All about PCOS – Polycystic Ovary Syndrome

PCOS – Polycystic Ovary Syndrome

Do you struggle with acne and or excess hair growth?

Are your periods irregular?

Have you put on weight?

Are you having problems conceiving?

Then you may have undiagnosed PCOS

In this article you find answers and solutions

Facts about PCOS – W.H.O

• It is a worldwide epidemic
• Affects an estimated 6–13% of all fertile women
• Up to 70% of affected women remain undiagnosed worldwide. 
• Is a common hormonal condition that affects women of reproductive age.
• Usually starting during adolescence, but symptoms may fluctuate over time.
• Is the commonest cause of anovulation and a leading cause of infertility
• Is associated with a variety of long-term health problems that affect physical and emotional well-being.
• PCOS is a chronic condition for which there is no cure
• Some symptoms can be improved through lifestyle changes, medications and fertility treatments.
• The cause of PCOS is unknown but women with a family history and or type 2 diabetes are at higher risk.
• PCOS runs in families, but there are ethnic variations in how PCOS manifests itself and how it affects people.
• Symptoms don’t necessarily disappear after menopause

The Fundamental Cause

• Excess Testosterone
• WHY?
• Treatment should focus on the cause

Why the excess Testosterone

• Acute stress
• Adrenal, Pituitary or Hypothalamus tumours
• Adrenal Hyperplasia
• Ovarian dysfunction
• Obesity
• Insulin Resistance

Where is Testosterone Produced

• 25% Ovaries
• 25% Adrenal
• 50% Adrenal Androgen precursors in skin and fat cells, such as DHEA, Androstenedione

Possible symptoms

• Heavy long, intermittent, unpredictable or absent periods
• Infertility
• Acne or oily skin
• Excessive hair on the face or body
• Male-pattern baldness or hair thinning
• Weight gain, especially around the belly.

Current Medical Criteria for Diagnosis – 2 out of 3 of the following

• Symptoms due to increased androgen hormones (DHEA-S, Testosterone, DHT) production, such as
• Acne
• Hirsutism
• Hair loss (male pattern baldness)
• Irregular periods, due to hormone imbalances and anovulation
• Poly(many) cysts seen on an ultrasound – BUT younger females quite normally mobilize many follicles/cysts every month, known as – PCO / Poly-Cystic-Ovary, which isn’t dangerous and doesn’t affect pregnancy
• Blood tests can be used to identify characteristic changes in hormone levels, although these changes are not universal. Women with polycystic ovary syndrome may have elevated levels of:
• Testosterone
• Estrogen
• LH, Luteinising Hormone – A pituitary hormone which increases ovarian Testosterone production and ovulation
• Insulin – blood glucose regulator and fat storing hormone
• AMH, Anti-müllerian Hormone – indicator of how many eggs in the ovaries

Better to Diagnose by Exclusion – Is there?

• PCOS physiology is complex – find the Root cause
• Don’t make assumptions – it’s a syndrome
• 80% is due to ovarian dysfunction
• Adrenal, Ovarian, or Pituitary tumours
• Problems with Aromatase production – less Aromatase more Testosterone
• Toxicity – women with PCOS may be poor detoxifiers
• Low or high Estrogen 
• Excess endocrine disruptors – BPAs decrease Aromatase
• Estrogen pathways malfunction
• Receptors may not work properly
• Less (if any) ovarian Estradiol production
• Low levels of Estradiol in the brain increases the production of the hormone LH which will increase Testosterone production in the ovaries (in the hope of making Estradiol)
• Estrogen is key for mitochondrial function and glucose transport into cells, so low Estradiol = higher blood sugar = increased Insulin production and resulting fat storage and lower energy production
• Estradiol dictates where fat is stored – breast tissue, butt, hips and thighs, NOT visceral or tummy
• Excess Insulin production increases ovarian Testosterone production

Other possible causes

• Lifestyle
• Gut
• Diet
• Sleep
• Lack of light
• Gut dysbiosis
• Gut microbiome changes with hormone imbalances
• And changes in gut microbiome can disturb the breakdown and absorption of glucose
• Diet
• Fast foods / Ultra Processed Foods
• High fat and high sugar diets
• Deficiency of healthy fats
• Circadian rhythm dysregulation aka poor sleep
• Low Melatonin
• Melatonin has receptors on ovaries, which is key to regular menstrual cycles 
• Blue light decreases Melatonin
• Lack of sleep increases Cortisol, which increases blood glucose and the need for Insulin
• Stress
• Women with PCOS have higher levels of Cortisol
• Liver dysfunction
• Check for NAFLD / Non-Alcoholic Fatty Liver Disease
• Thyroid dysfunction
• Increased Prolactin
• Maybe due to a Pituitary Tumour
• Stimulates Adrenal glands to produce Androgens
• Supresses LH and FSH – abnormal menstrual cycles
• Acquired or late onset Adrenal Hyperplasia = low Cortisol = increased ACTH = may end as DHEA = increased Testosterone

Possible Treatments

Start with the gut

• All females with PCOS have gut dysbiosis
• Change the diet
• Remove Omega 6 fatty acids aka seed and vegetable oils
• Remove UPFs Ultra Processed Foods
• Eat more fermented foods
• Regular food times, aim for 3 good meals per day
• Stop snacking
• Check for underlying issues – poor motility, leaky gut, IBS, SIBO, liver problems
• Food Timing
• WHEN you eat is as important as what you eat. A small Chinese study demonstrated that women who ate 2/3 of their calories at breakfast and the last /3 at 3pm for 6 weeks saw a 52% decline in Testosterone levels)
• Another study here
• When you eat effects the Adrenal glands
• Insulin sensitivity is best the 1st half of the day
• Insulin resistance is 7 x more in females with PCOS
• Insulin makes and stores fat – the hormonal skillset to burn fat is different
• Walk after meals

Exercise

Does more than just help you drop the extra kilos

• Increases muscle mass

• Muscle reduces Insulin resistance as they need glucose and fat
• Muscle aids weight control

• Improves hormone balance.
• Increases heart health, which may be affected by PCOS

• Aerobic exercise, gets your heart going, aim for

• walking, cycling or swimming, 60 minutes every day perhaps 2 x 30-minute or 3 x 20-minute walks

• Strength training, increases muscle mass and quality, aim for   

• 2 x 30 – 60 minutes of strength training per week.

Mind Body Medicine

PCOS impacts and is impacted by mind and body

Supporting mental health matters.

Counselling

• Your guide in times of darkness

Mindfulness

• Calm your mind to pause the ‘chaos’

• Slow breathing
• Meditation
• Acupuncture
• Hypnosis 

Education

• Knowledge is power

• Learning about PCOS puts you in control and guides you to which steps you need to take to improve your health.

Medical treatments – Focus on treating the symptoms

Irregular or absent periods

• The contraceptive pill
• An intermittent course of progestogen tablets – no thickening of the womb
• An intrauterine device (IUD), no thickening of the womb.

Fertility problems

• Clomifene – encourages the monthly ovulation
• Letrozole (off label) – lowers Estrogen levels which increases FSH which promotes follicle development and therefore ovulation
• Metformin (off label) lowers insulin and blood sugar levels which decreases Testosterone production in the ovaries enabling ovulation, encouraging regular monthly periods and lowering the risk of miscarriage. Metformin can also have other long-term health benefits, such as lowering high cholesterol levels and reducing the risk of heart disease. Not licensed for treating PCOS in the UK, but because many women with PCOS have insulin resistance, it can be used “off-label” in certain circumstances to encourage fertility and control the symptoms of PCOS.
• Gonadotrophin injections and other IVF treatments – but there’s a higher risk of overstimulation and multiple pregnancies.
• Off label means that Doctors sometimes use an unlicensed medicine if they think it’s likely to be effective and the benefits of treatment outweigh any associated risks.

Unwanted hair growth and hair loss

• The combined oral contraceptive pill is usually used to treat excessive hair growth (hirsutism) and hair loss (AGA androgen alopecia).
• A cream called eflornithine can also be used to slow down the growth of unwanted facial hair, but does not remove it and it is not always available on the NHS or EU.