Polycystic Ovarian Syndrome

Symptoms, Root Causes, Diagnosis & Treatment

Polycystic ovarian syndrome (PCOS) is a multisystem syndrome with variable causes that put women at increased risk for a variety of health issues. It is a common problem among women of reproductive-aged years with the most common manifestations of menstrual abnormalities, infertility and abnormal hair growth in unwanted places.

No two women have exactly the same symptoms and needs. A number of factors contribute to the development of PCOS, including genetics, hormones, lifestyle and environmental. Women with PCOS are at increased risk of diabetes, cardiovascular disease, blood clots, high blood pressure, sleep apnea, depression/anxiety, and endometrial cancer.

The management of PCOS is a life-long process. Each patient should be evaluated and individually treated based on her root cause, health status and desire for pregnancy. Getting to the root cause is imperative to guide treatment. There are many lifestyle changes that can assist with guiding the course of treatment as well.

Symptoms of polycystic ovarian syndrome

A wide range of symptoms may be present depending on the root cause. Women may have irregular periods or no cycles at all, acne, weight gain, male pattern hair loss, hair in unwanted places, infertility, mood swings (prone to anger, irritability), multiple small cysts on ovaries (seen as string of pearls on ultrasound), weight gain (approximately 30-75%), fatigue and insulin resistance. 

Root Causes of PCOS

PCOS is not just an ovarian problem. The ovaries produce approximately 25% of testosterone, 50% of the hormone that makes testosterone, and 20% of the DHEA (an androgen that is the precursor to the sex hormones). The adrenals produce approximately 25% of the testosterone, 50% of the hormone that makes testosterone, 80% of the DHEA, 100% of DHEA-S. The other 50% of testosterone is made in adipose tissue.

There can be problems with both the ovaries and the adrenals. Insulin resistance contributes because high insulin levels lowers the hormone that binds testosterone, that leads to an elevation in testosterone which in turn does not allow ovulation and low progesterone production. It is the hypothalamus-pituitary-adrenal axis (HPA-axis) that stimulates the production of DHEA/DHEA-S and the hormone that makes testosterone. When the HPA is out of order, downstream problems ensue.

Diagnosis

Comprehensive testing and clinical history is so important for uncovering the root cause. Depending on the symptoms and history, a fasting glucose, fasting insulin, thyroid panel, cardiovascular testing, pelvic ultrasound may be checked.

Perhaps the most important test is comprehensive hormone testing which looks at the metabolism of hormones, the pathways, cortisol patterns, organic acids, melatonin, and more which is done through saliva and urine. At Empowered Health, the goal is to get to the root cause to better understand the pathways that is driving PCOS to assist with guiding treatment.

Nutrition and PCOS

Nutrition is very important with women with PCOS, no matter the cause. The focus should be on a low glycemic load that includes whole grains, increased fiber with reduced saturated fat. Avoiding refined white sugars and refined carbohydrates, while consuming optimal sources of proteins and plenty of fruits and vegetables is crucial.

Lifestyle Components

There are many lifestyle factors that can assist with improving PCOS. Depending on the root cause of PCOS, exercise with moderate effort 3-5 days per week is recommended. If low levels of cortisol is driving PCOS, exercise habits and intensity may be decreased initially to prevent extra stress on the adrenal glands. Refraining from smoking, alcohol and other toxins is also very important.

Restoration of the HPA axis is a key treatment recommendation that often is neglected. Sleep is important for optimizing the HPA axis along with stress management techniques including meditation, deep breathing, self-care, relaxation, and mindfulness. There are many supplements that can assist with treatment along with pharmaceutical options if needed. At Empowered Health, we practice mind-body medicine and strive to get to the root cause to individualize treatment for each woman with PCOS. 

References

Polycystic Ovarian Syndrome. Dr. Andrew Weil Center for Integrative Medicine, University of Arizona.

The Case of PCOS: Evaluating ovarian and adrenal hormones. Precision Analytical INC. https://dutchtest.com/video/pcos-webinar/

Polycystic ovarian syndrome, diagnosis, treatments. UpToDate, 2022. http://uptodate.com