Polycystic Ovarian Syndrome (PCOS) is a reproductive disorder characterised by multiple cystic growths on the ovaries (polycystic ovaries). PCOS develops when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, either through the release of excessive luteinising hormone (LH) by the pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus. PCOS is characterised by a complex set of symptoms with research to date suggesting that insulin resistance is a leading cause.
A majority of patients with PCOS (some investigators say all) have insulin resistance. Insulin resistance is a common finding among both normal weight and overweight PCOS patients. These raised insulin levels contribute to or cause the changes in the Hypothalamic-Pituitary-Ovarian axis that lead to PCOS. More specifically, the high insulin levels cause a number of endocrine (hormone) changes associated with PCOS, including the following:
- Increased GnRH pulse frequency
- LH over FSH dominance (Luteinising Hormone: Follicle Stimulating Hormone)
- Increased ovarian androgen production
- Decreased follicular maturation
- Decreased SHBG binding (Sex Hormone Binding Globulin)
PCOS is the most common cause of oligomenorrhoea (infrequent periods) and amenorrhoea (no periods), and thought to affect 4-7% of normally menstruating women. These women may have reduced fertility and an increased risk of miscarriage.
Major risk factors for PCOS include:
- Insulin resistance
- Family history of PCOS
- Nutritional deficiencies
- High glycaemic load diet
- Sedentary lifestyle
Common signs and symptoms of PCOS include:
- Enlarged ovaries, generally 2-3 times larger than normal, resulting from multiple cysts
- Irregular menstrual cycles – i.e., oligomenorrhoea or amenorrhoea
- Hirsuitism (espcially facial hair)
- Central obesity – "apple-shaped" obesity centred around the lower half of the torso
- Infertility, generally resulting from chronic anovulation (lack of ovulation)
- Elevated serum androgens (male hormones), specifically testosterone, androstenedione, and dehydroepiandrosterone sulphate (DHEAS), causing hirsutism and occasionally masculinisation
- Androgenic alopecia (male-pattern baldness)
- Jaw-line acne, oily skin, seborrhoea
- Acanthosis nigricans (associated with insulin resistance)
- Prolonged periods of PMS-like symptoms
- Sleep apnoea (especially if with metabolic syndrome)
- Chronic pelvic pain
- Blood sugar dysregulation – e.g., hypoglycaemic episodes, diabetes, etc
In cases of PCOS where insulin resistance is present, treatment priorities are diet, weight loss (if needed) and exercise to help normalise insulin levels. This effectiveness of these lifestyle strategies varies with the individual, and when further support is needed Jodie prescribes Herbal Medicines and specific Nutrients to help correct the hormone imbalances and provide specific nutrients to the ovaries and thyroid gland. Supporting endothelial health (the lining of blood vessels) is also important when insulin resistance is present. This endothelium is prone to inflammation (i.e. oxidative stress*) and looking after this delicate tissue can prevent cardiovascular complications in the longer term.
Diet, Exercise, Specific Nutrients and Herbal Medicine play an important role:
- Diet: This is unique to the individual and includes: Low Glycaemic Index diet, Low-moderate carbohydrate diet and/or Anti-inflammatory diet. It is also important to any identify food intolerances and correct dysbiosis if present.
- Nutrients: Zinc, Selenium, Iodine, CoQ10, Chromium, Activated B Vitamins, Magnesium, and others
- Exercise: High Intensity Interval Training (HIIT) is ideal, but any type of movement is beneficial
- Herbal Medicines: Gymnema, Shatavari, Paeonia, Cinnamon, Licorice, Dong Quai, Globe Artichoke, Barberry and in some cases, Chaste Tree
- Probiotics (if dysbiosis present): Lactobacillus rhamnosus GG (LGG), L. plantarum (299v) and others
* Oxidative stress and damage to the endothelium can occur from: high stress levels, smoking, high blood pressure, high blood sugar levels, poor diet and a lack of exercise.