Polycystic Ovarian Syndrome or PCOS is a common endocrine disorder affecting about 10% women of reproductive age. Although it is very common, it often goes undiagnosed for many years as the symptoms may vary for each affected woman.
So what exactly is PCOS?
PCOS was first described in 1935 by Doctors Stein and Leventhal in women who were obese, had irregular menstrual cycles, ovarian cysts, acne and excess hair growth (hirsutism). PCOS was considered a hormonal imbalance where women had excess androgens (male hormones like testosterone) as the underlying cause of their symptoms. Although these are considered “classic” symptoms of PCOS, not all women experience all of these symptoms. It is now known that PCOS is a much more complex syndrome which is not only an endocrine (hormonal) disorder but a metabolic disorder as well. Many women with PCOS also have Insulin Resistance as a driving factor of symptomatology.
So what are the symptoms of PCOS?
Symptoms of PCOS include infertility, irregular periods, acne, weight gain, unwanted facial hair, and thinning of hair or hair loss. Women with PCOS also have higher rates of depression and anxiety which may be related to the underlying inflammation associated with PCOS. There is also an increased rate of eating disorders in patients with PCOS , especially Binge Eating Disorder. Left untreated, women with PCOS also have higher rates of diabetes, heart disease, endometrial cancer and stroke.
So what causes PCOS?
We know that genetics plays a role in the development of PCOS but the causes are multifactorial. Your genes are not your destiny! Your genetic predispositions may be improved or harmed by environmental factors and exposures including lifestyle factors like stress. We know that 50-70% of women with PCOS show measurable insulin resistance. Insulin stimulates secretion of testosterone in the ovary which leads to elevated levels of circulating testosterone which accounts for symptoms like acne, hirsutism and male pattern hair loss. We also know that gut dysbiosis (imbalance of gut bacteria) as well as the function of our mitochondria (energy centers of our cells) may contribute to the development of PCOS. How your body processes carbohydrates, fats and proteins may be impaired if your mitochondrial function is impaired.
How is PCOS diagnosed?
PCOS is diagnosed clinically- meaning that women may experience some or all of the classical symptoms discussed after other conditions have been ruled out. Blood testing and ultrasounds of the ovaries may help to confirm PCOS but lack of abnormalities on hormonal testing or lack of small ovarian cysts does not mean that you do not have the condition. Test results may be variable according to the timing of when they are taken.
I think that I have PCOS or I have been diagnosed with PCOS. What should I do?
It is important to be evaluated by a physician knowledgeable in the diagnosis and treatment of PCOS as appropriate intervention is necessary to avoid long term health consequences. Some actionable steps are:
1) Balance your Blood Sugar- It is important to keep your blood sugar in check as we know that many women with PCOS have measurable insulin resistance. Your physician may recommend medications such as Metformin to lower insulin resistance and stabilize your blood sugar. However, it is equally important to maintain healthy eating habits that will keep your blood sugar balanced during the day. This can be accomplished by eating regular meals throughout the day which contain protein, healthy fats, and vegetables. Limit simple carbohydrates and avoid sugar and processed foods. The more plants and color in the diet the better! There are well studied supplements and herbs that help to balance your blood sugar as well. Work with a physician knowledgeable in how to incorporate these into your therapeutic plan.
2) Nourish your adrenal glands – Let’s face it. Most of us are under some degree of chronic stress. The high levels of cortisol secreted by adrenal glands in response to stress increases our blood sugar which leads to insulin resistance. We can help to supports our adrenal glands and invoke a relaxation response through meditation and getting adequate sleep. While exercise is great, overtraining may actually illicit a stress response in the body and increase inflammation. Speak with your doctor to see if your current exercise regimen is serving you well.
3) Balance your hormones and Support Hormonal Detoxification – One of the mainstays to balance circulating testosterone levels is the use of Oral Contraceptive Pills. They work to lower testosterone levels by increasing binding globulins that help to bind up the excess circulating testosterone. They also allow women to achieve regular menstrual cycles. While it is standard practice to use oral contraceptive pills, they are not without side effects. There are also well studied supplements and herbs that may be helpful as part of your therapeutic plan to help with lowering your testosterone levels. We should also be mindful to reduce our environmental exposures to chemicals that act as hormone disruptors. From the food we eat, to our household products to our beauty products, to our food packaging, it is important to be mindful of the chemicals that we are putting both on and in our bodies.
PCOS is a complex syndrome with many root causes and potential interventions. Speak with your doctor to see if your symptomatology may be due to PCOS and what interventions may be right for you.
Stephanie Strozuk, MD, FAAP is the founder of Evolved Adolescent and Young Adult Medicine- New Jersey's only private integrative medical practice dedicated exclusively to the health and wellbeing of tweens, teens and young adults. Dr. Strozuk is board certified in both Pediatrics and Adolescent and Young Adult Medicine. She has held academic positions at the Mount Sinai School of Medicine and at Rutgers - Robert Wood Johnson School of Medicine. She has also obtained additional training through the Institute for Functional Medicine and uses a functional medicine approach in her practice.