PCOS is a metabolic disease affecting the endocrine – ovaries, adrenals, pituitary and fat cells.
A doctor may diagnose PCOS if a woman has:
- Irregular periods
- Higher levels of androgen (male hormones) shown in blood tests
- Symptoms like acne, male-pattern balding, or extra hair growth on face, chin, or body
Despite the name, there are no cysts on the ovaries. If a woman has ovarian cysts, they experience pain in the pelvic area. Most women with PCOS do not experience pain in the pelvic area.
PCOS affects an estimated 10% (1 in10) women of childbearing age. PCOS is not one disease. It is a set of symptoms, with the key symptom being impaired ovulation which leads to androgen excess or a high level of male hormones.
PCOS diagnosis is often made with a combination of clinical observation / symptoms and the results of investigations including:
- Ultrasound internal scan however not all women with PCOS have cysts.
- Blood tests: Level of androgens (male hormones), such as testosterone. Another test will measure the hormones involved in egg development.
The Symptoms of PCOS can include:
- Irregular menstrual periods (e.g. irregular or no menstruation, or long phases of very light or very heavy menstruation)
- Impaired ovulation
- Higher levels of androgen (male hormones)
- Acne, oily skin, male-pattern balding, or extra hair growth on face, chin, or body
- Thinning of the hair on the head (male-pattern hair loss)
- Deepening of the voice
- Breast size (either large and oestrogenic or small)
- Dandruff
- Infertility
- Insulin resistance and increased insulin levels
- Type 2 diabetes (According to the Centers for Disease Control and Prevention (CDC), more than half of women with PCOS develop type 2 diabetes before they turn 40.)
- Obesity and weight gain
- Elevated lipids and high cholesterol
- Hypertension (high blood pressure)
- Mood swings and depression
- Obstructive sleep apnoea
- Pregnancy issues include gestational diabetes, preeclampsia, high blood pressure and preterm birth
What causes it?
There is currently no clear medical explanation of what causes it PCOS. Some suggestions include:
- A hereditary link and genetics and diabetes in the family
- Insulin resistance
- Inflammation
- Stress
- Obesity and excess body fat causes women to produce more testosterone and oestrogen
- Hypothyroidism impairs insulin sensitivity, which increases risk of PCOS
- Recent studies showing PCOS women have elevated BPA in their blood https://pubmed.ncbi.nlm.nih.gov/37060405/#:~:text=Bisphenol%20A%20(BPA)%20is%20a,may%20contribute%20to%20PCOS%20pathogenesis
There are 4 types of PCOS:
- Insulin resistant (70% of cases)
- Post pill (androgen surge especially if the pill contained progestin)
- Adrenal PCOS (elevated DHEA and cortisol with normal testosterone)
- Chronic inflammatory – gut connection and leaky gut (diagnosed with C-reactive protein and white blood cell levels)
What is the medical approach to treatment?
The medical approaches to PCOS are:
- Metformin (reduces glucose released by the liver)
- The contraceptive pill
- Androgen blockers
- For acne there is Accutane (a synthetic form of vitamin A that shrinks the oil glands in the skin)
- For fertility there is clomiphene to induce ovulation, anti-oestrogen
- Surgery or IVF
- Weight loss by any means possible (challenging with hypothyroidism)
What is a natural approach?
Body identical micronized progesterone shows great benefit with PCOS, this is currently not licensed in the UK for this use despite synthetic progesterone being offered.
According to Professor Jerilynn Prior, “cyclic progesterone therapy for treatment of PCOS’ could be beneficial for the following reasons
- Progesterone has anti-androgen benefits and can promote ovulation
- By competing for the enzyme 5-alpha-reductase, progesterone reduces dihydrotestosterone (DHT), the active form of testosterone, thus relieving acne, hirsutism, and androgenic alopecia. This is the same enzyme that converts progesterone to the calming neurosteroid allopregnanolone, which is why progesterone is usually good for mood.
- By increasing metabolic rate, progesterone can promote weight loss.
We believe in a whole health approach as an option for alternative treatments and natural therapy
- Eat a diet that balances blood sugars to support hormones associated with mood such as ghrelin and leptin. LINK TO PFC
- Remove food intolerances to reduce inflammation.
- Use Adaptogenic herbs to reduce the impact of stress hormones ensuring that you make enough progesterone for the luteal phase of your cycle
- Work on gut health to reduce oestrogen dominance and supporting your liver with supplements such as N-acetyl-L-cysteine, Calcium-De-Glucarate and DIM (we recommend working with a practitioner to ensure these are safe for you to use)
- Strength conditioning exercise and cardio are good for hormone balancing.
- Explore how micronized, body identical progesterone can benefit you so you can push to find a doctor who works with this approach
Specifically for Insulin resistant PCOS
The ketogenic (keto) diet may lower testosterone levels in women with polycystic ovary syndrome (PCOS), according to a new paper published in the Journal of the Endocrine Society.
- They found women with PCOS who were on the keto diet for at least 45 days saw
- significant weight loss and an improvement in their reproductive hormone levels
- Their follicle-stimulating hormone ratio was lower, which means they may have a better chance of ovulating.
- The women also had lower testosterone levels, which could help with excess hair growth and other symptoms of excess male sex hormones.
- https://www.news-medical.net/news/20230908/Keto-diet-may-lower-testosterone-levels-in-women-with-PCOS
We also recommend working with a coach who is trained to support you to find the right supplements that could help you
And finally – try our free symptom assessor to have an idea where to start!