Polycystic Ovarian Syndrome (PCOS)
The most common gynaecological complaint that I see in my clinic these days is Polycystic Ovaries/Polycystic Ovarian Syndrome (PCOS). Some women only have the cysts (PCO), while others have no cysts but have the syndrome (PCOS). Some have both. The one thing that they all have in common is that they all have insulin resistance. For the sake of this article I am going to call this complaint PCOS so people don’t get confused. If you or someone in your family suffers from Irregular cycles, gets hormonal acne, gets extra hair etc, then there is a good chance they have it. They also need to get it looked at and treated early before it affects future fertility. You only need 1-2 of the symptoms to have the syndrome too.
Polycystic Ovarian Syndrome (PCOS) is a reproductive disorder characterised by multiple cystic growths on the ovaries. PCOS develops when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, either through the release of excessive luteinising hormone (LH) by the pituitary gland or through high levels of insulin in the
blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus. It can also be caused by oestrogen dominance too.
PCOS is characterised by a complex set of symptoms with research to date suggesting that insulin resistance is a leading cause. A majority of patients with PCOS (some investigators say all) have insulin resistance. Insulin resistance is a common finding among both normal weight and overweight PCOS patients. Many years ago it was thought that you had to be overweight to have PCOS, but now we know that many normal and underweight women have too. Their elevated insulin levels contribute to or cause the abnormalities seen in the hypothalamic-pituitary-ovarian axis that lead to PCOS. Specifically, hyperinsulinaemia causes a number of endocrinological changes associated with PCOS too. Anyone with polycystic ovaries does have a more than 50% chance of developing diabetes later on as well
Despite the link between insulin resistance and diseases states like PCO/PCOS, there is also a genetic link and this is mostly through the parental mode of inheritance. Someone in your family blood line will have had this disease. Some may know about it, others may not. Many of our parents and grandparents generation thought that menstrual irregularities were just a normal part of life and many were told it was normal and that they just had to suck it up. This is why we have so many issues with common gynaecological conditions today not being diagnosed properly, because some of this ignorance is still filtering through the medical system, or being passed down as what women class as normal. Menstrual irregularities are not normal and women need to know this. The other thing that we need to teach women, is that once a disease like PCOS, endometriosis is expressed out into the body, it is there. It is then up to the woman to get help in treating and managing the disease. The good thing with PCOS, is that it is now known to be reversible through diet and lifestyle changes, but in order to do so, one must be very strict in what one eats and how one keeps the body healthy, both physically and emotionally too.
PCOS is the most common cause of oligomenorrhoea and amenorrhoea, although 20-25% of normally menstruating women have PCOS. These women may have reduced fertility and an increased risk of miscarriage.
Major causative factors and risk factors that can contribute to the incidence of PCOS include: Insulin resistance
Please note that women of normal weight, or those underweight, or lean can still have PCOS. PCOS is not limited to those that are overweight.
Family history of diabetes Stress
Symptoms & Signs
Common signs and symptoms of PCOS include:
Hirsutism ( Excess hair growth), Hair Loss, Acanthosis nigricans
Multiple cysts on the ovaries
*Please be aware that sometimes only 1-2 symptoms are needed for diagnosis. Some women are actually asymptomatic and would not even know that they have PCO, or PCOS. While PCO and PCOS can affect fertility, not all women with this disease will struggle to have a child either. Like other gynaecological issues like endometriosis, the symptoms do not always correlate to the severity of the disease
Diet and Lifestyle
Dietary and lifestyle changes are a must in the management of PCOS. The world health organisation recommends that dietary and lifestyle changes are the number one treatment for PCOS along with other therapies
By consuming reduced amounts of low glycaemic index carbohydrates, keeping protein levels up to maintain muscle mass and eating ‘good’ fats, insulin levels are reduced and fat stores can be accessed as fuel for energy production (thermogenesis).
The Wellness/Zone/Paleo/Primal style diets that I promote in my clinic help women with PCOS to maintain steady blood sugar and insulin levels and will assist in weight loss and also maintain body mass for those underweight. A diet composed of mainly low-GI foods combined with regular exercise will also help to combat the effects of insulin resistance. This is why the Paleo/Primal style diets are the best diets to follow. To be honest people with PCOS should get rid of grains altogether. Years go, we would have just called these style of diets clean health eating, but now we have names attached to them
A diet high in vegetables (non-starchy), small amounts of Low-GI fruits, essential fatty acids and lean protein sources provides essential phytonutrients, antioxidants, magnesium and helps to control inflammation and hormonal dysregulation.
Regular resistance training, or high interval exercise, is a must too (starting slowly and increasing as patient’s fitness improves)
Acupuncture, Chinese Herbal medicines, Nutritional supplements etc, are also a big part of the treatment on a complementary medicine level and can help dramatically. There is lots of research to support use of supplements and complementary medicines that can help PCO/PCOS. At my clinic I also have our own herbal medicine formulas to treat PCOS too. Some women may need a combination of complementary medicine treatments alongside medical treatments too and this is something I assess in my consultations with women.
Medically, insulin-regulating medications (metformin), hormone treatments (Pill, HRT) are used to regulate the cycle, control insulin resistance and prevent further cysts developing. There are natural supplements you can use that are far better for you and without the side effects of Metformin.
You can also now get a procedure called “Ovarian drilling” to laser the cysts and help with the healing of the ovaries in severe cases. Some women may need surgery to help this disease and some women also have other gynaecological conditions such as endometriosis at the same time as having PCO/PCOS and this again warrants surgical intervention. Disease states like PCOS and Endometriosis often go hand in hand and are often triggered by the same causal factors.
While many women are put on the oral contraceptive pill (OCP), please remember going on the pill does not fix this problem, it just masks it. You don’t want to just mask a condition, with out treating it at the same time and this often what leads to long term issues with fertility later on.
This is why anyone with irregular cycles should see a women’s health specialist like myself, or a gynaecologist, not just your GP. You need to see someone who specialises in this area and knows what to look for and how to treat it properly.
Dr Andrew Orr (Reproductive Medicine & Women’s Health Specialist)
“The Brisbane Baby Maker” & “Women’s & Men’s Health Crusader”
“Leaving No Stone Left Unturned”