Polycystic Ovarian Syndrome (PCOS) is a complex hormonal condition that can cause horrible mental and physical problems like irregular menstrual cycles, excessive facial and body hair, scalp hair loss, acne, obesity, reduced fertility, and low self-esteem. It also increases the risk of diabetes, heart attack, stroke and endometrial cancer.
These days PCOS is relatively common, especially in infertile women. Around 20% of women of reproductive age have it, but 70% of these cases remain undiagnosed!
How is PCOS Diagnosed?
Diagnostic criteria have changed over time, and current guidelines reflect the fact that around a third of women may have polycystic ovaries seen on an ultrasound, but they do not all actually have PCOS. The fact is you can be skinny and still have PCOS or have regular periods and still have PCOS or have normal androgen hormone levels and still have PCOS.
A diagnosis of polycystic ovary syndrome can be made when at least two out of three of the following criteria are met:
The ovaries are 'polycystic' (12 or more follicles are visible on one ovary, or the size of one or both ovaries is increased).
There are: high levels of 'male' hormones (androgens) in the blood (hyperandrogenism) or symptoms suggesting an excess of androgens (excess facial or body hair growth, scalp hair loss, acne).
There is menstrual dysfunction (lack of periods or menses, irregularity or lack of ovulation).
What causes PCOS?
Though there are some other causes such as BPA toxin exposure, thyroid, adrenal or pituitary issues, most people have PCOS due to diet induced insulin resistance.
In insulin resistance the Liver and muscles stop listening to insulin so the body needs to make more and more to keep blood sugar levels in check. (Insulin lowers blood sugar and helps push it into cells). Unfortunately the ovaries still listen so as the abnormally elevated insulin levels continue, they are changing their function. The result is higher than normal male hormones (Testosterone). High insulin causes increased Estrogen and Androgens which cause low SHBG which increases free Testosterone. This creates a feed-forward cycle of more and more male hormones being made and further imbalance. Insulin promotes growth of follicles in the ovaries and has a devastating impact on blood vessels generally.
The characteristic increased numbers of pre-antral follicles in the ovary, arrested follicular maturation and disruption to the selection of the ovulatory follicle cause the abnormal Ultrasound findings. These are due to either a reduced sensitivity to follicle-stimulating hormone (FSH) or enhanced follicular activity of luteinizing hormone (LH). Usually this is related to abnormal secretion of gonadotropin-releasing hormone (GnRH) and excessive LH release that stimulates theca cells to over-produce androgens. The peripheral conversion of circulating androgens in adipose tissue, stroma and skin to oestrogens results in increased oestrogen production, and the imbalance worsens. Women with PCOS have higher oestrogen levels and lower levels of progesterone in their bodies, which impacts their menstrual cycles, and increases the risk of developing uterine cancer.
First-degree female relatives of someone with PCOS have a 50% chance of developing PCOS themselves. Usually sisters have similar symptoms however what is interesting is brothers of women with PCOS also have insulin resistance and abnormal levels of hormones (DHEA-S levels)
The best solution for most women is not surgery, and medication only treats the symptoms.
The root cause is the insulin resistance which can be reversed with specific dietary changes. (It is similar to our approach for reversing obesity which you can read about here, though we customise it to you and your PCOS). Sometimes we also use Functional Medicine to balance hormones directly.
Most patients find their skin clears up, they lose weight, feel better than they have in years and get regular cycles back. Even if you don’t have much weight to lose, the approach is effective and in a few months most patients notice dramatic changes to their wellbeing. Couples struggling with infertility frequently find they fall pregnant as their PCOS is reversed.
If you would like to discuss your personal experience and have a tailor-made solution for your PCOS symptoms, book in with one of our functional medicine doctors at Evergreen Doctors today.