Although most commonly associated with androgen excess, Polycystic Ovarian Syndrome (PCOS) is the outcome of a systemic metabolic and reproductive hormone dysregulation. So, what is PCOS and how can we restore hormonal and metabolic health once it has been diagnosed?
PCOS affects circa 12-20% of Australian women of reproductive age, and is more common in women who are overweight or of indigenous background. The prevalence of PCOS has been steadily increasing over the last decade1.
It is also the most common cause of anovulatory infertility in Australian women1. Ovulation is the essential prequal to conception, which is why women with PCOS may have issues with fertility.
The term polycystic ovarian syndrome (PCOS) is a misleading name for what is essentially a multifaceted metabolic condition that has broad-ranging systemic effects, which impact hormonal and metabolic health. In fact, having polycystic ovaries is only part of the PCOS diagnosis.
A PCOS diagnosis comes with the presence of at least two of the following criteria:
1. Oligo-anovulation (irregular or missing periods)
2. Clinical or biochemical evidence of high androgens (excess facial / body hair growth, male pattern hair loss, acne, elevated androgens on blood test)
3. Polycystic ovaries on ultrasound examination
AND the exclusion of other causes of irregular periods and high androgens, such as a thyroid disorder or high prolactin2.
A diagnosis of PCOS comes as a shock to most women, and its potential to lead to fertility problems are legitimately cause for concern. Often, women are put on the contraceptive pill by their doctors, and told to come back when they want to have a baby.
On the other hand, natural medicine, along with dietary and lifestyle modifications, can address the causes of PCOS to achieve great results. With the right type of support, PCOS can be successfully managed, and symptoms can be completely reversed in some cases.
There is no single triggering factor in PCOS. Rather, it is the result of a complex interaction between genetics, environment and lifestyle factors.
Genetics:
We all carry subtle genetic variations that may predispose us to certain conditions. In the case of PCOS, it appears that stress and poor diet can trigger genes that influence insulin signalling, hormone metabolism, and the production of androgens from the ovaries and adrenal glands.
Insulin Resistance:
Circa 80% of women with PCOS have some degree of insulin resistance. For this reason, insulin resistance is rightly the main focus on research and treatment. Insulin is a hormone that acts like a key, allowing glucose (sugar) from the blood stream to enter the cell, where it is used as fuel. In insulin resistance, cells do not readily open to insulin, forcing the pancreas to produce more and more insulin to try to get sugar out of the blood and into the cells. What this means is that we have excess sugar and insulin in the blood stream, but not enough sugar in the cell where it is actually needed. Hello fatigue (due to lack of cellular energy) and sugar cravings, despite high levels of sugar in the blood. Excess circulating insulin leads to weight gain, but it also overstimulates ovarian follicles, causing the appearance of polycystic ovaries. This overstimulation results in excess production of androgens, and disrupts the hypothalamic-pituitary-ovarian axis (signals from the brain to the ovaries), resulting in oligo/anovulation.
Once only associated with obesity, normal weight women with PCOS can also have insulin resistance. However, overweight women are more likely to experience more pronounced menstrual irregularity and signs of androgen excess.
The development of insulin resistance relies of several factors, including diet, stress and inflammation.
Diet:
A typical diet that would lead to insulin resistance is a high sugar, low fibre diet. That is, a diet that pertains refined carbohydrates, sugary foods and drinks, and inadequate vegetable intake. Some women may be more sensitive to a diet high in refined carbohydrates, due to individual genetic susceptibility. What this means is, carbohydrate tolerance is individual. Just because you don’t eat as many carbohydrates as your friend who doesn’t have PCOS, doesn’t mean that your intake of carbohydrates may not be a factor in your insulin resistance.
Stress:
Stress can play a significant role in PCOS development due to its ability to alter glucose metabolism, insulin sensitivity, and impact the production of adrenal hormones. In women, both the ovaries and adrenal glands produce hormones that act as androgens. In women who have been ‘burning the candle at both ends’ so to say, the adrenal glands start to produce higher levels of androgenic hormones, such as DHEA-S. In fact, chronically stressed women with PCOS may present with normal testosterone levels (the androgen secreted primarily from the ovaries), but elevated DHEA-S levels, which can be the cause of their male pattern hair loss, excessive facial or body hair, or acne.
Inflammation:
Inflammation is an overlooked factor in PCOS. It is a double-edged sword that drives both insulin resistance and the production of androgens from polycystic ovaries. There are many causes of low-grade inflammation, but one of the most common is poor digestive function and dysbiosis. Dysbiosis is the imbalance of the billions of bacteria living in our guts. Causes of dysbiosis include a high sugar, high saturated fat diet, pesticides, food additives, medications such as antibiotics and the oral contraceptive pill, and stress. Dysbiosis may lead to increased intestinal permeability, whereby toxins or undigested food particles leak into the blood stream, causing chronic low-grade inflammation. Healthy bowel function is also imperative for hormone metabolism (as hormones are excreted via the bowels). Therefore, when gut symptoms are present, treating the gut is essentially the first step in treating PCOS.
Treating PCOS:
Dietary intervention is the first line treatment in most PCOS cases. An anti-inflammatory diet, such as one which is high in plant foods, with moderate intake of fish, seafood, nuts and seeds to provide healthy fats and adequate protein, is the best way to improve insulin sensitivity, and support hormonal and gut health.
Exercise is an important feature in PCOS recovery, but must be tailored to the individual. For example, women with a typical picture of insulin resistant PCOS would benefit from a more intensive exercise protocol than women with elevated DHEA-S only (stress induced), who would get more benefit from a more restorative routine.
To support diet and lifestyle intervention, both nutritional and herbal medicines work exceptionally well in PCOS. Nutrients such as magnesium3, chromium4 and alpha lipoic acid5 help to stabilise blood sugar levels. Nutraceuticals such as inositol6 and N-acetylcysteine7 have been shown to improve insulin sensitivity. Herbs such as Peony and Licorice8 have been used for centuries to support ovarian function, ovulation and the adrenal glands, while also reducing the production of androgens in the ovaries.
Naturopathic medicine has a huge role to play in women’s health. It is safe, effective, and actually addresses the root causes of conditions such as PCOS. You do not need to be on the contraceptive pill to manage PCOS. The pill effectually stops the natural production of your reproductive hormones, making it a band aid solution that may not actually improve symptoms, and will likely lead to more problems when stop you taking it.
A Naturopath can work with you to address what is causing your PCOS, and develop a personalised protocol to improve your hormonal and metabolic health, naturally.
Book an appointment with Naturopath Liana Madera to uncover the root cause of your PCOS, and start experiencing the benefits of a natural cycle.
The journey to hormonal health is not always easy, but once you find your balance, you’ll have the key the lifelong female vitality.
References
1. Deswal R, Narwal V, Dang A, Pundir CS. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. Journal of Human Reproductive Sciences. 2020;13(4):261-271. doi:10.4103/jhrs.JHRS_95_18
2. Azziz R. PCOS: A diagnostic challenge. Reproductive BioMedicine Online. 2004;8(6):644-648. doi:10.1016/S1472-6483(10)61644-6
3. Morais JBS, Severo JS, de Alencar GRR, et al. Effect of magnesium supplementation on insulin resistance in humans: A systematic review. Nutrition. 2017;38:54-60. doi:10.1016/j.nut.2017.01.009
4. Ashoush S, Abou-Gamrah A, Bayoumy H, Othman N. Chromium picolinate reduces insulin resistance in polycystic ovary syndrome: Randomized controlled trial. Journal of Obstetrics and Gynaecology Research. 2016;42(3):279-285. doi:10.1111/jog.12907
5. Evans JL, Goldfine ID. α-Lipoic acid: A multifunctional antioxidant that improves insulin sensitivity in patients with type 2 diabetes. Diabetes Technology and Therapeutics. 2000;2(3):401-413. doi:10.1089/15209150050194279
6. Unfer V, Carlomagno G, Dante G, Facchinetti F. Effects of myo-inositol in women with PCOS: A systematic review of randomized controlled trials. Gynecological Endocrinology. 2012;28(7):509-515. doi:10.3109/09513590.2011.650660
7. Javanmanesh F, Kashanian M, Rahimi M, Sheikhansari N. A comparison between the effects of metformin and N -acetyl cysteine (NAC) on some metabolic and endocrine characteristics of women with polycystic ovary syndrome. Gynecological Endocrinology. 2016;32(4):285-289. doi:10.3109/09513590.2015.1115974
8. Goswami PK, Khale A, Ogale S. Natural remedies for polycystic ovarian syndrome (PCOS): a review. International journal of pharmaceutical and phytopharmacological research. 2012;1(6):396-402.