PCOS, Polycystic Ovarian Syndrome
This is a complex condition characterised by decreased ovulation, loss of menstrual periods, infertility, weight gain, excessive body hair and acne.
by Sharon Erdrich
The term ‘polycystic’ ovaries describes the ovaries – on ultrasound numerous follicular cysts (2-6mm in diameter) can be seen on the peripheries of a classically enlarged ovary. Many women (approx. 20%) have ovaries that are polycystic, but do not have any of the other symptoms or hormone findings of PCOS.
Who Gets It?
PCOS is one of the most common endocrine disorders in females, affecting around 6-10% of reproductive age women.
Some women have polycystic ovaries (PCO) without ever developing the syndrome of PCOS.
The causes of PCOS are unclear. Considerations are:
- genetic predisposition: approx 40% of women with a family history of PCOS will have PCO, but may not develop PCOS.
- Many of those who are affected often have both male and female relatives with type II diabetes, obesity, elevated blood triglycerides or high blood pressure. They may also have female relatives with infertility, hirsutism or menstrual problems.
- ovarian dysfunction (leading to very low oestradiol and high ovarian androgens) resulting in excess androgens (male hormones)
- Excessive weight gain: high amount of adipose tissue leads to the conversion of androgens to oestrone
- Adrenal dysfunction: excessive production of androgens by the adrenals
- Higher-level endocrine dysfunction: inappropriate hormone release from the Hypothalamus & pituitary glands.
- Use of anti-epileptic medication especially valproate is associated with PCO and hyperandrogenism
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What’s Going on in the Body?
Inappropriate hormone production means that a number of irregularities occur:
- The ovaries are stimulated to develop an egg but this does not proceed to full maturation and ovulation.
- Numerous follicles accumulate which means that there is a constant production of higher levels of hormone
- The secretion of androgens contributes to persistent anovulation.
- The ovaries may be enlarged with smooth, thickened capsules or may be normal in size. Typically, the ovaries contain many cysts.
- Circulating levels of testosterone (normally found in low levels in women) tend to be elevated.
What are the Risks Associated with PCOS?
- With proper diagnosis and treatment, most PCOS symptoms can be adequately controlled or eliminated.
- Infertility can be corrected and pregnancy achieved in most patients. However, hormonal disturbances and anovulation may recur.
- Because of the high rate of hyperinsulinaemia observed in PCOS, women with the disorder should have their glucose levels checked regularly to monitor for the development of diabetes.
- Blood pressure and cholesterol screening are also needed because women with PCOS tend to have high levels of low-density lipoprotein (LDL) cholesterol and triglycerides, which puts them at risk for developing heart disease.
- Women suffering PCOS have an increased risk of developing Syndrome X, cardiovascular disease, hypertension, altered lipoprotein profiles, type II diabetes, gestational diabetes, endometrial hyperplasia, endometrial cancer, and glucose intolerance.
- One of the major features of polycystic ovary syndrome is insulin resistance.
- This produces the high levels of testosterone which interferes with the normal pituitary control of the ovarian hormones, leading to anovulation, amenorrhoea, and infertility.
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What are the Symptoms?
Symptoms typically begin during puberty and worsen with time.
PCOS accounts for 75% of women with anovulatory infertility (not ovulating), 30% to 49% of secondary amenorrhoea (no periods), and 85% to 90% of women with oligomenorrhoea (infrequent periods).
How is it Diagnosed?
Diagnosis is made according to symptom picture plus serum hormone tests plus ultrasound. Lab Tests: High levels of androgens plus less than 6 menstrual cycles in one year is diagnostic of PCOS, after elimination of other possible causes, including ovarian or adrenal gland tumours.
Usual Medical Treatment
Aim is management of symptoms, but depends on the woman’s stage of life. For women who do not require birth control, causing a woman to have a period 4 times a year is all that is required.
How Successful is Natural Treatment?
Some women can completely reverse PCOS by making changes to their diet and lifestyle. Determining the levels of hormones is a crucial factor in planning those changes. Evaluation of insulin levels, via a standard laboratory test, determines the role of this hormone in managing your weight.
What Should I do Next?
If you have, or think you have PCOS, we strongly recommend an appointment with one of our naturopaths as soon as possible to get you back on the path of good health. Prevention of developing Metabolic Syndrome is crucial, and it’s never too late to start to turn back this condition. Ordering your DUTCH test before the appointment will save time overall.