Everything you need to know about PCOS

Feb 8

What is polycystic ovarian syndrome (PCOS)?

PCOS is a complex multifactorial condition resulting from an imbalance in sex hormone production by the ovaries. PCOS is characterised by elevated androgen levels (male hormones such as testosterone), menstrual irregularities, and/or an excessive number of small cysts on one or both ovaries. PCOS is one of the most common hormonal disorders, affecting 1 in 10 women of reproductive age. The primary cause is not well understood, however, there is thought to be a combination of lifestyle, environmental, and genetic factors involved. PCOS is both an endocrine and metabolic disorder, which is closely connected to insulin resistance.

Insulin resistance is when the pancreas produces enough insulin, but the body does not respond to insulin effectively. When this happens, the pancreas produces more and more insulin trying to get the message across to the body, which generates inflammation and causes weight gain. Excess insulin can also be an underlying driver of PCOS. High insulin can impair ovulation and cause the ovaries to produce excess testosterone. High testosterone is the cause of many of the symptoms associated with this condition. It is important to understand that not all women with PCOS have an issue with their insulin. Insulin resistance is prevalent in roughly 35-80% of women with PCOS. PCOS affects many different body systems and symptoms can vary. Undergoing testing can help you to discover what may be driving your individual symptoms. A holistic approach is essential to address the many different aspects of this condition.

How do I know if I have it?

Typically, symptoms manifest in adolescence. Many young girls will start taking oral contraceptives (such as the pill) to help with heavy periods or acne which is usually being driven by high testosterone. It is usually only when deciding to quit birth control, where we see symptoms return. This is because symptoms have been suppressed, but the underlying condition/s have not been addressed. It is important to receive an accurate diagnosis of PCOS from your GP, as many of the symptoms associated with PCOS are interlinked with other conditions. In Australia, the Rotterdam criteria is the most widely accepted guideline for PCOS diagnosis. Women generally need to have two out of three of the following:

Oligo-anovulation (infrequent ovulation) or anovulation (no ovulation)
Hyperandrogenism (high levels of androgens such as testosterone) seen in blood test
Polycystic ovaries found on ultrasound

Other common signs/symptoms to look out for:

Acne and/or oily skin —> excess oil production stimulated by high testosterone
Irregular cycle (cycle less than 25 days or more than 35 days)
Excess facial or body hair growth —> high testosterone
Alopecia (scalp hair loss) —> high testosterone
Weight gain or difficulty losing weight —> insulin resistance
Mood swings —> hormone fluctuations
Difficulty falling pregnant —> irregular ovulation/anovulation
Increased appetite, carbohydrate cravings —> high insulin
Anxiety, depression, poor self-esteem, and negative body image —> possibly due to hormonal imbalances or as a consequence of experiencing the symptoms associated with PCOS

The good news:

Although there are pharmaceutical medications available to help manage symptoms associated with PCOS, these medications do not correct the underlying cause of these imbalances. It is important to consider all options when looking into managing this condition. Here are just a few of the many lifestyle and environmental habits you can implement which have been shown to benefit in the management of this condition:

Eating a balanced and diverse diet full of nutrient-dense wholefoods can play a huge role in improving many of the symptoms associated with PCOS. Eating meals regularly/not skipping meals and consuming low glycaemic index foods (e.g. non-starchy vegetables, legumes, eggs) as opposed to high glycaemic index foods (e.g. white bread, white rice, potatoes) is important for stabilised blood sugar levels, weight management, and satiety.
Tracking your cycle through apps such as ‘Kindara’ or ‘Flow’ can be a useful tool to indicate changes in hormone levels and determine whether ovulation is occurring by using the basal body temperature (BBT) method.
Certain exercise such as aerobic exercise (eg., walking, swimming, cycling) can play a role in improving insulin resistance by increasing insulin receptors. Additionally, incorporating moderate strength training such as light weightlifting may be beneficial for women with PCOS as strength training can help regulate androgen levels. Exercise also improves overall mood and wellbeing which can help to improve some of the psychological features associated with PCOS.
Stress management is crucial as stress can exacerbate symptoms of PCOS. It is important to engage in stress-reducing activities such as yoga, meditation, journalling, deep breathing, and spending time in nature.
Acupuncture has been shown to improve menstrual regularity, reduce symptoms of androgen excess, increase insulin sensitivity, and promote ovulation in women with PCOS.
As PCOS can affect fertility due to irregular ovulation or anovulation, it is crucial to address any hormonal imbalances before trying to conceive to promote a healthy pregnancy. There are many potent herbal medicines that can assist in correcting hormonal imbalances.

Beneficial herbal medicines & nutritional supplements:

· Myo-inositol has been shown to increase insulin sensitivity, reduce androgen levels, restore normal menstrual cycles, and induce ovulation thereby facilitating pregnancy

· Magnesium deficiency is associated with insulin resistance. Women with PCOS have been found to have significantly lower magnesium levels, therefore increasing dietary intake (and possibly supplementation) is encouraged. Magnesium supplementation has been shown to reduce body mass index (BMI), reduce testosterone levels, and reduce luteinising hormone (LH) levels which are usually high in women with PCOS

· Spearmint tea has been shown to reduce testosterone levels

· Cinnamon can increase insulin sensitivity and promote blood sugar regulation and therefore can be valuable in women with insulin resistance associated with PCOS

· Peony can modulate the reproductive hormone oestrogen, reduce androgen production, and improve progesterone levels by normalising ovarian function

· Liquorice & Peony combination of these two herbs can reduce testosterone levels, improve pregnancy rates, and lowers LH

The bottom line:

For many women, a PCOS diagnosis can be a relief to finally understand why you have been feeling and experiencing certain symptoms. It can also promote empowerment to take charge of your own health and adjust your lifestyle habits to minimise some of the undesirable effects associated with this condition. There is a multitude of support for women living with PCOS in the form of nutritional supplementation, herbal medicine, and lifestyle modifications. There is also an abundance of books and podcasts freely available to educate and empower you to live a healthy, happy and abundant life.

A naturopath can address hormonal imbalances by investigating your signs and symptoms, analysing blood tests, recommending specific testing (such as a hormonal profile), and formulating an individualised treatment plan which can help you to reach your health goals. It is important to note that not every woman with PCOS will have the same underlying drivers for their symptoms and may present differently, which is why having a practitioner that can support you in your health journey is so fundamental. This is a condition which can be managed effectively with the right tools and guidance.

Books worth reading and podcasts worth listening to: