What is PCOS?
Polycystic ovary syndrome is a common endocrine disorder among women of reproductive age (after menarche and prior to menopause), characterized by hormonal imbalances, metabolic abnormalities, menstrual and ovulatory dysfunction, with or without the presence of polycystic ovaries. PCOS is associated with hyperandrogenism, hyperinsulinaemia, weight gain/obesity, hirsutism, acne and infertility.
Due to conflicting factors such as, the lack of well-defined diagnostic criteria and the varied manifestations of symptoms that a patient may present with, identification of PCOS is confusing, which may lead to misdiagnosis. Additionally the presence of polycystic ovaries in "normal" women may further confuse the diagnosis thereof, resulting in prevalent statistics of PCOS with significantly large percentage ranges.
Insulin and PCOS:
Excess insulin due to insulin resistance increases androgen production:
Insulin signals the ovaries to secrete elevated levels of testosterone and oestrogen. Increased levels of these two hormones causes; acne, hirsutism and suppresses ovulation.
Insulin resistance seen in PCOS may be due to genetic factors or as a result of being overweight (related to diet and inactivity) or otherwise a combination of both of these factors.
Environmental factors and PCOS:
• Environmental endocrine-disrupting chemicals (phenols, phthalates, phytoestrogens) found in products such as; nail polish, cosmetics, shampoos, lotions and perfumes, may interfere with the hormonal system resulting in hormonal imbalances.
• Bisphenol A, is used in the manufacturing process of many commonly used plastics (water bottles). BPA exhibits oestrogen mimicking hormone-like properties that may interfere with the endocrine system.
• Endocrine disruption may occur as a result of overexposure to antibiotics, present in food products due to modern animal farming practices and drinking water contaminated by pharmaceuticals, via disposing of unwanted medications down toilets and medications that are passed out in urine or feces, that remain in the drinking water after purification by water treatment plants.
Genetic factor and PCOS:
PCOS has a genetic link and thus, there is an increased susceptibility to PCOS if it present in women among ones family.
PCOS is a hormonal and metabolic imbalance prevalent among women of childbearing age and is therefore a disorder typically expressed within women. However, men in families with PCOS may present with manifestations of PCOS symptoms, including premature male-pattern baldness, excessive hairiness and irregularities in insulin metabolism and hormonal shifts - indicating that there is a genetic susceptibility to this disorder.
Weight gain and PCOS:
Being above a healthy weight may trigger/ enhance symptoms associated with POCS.
Risk Factors for the Development of PCOS Include:
• Mother or sister with PCOS (genetic factor)
• Obesity (metabolic dysfunction)
• Diabetes - type 2 (insulin resistance)
• Smoking (increases androgen levels)
PCOS typically starts with an imbalance in the level of sex hormones, subsequently becoming a metabolic imbalance, interfering with the way the body utilizes insulin. The combination of these two imbalances creates a cascade of other health issues and further complications within the body.
PCOS is closely linked to insulin resistance which may be induced by genetic factors or pre-existing obesity. Defective insulin metabolism results in, excess insulin present in circulatory blood, this excess greatly promotes:
• Polycystic ovaries, the formation of small cysts (fluid-filled follicles) within the ovaries that cause the ovaries to enlarge.
• Weight gain and/or difficulty losing weight.
• Increased risk of heart disease by elevated levels of “bad” Cholesterol (LDL) and triglycerides, accompanied by decreased “good” cholesterol (HDL) levels.
• Increased risk of type 2 diabetes.
Hyperinsulinaemia (excess insulin) typically expressed in PCOS may lead to, hyperandrogenism (excess androgens - male hormones) in females, this hormonal imbalance facilitates, virilization and causes menstrual and ovulatory dysfunction which may lead to increased rate of miscarriages and infertility.
Hyperinsulinaemia and hyperandrogenism affects many organs, tissues and systems. Primarily the reproductive system and cardiovascular system and their related organs due to endocrine gland dysfunction of the pancreas, hypothalamic-pituitary-ovarian axis as well as the thyroid and adrenal glands.
Elevated Androgens and PCOS
Hyperandrogenism - elevated levels of androgens - in females. Androgens control the development and maintenance of male secondary sex characteristics, therefore excess androgens in females facilitates virilization:
• Seborrhea (inflamed skin)
• Hirsutism (increased body/ facial hair)
• Hair loss on scalp
• Deepening of the voice
• Elevated sex drive/ libido
Metabolic Abnormalities and PCOS:
• Hyperinsulinaemia - excess insulin - due to insulin resistance, which may lead to the development of type 2 diabetes.
• Hyperlipidaemia, high levels of blood cholesterol and fats (triglycerides) due to weight gain and/or obesity associated with PCOS.
• Polycystic ovaries.
• Menstrual dysfunction (amenorrhoea/ oligomenorrhea).
• Ovulatory dysfunction (Oligoovulation/ anovulation).
• Depression and anxiety.
• Acanthosis nigricans, darkening of the skin in the armpits, back of the neck, or groin.
PCOS is a huge red flag for the beginning of type 2 diabetes, cardiovascular disease and infertility.
Other Pathologies Frequently Confused With PCOS
• Adrenal Hyperplasia – similar symptoms include, irregular menstruation.
• Hypothyroidism - under-secretion of thyroid hormone from the thyroid gland, affects all aspects of metabolism.
• Hyperprolactinemia - elevated levels of prolactin in circulating blood - symptoms include, mensturation dysfunction (oligomenorrhea/ amenorrhea), acne and hirsutism.
• Cushing's syndrome - elevated cortisol levels - similar symptoms included, excessive hairiness, high blood pressure, acne, darkening of the skin, hair loss, anxiety, depression and infertility.
• Androgen-secreting Neoplasms - adrenal tumours secreting androgens in women, similar symptoms include, virilisation.
• Syndromes of severe insulin resistance, similar symptoms include, metabolic dysfunction.
• Androgenic/anabolic drugs, similar symptoms include, virilization, growth of vocal cords and body hair.
How to Diagnose PCOS:
Naturopathic nutritional advise will be tailored to support medically diagnosed conditions and/ or health concerns agreed and identified by the two parties.
Naturopathic nutritional practitioners are not permitted to diagnose or claim to treat medical conditions.
Naturopathic nutritional therapy is not a substitute for professional medical advise and treatment.
The following diagnostic procedures may be used to validate PCOS within a patient, after consideration of other conditions portraying similarities in signs and symptoms has been eliminated.
Case History Analysis
• Menstruation (bleeding time and cycle, amount of blood flow, duration, quality of blood).
• Hirsutism and acne.
• Sex drive and labido.
• Fertility – experiencing difficulty getting pregnant.
• Family history of PCOS.
• Weight - difficulty losing weight (may relate to insulin resistance).
• Seborrhea (inflamed skin)
• Hair loss on scalp
• Deepening of the voice
• Pelvic ultrasound - 12 or more follicles, 2-9mm in diameter indicates PCOS.
• Pelvic CT scan or MRI to visualize the adrenals and ovaries.
• Sex hormone levels - Androgen levels (testosterone and DHEA-S) and oestrogen levels.
• Pituitary serum levels - Prolactin levels, FSH and LH levels, GnRH stimulation.
• Thyroid function
• Insulin levels
• Lipid panel
• Glucose levels
• Saliva test (to test for free unbound sex hormone fraction).
• Oral Glucose Tolerance Test (to test for gestational diabetes associated with PCOS).
• Hormone activity (thyroid function and oestrogen metabolites).
• Presence of glucose.
• Metabolic imbalances.
PCOS currently has no cure, however there are many allopathic treatment methods and alternative therapies that provide symptom relief and can reverse current or prevent potential future, fertility problems and complications associated with PCOS.
Due to PCOS being a complex female health issue our protocols needs to be of equal complexity and thus should include a diverse selection of therapy methods. It is of utmost importance for the practitioner to ensure that personalised protocols are established, based on an individuals diagnostic status presented in clinic. It is our aim as Naturopathic Nutritional Practitioners to use specific foods, neutraceuticals and exercise to target the root causes that mediate PCOS related dysfunctions and abnormalities. Our therapeutic aims include:
Improve insulin resistance
Rectify hormonal imbalances
Lower excess androgen levels
Promote healthy digestion
Regulate ovulation and menstruation
Improve hyperlipemia (high cholesterol and triglycerides)
Improve hirsutism and acne
With assistance from a Naturopatic Nutritional Practitioner a patient can drastically improve their condition. PCOS is a hormonal imbalance and thus it presents with a varying degree of symptoms and many other underlying/ potential health risks and complications. Therefore the treatment thereof needs to be based on the individual's particular diagnosis, subsequently with a personalised nutrition plan. However I am going to discuss the treatment/ management of PCOS through nutrition in a broad sense.
Diet and Lifestyle:
• Eat a diet low GI foods
• Eat a diet high in fiber
• Eat protein with every meal
• Eat essential fatty acids daily (cod liver oil, evening primrose oil, flax seed oil, EPA and DHA)
• Eat organic hormone free dairy and meats sparingly.
• Filter water
• Use natural comsetics and cleaning detergents
• Try yoga and meditation
• Sleep 8-9 hours per night
• Spend time outdoors and in nature to support mental health
• Minerals: calcium (protects cardiovascular health), magnesium, chromium
• Vitamins: whole food multivitamin, vitamin D (plays a role in glucose metabolism), vitamin B6 (can help balance prolactin levels).
Adaptogen herbs (helps the body adapt to mind-body stress and may help to normalize the body's endocrine system)
Holy basil (anti androgen properties and controls insulin levels)
Licorice root (promotes normal metabolic function)
Fenugreek (promotes glucose metabolism and improves insulin resistance)
Spearmint Tea (anti androgen properties).
Vitex (chaste tree berry)
Amla (the Indian gooseberry, is rich in antioxidants and Vitamin C and helps with controlling blood sugar and improves fertility in women), Saw Palmetto (Saw Palmetto extract, inhibits DHT production, which may help women with hirsutism)
Apple Cider Vinegar (helps control blood sugar levels).
• Natural Progesterone Cream.
• Inositol - improves insulin resistance, decreases testosterone levels and promotes the breakdown of fats.
Providing natural treatment (nutrition) support alongside orthodox treatment may be highly beneficial in achieving effective results at an increased rate. However combination treatments may negatively interact with one another, having adverse effects that may deteriorate the patients condition. Therefore exclusion of all nutritional treatments that may interfere with pre-existing orthodox treatment methods is essential.
Liquorice root is effective in promoting metabolic function and is commonly used in nutrition to reduce metabolic dysfunction portrayed in PCOS. However Liquorice has an affect on hormones and may therefore negatively impact a patient on an oestrogen pill perscription. Liquorice may affect the breakdown of drugs metabolised by the liver, which in turn may be detrimental to patients on prescription drugs.
What are the Complications Associated with PCOS?
PCOS is a female hormonal health issue of the endocrine system which is an extremely sensitive, precise and complex system, dysfunction thereof can be difficult to treat with a limiting prognosis. Early diagnosis and treatment, alongside a healthy diet, regular exercise, appropriate sleep and stress control can greatly alleviate the symptoms associated with PCOS.
PCOS may present in varying severity such as mild, moderate or severe and therefore the prognosis will differ accordingly. However the goal for PCOS is to improve insulin resistance, rectify hormonal imbalances, regulate ovulation and menstruation and to maintain fertility as well as to reduce the risk of potential complications through regular medical assistance and monitoring.
Complications may arise in women with PCOS include:
• Cardiovascular disease
• Endometrial cancer
• Breast cancer
• Heart attack
• High blood pressure (hypertension)
• High levels of "bad" cholesterol (LDL) and low levels of "good" cholesterol (HDL)
• Anxiety and depression
• Sleep apnea
Mental Health and PCOS:
Due to PCOS having such varied manifestations of symptoms, diagnosis thereof can be timely and costly, aggravating frustration within patients. Many patients suffering with PCOS are not well informed on their condition and insightful accurate information may be hard to find without professional assistance. Therefore regular medical care to monitor a patients progression is of utmost importance especially to reduce the risk of further complications. Self help groups will provide patients with a support system that can dramatically improve their condition by promoting mental health. Many patients affected by PCOS experience depression, anxiety and a low self-esteem due to the physical symptoms expressed through this disorder such as excess hair, acne, darkened skin and weight gain/ obesity, leaving patients with a negative self image.
PCOS is one of the leading causes for increased rate of miscarriages and infertility which may invest a substantial amount of fear among women suffering with this condition, which can be pacified with additional support, help and a deeper understanding of their disorder. Some institutions, practitioners and other forms of medical care may display disinterest towards patients seeking additional support. Therefore self-help groups in my opinion will be most beneficial to patients suffering with PCOS as they provide assistance and support that is personalized with careful sensitivity.