You can't detox your uterus—debunking popular myths about PCOS

Misinformation abounds when it comes to polycystic ovary syndrome (PCOS), especially on social media. Understanding the data and what doctors actually do recommend is key.

When Leah noticed cystic acne in her late 20s, the pandemic had just started, and her dermatologist suggested it was probably from wearing a mask. When wiry hairs appeared on her chin, she blamed her ethnicity. But once she began to gain weight, without changing her diet or active lifestyle, she grew concerned.

Her primary care doctor discovered she had high testosterone, diagnosed her with a hormone disorder called polycystic ovary syndrome (PCOS), and advised her to drop some pounds. Three years and multiple doctors later, Leah turned to social media for answers; but also found a hive of misinformation.

Leah, who requested that her surname not be published to keep her medical history private, says she’s found “PCOSTok”—a hashtag that TikTok users include in their videos to link content about PCOS—to be more engaging than the meetings with her doctors, but she sensed a lot of what she saw and read was false.

Experts estimate that anywhere between six and 20 percent of women have PCOS, which causes symptoms ranging from hair growth on the face and body to infertility. To be diagnosed women should have two of the following three symptoms: irregular and infrequent periods (eight or fewer per year), high levels of androgens (male hormones like testosterone), and immature follicles—often referred to as cysts—on their ovaries, which can be seen in an ultrasound.

The disorder is often diagnosed when a woman is struggling to get pregnant, but the condition affects far more than just fertility. Women with PCOS have heightened risks of heart disease, diabetes, anxiety, depression, insomnia, obesity, endometrial cancer, chronic low-grade inflammation, and more. Androgens interact with insulin, a hormone that influences glucose levels in the blood. Between 65 and 95 percent of women with PCOS have insulin resistance, an inability to use the hormone insulin effectively, and more than half develop diabetes by the age of 40.

“A common misconception, even among doctors, is they think it’s just a reproductive problem,” says Jennifer Roelands, an integrative gynecologist who specializes in treating PCOS. But really, it’s a reproductive and metabolic issue.

Scientists still have a lot to learn about what causes PCOS and why the condition can look so different between women. Some with PCOS have obesity while others are lean. Some have extremely high cholesterol and vitamin deficiencies while others do not. Many conceive easily; others spend years trying to get pregnant.

Many women with PCOS, like Leah, are frustrated by the lack of clarity on the causes, consequences, and treatment options for their condition. To satisfy their desperation for answers, a slew of influencers—ranging from patients to gynecologists, dieticians, personal trainers, and purported experts in “hormonal healing”—have cropped up on social media, aiming to fill in the blanks. But they don’t always describe the nuances of this poorly understood condition accurately .

Here are some of the most common claims about PCOS found on social media, and where the science stands.

There are four types of PCOS: False

Many influencers suggest that there are four distinct types of PCOS, and each one has its own cause: insulin resistance, inflammation, adrenal gland dysfunction, or ceasing birth control.

Experts say that this characterization is misleading.

Cheruba Prabakar, a gynecologist at Lamorinda Gynecology and Surgery in Lafayette, California, says there’s no evidence of these subtypes in the medical literature. Felice Ramallo, lead dietician at Allara, an online platform for PCOS treatment, explains that most people with PCOS have both inflammation and insulin resistance, not one or the other.

It’s true that a subset of women with PCOS have high levels of hormones produced by the adrenal gland such as DHEAS—a precursor of testosterone—but that is in addition to the other characteristics of their condition; it isn’t the cause of PCOS.

Stopping birth control also does not cause PCOS. If you experience a surge in symptoms after discontinuing oral contraceptives, it’s likely because the testosterone-lowering drugs—often considered the first line of treatment for PCOS—were masking symptoms while you took them. Unfortunately, when you stop taking them, your androgens rise again. You may start to experience symptoms you didn’t realize you had.

Still, Ramallo says, that while there are not four distinct varieties of PCOS, she sometimes finds it helpful to describe different causes of individual symptoms. For example, excessive cravings for carbohydrates are typically a result of insulin resistance, and treatments that regulate blood sugar may curb these desires.

Additionally, symptoms can change throughout life; women in their 20s are more likely to have symptoms such as facial hair and acne, whereas women in their 30s and older may suffer more metabolic effects such as obesity and high cholesterol.

Women with PCOS should cut out gluten and dairy: False

“There’s no data whatsoever to support that” women with PCOS should stop eating gluten or dairy, unless they have celiac disease or a known allergy or intolerance, says Roelands.

Ramallo, whose clients frequently ask about restrictive diets such as gluten-free, keto, and intermittent fasting, emphasizes that dairy and wheat are “wonderful food groups that provide a lot of nutrient density for a lot of people.”

Still, lifestyle changes are one of the best options for managing PCOS, according to the National Institutes of Health (NIH). There are two types of diets—anti-inflammatory and low-carb—that have been shown to improve symptoms. Anti-inflammatory diets like the Mediterranean diet, which are rich in berries, greens, and omega-3 fatty acids found in fatty fish and olive oils, can help lower inflammation throughout your body. Women who are overweight and have PCOS who followed an anti-inflammatory diet for 12 weeks lost seven percent of their body weight and saw improvements in a variety of blood markers such as cholesterol levels, according to one small study.

Low-carb diets, in which women get less than 45 percent of their calories from carbohydrates (which is much less restrictive than the keto diet, which only permits 5-10 percent of calories from carbohydrates), helped women regulate blood sugar, lose weight, and improve hormone levels and menstruate more regularly.

Lowering the stress hormone, cortisol, treats PCOS: Misleading

While some small studies suggest that women with PCOS do sometimes have higher levels of cortisol than their non-affected counterparts, these levels typically still fall within a healthy range.

The symptoms social media influencers describe in videos are associated with extremely high levels of cortisol—a symptom of Cushing’s Syndrome, which is “a completely separate thing than PCOS,” explains Ramallo.

Heightened cortisol can certainly play a role in the PCOS disease process. Prabakar says simply, “cortisol is involved in everything.” However, levels of cortisol fluctuate throughout the day, and common blood tests are notoriously inaccurate. “They don’t tend to really contribute much to the medical picture,” of PCOS, says Ramallo. “If somebody’s mentally stressed, let’s just take care of their mental stress,” rather than monitoring cortisol levels.

Another myth that influencers have propagated is that women with PCOS should avoid high intensity exercise that they claim could spike your cortisol and instead opt for slow, meandering walks and low-stress routines. Roelands says, “There’s no data that supports that PCOS patients cannot do vigorous exercise.” In fact, one small study found that women with PCOS who did three high-intensity interval training sessions per week for eight weeks reduced cortisol levels.

Supplements such as inositol can reverse PCOS: Misleading

PCOS is a lifelong condition that cannot be reversed, but there are some supplements that may ease symptoms. One of the most well-studied supplements for PCOS symptoms is inositol.

Fertility clinics have long recommended inositol to help improve egg quality, whether their patients have PCOS or not. More recent evidence suggests it can also help with insulin resistance and improve many other symptoms of PCOS, but scientists are still investigating how it works, and which symptoms it can and can’t treat.

You can detox your PCOS uterus with tea: False

“There is no such thing as detoxing the uterus,” says Prabakar. Your uterus is not toxic and does not need to be “cleaned.”

However, there are some ingredients in teas that can help with PCOS. Ramallo explains that spearmint tea, for example, is known to help lower testosterone levels in women with PCOS. Green tea can also improve PCOS symptoms by lowering inflammation.

It’s not always easy to tell what’s accurate and what’s not on social media, but Leah remains wary about claims that certain pills will cure her PCOS. The BS “meter goes really hard with that,” she says.

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