PCOS 101

Polycystic ovarian syndrome (PCOS) is the most prevalent endocrine disorder, affecting about 5-10% of women of reproductive age. Classic PCOS comes with a set of symptoms, such as irregular or absent periods, evidence of high androgens (excess hair growth, thinning hair, acne), being overweight or obese, and multiple small cysts on the ovaries, hence the name “polycystic” – meaning many cysts or immature follicles which fail to ovulate and get trapped inside the ovary. To be diagnosed with classic PCOS, you will have at least 2 of the following signs or symptoms:

1. oligo- or chronic anovulation

2. clinical and/or biochemical signs of hyperandrogenism

3. polycystic ovaries by ultrasound

It is a complex condition, as we still don’t know its exact cause. Some factors that may be at play are insulin resistance, chronic low-grade inflammation, fatty tissue dysfunction (lipotoxicity) and heredity. Because of its involvement with multiple body systems, symptoms can vary. For this reason, it may go undetected by some doctors.

Signs & Symptoms of PCOS

• Irregular or absent periods
• Lack of ovulation or anovulatory cycles
• Infertility
• Overweight or obesity
• Weight gain, especially around the abdomen
• Pelvic pain
• Lower libido
• Excess hair growth (ie. chin, chest, stomach, upper lip, backs of arms, sides of thighs)
• Acne
• Thinning hair
• Acanthosis nigricans – discoloration or darkening of skin around the neck, underarms and skin folds
• Depression
• Anxiety
• Blood sugar problems (ie. high fasting blood glucose)
• Insulin resistance
• Hormone imbalance (i.e. low progesterone)
• High androgens (i.e. testosterone, DHEA-S, androstenedione)
• High LH to FSH ratio
• Elevated inflammatory markers (CRP, ESR)
• Elevated anti-mullerian hormone (especially for age)
• High stress and adrenal dysfunction
• Ovarian cysts
• Thyroid dysfunction

There are subtypes of this disorder that are different from the “classic” PCOS. Women with atypical PCOS can be lean and may or may not have significant insulin resistance. Some women get their periods regularly (although lack of ovulation may still be present), others may have mild or no acne and normal blood androgen levels. Multiple ovarian cysts may not be present. Because PCOS can be a confusing condition with multiple factors at play, it is best to seek advice from a health care practitioner who focuses on women’s health for a proper diagnosis and adequate treatment.

Why is PCOS important to know about and treat?

PCOS is responsible for approximately 25-30% of infertility in women, which is mainly anovulatory. Miscarriage rates are also slightly higher in a woman with PCOS, possibly due to poor egg quality and low progesterone levels. Women with untreated PCOS also have a higher risk for developing cardiovascular disease, diabetes, endometrial cancer, gestational diabetes, sleep apnea and liver disease. Working with a naturopathic doctor can optimize your fertility, help to maintain a healthy full term pregnancy and minimize the risk of chronic diseases related to PCOS. When a holistic approach is taken, PCOS symptoms can drastically be reduces, if not totally eliminated with the help of nutrition, exercise and key supplements and herbs.