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Re-think PCOS

As most women are aware PCOS or Poly Cystic Ovary Syndrome is a common is a reproductive condition that affects 8-13% of women who are of a reproductive age. Ultrasound diagnosis usually confirms the presence of multiple small cysts of the ovaries.

Symptoms of PCOS vary but usually include:

  • Irregular menstrual cycle, hirsutism, acne, alopecia and recurrent miscarriage

  • Elevated androgens, luteinizing hormone (LH), oestrogen and prolactin

  • Insulin resistance, risk of type 2 diabetes, obesity, fatty liver and elevated cholesterol

  • Anxiety and depression

The Rotterdam Criteria requires two of the following symptoms in diagnosing PCOS:

  1. Irregular periods;

  2. Clinical and/or hyperandrogenism (elevated androgens)

  3. Polycystic ovaries; and exclusion of other causes

As part of my ongoing commitment to finding new ways of supporting my clients I recently attended the ATMS PCOS Symposium. This event was a unique opportunity to listen to a diverse range of speakers including: Prof. Robert Norman, Lara Briden, Leah Hectman, Prof. Nigel Stepto and Dr Carolyn Ee. Each speaker gave their insights into PCOS from a medical, exercise physiology and naturopathic point of practice. The opportunity to attend the symposium gave me the opportunity to learn the current evidence in treating and understanding PCOS.

If there is one thing I would like all women to know who have PCOS; it would be to treat the individual woman not the just another woman with an ambiguous fertility condition. Women with PCOS require support in preconception, pregnancy, post-natal and beyond their fertile years.

Is PCOS over diagnosed?

It does sometimes seem that every second young woman I see has symptoms or has been diagnosed with PCOS. It is important to consider that some forms of PCOS are temporary. Temporary symptoms of PCOS can be caused by eating disorders and ceasing the contraceptive pill. It is also important to consider that sometimes it is not PCOS. Other conditions such as hyperandrogenism, pituitary tumours, hyper thalamic amenorrhea and FSH insufficiency should be ruled out.

Teenagers will present with polycystic ovaries simply because their ovaries are still maturing. Young ovaries have more eggs and upon ultrasound they will appear to be polycystic but not in an adult diagnosis. Women’s ovaries take up to an estimated 12 years to mature, diagnosing PCOS before this time may be misleading and incorrect.

PCOS and the Pill.

If the young woman does show symptoms such as irregular periods, acne, hair growth and weight gain it is best to try and manage their symptoms with diet, lifestyle and complementary medicine. Prescribing the contraceptive pill to these young women can aggravate other symptoms such as weight gain, mood disorder that are indicative of PCOS. The contraceptive pill also pauses the maturation of the ovaries which can aggravate PCOS. PCOS is an anovulatory condition, the contraceptive pill is an anovulatory medication. How can the Pill, fix PCOS?

Does PCOS mean infertility?

PCOS diagnosis often sends women in to a state of panic, worried that they will not be able to conceive. PCOS is not a message to women that they are “barren”. With the correct support women with PCOS are often able to fall pregnant. Medically they may be prescribed Clomaphine, Metformin or Letrazole to improve ovulation. Dr Robert Normans view that IVF is really a last resort and often not necessary.

For many women who have the characteristic overweight PCOS, losing weight and exercising can increase the chances of significantly. Studies have shown that in overweight women with PCOS, exercise and weight loss increased their ovulation by 35% and improved their menstrual pattern by up to 78%.

Does PCOS need a new name?

The current research shows that the cysts on the ovaries are not exactly cysts, they are trapped follicles. The follicles stick together and present in ultrasounds to be cysts.

Given that PCOS is a bit of a misnomer and creates confusion around how best to manage the symptoms, perhaps a title that refers to its function rather than its presentation may be more appropriate. Metabolic reproductive syndrome could be a better name is it makes the connection with the reproductive system and insulin resistance. Anovulatory androgen excess also resonates with the symptoms as there is an absence of ovulation driven by an excess in androgens.

How can nutritional medicine improve outcomes for women with PCOS?

Nutritional medicine has a vital role to play in supporting women with PCOS and improving their fertility outcomes. Nutritional medicine effectively reduces the metabolic impact of PCOS by focusing on the following treatment outcomes:

  • Supporting healthy female hormone profile through diet, lifestyle and supplementation

  • Support and prevent metabolic syndrome through treating the cardiovascular and liver function

  • Improve body composition

  • Stabilize blood sugars and reduce insulin resistance

  • Support stress levels and reduce cortisol levels

  • Improve quality of the ovaries

  • Reduce side effects of metformin and clomiphene

  • Improving the intestinal microbiome

Nutritional medicine has not just a role to play in supporting fertility in women with PCOS but improving their wellbeing beyond their fertile years.

Get the right info!

We are all guilty of Googling our symptoms whatever they may be. I do encourage all women who have been diagnosed with PCOS or believe that they may have symptoms that are consistent with PCOS to get the right information.

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