Unsure if you have PCOS? Here’s how to find out.
PCOS, or polycystic ovarian syndrome, is one of the most common hormonal conditions in women of a reproductive age, believed to affect up to 15% of the female population. Because it affects such a large number of women worldwide, it is something we commonly see in practice. In my experience once a woman understands her PCOS and what might be driving it, she feels empowered knowing that there is so much she can do to manage it naturally with her diet and lifestyle.
So, what is PCOS?
The term ‘polycystic ovary’ or PCO is actually a bit of a misnomer. It refers to the ultrasound appearance of an ovary which looks to be filled with many small cysts. But these ‘cysts’ are actually just follicles and can be seen on the ovarian ultrasound of about 20% of ALL women, even women who have regular menstrual cycles and normal hormonal profiles. Every month, these normal cysts grow, burst and are reabsorbed. For a woman who is ovulating regularly one of these follicles will become larger than the others, suppressing the growth of all the other follicles. In the case of PCOS, rather than a dominant follicle emerging ready for ovulation, all the follicles continue to grow a little bit giving the appearance of a ‘polycystic’ ovary on an ultrasound. So, lots of follicles in an ovary could point toward some type of hormonal abnormality or equally, it could just be normal for you at this time in your cycle.
Polycystic ovarian syndrome or PCOS however, is a bit more complex and usually includes multiple ovarian follicles plus a tendency to the over production of androgens or male hormones and/or erratic ovulation and irregular periods. Specifically late periods or too many days of bleeding. Other symptoms of PCOS can be excessive facial or body hair, a deepened voice, acne, hair loss, weight gain and infertility.
PCOS is largely a metabolic condition which often goes hand in hand with insulin resistance. This reduced sensitivity to insulin may be present regardless of a woman’s weight and is estimated to be present in 50-70% of women with PCOS. Long term, this decrease in insulin sensitivity can increase the likelihood of developing diabetes and cardiovascular disease so it does need to be taken seriously.
So how do you find out if you have PCOS?
If you have an irregular menstrual cycle or no period at all or have symptoms of androgen excess then the first step is to do a series of blood tests to evaluate androgen levels including DHEAS and free testosterone, as well as SHBG and FSH and LH levels.
The next step is to establish whether you have insulin resistance by checking your fasting insulin through a blood test. A healthy insulin sensitivity ideally should be less than 8 mIU/L. Too much insulin can impair ovulation and cause your ovaries to make more testosterone instead of oestrogen. Too much insulin also stimulates your pituitary gland to make more luteinising hormone (LH), which makes even more androgens and can stop your follicles from developing properly. Finally, too much insulin lowers the androgen-binding protein SHBG. Normally most of the circulating testosterone would be bound to SHBG making it less able to exert its masculine effects on skin and hair. If SHBG falls, more unbound testosterone circulates in the body which can cause acne and male pattern hair growth.
Other tests may be ordered depending on the symptoms you have but will often include thyroid function and prolactin levels, especially if irregular or absent menstrual cycles are an issue. Cholesterol levels may also be checked as almost a third of all women with PCOS have elevated triglycerides. Vitamin D improves insulin sensitivity and promotes healthy maturation of ovarian follicles so knowing if you are deficient is also important if you have been diagnosed with PCOS.
So, what do you do if you have been diagnosed with PCOS?
Because PCOS is not a black and white condition every woman’s symptoms can be a little bit different. Some women continue to cycle regularly with PCOS, or have only slightly longer cycles, while others can go months apart between periods. Not every woman will have raised insulin and equally not every woman will experience weight gain. Not all women with PCOS show signs of male pattern hair growth and similarly not all women have acne. Therefore, in general terms a naturopath’s treatment of PCOS is focused on improving insulin resistance (if it’s an issue), ensuring a regular menstrual cycle, reducing the effects of excess androgen levels and improving fertility for those women wanting to become pregnant. PCOS can be complex, but treatment doesn’t need to be complicated, or expensive! With the right nutrition and lifestyle changes, as well as tailored herbal and nutritional support PCOS can become a very manageable condition.
If you have been diagnosed with PCOS you might be wondering, but what can I do about it? A whole lot! In Part 2 of this blog, we’ll talk about how making even the simplest of changes to your diet and lifestyle can effect a huge change in your hormones and symptoms of PCOS.
Bobbie X