Polycystic ovarian syndrome is a condition that is affecting more and more women and girls – it affects 1 in 7 women worldwide making it one of the most common endocrine disorders to affect women of reproductive age.
This is one of the most common conditions that I see in our clinic, as women are usually frustrated by the lack of conventional treatment options available to them. Unfortunately, this condition is often incorrectly diagnosed and misunderstood in a lot of women. It is also being increasingly diagnosed in young girls – often unnecessarily
It really seems that PCOS is becoming an epidemic, and information about this condition is greatly lacking! PCOS is a 20th century condition, along with the increase of heart disease, diabetes and obesity. And the reason they are all increasing together is because they are all being (mostly) caused by the same things. We’ll get into what that is later, but first we should cover what PCOS actually is.
The name poly-cystic ovarian syndrome implies that the main feature of the condition is the presence of small cysts on the ovaries, however with current diagnostic criteria this is actually not required for a diagnosed, and not all women with PCOS have cysts on their ovaries. This is just one of the possible symptoms that makes up this condition.
In this article I wrote for Western Sydney Mum’s Hub I discuss what PCOS actually is, as well as outline the symptoms of PCOS and debunk some myths. I also talk about the causes of PCOS, and my key natural treatments.
Symptoms may include:
· Irregular or absent periods
· Insulin resistance (high insulin levels picked up in a blood test)
· High testosterone (androgen) levels in a blood test
· Hirsutism (Excess hair growth, usually in areas such as the lip, arms, lower back)
· Sugar cravings
· Blood sugar fluctuations (e.g. feeling irritable or dizzy if you skip a meal)
· Weight gain or difficulty losing weight, especially from around the middle
· Ovarian cysts (picked up by ultrasound)
· Thinning head hair
· Painful periods or pain on ovulation
· Fertility problems including difficulty conceiving and increased miscarriage rates
· Skin tags
· High cholesterol levels
The condition is diagnosed differently according to different criteria, however most commonly it is by the presence of 2 of the following 3 factors:
· Irregular or absent ovulation/periods
· High androgen levels (the male hormone) found in blood tests
· Symptoms of high androgen levels such as hirsutism and acne.
· Other conditions which cause these symptoms must be ruled out.
LET’S CLEAR UP SOME PCOS MYTHS
- Having cysts on the ovaries is not the main way of diagnosing PCOS. Not all women with PCOS have cysts, and as a stand-alone symptom having cysts on the ovaries isn’t enough to diagnose PCOS.
- It’s normal for cysts to grow on the ovaries – these are actually your ovarian follicles (or eggs) growing and releasing, however in PCOS these do not grow properly and this is what can result in the typical appearance of a PCOS ovary.
- PCOS doesn’t always affect your fertility negatively. This understanding is mostly based on people with severe cases of PCOS and so the understanding of to what degree it affects the fertility of those with milder forms of PCOS is lacking.
- You aren’t always stuck with PCOS for life. Many young girls who are diagnosed with PCOS can grow out of this condition by the 30s.
- The oral contraceptive pill is not the best way to treat PCOS. Yes it can bring on a regular, predictable bleed, but remember that this is not a true period, and the pill can make the condition worse after stopping.
- If you get period pain it is not due to PCOS – there is likely something else going on that is contributing to the period pain such as endometriosis or primary dysmenorrhea (the fancy term for period pain not attributed to an obvious cause). It is possible to have both endometriosis and PCOS.
- Thin women and girls can have PCOS too, and can still have insulin resistance.
Top causes of PCOS
Nearly all cases of PCOS have insulin resistance. Insulin resistance is when the cells have difficulty taking up glucose from the bloodstream, often resulting in an increased secretion of insulin, which worsens the symptoms of PCOS.
Even if your blood sugar levels are normal, you can still have insulin resistance. It is vital that insulin levels are tested too, but they aren’t always automatically done, so you may need to ask.
As I was mentioning earlier, I believe that insulin resistance is the link between these 20th century conditions. Insulin resistance can be a genetic problem, but the food choices that we make play the biggest role in the development of this condition. Highly processed foods, refined carbohydrates and excess sugar are the evil culprits that lead to the development of insulin resistance by causing our blood sugar levels to be elevated over a long period of time. Insulin is a hormone that is secreted by the pancreas in response to high blood sugar levels. Its job is to put the sugar into the cells. When the levels of sugar in our blood are high for an extended period of time, insulin is produced more and more, and our cells begin to ignore it (like in The Boy Who Cried Wolf). This leads to high circulating insulin, and this is where the problem comes from.
Insulin is known for its ability to lower blood sugar levels. The way that insulin does this is by storing the sugar in the form of glycogen – but the body can only store so much of this, and when it’s full the sugar gets stored as fat (most commonly in the abdomen, causing the typical apple body shape).
High androgen levels
Androgen are a group of hormones that includes testosterone. They may be called ‘male hormones’ but both men and women produce androgens, just in different amounts and with different actions.
There are a few different types of androgen markers that are tested in blood tests, including total testosterone, SHBG, androstenedione and DHEA.
For most women with PCOS the insulin resistance is usually the biggest issue which causes high androgen levels. However, for some (approximately 20%), high androgen levels may be present unrelated to insulin resistance, and this is most often due to stress.
Sometimes there can be some less common causes of PCOS. This can include nutritional deficiencies (such as iodine or zinc), inflammation and thyroid disorders. For some women they may have developed PCOS because of taking the oral-contraceptive pill. Often this will resolve within about a year (herbal medicine can reduce this time frame to 3-4 months).
Key Natural Treatments for PCOS
What treatment is used for PCOS depends on the underlying cause and a practitioner can guide you further on this. These are some of my favourite treatment tools:
- Test for and treat insulin resistance, typically with an exercise regime and a low-GI diet (you can read some tips for a Low GI, Nutrient Dense Diet here).
- Cut out/down sugar in the diet.
- Cut out/down dairy.
- If androgen levels are high without insulin resistance, herbs and nutrients that can reduce the excess of this hormone include Saw Palmetto, Peony and Licorice, and the mineral Zinc.
- If DHEA is high or there is a lot of stress around the time of puberty or currently, herbal medicine to support the nervous system such as nervine and adaptogen herbs, the mineral magnesium and B vitamins can be helpful.
- The amino acid myo-inositol is helpful for supporting blood sugar levels and reducing anxiety and can be a great tool in the kit to treat PCOS.
If you or your daughter has been diagnosed with PCOS or you suspect that this may be an issue for you, seek advice from a naturopath experienced in this area as there is much that can be done to help.