Polycystic Ovaries(PCO) and Polycystic Ovarian Syndrome (PCOS)
The most common reproductive disorder that I see in my clinic these days is Polycystic Ovaries/Polycystic Ovarian Syndrome (PCOS). Some women only have the cysts (PCO), while others have no cysts but have the syndrome (PCOS). Some have both. The one thing that they all have in common is that they all have insulin resistance. For the sake of this article I am going to call this complaint PCOS so people don’t get confused. If you or someone in your family suffers from Irregular cycles, gets hormonal acne, gets extra hair etc, then there is a good chance they have it. They also need to get it looked at and treated early before it affects future fertility.
Polycystic Ovaries (PCO) is a reproductive disorder characterised by multiple cystic growths on the ovaries. In large it is an endocrine and hormonal disorder, but it has potential to cause gynaecological and reproductive issues and these issues can be varied. Women with PCOS may not have cystic formation and just have symptoms that are part of the syndrome only (eg-acne, irregular cycle).
PCOS develops when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, either through the release of excessive luteinising hormone (LH) by the pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus. It can also be caused by oestrogen dominance too.
PCOS is characterised by a complex set of symptoms with research to date suggesting that insulin resistance is a leading cause. A majority of patients with PCOS (some investigators say all) have insulin resistance. Insulin resistance is a common finding among both normal weight and overweight PCOS patients. Many years ago it was thought that you had to be overweight to have PCOS, but now we know that many normal and underweight women have too. Their elevated insulin levels contribute to or cause the abnormalities seen in the hypothalamic-pituitary-ovarian axis that lead to PCOS. Specifically, hyperinsulinaemia causes a number of endocrinological changes associated with PCOS too. Anyone with polycystic ovaries does have a more than 50% chance of developing diabetes later on as well PCOS is the most common cause of oligomenorrhoea and amenorrhoea, although 20-25% of normally menstruating women have PCOS. These women may have reduced fertility and an increased risk of miscarriage.
Major causative factors and risk factors that can contribute to the incidence of PCOS include:
- Insulin resistance
- Family history of PCOS
- Family history of diabetes
- Nutritional deficiencies
- High glycaemic load diet
- Sedentary lifestyle
Symptoms & Signs
Common signs and symptoms of PCOS include:
- Irregular menstrual cycles – i.e., oligomenorrhoea or amenorrhoea Infertility, generally resulting from chronic anovulation (lack of ovulation)
- Elevated serum (blood) levels of androgens (male hormones), specifically testosterone, androstenedione, and dehydroepiandrosterone sulphate (DHEAS)
- Central obesity – “apple-shaped” obesity centred around the lower half of the torso
- Androgenic alopecia (male-pattern baldness)
- Acne, oily skin, seborrhoea
- Hirsutism ( Excess hair growth)
- Acanthosis nigricans
- Prolonged periods of PMS-like symptoms
- Sleep apnoea
- Multiple cysts on the ovaries Enlarged ovaries, generally 2-3 times larger than normal, resulting from multiple cysts
- Chronic pelvic pain
- BGL dysregulation – e.g., hypoglycaemic episodes, diabetes, etc Hypothyroidism
Diet and Lifestyle
Dietary and lifestyle changes are a must in the management of PCOS. The world health organisation recommends that dietary and lifestyle changes are the number one treatment for PCOS along with other therapies By consuming reduced amounts of low glycaemic index carbohydrates, keeping protein levels up to maintain muscle mass and eating ‘good’ fats, insulin levels are reduced and fat stores can be accessed as fuel for energy production (thermogenesis). The Wellness/Zone/Primal style diets that we promote in my clinic help women with PCOS to maintain steady blood sugar and insulin levels and will assist in weight loss and also maintain body mass for those underweight. A diet composed of mainly low-GI foods combined with regular exercise will also help to combat the effects of insulin resistance. This is why the Primal style diets are the best diets to follow.
To be honest people with PCOS should get rid of grains altogether. Refined carbohydrates including sugar, sweets, fruit juices, white breads, pasta and should be avoided. These foods have a high glycaemic index and are damaging in any amount for PCOS sufferers. A diet high in vegetables (non-starchy), small amounts of Low-GI fruits, essential fatty acids and lean protein sources provides essential phytonutrients, antioxidants, magnesium and helps to control inflammation and hormonal dysregulation.
Smoking cessation is the highest priority in currently smoking patients.
Regular resistance training, or high interval exercise, is a must too (starting slowly and increasing as patient’s fitness improves)
Acupuncture, Chinese Herbal medicines, Nutritional supplements etc, are also a big part of the treatment on a complementary medicine level and can help dramatically. At my clinic we also have our own herbal medicine formulas, supplements and medicinals to treat PCOS too.
Medically, insulin-regulating medications (metformin), hormone treatments (Pill, HRT) are used to regulate the cycle, control insulin resistance and prevent further cysts developing. There are natural supplements you can use that are far better for you and without the side effects of Metformin.
You may also need a procedure called “Ovarian drilling” to laser the cysts and help with the healing of the ovaries in severe cases. Just remember going on the pill does not fix this problem, it just masks it.
This is why anyone with irregular cycles should see a women’s health specialist like myself, or a gynaecologist, not just your GP. If you need any help or advice with PCOS, or irregular periods then message, email, or phone my clinic.