Polycystic Ovarian Syndrome (PCOS) affects 1 in 10 women of childbearing age (1). It is estimated that up to 70% of women with PCOS have not been diagnosed (2). PCOS is a disorder of the endocrine system affecting sex hormones, hypothalamus-pituitary communication, and insulin secretion/production.
Symptoms of PCOS include (3):
- Irregular periods
- Heavy bleeding
- Increased hair growth (facial and body)
- Weight gain
- Darkening of the skin
- Gastrointestinal Issues
- Insulin Resistance
What is PCOS?
PCOS is caused by an imbalance in the hormones in your brain and your ovaries. During a normal cycle, estrogen levels increase in the first half of the cycle. When there is an estrogen spike, this signals the brain to release Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH). FSH stimulates the ovary to produce a follicle and LH triggers the ovary to release a mature egg (2).
When a hormone called LH is too high, this can cause the ovaries to produce too much testosterone (hence the increased hair growth and acne). In PCOS, LH levels are often high when the menstrual cycle starts. Because levels of LH are already elevated, there isn’t a surge that causes ovulation to occur (why the periods may be irregular). Some women may ovulate occasionally, or not at all. This may cause their periods to be close together, far apart, or not occurring.
Each month, the ovaries develop many follicles. Folliculogenesis (or development of the follicles) begins the last few days of the preceding menstrual cycle until the release of the mature follicle at ovulation. Women begin puberty with around 400,000 follicles!
The development of the follicles occurs in several stages. Multiple follicles develop at once, and by day 8 of the cycle, the body recognizes the “strongest” follicle and therefore promotes more growth of that follicle while suppressing growth of the other follicles (5). In women with PCOS, the ovary isn’t receiving the correct signals from the brain to produce the hormones that it needs to mature these follicles. Since there is a lack of communication, the body doesn’t ovulate (release of the mature egg) and the follicles continue to exist leading to “polycystic ovaries” (6).
What causes PCOS?
PCOS may also be associated with insulin resistance or sugar handling issues. It is estimated that 65-70% of women with PCOS have insulin resistance. 70-80% of these women are considered obese and 20-25% of these women are considered lean (4). Insulin is a hormone secreted by the pancreas. When you eat, particularly carbohydrates, food gets broken down into glucose. As your glucose levels rise in your blood, the pancreas releases insulin to help bring those levels back down. It does this by helping to move glucose into the cells so that they can be broken down into ATP- aka energy. This can also prevent the body from using fat for energy. Increased insulin levels can cause the ovary to produce more androgen hormones, such as testosterone.
Research has shown that there is a strong inflammatory process associated with PCOS. It has been identified that elevation of multiple inflammatory markers including CRP, IL-18, MCP-1, and WBC are present in many women with PCOS (7). Inflammation can be caused by a number of things including: food sensitivities, infection, thyroid dysfunction, and stress- to name a few.
PCOS has been proven to be a familial condition. It is estimated that 20-40% of women with PCOS have a mother or sister with the condition (8).
Oral Contraceptives (OCPs) remain to be one of the most frequently prescribed medications for the treatment of PCOS. However, an article published by The Journal of Clinical Endocrinology and Metabolism suggests that OCPs may exert adverse metabolic effects. Meaning, OCPs may make insulin resistance worse and increase risk of other metabolic actions that can increase long-term risk for diabetes and cardiovascular disease (9). This journal suggests that more research is warranted before prescribing all women with PCOS Oral Contraceptives.
Thyroid disorders are more prevalent in women with PCOS than the general population. Abnormalities in thyroid hormones may inhibit ovulation by affecting levels of FSH and LH (10). Being overweight or obese can also play a role in thyroid function, with most of these people showing an elevated TSH (suggesting hypothyroidism). Increased TSH can lead to increased adipose (fat) tissue, which can lead to increased inflammation and increased insulin resistance (10).
Guidelines from the Endocrine Society utilizes the Rotterdam Criteria for diagnosis. Two of the following three criteria are required for a diagnosis of PCOS (11).
- Oligo/anovulation (infrequent or absence of ovulation)
- Hyperandrogenism (increased “male” hormones)
- Clinical: hirsutism or less commonly male pattern baldness
- Biochemical: Raised FAI (Free androgen index) or Free Testosterone
- Polycystic ovaries on ultrasound
As mentioned above, there are many factors to consider when treating PCOS. This may include evaluating thyroid function, sugar handling, and determining what may be creating increased inflammation. It is important to consider all factors before prescribing medications.
If you are interested in learning more on this topic (including testing and treatment options) CLICK HERE to register for a FREE webinar on ‘Managing PCOS from a Natural Perspective’.
- Images are from Google Images