What if PCOS isn't the Problem? - Notes on Stefani Ruper's theory

I love Stefani Ruper's work - she's done some great studies. It was her work that lead me to my own understanding of the issues, and I follow her blog avidly. 

I suppose what I've done is to take her work and to extrapolate was happens when you get to Stefani's stage and then leave the problem untreated for 10 years - that's where I've been personally and it's given me an interesting insight. 

Taking her work and building on it, I've come to a different conclusion: for me, I agree with everything Stefani says (broadly) but then I started to look back at the origins, the underlying causes, the stuff which tripped me up time and again. 

What I found and can't ignore is that I don't believe that PCOS is the original issue: the hormone imbalance is. 

The causes of  Type 2 PCOS were succinctly described by Stefani in her 2012 treatise PCOS Unlocked: The Manual.  Her book centres around PCOS, the definition is no less valid:

• - Type II PCOS because your reproductive organs are under significant stress, which comes from being underweight, losing too much weight or psychological stress (and usually a combination of all three).
• - Type II PCOS is characterised not by hormone excess but by hormone deficit. Eating a restrictive diet, exercising excessively, and weight loss can all decrease levels of pituitary and female sex hormones in the blood. 

These are all metabolic stressors. Psychological stress is also significant and can halt menstruation. Usually – and most often recognised by medical professionals – these phenomena lead to the menstrual disorder hypothalamic amenorrhea. But in some women, cystic ovaries develop, giving them PCOS instead. The biochemistry of these women’s stress responses as well as the degree of metabolic damage (such as insulin resistance) that has been done to them in the past is what combines hypothalamic amenorrhea and PCOS in this specific population of type II PCOS patients. 

In short, if you’ve been/are or were in the following category when your symptoms developed, here’s what caused your disease:

• - Drastic weight loss (> 20 pounds)
• - Weight loss below level of body fat during puberty
• - Daily exercise
• - Obsession with exercise and/or body image
• - Low body fat
• - Extreme stress
• - Poor sleep

Yep, that was me, still IS me, except that I'm able to manage my symptoms now.

The effect of these symptoms is to cause a full-scale shut down of the entire hormone system, and then all bets are off: weight is unmanageable, sleep is impossible, psychologically the effects are paralysing, and there is a descent into a downward (and accelerating spiral), in which the concerns about the disease lead to more of the problem behaviours above (stress about getting fatter, drive to do more and more exercise in order to combat the problem, eating less and less to counter the problem) which only exacerbates the situation further.

Here's the difference though: I got to the point which Stefani describes by the age of about 27, and then spent 10 years with no support and no idea of what was going on - this lead me to have even more stress, and a much longer exposure to the syndrome. In this time, I went from low body fat, stressed body etc, to insulin becoming a major ruler. Over time, instead of insulin resistance just causing PCOS type problems and hormone deficit, my response to insulin became greater and greater, meaning that I could literally not eat for a week and gain weight, and when I did eat, the insulin response would be massive. Coupled with this, stress levels got higher and higher, and the whole set of symptoms got bigger and bigger. 

In that time, I put on more than 100lbs. This despite exercising heavily (12 hrs per week, intensive cardio). My insulin responses were huge:

• - not eating lead to extreme anxiety, insulin build-up
• - when I did eat the insulin response was far higher than one would ordinarily expect
• - to this day,  if I eat anything which produces an insulin response (especially anything carb), my insulin levels go through the roof and this leads to a whole rush of other symptoms returning

This lead me to an interesting conclusion: if my PCOS is caused by insulin response, and  if I can create all the symptoms I discuss on this blog, just by going back to my old behaviours (sandwich anyone?), then surely, I've identified the cause. Hormone disruption is my problem, not the PCOS which appears as a symptom of it. 

I believe that PCOS is only one of the symptoms of the disease, whereas Stefani puts PCOS front and centre, but we agree on pretty much everything else and I can’t fault her conclusions. I just don’t think PCOS is the root cause.

What I also agree with is that actually, this syndrome comes from a perfectly natural and logical response, just mutated in a way which is unhelpful:

In times of chronic stress, estrogen levels are actually designed to drop, and they do this for a very good reason. Primally, If you're involved in a war with a neighboring tribe or dealing with the effects of a natural disaster, it's a really bad idea to be pregnant or to have a baby. It's high risk indeed for mother and child to be in a dangerous place. Thus, in response to the stress, oestrogen levels drop, taking fertility with it, to be restored once it's safe again.

In the case of this modern syndrome, stress occurs, oestrogen levels drop, but of course the stress continues over a long period of time, it never goes away, and the oestrogen levels stay down.

This leads me to the saving grace with all this which is that actually knowing that the oestrogen levels drop for a reason gives me hope. They dropped for a good reason, albeit inappropriately, and by that same logic the MUST possess the ability to go back to normal again. We just need to find the key to make that reverse possible.

If you want to read Stefani's excellent blog, you can reach it here: www.paleoforwomen.com