Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome is a very common hormonal problem for women of reproductive age. Common symptoms include long menstrual cycles, acne, facial hair, and weight gain. Many of these are unwanted, but thankfully, there’s many ways to naturally manage this condition.
What is Polycystic Ovarian Syndrome?
PCOS is a hormonal condition primarily characterized by hyperandrogenism and ovulatory dysfunction. The cause of PCOS is unknown. Common symptoms include moderate-severe acne, unwanted hair, weight gain, irregular menses, and inability to ovulate.
How is PCOS Diagnosed?
The Rotterdam Criteria is the preferred method for diagnosing someone with PCOS. An individual needs to have 2 of the 3 criteria below to fit the diagnosis:
Oligo and/or anovulation: irregular or completely absent ovulation
Clinical or biochemical signs or hyperandrogenism: high testosterone and DHEA or presence of hirsutism which is excessive hair growth, most often in unwanted areas of the body
Polycystic ovaries: multiple tiny cysts on the ovaries seen on transvaginal ultrasound
Many women can be diagnosed with PCOS based on history and physical exam findings, however PCOS can only truly be confirmed when other conditions (thyroid disease, congenital adrenal hyperplasia, hyperprolactinemia, and androgen-secreting tumors) are ruled out.
What Are Labs That My Physician Should Be Ordering?
The following labs/imaging are probably the most important to confirm a diagnosis of PCOS and ensure that there are no other comorbidities.
testosterone (free & total) and DHEA - these are usually elevated
glucose, insulin, and HbA1c - to rule out insulin resistance and/or diabetes
LH and FSH - ideally the ratio of these two hormones is 1:1, but in PCOS it is often much higher
prolactin - to rule out hyperprolactinemia, although elevated prolactin is also common in PCOS patients
progesterone - usually very low, ideally would be run on day 21 of cycle
transvaginal ultrasound - to visualize cysts on the ovaries
Are There Any Complications Associated with PCOS?
Often, women with PCOS have difficulty getting pregnant naturally, mainly because their ovulatory pattern is irregular or completely absent. This does not necessarily mean that you will need to go through IUI or IVF to get pregnant, but you do need to see a naturopathic doctor who can help you regulate your cycles so that you can get pregnant naturally.
Obesity and insulin resistance are both highly prevalent in women with PCOS. This increases the risk of type 2 diabetes, dyslipidemia and coronary heart disease (CHD). A high fasting insulin also makes it very difficult to lose weight, if that is a concern. It is imperative to have a primary care provider annually screen for all of these diseases so complications don’t arise.
Obstructive sleep apnea is another common finding in women with PCOS. If you are told that you snore or experience morning headaches and excessive sleepiness during the day, a referral for a sleep study may be warranted.
How is PCOS Managed?
There are many different ways to manage PCOS, depending on the physician and symptoms that you present with. Many traditional medical doctors prescribe COCs (combined oral contraceptives), which contain estrogen and progesterone, in order to properly balance those hormones and initiate a regular menstrual cycle in that manner. If your doctor diagnoses you with insulin resistance or type 2 diabetes, they will most likely prescribe Metformin, which will help decrease insulin levels and reduce androgen production. If you present with hirsutism and moderate cystic acne, Spironolactone is a common prescription, as it works as an antiandrogen.
There are many things we can also do naturally to regulate a menstrual cycle, decrease androgen levels, and lower insulin. Inositol is a sugar that is naturally produced in the body and help to regulate all of aforementioned processes. In addition to that, there are many herbs like saw palmetto and chamomile to maintain optimal levels of testosterone and sarsaparilla to promote progesterone production and ovarian function. I also like to focus on nutrition with my PCOS patients and ensure that they are eating a largely anti-inflammatory diet with plenty of fiber and minimal processed foods and sugars.