Do you have long or irregular cycles or no cycles at all? Adult acne? Infertility? Excess hair growth in new places? Too much hair falling out when you brush it? Unexplained weight gain or inability to lose weight? Unstable blood sugar or family history of diabetes?
Any one of these symptoms should lead your doctor to investigate if you have PCOS, or Polycystic Ovarian Syndrome. PCOS is a very common condition that affects between 5%-15% of the female population, and can often go unrecognized and untreated for years. It is a condition we treat often at The Women’s Vitality Center and we want to shed some light on it so that more women get the support they need.
WHAT IS PCOS?
Because of its name, many people think having cysts on the ovaries is the key feature of this condition – it is not. PCOS is a series of symptoms characterized by hyperandrogenism, or too much male dominant hormone (like testosterone, DHT, and DHEA), produced by the adrenal glands, ovaries, or both. The name comes from a finding on ultrasounds that showed multiple cysts on the ovaries of some patients with hyperandrogenism, but cystic ovaries are NOT required in order to be diagnosed with PCOS. The most common symptoms of PCOS are irregular cycles, stubborn weight gain, acne, and hair loss or unwanted hair growth.
SO WHY DOES THIS HAPPEN??!!
Researchers are still trying to understand the inner workings of PCOS. Possible contributing factors include genetics, environmental toxicity, and vitamin deficiency, but a common thread noted in studies is the confirmed presence of insulin resistance throughout most of the body and the simultaneous insulin sensitivity of the ovaries. Insulin resistance is when your cells no longer respond to insulin, so the body produces more and more insulin in an effort to overcome the resistance. At the same time, in patients with PCOS, the ovaries then get overstimulated because they are not resistant. PCOS patients also tend to show high levels of inflammatory markers, high levels of oxidative stress, and signs of mitochondrial dysfunction (mitochondria are the batteries of our cells that power all of our bodily functions).
GETTING A DIAGNOSIS
The official diagnostic criteria for PCOS is a patient having any two of the following:
- Irregular periods or no periods. For the purposes of PCOS diagnosis, this means cycles that are longer than 35 days, counting from the first day of one period to the first day of the next. Women of reproductive age who have stopped having periods altogether should also be worked up for PCOS.
- Hyperandrogenism. This could be acne; excess or thick hair growth on face, nipples, or stomach (called hirsutism), and excess hair loss (usually from the temples, crown, or part, but can be diffuse too). You also may have limited symptoms but high levels of DHEA, total or free Testosterone, Androstenedione, or Dihydrotestosterone on lab testing.
- Cystic ovaries. One or both ovaries containing 12 or more follicles between 2mm and 9mm in size or an ovary that is 10mL in volume. It is important to know that there are some women with polycystic ovaries who do not have PCOS, and many women with PCOS who do not have cysts on their ovaries.
While some people have very obvious symptoms that match this criteria, others may have minimal symptoms or even no symptoms. We sometimes treat patients “as if” they have PCOS if they are already managing diet and exercise fairly well and their symptoms aren’t as present or obvious, but they still have other indicators that their hormones are responding to insulin in a less than ideal way.
RISKS OF PCOS
Besides the physical symptoms that trouble many patients, PCOS is associated with multiple health conditions. Infertility is a common side effect of PCOS because of the ovarian dysfunction and lack of ovulation, even if cycles are regulated. Twice as many females with PCOS have metabolic syndrome as in the general population, symptoms of which can include high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. Fifty percent of PCOS patients are obese. There is an increased prevalence of nonalcoholic fatty liver disease, sleep apnea, high cholesterol, and rates of cardiovascular disease. Some evidence suggests an increased risk of mood disorders among patients with PCOS. Most tellingly, the presence of PCOS is associated with a fourfold increase in the risk of Type 2 Diabetes.
The good news is that these things can be reversed or greatly reduced using lifestyle changes and natural medicine! Let’s talk about that next…
HOW IS PCOS TREATED??
If you get diagnosed with PCOS by your regular OB/GYN, most likely you will be offered either the pill if you are not trying to get pregnant, or clomid or letrozole if you are. If you have mildly elevated blood sugars (also known as pre-diabetes) or frank type 2 diabetes you may be managed with metformin or insulin. If you are overweight, you may be advised to lose weight, but not given specific advice about how to do that. If you have hirsutism, you could be told to begin waxing or try laser hair removal treatments. While all these therapies can be helpful to reduce symptoms, currently conventional medicine does not have the tools to “treat the cause” of PCOS. As Naturopathic Doctors we are so fortunate to have both the training in conventional medicine to understand how to diagnose and treat PCOS, as well as the holistic individualized approach we take to health that relies on restoring the body’s normal physiological function and innate capacity to heal.
Here is our approach to PCOS:
- Understand YOUR specific presentation and pathophysiology. We do this with a detailed personal and medical history, thorough investigation of your symptoms and your lived experience, and a comprehensive look at your diet and lifestyle. We look at toxic exposures and other influences like stress and stress management, sleep, food sensitivities, meal hygiene, and more.
- Lab testing. First we rule out any more serious causes of your symptoms. Then, depending on your specific presentation, we take a comprehensive look at hormonal health by testing adrenal, thyroid, and ovarian hormones through blood, saliva, or urine (or two or three of these). We check hormones on specific days of your cycle or look throughout your cycle to understand what your body is producing and not producing over the month. We look at multiple markers for inflammation, oxidative stress, cholesterol, blood sugar regulation, and insulin resistance to understand how these things interplay with your hormones. If indicated, we will run comprehensive stool analysis to understand the role of the digestive system in your health.
- We develop a treatment plan. This will most likely include diet and lifestyle modifications that focus on developing a healthy daily sleep and wake schedule, balancing blood sugar through balanced meals that include quality protein, fats and fiber, and giving specific exercise instructions. We focus on a diet high in plants to restore proper mitochondrial function and reduce inflammation. We help you remove toxic exposures that affect your hormones and guide you in building an overall self-care plan that supports healing and hormonal balance.
- We recommend supplements. Depending on your symptoms and lab results, we customize a supplement plan that will help to restore normal ovarian function, reduce androgens, repair mitochondria, normalize and reduce inflammation. This could include vitamins like Vitamin D and Bs, probiotics, liver support, adrenal and/or thyroid support, nutrients and herbs for insulin function and blood sugar regulation, and testosterone reducing herbs.
PCOS is a highly treatable condition. If you are dealing with any of the symptoms described above, or just got a diagnosis for PCOS, there is hope for you! You can get back to having regular periods and clear skin, boost your fertility, and feel good and strong in your body. If you would like to learn more about how the doctors at The Women’s Vitality Center can help you, please schedule a free “Vitality Discovery Call” today.