By Dr. Angie Romero, ND
Polycystic ovarian syndrome (PCOS) is thought to be one of the most common endocrine disorders found in women; 1 in 10 women suffer from PCOS. The prevalence of PCOS is generally between 3% and 10%.
PCOS is a diagnosis of exclusion, meaning that various other conditions need to be ruled out to determine if a patient has PCOS. For this reason, a large number of individuals suffering from this condition remain undiagnosed.
How is PCOS diagnosed?
It is important for patients to be proactive and speak to their health care providers, if they suspect that they could be suffering from PCOS.
Currently, the Rotterdam criteria is used to diagnose patients with PCOS. This criteria require women to present with at least two of the following symptoms:
• Hyperandrogenism: Meaning elevated levels of androgens, which clinically presents as abnormal hair growth on parts of the face, chest, back and abdominal area. Hyperandrogenism can also cause hormonal acne and excessive hair loss.
• Ovulatory dysfunction: An average menstrual cycle is 28 days. In PCOS menstrual cycles can either be irregular, prolonged (greater than 36 days) or infrequent. An infrequent menstrual cycle is defined as fewer than 8 cycles per year.
• Polycystic ovaries: This is detected by an ultrasound. It is important to understand that this is not present in every case of PCOS. It is probable that you are suffering from PCOS If you are presenting with any of the other symptoms in the absence of polycystic ovaries.
Other symptoms to look for:
- Weight gain/difficulty losing weight, fatigue, irritability and acanthosis nigricans.
- Gestational diabetes or pregnancy-induced high blood pressure
- Nonalcoholic steatohepatitis — severe liver inflammation caused by fat accumulation in the liver
- Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels
- Type-2 diabetes
- Sleep apnea
- Depression, anxiety
- Eating disorders
What is the root cause of PCOS?
Determining which type of PCOS you have is key to finding a longterm solution to this condition. There are four drivers of PCOS: Insulin-resistant PCOS, Inflammation-base PCOS, adrenal PCOS, and Synthetic Hormone-Induced PCOS.
This is the most common type of PCOS. Insulin resistance refers to the body becoming resistant to the hormone insulin. Insulin is in charge of helping blood sugar enter the body’s cells so it can be used for energy.
Higher levels of insulin can interfere with ovulation by increasing androgens such as testosterone and decreasing estrogen levels. Changes in these hormones can result in irregular cycles and other symptoms like weight gain, acne, hirsutism, mood swings, and thinning hair. Women with this kind of PCOS usually have blood sugar and insulin levels that suggest diabetes or prediabetes.
Inflammation-based PCOS is most often seen in women who are not overweight and who do not present with the classic symptoms of PCOS. High levels of inflammation signal the ovaries and adrenal glands to produce more androgens, leading to PCOS. Inflammation can be caused by a variety of factors including food intolerances/ other digestive issues, chronic injuries, prolonged exposure to environmental toxins, mental trauma and poor lifestyle/ diet habits.
Synthetic Hormone-Induced PCOS
Synthetic hormone-Induced PCOS is common for women who have been on the pill or other hormonal birth control for an extended period of time. These women have absent menstrual cycles for at least 3-4 months post birth control. Hormonal birth control works by interfering with the communication between the pituitary gland and the ovaries, in order to prevent pregnancies. Therefore, it can take time and proper support in order to establish that communication again.
Adrenal PCOS is usually diagnosed after all of the other types have been ruled out. There tends to be high levels of DHEAS and normal levels of other androgens, such as testosterone, in patients with adrenal PCOS. This type of PCOS is usually caused by the body’s response to stress.
Is PCOS manageable?
Early management of PCOS is essential to prevent further complications. To properly manage this condition, it is imperative that each treatment plan is tailored to addressing each patient’s symptoms, unique concerns and identifying their biological condition. There are multiple ways to manage PCOS.
I like to start by looking at the foundation of all PCOS cases — diet and exercise. Then, I complement diet and exercise with adequate supplementation, stress management skills, and education on how to diminish exposure to environmental toxins.
Diet and exercise: In insulin-resistant PCOS, the focus is on regulating blood glucose levels throughout the day. This can be done by simply adding healthy fats (e.g avocados, nuts, avocado oil, chia/hemp/flax seeds) and high quality protein sources ( e.g lean poultry, legumes, eggs, fish) to each meal.
Also, it is important to increase the consumption of non-starchy vegetables ( e.g zucchini, pumpkin, tomatoes and cucumbers), and fruits that are lower on the glycemic index such as berries. Eliminating or reducing dairy consumption, avoiding processed food and refined sugars can also be beneficial.
In terms of exercise, I try to encourage my patients to find an activity that they enjoy. Whether it’s cycling, walking, dancing or jogging, it has been proven that exercise can reduce stress levels while also increasing the body’s sensitivity to insulin. I usually encourage my patients to aim for at least 150 minutes of exercise per week.
Supplementation: Proper supplementation can help regulate blood sugar and hormonal levels, decrease inflammation, regulate the body’s response to stress and aid in the process of toxin elimination. Supplementation should always be done under the guidance of a healthcare professional.
Stress management: There are various tools to manage stress. Exercise, as discussed above, is important. However, other practices like yoga, journaling and breathing exercises can also be beneficial in patients with PCOS.
Reduce environmental toxins: According to the Environmental Working Group (EWG), women use an average of 12 products a day containing at least 168 different chemicals. These chemicals can disrupt normal hormonal function, contribute to obesity, insulin resistance, menstrual dysregulation and infertility. The EWG’s website serves as a great source of information where those interested can find information on how to make healthier and smarter choices on things like food, personal healthcare items, and cosmetics.
If you have been recently diagnosed with PCOS or have been dealing with it for a while, remember that there is always support available to you.
There are multiple alternatives to managing your condition properly so that you can always feel empowered to take full control of your health and well-being. -LP