Finding and treating the root cause of PCOS

Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder, affecting between 5 and 15% of reproductive aged women worldwide and is one of the causes of infertility.

This complex condition presents with of a set of symptoms which have arisen due to hormonal irregularities or imbalances. The symptom presentation varies between individuals, but what is universal is that they are all unwanted!

These varied PCOS symptoms are all driven by several underlying factors and can include:

• Acne/excess oil production in skin/hair

• Hirsutism (excess unwanted hair growth on the face/body)

• Male pattern baldness or hair thinning

• Weight gain/stubborn weight loss

• Darkened skin patches

• Irregular periods or no periods

• Subfertility/infertility

Insulin resistance is one of key physiological imbalances in PCOS cases. When we consume sugar, our pancreas responds by pumping insulin into our bloodstream to transport the sugar (glucose) to our cells for cellular energy, or to our liver/muscle cells for storage. When we consume too much sugar, an increased demand on our pancreas to secrete more and more insulin decreases its insulin signalling over time and eventually results in insulin resistance. Insulin resistance is also referred to as Metabolic Syndrome (MetSyn) or pre-diabetes.

Females are born with low level androgens, formed by the ovaries or adrenal glands, however when high levels of insulin which are commonly seen in PCOS lead to hypersecretion of luteneizing hormone (LH) by the theca cells of the ovaries, high levels of androgens such as testosterone and dehydroepiandrosterone sulfate (DHEAS) are generated. It is also insulin that decreases the synthesis and secretion of sex hormone binding globulin (SHBG) by the liver, resulting in a further excess of circulating free testosterone and associated symptoms.

As such, diagnostic blood tests for PCOS will indicate high insulin levels (fasting insulin needs to be tested), a high FAI (free androgen index) and a low SHBG protein level.

Did you know that nutritionists order both pathology testing via your GP and functional testing directly with the laboratories?

Although PCOS is a diagnosis of exclusion, whereby common diseases with similar presenting symptoms must firstly be ruled out, its diagnosis must still be formed by The Rotterdam Criteria of 2003, requiring the presence of at least 2 of the following:

• Hyperandrogenism (diagnosed from either clinical or biochemical presentation)

• Ovulatory dysfunction - either oligomenorrhea or amenorrhea (cycles more than 35 days apart but less than 6 months apart or absence of menstruation for 6 to 12 months after a cyclic pattern has been established)

• Polycystic ovaries on ultrasound

What confuses a lot of people is that although polycystic ovarian morphology (on ultrasound) is part of the diagnostic criteria, a PCOS diagnosis actually has nothing to do with the presence of cysts on the ovaries! You can in fact, have cysts on your ovaries and have perfectly normal hormones. It is the ANDROGEN EXCESS that determines your PCOS diagnosis. You can have ovulatory dysfunction and cysts on ultrasound but if you don’t have hyperandrogenism, you do not have PCOS.

These “cysts” that appear on an ultrasound are actually follicles, or fluid filled sacs produced by the ovaries each month, secreting both oestrogen and progesterone and releasing an egg at ovulation. Therefore, ‘polycystic ovarian syndrome’ is technically a misnomer, as these “cysts”on the ovaries are in fact antral follicles. Such cysts still can be part of the PCOS diagnosis when presenting alongside a high androgen picture, however large and painful cysts are a different story and are not related to a PCOS diagnosis at all!

The confusion surrounding the diagnostic criteria and cyst presentation has been so much so that several new names for PCOS have been proposed. These names, proposed in order to overcome such diagnostic pitfalls include:

• Metabolic reproductive syndrome

• Oestrogenic ovulatory dysfunction

• Functional female hyperandrogenism

• Hyperandrogenic Persistent Ovulatory Dysfunction Syndrome (HA-PODS)

Despite its prevalence, the time from the onset of symptomatology and through usually several different doctor’s appointments to the official diagnosis is usually 1 year or beyond. PCOS can often be misdiagnosed for Hypothalamic Amenorrhea, which presents with similarities such as an absence of menstruation and mild androgenergic symptoms however the root cause and therefore the treatment is completely different.

Did you know that there are 4 functional types of PCOS?

1. Insulin resistant PCOS

2. Post-pill PCOS

3. Inflammatory PCOS

4. Adrenal PCOS

The root cause for each type of PCOS is different, and therefore the treatment that we as nutritionists and naturopaths use to treat the underlying drivers behind the condition is varied. As you may know, diet and lifestyle modifications are imperative when it comes to treating the cluster of symptoms, and this will be individualised on a case-by-case basis. Some common supplements to treat insulin resistance, support the adrenal glands, address inflammation and hormonal imbalances include:

• Magnesium

• Inositol

• Chromium

• Vitamin B6

• N-acetyl cysteine

• Zinc

• Fish oil

If you have PCOS diagnosis, and are still suffering from symptoms, or you are not sure if your symptoms are as a result of one of the 4 functional types of PCOS, please don’t hesitate to reach out and book a 15 minute Discovery Call to discuss where you’re at and how I can help support you to return to health.