Polycystic Ovarian Syndrome (PCOS)
Polycystic ovarian syndrome (PCOS) is a systemic disorder which has a diverse range of symptoms and drivers. Accurate figures of how many women are affected are mixed and the range could be between one in seven to one in fifteen. Diagnosing the condition has proven challenging and a definitive criteria for classification, contentious. There can be four general types of PCOS (including insulin-resistant PCOS, inflammatory PCOS, pill-induced PCOS and hidden-cause PCOS).
Common amongst women with PCOS is insulin resistance and obesity, particularly around the mid section (giving an “apple shape” to the women affected). Sometimes, but not always, there is a deficiency of healthy oestrogen ratios and excess of androgens produced. Androgens are a type of masculinising hormone which, under normal circumstances, the body converts to oestrogen, but in the PCOS woman this process is impaired. Continued hormonal dysregulation can lead to classic PCOS symptoms, including:
Hirsutism - heavy hair growth in expected places such as the face, jawline, cheeks, belly button, and nipples. Early signs can include an early appearance of pubic hair in young girls.
Infertility, menstrual abnormalities (like irregular cycles, cycles which last longer than 35 days, scanty periods and pain which is described as ‘vice like’ or sharp stabbing with extreme cramping), amenorrhoea (absent periods) and anovulatory cycles.
Insulin resistance which can lead to weight gain that won’t shift (although this is not an absolute). Interestingly up to 80% of PCOS women will experience insulin resistance, even amongst those within a healthy-weight range.
Acne, particularly on the face, neck, back and chest.
Alopecia or thinning hair.
Some lesser well known symptoms and long-term complications can also include:
Fatty liver. The central adiposity which can give a PCOS picture a rounded ‘apple’ body shape, elevated androgen levels, and the combination of insulin resistance are considered as the primary contributing factors related to fatty liver development in PCOS.
Depression, stress and low mood. The adrenal glands can be a source of excess androgens which can be converted to oestrone levels within fatty tissue. This can create something of a snowball process, when it triggers a suppression of egg-producing follicular hormone, encouraging too much luteinising hormone which then continues to feed into producing even more androgens than before in a snowball effect.
Type 2 Diabetes. Prolonged insulin resistance can result in insufficient glucose entering the cells for energy production. The pancreas starts to produce higher quantities of insulin to promote absorption into the cell. If left unresolved, the pancreas’ ability to continue this process, can decline, leading to higher risk of developing type 2 diabetes. Believed to impair ovulation and leading ovaries to make testosterone instead of oestradiol.
Sleep apnoea. Perhaps because of the tendency towards weight gain and obesity, sleep apnoea and breathing difficulties can be a symptom of PCOS.
Delayed menopause. Although it may delay menopause between two to four years, the symptoms and drivers of PCOS do not stop at menopause.
While evidence has not clearly linked environmental toxins with increased risk, studies have found significantly higher levels of perfluorinated compounds, polychlorinated biphenyls (PCBs), bisphenol A (BPA), pesticides and polycyclic aromatic hydrocarbons amongst women with PCOS compared with women who don’t. There is some evidence which links maternal exposure to BPAs with PCOS development in the daughters of these women.
Some of these symptoms are serious and best treated quickly by a trained health professional. The uniquely challenging aspect to PCOS is that symptoms extend beyond menopause which is why in natural medicine it’s considered a metabolic disorder and not a menstrual disorder. Like anything health related, it is not a static diagnosis and there is great capacity to resolve some of the common symptoms.
The Royal Australian College of General Practitioners (RACGP) has identified the first line interventions to support women experiencing PCOS is consumption of a healthy diet with behaviour change support and exercise to aid in weight loss. When combined with moderate and regular exercise for weight management, hormone clearance and stress management we can give hope of improved quality of life, weight and avoidance of some of the long term impacts. As a result of the adrenal gland involvement supports to resolve unwanted symptoms can often involve stress management techniques as well.
It is a syndrome which can take time to unravel and is best supported by a healthcare professional.
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