What is PCOS?
Ask around your groups of girlfriends and chances are at least one or two will tell you they, or someone they know, experiences symptoms of PCOS. As a woman of reproductive age, getting a diagnosis of PCOS can devastating, especially when you are suddenly overloaded with a bundle of really scary information– the increased risk of infertility, troubles to conceive, increased susceptibility for weight gain, pre-cursors to diabetes...
I know, I’ve been there. But take a deep breath, here’s the lowdown on what you need to know.
First up, what is PCOS?
Give us the stats…
Polycystic Ovary Syndrome (PCOS) is a hormonal and metabolic condition that affects up to 1 in 5 women and is the single most common endocrine disorder for women of reproductive age.
That’s roughly 12-18% of young women affected.
The name itself is somewhat misleading though, as it is not a disorder of the ovaries themselves, but rather the effect of increased levels of hormones on the ovaries that causes the vast array of symptoms experienced.
Frustratingly, whilst there has been a large amount of research undertaken in recent years, there is still a huge amount unknown about this condition and where it truly stems from. However, what is evident is that both genetics and lifestyle factors play an influential role in the hormones changes that contribute to the development of PCOS.
What are the symptoms
Symptoms of the disorder range greatly between individuals, and people may experience some and not the others, or present with a combo of the whole lot of them.
As PCOS is a cocktail condition of the reproductive, metabolic and emotional systems, symptoms are displayed in each of these areas.
Some common defining symptoms include:
· Excess body and facial hair (hirsutism)
· Scalp hair loss and Alopecia
· Increased risk of weight gain
· Emotional distress
· Irregular bleeding or no period
· Infrequent or absent ovulation
The weight paradox
For many women, weight gain can exacerbate PCOS symptoms and a small percentage of weight loss may improve PCOS, however there are two factors to consider here:
1. it is still unclear if PCOS directly causes weight gain to begin with – though commonly PCOS symptomatic women carry excess weight in the area of the body (around the belly and hips) which is indicative of hormonal imbalance.
2. Imbalanced hormones make it trickier to lose weight regardless of how much exercise you are doing. This is especially important to consider if you begin overtraining - as this sends your cortisol (the stress hormone) levels skyrocketing, which will only inhibit weight loss further.
Overtraining can lead to Adrenal Fatigue, whereby the adrenal glands which support and regulate hormone function begin to shut down by way of burn out, increasing cortisol levels and inhibiting weight loss or counteractively causing weight gain.
The hormonal stuff
Usually for women with PCOS the insulin levels and androgens (male type hormones) fall within the higher range or “above normal” levels, even if just marginally.
Genetic and lifestyle factors – diet, body fat percentage, exercise patterns, duration and quality of sleep, exposure to chemical and toxins – play a part in hormonal changes, which do one of two things:
On one side, there is an increase in androgen levels, which may lead to hirsutism and/or acne, and may cause the increased development of ovarian follicles - contributing to a lack of ovulation and an increase in oestrogen, which then disturbs the menstrual cycle regularity.
On the other, there is an increase in insulin levels – usually from diet and activity factors (or lack thereof) – this increases the levels of androgens in the body and may cause the formation of ovarian follicles, contributing to a lack of ovulation and an increase in oestrogen, which again disturbs the menstrual cycle. Consistently increased insulin levels also increase the risk of developing diabetes which in turn increases the cardiovascular risk factors and changes the PCOS diagnosis to one of a metabolic syndrome.
A term that seems to go hand in hand with PCOS is Insulin Resistance. From above we can see that an increase in insulin levels in the body can contribute to an increase of the male hormones in the body which may begin the knock-on effect, but what really is Insulin Resistance?
Insulin has many actions in the body, but primarily it is the hormone responsible for stabilizing glucose (sugar) in the blood. This works in a key-like action by linking to a receptor on the cell. Once the insulin links in, the cells respond by allowing glucose to pass from the blood, into the cells, thereby lowering the blood glucose levels. In up to 80% of women with PCOS, the cells become resistant to insulin, that is the “key” (insulin) links with the “lock” (receptor) but the cell does not respond and blocks the entry of glucose into the cell. In an attempt to compensate for the lack of glucose in the cell, the body signals the brain to produce greater quantities of insulin. However, when insulin levels are high they have adverse effects throughout the body, including on the ovaries and in the liver. Over time even higher levels of insulin become ineffective and in some women, the blood glucose levels may rise to the point where they are prediabetic or become type 2 diabetic. Insulin resistance can occur in women of all weight ranges.
Features of insulin resistance include weight gain, cholesterol changes and abnormalities in ovary function, whilst excess weight and inactivity can increase the severity of insulin resistance. Lifestyle management including a healthy diet, regular exercise and weight loss is recommended as the first and most effective treatment for women with PCOS. In women who are carrying excess weight, a reduction of as little as 5% of total body weight has been shown to reduce insulin levels, improve menstrual function, reduce testosterone levels and as such improve the ongoing symptoms.
But I work out? I’m a healthy weight? Why me?!
The outdated myth is that PCOS only affects women falling in the overweight/under-active bracket. However, it is now commonly understood that the condition can occur to women of all body types, sizes and weight ranges. For those that fall in this category of PCOS-positive women, it is important to understand the hormonal profiling leading to these imbalanced levels and contributing lifestyle factors which have lead to body to the inflammatory state of PCOS.
Why am I crying so much?
So now, not only are your hormones bouncing all over the place – cue the emotional distress –but all the above symptoms; the body changes, weight gain, lack of menstrual cycle, fears of troubling falling pregnant , can lead to psychosocial issues of body image, self-esteem, depression and anxiety. It is completely normal to feel overwhelmed, confused, frightened and angry about this diagnosis. The compounding emotions are difficult to process and deal with, even without the extra hormonal turmoil you are experiencing.
The best thing to do? Chat to someone who has experience, such as a great practitioner or therapist, or to a close confidante to help unload some of the emotional pressure.
How you get diagnosed
It's important to know here, that the condition itself is not the most important part of the situation, the diagnosis is an alarm and instead of spot treating, it is essential to treat the entire endocrine system in a holistic nature, supporting the key core functions of your hormones.
There is no one single feature that leads to a diagnosis of PCOS, rather a diagnosis is confirmed if two of the following three features are present – without any other causes.
1. Hyperandrogenism; the presentation of higher levels of male type (androgen) hormones in the blood as proven via blood tests.
2. Menstrual problems; being the lack of a period or irregular periods tracked over a duration of time.
3. Polycystic ovaries; where 12 or more follicles are present on one ovary and/or both ovaries are enlarged, as confirmed by an ultrasound.
Irregular periods: The average menstrual cycle is 28 days with one ovulation, but anywhere between 21 and 35 days is considered “normal”. An “irregular” period cycle is defined as either: Eight or less menstrual cycles per year or Menstrual cycles longer than 35 days
Several factors are taken into consideration such as the history of your periods, symptoms of increased body hair or male pattern balding hair loss, chronic acne, significant changes to hormone levels and pelvic ultrasounds,
Follicles on the ovaries are normal and everyone has a certain number of follicles (which can be referred to as cysts) on their ovaries at any given time – after all, that is how women produce an egg for reproduction! However, it is the poly nature that becomes a defining feature, with scans showing upwards of 15 follicles on each ovary an indication that the ovaries are defined as polycystic.
Options for treatment
I know you need some good news right now and the great thing is, these symptoms CAN be reversed with lifestyle and diet changes.
Currently in Western medicine, traditional doctors are trained to offer treatments which will “fix” each of the symptoms individually, which for PCOS may look like:
- Birth control pills to “regulate” your period each month
- Antibiotics for your acne
- Anti-depressants and/or anti-anxiety medication for the emotional distress
- Metformin – the medication used for diabetes to control insulin levels
- Fertility drugs to help fall pregnant.
Unfortunately, these are just band-aid treatments which don’t look to the root of the problem and address the issues going on. If these don’t sit quite right (they certainly didn’t for me) or you can’t take medication, there are alternative options which CAN help holistically address the issue from the source and have lasting, reversible effects.
Functional doctors, hormonal specialists, herbalists, naturopaths and dieticians are just some of the practitioners who can all help address the root cause of the symptoms and help you implement changes to your diet and lifestyle. These may include looking at your food sources, assessing your exercise patterns, looking at your sleep and stress levels, the functioning capacity of your gut and digestive system and monitoring your hormonal patterns to help get your cycle back on track and aid ovulation.
This is a process, and it takes time and commitment to really address these areas. The key is to honestly see it as a total lifestyle change, start small and make little shifts to address the areas that need to be changed for your health and overall wellbeing. But slowly, symptoms can shift and slowly begin to reverse.
The best weapon is knowledge, so arm yourself with advice, information and understanding from all the qualified practicioners you can.
This is pretty much the bible for women experiencing PCOS and she offers a fantastic, comprehensive protocol to help balance your hormones, reserving symptoms and coping with the condition.
A doctor/practitioner you are comfortable with/has experience with PCOS who you trust to explain, help and advise your on your journey.
Alternative therapies that help manage lifestyle conditions and stress levels , such as acupuncture, massage, psychotherapy, meditation and/or yoga.
A self-care routine – it’s not selfish, it’s imperative.
It is a whole lifestyle change and TAKES time. There are no overnight fixes, but slowly you can become symptom free.
If you've just been diagnosed with PCOS, remember there are many options available to you to help healing. Symptoms can be reversed and things DO get better. For more details of my own personal experience with PCOS check out my journey here.
All evidence and statistics in this article are sourced from Jean Hailes - For Women's Health. A fantastic source for anyone wanting more information on PCOS.