
Vitamin E helps reduce cellular sensitivity to estrogen and helps to regulate estrogen dominance, a hormonal disbalance that many modern women, but especially those with PCOS, deal with because of stress, environmental toxins, and endocrine disruptors. As with any supplement, I recommend taking what is most relevant to you.
Beef Liver is the superfood our ancestors knew about. Almost every culture consumes organ meat traditionally, and it's no surprise that the liver is usually a special treat reserved for pregnant and nursing women and children. I won't go into it in this post, but along with a myriad of other bioavailable minerals and nutrients, liver is high in copper. Your body needs a balance of iron, copper, and zinc, and while iron supplementation has proven to be less effective than previously thought, copper helps to properly absorb, metabolize, and balance the trilogy of minerals. In an ideal world, we would consume liver in small portions multiple times a week, but even I, who grew up eating liver and really enjoys it, maybe remember to prepare it twice a month. For the majority of us, regular supplementation will suffice.
Shilajit is a resin exuded from rocks in the Himalayas. This wildcard supplement has a bit of mystique around it. The resin is mineral-rich and high in fulvic acid, which helps trigger the Follicle-Stimulating Hormone (FHA). Shilajit has long been used in Ayurvedic medicine, but the fact that even Andrew Huberman recommended it means it's worth considering. The biggest differences I noticed were in my mood and energy levels. Shilajit comes in tablet and resin form, and the recommendation is 50mg twice daily during the follicular phase of your menstrual cycle.
Bee Pollen is another way to supplement copper. I've gotten fresh bee pollen refrigerated at our co-op, but if you're nowhere near that kind of crunchiness, I've also tried this brand on Amazon, linked below. I find the flavor to be noticeable in coffee or tea, so I usually sprinkle on granola with honey or throw it into a smoothie.
Electrolytes are more than just something to take when you're working out or dehydrated. In fact, if you go over to the crunchy side of TikTok, many people remineralize their filtered water before drinking because drinking pure water can actually flush out essential minerals like sodium, potassium, and magnesium. I still drink plain water, but I try to sip on my mineral-rich Mama tea throughout the day, have at least one adrenal cocktail (see below), and make sure I properly salt my food, bone broth, and even beverages. I've tried many electrolyte mixes and haven't found one that I like the taste of (I can't stand monk fruit or stevia) and is affordable. Instead, I do one of two things. I either splash about an oz of Mitigate Stress Master Mineral Drink into my water or juice, or I add a scoop of dehydrated coconut water powder, a dash of cream of tartar (potassium), and a healthy pinch of real salt to water or juice for a DIY electrolyte blend.
Month 5: Prioritize gut health.
Fermented foods not only introduce helpful bacteria to your gut microbiome but often increase the bioavailability and digestibility of the food itself. The list of fermented foods is endless if you consider all the cultural variations and the fact that you can ferment just about any fruit or vegetable. While just a few years ago, it was hard to find live fermented foods in stores, even gas stations have kombucha now, and you can find live probiotic cream cheese, sour cream, sauerkraut, and sourdough* in health foods stores. I make most fermented foods from scratch now because they prove to be tastier and more cost-effective. While it's much easier than it seems, you may want to start incorporating the foods regularly into your diet before investing in any equipment. I'll try to share my methods for sourdough, kombucha, raw milk yogurt, water kefir, milk kefir, and sauerkraut in later posts.
*If you are trying to reap the benefits of sourdough or experimenting with your gluten tolerance, homemade seems to be the Store-bought sourdough, even the fancy-looking kind often contains added gluten and yeast in the ingredient list, so I'm unsure how long they ferment the bread and at what point they add the extra ingredients. For my gluten sensitivity level, 24 hours is the minimum time I ferment bread.
Month 5: Work on your stress levels.
Soft girl summer is in full swing, and it's the perfect time to slow down and prioritize rest. The single biggest hormone dysregulator is cortisol (stress hormone) and lack of sleep. Adrenal fatigue is not a medical diagnosis but rather a term used to group together symptoms resulting from long-term spiked cortisol levels. Everyone's circumstances and triggers are different, and while a lower-stress lifestyle or mindset is a worthy goal, there are a few ways we can support our bodies through stress.
Adrenal Cocktails are afternoon pick-me-up drinks that help support adrenal function by supplementing minerals like sodium, potassium, and magnesium. Magnesium, specifically, is essential to hormone function and has a much higher burn rate in times of stress. Most recipes include orange juice, coconut water (a natural source of electrolytes), real salt, cream of tartar (potassium), coconut cream, and whole-food vitamin C in the form of acerola. The potent combination of balanced minerals, glucose, and fat provides quick energy and replenishes electrolytes.
Acupuncture is a medically proven way to address hormone and energy imbalances in the body and can help reduce stress levels and boost fertility. This is not always affordable or accessible, but when I do prioritize regular acupuncture, the reduction in my stress levels in the weeks after is notable. My acupuncturist now has a two-year history of my pulses, menstrual cycles, and hormonal changes from pregnancy through post-partum and is a wealth of information on nutrition, supplementation, herbal remedies, and the newest scientific data not only applicable to me but to my family. If you're lucky enough to find a practitioner you trust, you may find that their expertise, especially with diagnoses like PCOS is invaluable.
Month 6: Track your vital signs.
Once you start implementing some of the changes over the 6 months, how can you tell if they're working? How do you know when you've "reversed" your PCOS. Of course, follow-up ultrasounds to check for cysts, blood work, or hormonal labs are great tools to use as a comparison to pre-protocol levels, but since many of us go through this process without a medical professional, there are other ways you can monitor your progress. You can learn a lot from measuring your body's signals.
Basal Body temperatures (BBT) can help track your menstrual cycle and your metabolic function. You can get a basic basal body temperature thermometer online. Your waking BBT should be between 96 and 98, with higher BBT indicating higher metabolic function and a 2-degree rise in combination with other signs like egg white texture cervical mucus indicating ovulation. When introducing foods or testing meal proportions, your temps can signal how much metabolic function is being diverted to digestion. If your temps remain high, your body is digesting easily, but if you get cold hands and feet or your BBT drops after a meal, it is a sign that an ingredient or combination is diverting energy from your body to digest. You can play around from there to test different combinations and preparation.
Blood Glucose testing should be a part of the entire healing journey, but small stretches of more consistent testing can help you compare your progress to baseline levels and indicate your level of insulin resistance. In my case, I watched for signs of reactive hypoglycemia (a large spike followed by an even greater dip). After months of eating well, testing food combinations, and trying to be active after meals, I found that even with less-than-ideal food combinations, I did not dip below my personal normal threshold.
Digestion is a major vital sign of health. There's a Jewish anecdote about a grandmother asking her grandson if he's pooping instead of how he's doing. She says that if you're pooping, you're eating, and if you're eating, you have money to buy food. In our case, our gut health impacts our hormone health, and regular bowel movements are a good indication that you're healing your gut lining and shoring up your microbiome.
Fertility is a major vital sign, regardless of your desire to conceive a child. It is a myth that menstruation goes hand in hand with suffering. Your periods should be regular, painless, and free of intense mood fluctuations, migraines, and breakouts. Any of those signs can signal mineral deficiencies or hormonal imbalances. You can take symptoms as an encouragement to keep working towards your goals or dig deeper into the specific symptoms to know what to work on next. Awakening Fertility has helpful tips from the Chinese medicine perspective.
At the end of my 6-month PCOS healing journey, I felt on top of the world. The circumstances around me were chaotic, I didn't feel like I had much control over the world, but I felt an absolute absense of symptoms for the first time in my life and got to know an energetic, happy, and optimistic me and I hope you experience that same feeling too.
This post has been long, I know. I spent over a week writing it and feel like I just scratched the surface, but I hope it's served as a launching pad for your PCOS journey and made just getting started a bit less daunting. You can reverse your PCOS. You can regulate your hormones, digestion, and energy levels and feel good the majority of the time. Stay curious, open to different perspectives, and remember that you're the expert on your own body. Trust it.
I will try to break down each month more comprehensively in future posts and add simple elimination diet meal plans and recipes for trickier foods like organ meats and smoked oysters. Feel free to reach out to me if you need recommendations for further reading or questions about anything I wrote.
The links above are meant to be informative, and while there are some affiliate links included, I will never link anything that I didn't use myself or don't stand behind fully.