PCOS is a common diagnosis that affect up to 10% of women. It’s best defined as a group of symptoms related to anovulation (the lack of ovulation) and a high level of androgens or male hormones. The main symptom of PCOS is irregular periods, specifically late periods with irregular bleeding.
We see PCOS not as a disease, but a group of symptoms related to androgen excess. We feel it should be described as an endocrine disorder.
Irregular periods are typical of anovulatory cycles.
Symptoms of PCOS:
- Excessive Facial Hair and Body Hair
- Acne
- Hair Loss
- Weight Gain
- Infertility
- Irregular periods
PCOS is essentially a problem with ovulation, which results in an overproduction of androgens, such as testosterone. In addition to the troubling symptoms, PCOS is associated with a long-term risk of diabetes and heart disease.
PCOS is much more than just a period problem. It’s a whole body hormonal condition than last a lifetime.
PCOS is normally diagnosed on an ultrasound. Of course, many think the polycystic appearance is an important feature of the condition. You’d be wrong.
Polycystic ovaries do not cause pain like other types of large ovarian cysts.
There is no definitive test for PCOS because it’s not a well-defined disease, but rather a group of symptoms.
The Androgen Excess & PCOS Society says a woman qualifies for a PCOS diagnosis with all three of the following criteria:
- ovarian dysfunction and/or polycystic ovaries
- clinical and/o biochemical hyperandrogegism
- exclusion of other conditions that would cause hyperandrogegism
In simpler words, you must have all three key of the following to be diagnosed with PCOS:
- irregular periods or polycystic ovaries on an ultrasound
- high androgens on a blood test or symptoms of high androgens
- other reasons for high androgens has been ruled out.
PCOS may soon get a new (more fitting) name. A couple have been put forward including Metabolic Reproductive Syndrome or Anovulatory Androgen Excess.
Only 25% of women that have PCOS get a diagnosis, and over 60% of women with PCOS are never diagnosed (largely because they don’t have polycystic ovaries).
Why is it important to do something?
- 75% of women with PCOS are diagnosed with hypothyroidism
- Diabetes is common, if not expected in women with PCOS
- Women with PCOS have the highest risk for cardiovascular conditions
- Androgenic alopecia is an undesirable consequence, especially to women after 40.
Quick Note: If your teenager has been diagnosed with PCOS, please know that polycystic ovaries are common as some girls do not experience a full ovulation in their early menstrual cycles.
There Four Different Kinds of PCOS
There are actually four different types of PCOS, although the most commonly diagnosed PCOS is the one where ovarian cysts are found. Some PCOS patients have a blend of two or more of these types of PCOS.
1. Insulin Resistant PCOS
The most important question is “do you have insulin resistance?” because insulin resistance is by far the most common driver of PCOS.
Too much insulin can lead to weight gain, heart disease, osteoporosis, and eventually diabetes. It can also lead to high androgens if you have the genetic susceptibility to PCOS.
Too much insulin lowers the androgen-binding protein SHBG, which results in even more free testosterone or unbound testosterone.
How to know if you have Insulin Resistance PCOS?
You have insulin-resistance PCOS if you meet all the criteria for PCOS (irregular periods and elevated androgens) plus you have insulin resistance.
If you are unsure, get tested. To the right, there is an image of HBA1C that you can get tested and levels that show insulin resistance.
Traditional testing looks at your fasting glucose which we also use in the clinic to detect insulin resistance.
INSULIN RESISTANCE BODY SHAPE TEST:
You can do an immediate test to see if you have insulin resistance by looking at your body shape. Apple-shaped obesity is weight gain around your waist.
You can take out a tape measure your waist to height ratio.
Your waist should be less than half of your height.
Insulin resistance is the most common driver of PCOS. If you have PCOS, there’s a 70% chance it’s the insulin-resistant type.
2. Post-Pill PCOS
This is the second most common type of PCOS.
Hormonal birth control can cause or worsen insulin resistance and is a major contributor to Insulin-Resistant PCOS.
For most women, ovulation will resume once birth control is stopped. For some of you ovulation will not retune for months or even years. During that time, you may qualify for a PCOS diagnosis.
3. Inflammatory PCOS
Your PCOS isn’t driven by insulin resistance or coming off the pill. Inflammatory PCOS is driven by inflammation and environmental toxins. Inflammation also plays a role in the previous types of PCOS – and indeed, in any period problem – but it is the primary driver of inflammatory PCOS.
Inflammation disrupts hormone receptors and suppresses ovulation. It also stimulate both your adrenal glands and ovaries to make more androgens.
Inflammation can come from insulin resistance. This is why we look at both your insulin markers and your inflammation at the same time.
Your PCOS is inflammatory PCOS if you meet all the criteria for PCOS (elevated androgens and irregular periods), plus you do not have insulin resistance, plus your periods were not affected by th pill, plus you have signs of inflammation as follows:
- digestive problems such are irritable bowel syndrome (IBS)
- unexplained fatigue
- headaches
- joint pain
- skin conditions such as eczema and psoriasis.
4. Adrenal PCOS
Hopefully you have been able to identify your PCOS. More than likely it’s the insulin-resistant PCOS, but if not here’s one more to consider. Your PCOS is adrenal PCOS if you:
- meet all the criteria for PCOS (elevated androgens and irregular periods)
- do not have insulin resistance
- were not negatively affected by coming off the pill
- have no signs of and symptoms of inflammation
- have normal ovarian androgens (testosterone and androstenedione) but elevated adrenal androgens (DHEAS).
In traditional medicine, PCOS is diagnosed with an ultrasound, but we identify PCOS by looking deeper at the Androgen Excess & PCOS Society standards. We don’t feel an ultrasound finding of polycystic ovaries is enough to diagnose PCOS.
There is a degree of overlap between the different PCOS types. For example inflammation is also a factor in both the insulin-resistant and adrenal types of PCOS.
Hidden Drivers of PCOS
Many things can impair ovulation and promote excess androgens. They include:
- Thyroid Disease
- Vitamin D Deficiency
- Zinc Deficiency
- Iodine Deficiency
- Elevated Prolactin
- Too little food or too little carbs
The great thing about identifying the a hidden driver of PCOS is that once you correct it, your symptoms should improve fairly quickly.
How we treat PCOS
First of all, it takes three full months for us to see normal ovulation resume.
If you are considering treatment for PCOS, we recommend that you commit to treatment for at least three months.
Naturopathic medicine looks at addressing the hidden drivers and naturally reducing androgens and bringing insulin into balance.
First, we identify the underlying type of PCOS to address what is causing PCOS to manifest.
In our initial consultation, we ascertain the type of PCOS, then we organise deeper testing so we can develop a corrective plan and find the underlying problem.
The different types of PCOS can lead us to different testing whether we need to look at inflammation levels, digestive issues, or metabolic function.
At the end of the day, PCOS can be reversed and normal menstrual cycles can resume.
We consider PCOS to be in remission when symptoms are reversed and periods are regulated.
Whilst PCOS can be in remission, you can be susceptible in the future. So we often do thorough nutritional programs to support maintaining balanced hormones and keeping your androgens down, reproductive hormones at healthy (age-appropriate) levels, and support healthy metabolic function.
Medical Options
Medical options often involve a Merina or an type of birth control, with a synthetic progesterone known as progestin.
This is largely because PCOS is often seen as a progesterone deficiency, because of the anovulatory menstrual cycles.
The only caveat is the consequence of increased insulin resistance.
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PCOS during Peri-Menopause or Post-Menopause
Many women that suffer from PCOS often turn 40 and feel like all the bleeding they missed in their twenties and thirties comes back with a vengeance.
At this point, many women need to look at a Merina or IUD to stop the hemorrhaging or flooding.
Women often start to see raised cholesterol, continued weight gain that won’t shift.
Between 45 and 57 years of age, 75% of women who have been diagnosed with PCOS are diagnosed with hypothyroidism.
Women that suffer from PCOS are in a particular sensitive body recalibration in their 40s largely because of the changes in their progesterone and oestrogen.
The insulin resistance of PCOS continues past menopause. If you don’t treat insulin resistance, you will have it your entire life.
Post menopause, when coming off the Merina or IUD or off birth control, many women can quickly find problems with a new diagnosis of diabetes, skin conditions, or hypothyroidism.
This is largely the underlying PCOS problem. Whilst PCOS and the condition itself is associated with the menstrual cycle, the effects of the condition are far more connected to the metabolic system.
If you would like to get tested and or to see how we can help you with what you feel may be PCOS or are dealing with PCOS symptoms, you can organise a Free Introductory Consultation with us here: https://calendly.com/nz-naturopathy/intro-consult
