What is PCOS?
Learn more about Policystic Ovary Syndrome
So what is Polycistic Ovary Syndrome?
Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is a hormone-related condition caused by an imbalance of reproductive hormones that affects millions of women, most without their knowledge. Whereby normal ovaries make the egg that is released each month as part of a healthy menstrual cycle; but with PCOS, the egg may not develop as it should or it may not be released during ovulation as it should be.
Estimates suggest that between 5 and 10 percent of the female reproductive population may have PCOS, being most prevalent in women under the age of 50. Shockingly, nearly 70% of cases are presumed to be undiagnosed, especially amongst younger women, as infertility is the primary clue that leads to most diagnoses. Although infertility is commonly the result of PCOS, if left untreated, PCOS may lead to more far-reaching health concerns, such as diabetes, heart disease, and endometrial cancer.
Polycystic ovary syndrome (PCOS):
affects millions of women and AFAB individuals worldwide
runs in families
is one of the leading causes of fertility problems in women
if not properly managed, can lead to additional health problems in later life
can have an impact on appearance and self-esteem
What causes PCOS?
The exact cause of PCOS is still unknown, but there do seem to be connections with family history and genetics, lifestyle or environment, and increased levels of two hormones in the body: insulin and androgens.
High levels of androgen.
Androgens are known to some as "male hormones," although all women make small amounts of androgens. Women with PCOS have more androgens than normal, which in turn prevents the ovaries from releasing an egg (ovulation) during each menstrual cycle. This results in extra hair growth and acne, two signs of PCOS.
High levels of insulin.
Insulin is a hormone the pancreas produces to help the body convert sugar from foods into energy. Insulin resistance is when your body’s cells stop responding normally to insulin, and instead block the entry of glucose into the cells. As a result, there is instability in your insulin blood levels which become higher than normal. Many women with PCOS have insulin resistance, especially those who are overweight, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes. Over time, insulin resistance can lead to type 2 diabetes.
PCOS & Hormones
Hormones are chemical messengers secreted directly through the bloodstream, taking them to organs and tissues to control many functions in your body, such as growth, energy, sexual function, reproduction, digestion and temperature.
The name ‘polycystic ovary syndrome’ is rather misleading, suggesting that the problem lies in the ovaries, and that you might have multiple ‘cysts’ on your ovaries. However, a woman can have PCOS with or without ovarian cysts and, even if she does have ovarian cysts, it does not necessarily mean that she has PCOS. These cysts associated with PCOS are actually eggs that do not get released from the ovary because of abnormal hormone levels.
Thus, the cause of PCOS is typically hormone-related. A woman with PCOS means her body has an imbalance of two hormones, insulin and androgens. Higher than normal levels of these hormones are responsible for the symptoms and signs of PCOS. It is thought that increased levels of insulin in the body cause the ovaries to work differently, which then produce excessive levels of androgens which in turn cause many of the symptoms of PCOS. Controlled hormone levels can lead to symptom improvement and normal functioning of the ovaries.
For many women, PCOS is a life-long disease. Symptoms usually manifest during late teens or early 20s, persisting through the reproductive years and into menopause. However, as with all other conditions, all women are different and will have different degrees of symptoms ranging from mild to severe.
The most common indicators of PCOS and other androgen disorders generally fall into one of three categories: changes in appearance, menstrual abnormalities, and metabolic or systemic disorders:
Changes in appearance
Acne on the face, chest, and upper back
Darkening of skin, particularly along neck creases, in the groin, and underneath breasts
Hirsutism or excessive hair on the face, chest, abdomen, or other parts of the body
Alopecia or hair loss
Unexplained weight gain or fluid retention
Severe menstrual pain
Amenorrhea or absence of menstruation
Irregular menstrual cycles
Metabolic or systemic disorders linked with PCOS include:
Infertility or reduced fertility
Diabetes or insulin resistance
To manage PCOS, it is imperative to know the root cause. This is done through determining the type of PCOS you have. There are four types of PCOS including insulin-resistant PCOS, inflammatory PCOS, pill-induced PCOS, and adrenal PCOS.
1. Insulin-Resistant PCOS
This is the most common type of PCOS and is the result of high levels of insulin in the body – it is often also referred to as metabolic syndrome or pre-diabetes. Insulin resistance is what happens when the cells in your muscles, fat and liver stop responding well to insulin, thus increasing blood sugar levels and forcing your pancreas to pump out even more insulin. High levels of insulin prevents ovulation and activates the ovaries to produce more androgens. Insulin resistance is thought to be caused by the intake of excess sugar, smoking, environmental toxins, and eating trans-fats.
3. Inflammatory PCOS
Inflammatory PCOS is when chronic inflammation harms normal body functions including ovulation and results in elevated androgens. This can cause visible body changes and irregular periods. Someone with inflammatory PCOS tends to have symptoms such as extreme fatigue, infections, skin issues like eczema or psoriasis, joint pain, bowel difficulties, or chronic headaches.
2. Post-Pill PCOS
The second most common type of PCOS is due to the consumption of oral contraception. Because the pills are used to suppress ovulation, this kind of PCOS may simply be a temporary condition related to a surge of androgens that are produced as your ovaries try to function normally again. Oral contraceptives that contain an androgen-suppressing form of progestin such as Yasmin or Ginet are often the culprit. However, the good news is post-pill PCOS will generally heal within a few months to a year when supported with the right diet, lifestyle and nutritional support.
4. Adrenal PCOS
The least common type of PCOS, adrenal PCOS accounts for only approximately 10% of all cases. Women with this kind of PCOS are either experiencing high levels of stress, or their bodies are reacting abnormally to stress. In either case, the tell-tale is when your tests show elevated DHEAs — an androgen produced in the adrenal glands— and normal levels of other androgens produced in the ovaries such as testosterone.
How Do You Get Diagnosed with PCOS?
Unfortunately, many women who suffer from the symptoms of PCOS don’t seek medical treatment because they are too embarrassed, or because the symptoms seem trivial and unrelated. Many of the symptoms could be perceived as awkward phases of development, reactions to stress or lifestyle choices, or concerns with a less-than-perfect body. For those who do seek treatment, doctors often dismiss their complaints because they can be categorized as cosmetic (and therefore not covered by insurance), or as merely affecting a woman’s ability to get pregnant, or simply unexplained “female problems.”
One of the reasons that PCOS seems to be underdiagnosed is that many people (patients and doctors alike) do not consider aspects of our appearance to be important enough to address. However, as we all know, our appearance does affect our overall sense of well-being.
The mind/body relationship is a very important contributor to our health, and especially a woman’s reproductive health. Dr. Christiane Northrup notes that the cyclic release of hormones from the hypothalamus is different in women with PCOS. We do not yet know whether this difference is the cause or the result of ovarian problems, but it is clear that the mind and body are both affected.
Talk about the Rotterdam criteria
Who is best qualified to diagnose and treat PCOS?
An endocrinologist, a skilled obstetrician-gynecologist (obgyn), a naturopathic doctor or a preventive/functional medicine doctor are usually equipped and knowledgeable to interpret test results and handle this syndrome.
Is there a cure for PCOS?
The typical approach to treating PCOS involves using oral contraceptives, androgen suppressors, synthetic estrogens, or other drugs that block hormone production. In short, most doctors will prescribe birth control pills (BCP) and metformin. However, these conventional approaches simply suppress symptoms and accentuate the problem without addressing the underlying cause. They will not cure your PCOS.
It is important to note that the BCP will only mask symptoms, not addressing the root cause. And if you stop the pill, your symptoms will return and most times, can be worse. Additionally, the pill can also increase insulin resistance and increase your risk for cardiovascular disease and stroke in the long term - two things that women with PCOS have a higher risk factor for.
Many practitioners believe that a cyclic regimen of progesterone therapy is the right starting point to treating PCOS. A practitioner by the name of Dr. Lee treated his PCOS patients with a bioidentical progesterone supplement, in conjunction with a proper diet, adequate exercise, and stress management. Dr. Lee claimed that “If progesterone levels rise each month … as they are supposed to do, this maintains the normal synchronal pattern … and PCOS rarely, if ever, occurs.”
Bioidentical progesterone has also proven to be effective for inducing fertility when there is some ovulatory dysfunction, with evidence indicating that bioidentical progesterone therapy poses no risk and is likely to benefit those wishing to become pregnant, and may even help maintain a pregnancy through the early months.
Another approach for treating PCOS is through usage of insulin-lowering medications, as it is especially important to regulate insulin production to allow the ovaries a chance to function normally. Studies have shown ovarian androgen levels in PCOS patients decrease significantly while taking these medications. However, this treatment works best when coupled with a healthy diet and proper exercise. For PCOS patients who are overweight, reducing their body weight by as little as 15% can significantly improve insulin sensitivity, restore ovulatory function, and reduce the effects of excess androgen.
In addition to bioidentical progesterone therapy and insulin-based treatments, a more holistic approach is the key to successfully treating PCOS, including:
Eating low glycemic and high fiber foods (fiber prevents recirculation of hormones from the gut and increases testosterone excretion)
Making other dietary changes such as omitting sugar, avoiding dairy products, eating more protein and consuming more omega 3 food products.
Consuming supplements such as Zinc and Vitamin D.
Inositol for PCOS Symptoms
Recent studies of a vitamin B factor by the name of D-chiro-inositol (DCI) has shown promising results for PCOS treatment. A study published in the New England Journal of Medicine in 1999 demonstrated that when a daily dose of 1200 milligrams of DCI was given for six to eight weeks, it promoted insulin action and decreased PCOS symptoms.
In 2012, Drs. Isabella Rosalbino and Emanuela Raffone discussed this topic in the Journal of Ovarian Research. They hypothesized that Myo-inositol (MI), a precursor to D-chiro-inositol, has greater benefit for women with PCOS, particularly in the area of infertility. While both DCI and MI restores ovulation in women with PCOS, MI has been associated with harvesting higher quality eggs, especially after IVF.
Myo-inositol can be found in foods like fruits, beans, grains, and nuts, whereas the richest sources of DCI are found in soy lecithin and egg yolks.
How to talk to doctors
Be your own advocate!
Ultimately you want a doctor who understands PCOS and who will listen to you. And this can be quite challenging but do not be afraid to listen to your heart or gut instincts. You are putting your life in their hands. You will need to make sure that you also respect and trust this doctor and their opinions. At the same time, doctors can only be as helpful as the information they are given so you will need to do your part in providing detailed and specific information about your symptoms and medical history. Now is not the time to be embarrassed about your own health, and only with this honesty that the root cause can be addressed.
If anything, be prepared for your appointment and have your list of questions ready. Remember, only you know your body well, and if you are not comfortable, that is completely fine. There is nothing wrong in seeking a second or even a third opinion. You are in the driver’s seat. Don’t be afraid to push back if they say everything is “normal” because normal is not optimal.
What types of tests should be ordered?
Other than the general screening (a lipids profile is important if you haven’t had one done recently), here are the types of blood tests that would help determine :-
Sex hormone binding globulin (SHBG)
Vitamin D (25OH)