The naturopathic guide to Poly Cystic Ovarian Syndrome (PCOS)

What is PCOS?

PCOS stands for Polycystic Ovary Syndrome, a common hormonal disorder affecting people with ovaries, primarily those of reproductive age. To be diagnosed with PCOS, you must meet at least two of the three Rotterdam criteria established during a conference in Rotterdam, Netherlands, 2003. These criteria were developed to provide a more comprehensive and inclusive approach to diagnosing PCOS, as previous diagnostic criteria were limited and needed to capture the full spectrum of the condition.

1. Ovulatory Dysfunction: This is typically confirmed through irregular menstrual cycles or the absence of menstruation (amenorrhea).
2. Clinical or Biochemical Signs of Hyperandrogenism: Clinical signs may include hirsutism (excess facial or body hair), acne, or male-pattern baldness. Biochemical signs are assessed through blood tests that reveal elevated levels of androgens (e.g., testosterone).
3. Polycystic Ovaries: This is usually confirmed via ultrasound imaging, which shows the presence of multiple small follicles (cysts) on the ovaries. These cysts are typically arranged in a “string of pearls” pattern.

While this is helpful, diagnosing someone based on these criteria instead of addressing each of the individual criteria to treat the underlying cause can be rather limiting.

From a Naturopathic perspective, we think of PCOS as having ‘types or variants that tend to explain the underlying cause of that person’s PCOS. These are the four main types of PCOS:

• Insulin resistance PCOS
• Post-pill PCOS
• Inflammatory PCOS
• Adrenal PCOS

What causes PCOS?

While we don’t know why someone can be more prone to PCOS, the key to getting to the bottom of an individual’s PCOS is to understand what the underlying drivers of the condition are.

If you have Insulin resistance PCOS, the key is to regulate your insulin and glucose using diet, nutritional and herbal supplements. If high DHEAS is driving your PCOS, then you might have Adrenal PCOS and chronic stress could be impacting you. Post-pill PCOS can occur when someone stops taking the pill and their androgen hormones temporarily surge. At the same time, inflammatory PCOS means that chronic inflammation could be stimulating ovaries to produce too much testosterone, so the main factor to address will be reducing overall inflammation.

Ovulation is essential in PCOS because once all the follicles have been made in the follicular phase (the first few weeks of your menstrual cycle), we get a surge of Luteinizing hormone (LH), which signals the dominant follicle to release an egg. That sends a message back to other developing follicles that they aren’t needed anymore and can be reabsorbed back into the ovary. If this important message doesn’t get across, the follicles can stick around and may cause polycystic ovaries.

What are the common symptoms of PCOS?

The main symptoms of PCOS are:

1. Irregular Menstrual Cycles: One of the hallmark symptoms is irregular or absent menstrual periods. This can include long cycles, infrequent periods, or no periods.

2. Hyperandrogenism:

• Hirsutism (excess hair growth)
• Acne
• Male pattern baldness or hair loss

3. Polycystic ovaries on an ultrasound: This does not apply to all PCOS cases, but in some, there might be an excess of follicles on their ovaries.

4. Weight gain

5. Insulin resistance

• Increased craving for high-carb foods
• Difficulty losing weight
• Elevated blood sugar levels, which may lead to type 2 diabetes

6. Acne or excessively oily skin

7. Pelvic pain caused by ovarian cysts

8. Infertility due to irregular ovulation or anovulation (lack of ovulation)

It’s important to note that not everyone with PCOS will have these symptoms, and the severity can vary widely. In some cases, PCOS can be misdiagnosed or treated as menopause, infertility or hypothalamic amenorrhoea, so it’s essential to get the correct information.

How is PCOS diagnosed?

PCOS is diagnosed using blood testing, physical symptoms and sometimes an ultrasound to look at the ovaries.

Blood testing should look for

• LH
• FSH
• Androgens such as testosterone, androstenedione, free androgen index
• DHEAS
• Cortisol
• Prolactin
• Fasting insulin and glucose
• Glucose tolerance testing
• Sometimes, on day 21, progesterone and oestrogen are checked for ovulation
• TSH, T3 and T4 to rule out thyroid conditions that could manifest with the same symptoms

Is there a cure for PCOS?

Regarding PCOS, the answer lies in addressing the underlying causes of the individual symptoms. Officially, there is no cure for PCOS, but as Naturopaths, we are well-placed to investigate and treat the symptoms and drivers that cause infertility and irregular cycles.

This means focusing on

1. Regulating the menstrual cycle
2. Using herbs and nutrients to reduce androgen-related symptoms such as acne and hirsutism
3. Supporting fertility by encouraging ovulation and supporting healthy implantation
4. Managing insulin resistance with lifestyle and dietary modifications
5. Supporting weight management where necessary
6. Monitoring blood markers to ensure that elevated levels don’t lead to diabetes or cardiovascular disease

Can PCOS lead to infertility?

PCOS can cause infertility because of anovulation or elevated androgens if the proper treatment isn’t employed.

The key to addressing these is to work backward and treat the underlying cause of infertility. If the issue appears to be anovulation, the solution will be using nutrition, herbs, and lifestyle modifications to regulate the cycle. In contrast, if the cause is high testosterone or low oestrogen, the solution will be using herbs, nutrition, and lifestyle modifications to reduce these levels.

While infertility is possible in PCOS, it’s not guaranteed

What is the relationship between PCOS and insulin resistance?

The relationship between Polycystic Ovary Syndrome (PCOS) and insulin resistance is significant and well-established. Insulin resistance is a common feature of PCOS and plays a central role in the development and progression of the condition. Here’s how they are connected:

Insulin Resistance in PCOS:

The relationship between Polycystic Ovary Syndrome (PCOS) and insulin resistance is significant and well-established. Insulin resistance is a common feature of PCOS and plays a central role in the development and progression of the condition. Here’s how they are connected:

Insulin resistance is when the body’s cells do not respond effectively to insulin, a hormone produced by the pancreas. Insulin primarily regulates blood sugar (glucose) levels by facilitating glucose uptake into cells for energy.

In individuals with PCOS, there is often a higher prevalence of insulin resistance than those without the condition. The exact cause of insulin resistance in PCOS is not fully understood, but it appears to be related to genetic and hormonal factors.

Hormonal Imbalances:

Insulin resistance in PCOS leads to an increase in insulin levels in the blood (hyperinsulinemia). High insulin levels can stimulate the ovaries to produce more androgens, such as testosterone. This hormonal imbalance can result in the symptoms of PCOS, such as hirsutism, acne, and irregular menstrual cycles.

1. Effect on Ovulation:

Insulin resistance can disrupt the normal ovulatory process. When the body resists insulin, it can lead to higher insulin levels in the bloodstream, suppressing ovulation. Due to this disruption in the ovulation cycle, irregular or absent menstrual periods are common in PCOS.

2. Impact on Metabolism:

Insulin resistance can also contribute to metabolic problems, including an increased risk of developing type 2 diabetes and obesity. It can lead to elevated blood sugar levels and the body’s inability to use glucose for energy efficiently.

3. A negative feedback Loop:

PCOS and insulin resistance can create a feedback loop. High insulin levels contribute to the hormonal imbalances seen in PCOS, which in turn can exacerbate insulin resistance. This cycle can further worsen the condition, so addressing both at once can be important to stopping it.

How can PCOS be managed?

From a naturopathic perspective, this is all about addressing the individual underlying factors.

High androgens

Reducing androgens using herbal and nutritional medicine, lifestyle and diet factors, and treating insulin resistance can lessen the symptoms of PCOS. Spearmint tea can be a nice way to introduce herbs into your routine, or you can chat with your naturopath for an individualised herbal tonic.

Insulin resistance

Management of PCOS often includes strategies to address insulin resistance, which can help improve symptoms and reduce the risk of associated health problems. Lifestyle modifications such as maintaining a healthy diet, regular physical activity, and weight management are essential for managing insulin resistance in PCOS. In some cases, herbal and nutritional medicines such as inositol can reduce insulin resistance.

Inflammation

Systemic or chronic inflammation affects the entire body rather than a localised area. Inflammation is the immune system’s natural and necessary response to injury, infection, or tissue damage. It is characterised by redness, heat, swelling, and pain at the site of injury or infection and is part of the body’s defence mechanism to help heal and protect against harmful invaders.

Systemic inflammation is a long-term, low-grade inflammatory state that can persist throughout the body for weeks, months, or even years. It can occur without an apparent injury or infection and may not produce the classic signs of acute inflammation.

This has been linked to a wide range of chronic health conditions and can be impacted by lifestyle, obesity, chronic stress, infections, autoimmune conditions, and diet. Anti-inflammatory herbs and nutrients such as turmeric can be helpful alongside an anti-inflammatory diet rich in plants and healthy fats.

Supporting adrenals

Chronic elevated stress levels can cause an increase in our cortisol and DHEAS levels, which can cause hormonal imbalances or anovulation that may lead to PCOS.

Self-care and stress reduction techniques are integral, but we also have herbal adaptogens such as licorice and withania that can help if your cortisol levels are high.

Implementing journaling, meditation, or breathing exercises can also go a long way toward supporting your adrenals.

What are the long-term health risks associated with PCOS?

PCOS is associated with several long-term health risks and complications, many of which are linked to hormonal imbalances, insulin resistance, and inflammation. It’s important for individuals with  Some of the main long-term health risks associated with PCOS include:

1. Type 2 Diabetes: Insulin resistance is common in PCOS, and over time, it can lead to elevated blood sugar levels and an increased risk of developing type 2 diabetes. Regular monitoring of blood sugar levels and lifestyle modifications (such as diet and exercise) are essential for diabetes prevention and management.
2. Cardiovascular Disease: PCOS is associated with several risk factors for cardiovascular disease, including high blood pressure, high cholesterol levels, obesity, and insulin resistance. These factors can increase the risk of heart disease, stroke, and other cardiovascular conditions.
3. Metabolic Syndrome: Metabolic syndrome is a cluster of conditions that increase the risk of heart disease and type 2 diabetes. It includes high blood pressure, high blood sugar, abnormal cholesterol levels, and abdominal obesity. PCOS is often considered a risk factor for metabolic syndrome.
4. Endometrial Cancer: Irregular or absent menstrual cycles in PCOS can lead to an overgrowth of the uterine lining (endometrial hyperplasia), which increases the risk of endometrial cancer. Management of menstrual irregularities with appropriate treatments can help reduce this risk.
5. Infertility: PCOS is a leading cause of female infertility due to irregular ovulation or anovulation (lack of ovulation). Fertility treatments and interventions may be necessary for individuals with PCOS who wish to conceive.

Can PCOS be prevented?

It is essential to investigate any symptoms you are having when PCOS occurs. Understanding why you might be experiencing acne, irregular cycles, insulin resistance, or excessive hair growth can help you avoid being diagnosed with PCOS.

Suppose you suspect you have PCOS but are unsure where to start. In that case, a naturopath is a significant first step to understanding what you might need to investigate and make a treatment plan to address any underlying causes.