What is PCOS?
Polycystic Ovarian Syndrome (PCOS) is a common hormonal condition which affects 12-22% of women of reproductive age (1). It is characterised by higher than normal levels of male sex hormones or androgens, which leads to metabolic and reproductive system dysregulation. It is the leading cause of infertility in females, and unfortunately 70% of cases go undiagnosed (1).
What are the signs and symptoms?
Oligomenorrhoea (irregular and infrequent menstrual periods of less than 6-8 per year)
Amenorrhoea (an absence of menstrual periods)
Hirsutism (male-pattern hair growth to the face, chin, and body)
Hormonal acne on the face, chin or body
Weight gain or difficulty losing weight (but not in all cases)
Metabolic syndrome (insulin resistance, pre-diabetes, obesity, high cholesterol)
Fatigue
Difficulty falling pregnant
Anxiety or depression
What causes PCOS?
Insulin resistance is present in as many as 70% of PCOS cases, which is an underlying driver for the condition (2, 4). Elevated serum insulin disrupts metabolic signalling pathways, which leads to an overproduction of androgens by the theca cells of the ovaries (3). Higher than normal circulating androgens including testosterone, androstenedione, and dehydroepiandrosterone (DHEAS) disturb normal hormonal balance which impairs ovulation. Excess follicles develop on the ovaries in an attempt for the body to ovulate, however failure to do this results in anovulatory cycles and missed periods. Sub-fertility, infertility and an increased risk of miscarriage can occur due to this ovulatory dysfunction (1).
Excess androgens cause male-like characteristics of male-pattern hair growth, acne and male-pattern hair thinning, as well as further compound the issue of hyperinsulinaemia and insulin resistance (3). Women with PCOS have an increased risk of developing metabolic syndrome which encompasses obesity, pre-diabetes, and dyslipidaemia (1).
There are 4 main types of PCOS which are Insulin-resistant, Post-pill, Inflammatory and Adrenal PCOS, with each having a different mechanism in how the condition manifests (4).
How is PCOS diagnosed?
Diagnosis is based on the Rotterdam criteria, whereby 2 of the 3 of the following signs and symptoms must be present:
1) oligomenorrhoea/anovulation
2) hyperandrogenism:
hirsutism or male pattern alopecia, or
raised Free Androgen Index or free testosterone on a blood test.
3) polycystic ovaries on ultrasound:: >10 small antral follicles on both ovaries or one ovary.
The exclusion of other possible conditions is essential including: adrenal gland disorders, tumours, thyroid dysfunction and hyperprolactinaemia.
How is PCOS medically treated?
Typical medical treatment of PCOS often involves prescribing the oral contraceptive pill to regulate the menstrual cycle and suppress ovarian androgen production. The pill however doesn't actually regulate the menstrual cycle, rather it suppresses ovarian function and creates a pseudo period or "withdrawal bleed" which confuses women into thinking they have a normal 28 day cycle. This can further compound the issue of PCOS when the decision is made to come off the pill to try and conceive, whereby ovarian function remains suboptimal and symptoms related to excess androgens can quickly resurface.
Other medications may be prescribed by doctors including androgen blocking medications, and metformin for blood sugar control, but these medications can have side effects.
Nutritional treatment of PCOS
There are many proven nutritional and supplemental strategies for treating PCOS.
Seek guidance from a natural health professional: It's always recommended to seek guidance from a qualified professional such as a Clinical Nutritionist who can appropriately assess, test and treat your symptoms.
Address the driving cause: Identify which of 4 types of PCOS is present eg Insulin-resistant, Post-pill, Inflammatory and Adrenal PCOS. Each of these subtypes require a different strategy in the treatment. I will share more on this in another post.
Support ovulation: Nutritional and supplemental strategies can promote optimal hormonal balance and spontaneous ovulation.
Improve insulin sensitivity and stabilise blood sugar levels.
Support liver detoxification: The liver inactivates and filters hormones from the blood via phase 2 liver detoxification pathways, including oestrogen, testosterone, DHEA and cortisol.
Support a healthy weight: 60% of women with PCOS struggle with excess weight, as weight gain can be accelerated due to unbalanced hormones and insulin resistance (1). Dietary and exercise strategies are an important part of the management of PCOS.
Nourish the adrenal glands: improving stress adaptation and resiliency of the adrenal glands is important in PCOS, due to the significant role that the adrenal glands play in hormone production and blood sugar regulation.
Nutrient support: Myo-Inositol, N-acetyl cysteine (NAC), magnesium, zinc, chromium, vitamin D, and essential fatty acids have shown benefits in PCOS.
The science behind nutritional interventions of PCOS
If you suspect you may have PCOS or have been diagnosed with the condition, I would love to help you rebalance your hormones through natural means. Reach out for a FREE Discovery Chat : )
References