Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS)

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?

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.

 

Polycystic Ovarian Syndrome (PCOS)

 

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
  • Obesity
  • Family history of PCOS
  • Family history of diabetes
  • Family history of insulin resistance
  • Family history of cardiovascular disease
  • Stress
  • 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
  • Hypothyroidism

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.

You’ll find the best-selling, US version here or the version written especially for women here. If you’re in Australia, you might like to source the book from Book Depository (free shipping).

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.

 
Last Updated: June 28, 2015

CONTRIBUTOR

Based in Brisbane, Australia, Doctor Andrew Orr is a Women's Health & Reproductive Specialist, with masters degrees in both fields. He's also a nutritionist and a doctor of Traditional Chinese Medicine. Doctor Orr's fertility work with couples has resulted in the births of over 10,000 babies.


27 comments

    1. I just want to encourage you claudia as it is possible. I tried lots of treatments with no luch and ivf was next step. I wasn’t ready so we planned a big trip instead and then i fell pregnant naturally! I did change my diet and used a good naturopath and acupuncture so dont give up ☺

  1. I have pcos for the last 13 years would love to get more information about it as doctors don’t tell you enough about it. I am with my partner 5years and trying for a baby a year and no luck

  2. i had PCOS…it started when i had a miscarriage about 3yrs ago….and my Doctor told me if i did a surgery to remove the cysts i will b ok..and i did…but im still having irregular periods…so i was wondering if u have any advise that can help…please

  3. I was diagnosed with pcos almost two years ago. I’m interested in Shen therapies. I’m currently on metformin and have been since being diagnosed.

  4. A soo believe that good diet made me concieve at 38 yrs wasn’t trying yoghart natural n nuts especially with exercise made me conceive have pcos never fell before ,my lifes complete funny also ended up with gestational diabetes 🎀xx zhealthy baby

  5. My name is Tiffany.I’m a 25 year old healthy individual other than pcos,which I have suffered from for many years.I was diagnosed when I was 16…at the time I had health insurance and soon after I lost it.My o.b.g.y.n put me on Metformin and told me to loose some weight, exercise and eat healthy.I did loose weight, at the time I believe I was 147lbs and now weigh 123lbs.I don’t exercise like I should but I do eat healthy.I also am married and we have been together since I was 17 and married for 7 years….because of the pcos I haven’t been able to conceive at all, we have been trying for bout 5 years and 0 positive pregnancy test.So my question is,is there anything over the counter medication that me and my husband can try

    1. Hey Tiffany,

      I also have PCOS and have been trying to conceive. My GYN has suggested I take prenatal vitamins and pregnitude. Pregnitude is over the corner but must be ordered by the pharmacist. It comes in powder form that you put in a glass of water twice a day. I’m on my 1st month of it. Hopefully this helps you & anyone else.

    2. Hi I was put on clomide twice a day for the first 5 days of my period and it’s gets you to ovulate normally. Hope this helps. But the doctor actual put me in this.

      1. I was on that and still did not ovulate so please remember not everyone is the same. I have been trying to concieve for 9 years and i finally got my wish. I am currently 24 weeks pregnant with a little boy. So just keep on trying and dont stress about it.

  6. Hi Dr Andrew Corr
    Thanks for sharing this link about polycystic ovarian syndrome.
    Actually I am one of those womens suffering with this problem and everytime I went to ob gyne doctors the only medication I received is to take contraceptive pills which is diane 35 just to balance my hormones and my period became normal.may I know if this pills can cure this cyst that grown in my ovary?and sometimes I noticed pained on my right ovary and sometimes pained also on my pelvic…and I planned also to get pregnant after 1yer…so can I asked some advice from you for the best medication regarding my ovarian problem?im scared I wont get pregnant anymore.
    Thank you and God bless

  7. I have pcos from my cycle start I am with my partner 2years and trying for a baby a year and no luck.Using so much madicine but not at controle pcos.Dr sugest surgery but we are not goiong under surgery when dr give Ingection starting EGG release i take that 5 months no i stoped .Pl give me the best tretment here (hyderabad in INDIA)

  8. I’ve had Pcos for 10 years or more but it was diagnosed 10 years ago. I got on metformin I lost some weight but I still felt very Ill, then changed my life style in eating habits and I’ve had 4 kids since then in 10 years. I noticed that as soon as I would change my eating habits to the recommend way on here I would increase my fertility and decrease the estrogen hormone my insulin bettered and I’m Diabetic free!

  9. Hi,
    I am 34 and I have 4 children. I am not boasting but I never had issues falling pregnant. Since the birth of my last child who is 2yrs old I breast feed her for 19mths (Jan this year) I have had serve pelvic pain, iiregular periods, increased acne on face, chest and back and facial hair. I also have have Hashimotos disease. I have ultrasounds, bloods tests and have came back normal. I have a family history of POCS and endometriosis. My dr has no idea why all this is happening?????

  10. this article has nothing about diagnosis.
    is there a test? is it a blood test? is it a invasive test?
    those details would have helped.

    1. I was diagnosed with pcos 20 yrs ago…suspicion was based on symptoms. Diagnosis was confirmed by ultrasound .. btw.. I am now 44 and 9 1/2 months pregnant with my first child..I didn’t try. ..just happened after weight loss surgery

  11. Pls Doctor, I was diagonised with PCOS and been on metformin for a while now with other vitamins, what else can I do to help me conceive

  12. Hi Dr,

    I was diagnosed with PCOS, but then i got pregnant, my Gyn asked me to take metformin for the first 3 months, but it didn’t suit me, it had multiple side effects on me so i stopped it during the second month. Should i keep taking it or its ok?

  13. Hi All, I am mid 30s, was diagnosed with pcos and thyroid condition at 19yrs. Told would not have children.
    Thankfully I have one little boy and another child on the way. I share this as a do not lose hope. If it is meant to be it will find a way. Good luck all.

  14. Hey…i am of 25…last year only i was diagnosed with pcos..the problem m facing is m not able to loose weight ,though m doing gyming n aerobics n dieting too..bt still dere is nothing happening with my weight..plz suggest me sumthing ..wat to do..

    1. I would cut out sugar and grains from your diet, and make sure you’re getting enough protein. Drink lots of water in place of juices, soft drinks, flavoured milks, sports drinks etc. Grains are in lots of processed foods – cereals, bread, biscuit, cake, pasta – get rid of those. Look up a paleo style of diet.

  15. I’ve been diagnosed with PCOS since i was 13 years of age and now I am 22. I’ve been prescribed Diane 35 since then and around 1 year ago I’ve been taking Metformin along with it. I’m thinking of stopping the use of Diane 35. I will be getting married soon. Would this help me have kids in the future?

  16. hi my wife is having irregular periods an lately she went up to 30 days from 21 we’ve been trying but all in vein plz help?

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