The most common gynaecological complaint I see in my clinic is Polycystic Ovaries/Polycystic Ovarian Syndrome (PCOS).
Some women only have cysts (PCO), while others have no cysts but have the syndrome (PCOS). Some have both.
For the sake of this article, I am going to call this complaint PCOS, so people don't get confused.
However, the one thing they all have in common is they all have insulin resistance.
If you or someone in your family suffers from irregular cycles, gets hormonal acne and has extra hair, there is a good chance they have PCOS.
They also need to get the problem looked at and treated early, before it affects their fertility.
What Is Polycystic Ovarian Syndrome (PCOS)?
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.
This can occur due to 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 insulin resistance to be a leading cause.
The majority of patients with PCOS (some investigators say all) have insulin resistance, and there is likely to be a family history of insulin resistance too – genetics does play a fairly strong role in PCOS.
Insulin resistance is a common finding among both normal weight and overweight PCOS patients.
Many years ago, it was thought you had to be overweight to have PCOS, but now we know that many normal and underweight women have it 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 has more than 50% increased chance of developing diabetes down the track.
PCOS is the most common cause of oligomenorrhoea (light or infrequent periods) and amenorrhoea (an absence of periods), although 20-25% of normally menstruating women have PCOS. These women may have reduced fertility and an increased risk of miscarriage.
Risk Factors For Polycystic Ovarian Syndrome
Major causative factors and risk factors that can contribute to the incidence of PCOS include:
- Insulin resistance
- Family history of PCOS
- Family history of diabetes
- Family history of insulin resistance
- Family history of cardiovascular disease
- Nutritional deficiencies
- High glycaemic load diet
- Sedentary lifestyle
Symptoms & Signs of PCOS
Common signs and symptoms of PCOS include:
- Irregular menstrual cycles i.e., oligomenorrhoea or amenorrhoea
- Infertility, generally resulting from chronic anovulation (lack of ovulation)
- Elevated serum (blood) levels of androgens (male hormones), specifically testosterone, androstenedione, and dehydroepiandrosterone sulphate (DHEAS)
- Central obesity (apple-shaped), centred around the lower half of the torso
- Androgenic alopecia (male-pattern baldness)
- Acne, oily skin, seborrhoea
- Hirsutism (excess hair growth)
- Acanthosis nigricans
- Prolonged periods of PMS-like symptoms
- Sleep apnoea
- Multiple cysts on the ovaries
- Enlarged ovaries, generally 2-3 times larger than normal, resulting from multiple cysts
- Chronic pelvic pain
- BGL dysregulation — e.g., hypoglycaemic episodes, diabetes, etc
The Importance of Diet and Lifestyle
Dietary and lifestyle changes are an absolute 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 a reduced amount of low glycaemic index carbohydrates, keeping protein levels up to maintain muscle mass and eating ‘good' fats (e.g. avocado, egg, coconut oil, uncooked olive oil, chia seeds, fish), insulin levels are reduced and fat stores can be accessed as fuel for energy production (thermogenesis).
The Wellness/Zone/Paleo 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 maintain body mass for those underweight.
A diet composed of mainly low-GI foods combined with regular exercise will help to combat the effects of insulin resistance. This is why the Paleo style diets are the best diets to follow. Ideally, people with PCOS should get rid of grains altogether. Women with PCO and PCOS do not process sugars and refined carbs properly, which leads to making the PCOS and PCO worse.
Refined carbohydrates including sugar, sweets, fruit juices, white breads and pasta should be avoided. These foods have a high glycaemic index and are damaging in any amount for PCOS sufferers.
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 your fitness level improves).
Smoking and PCOS
Smoking cessation needs to be the highest priority for patients who smoke.
Allan Carr’s Easy Way To Quit Smoking is a fantastic book based on a program with a very high success rate. According to two studies (as published by the Journal of Addictive Behaviours), Allan Carr’s Easyway has an astonishing 53.3% success rate and has helped over 14 million people stop smoking.
Acupuncture and Chinese medicine can also support smoking cessation – it’s entirely possible to quit smoking, easier and sooner than you think.
Other Treatments For PCOS
Acupuncture, Chinese medicine and nutritional supplements are another big part of treating PCOS – complementary medicine can help dramatically. In my clinic at Shen Therapies, we have our own specially designed formulas to treat PCOS.
What About Metformin and Other Medications?
Insulin-regulating medications (Metformin), hormone treatments (the pill, HRT) are used to regulate the menstrual cycle, control insulin resistance and to prevent further cysts developing. You can even get a procedure called “ovarian drilling”, which lasers the cysts and helps with the healing of the ovaries in severe cases.
Just remember: going on the pill does not fix this problem, it just masks it. This is why anyone with irregular cycles should see a women's health specialist like myself, or a gynaecologist. Not just your GP, as they do not have specialised training such conditions.
Whatever you do, don’t leave your fertility in the hands of someone who wont help you to fix the root cause of the problem.