Polycystic Ovarian Syndrome is one of the most complex female health issues of our time.
It is also the most common endocrine disorder in women of reproductive age.
PCOS can be accompanied by variety of health issues, and can directly impact infertility.
Classically PCOS presents with irregular menses, abnormal hair growth , weight gain etc, but not all women diagnosed with PCOS will have all these symptoms .
In this article we will discuss what are the causes,symptoms,and health risks of PCOS.
We will look in to the medical treatmens,natural options, exercise and what dietary changes need to be done.
What Causes PCOS?
The exact cause is not known and some say that genetic predisposition is one of the main causes so if a women’s mother or sister has PCOS she has a risk or getting it too.
Another cause attributed to cause PCOS is the amount of hormonal treatments that the women’s mother has taken to conceive.
PCOS is certainly affected by diet and lifestyle changes
Exposure to certain environmental toxins is also considered an contributing factor.
Insulin is a hormone produced in the pancreas and is responsible for converting glucose in to energy, it also plays an important role in carbohydrate and lipid metabolism.
Insulin resistance happens when the body’s cells become resistant to the effects of insulin.
When this happens, higher levels of insulin are needed so that insulin can have the proper effects.
This makes the pancreas to work harder and harder to produce more insulin.
Insulin also signals the ovaries to secrete testosterone and on the other hand inhibit hepatic sex-hormone binding globulin (SHBG) production which leads to an increased level of circulating testosterone.
(This is why many women with PCOS experience male pattern baldness, facial hair )
Excess insulin in the bloodstream also signals the ovaries to release more estrogen which can suppress ovulation.( a reason for unovulatry cycles)
When we get infected by to bacteria or virus our blood cells produce substances to fight this infection this is known as low inflammatory response
Low grade inflammation can cause insulin resistance and atherosclerosis.
Low grade inflammation can also be triggered by certain food products like refined sugar and processed food.
Signs and Symptoms of PCOS
- Irregular menstrual cycles
- Absent period
- Anovulatory cycles
- Abnormal mid-cycle bleeding
- Excessive or heavy menstrual bleeding
- Alopecia (balding)
- Hirsutism (excessive body hair)
- Acanthosis nigricans – a darkening of the skin in the armpits, back of the neck, or groin
- Polycystic ovaries
- History of ovarian cysts
- Mood disorders
- Recurrent Miscarriage
Health and Fertility Risks Associated with PCOS
- Menstrual cycle irregularities
- Possible increased risk for endometrial and breast cancer due to unopposed estrogen
- Cardiovascular disease
- Gestational diabetes
How is PCOS Diagnosed?
The first time PCOS was diagnosed because of the presence of ovaries seen by ultrasound.
Over a period of time doctors have realised that PCOS is not just about ovaries and it is a complex health issue.
This led to certain criteria that must be recognized to be diagnosed with PCOS, rather than just the presence of polycystic ovaries.
In fact it is seen that some women have many symptoms of PCOS but their ovaries are normal.
Pituitary and Ovarian Hormone serum levels:
- Luteinizing Hormone (LH)
- Follicle Stimulating Hormone (FSH)
- Free testosterone
- Free androgen index (FAI): 17-hydroxyprogesterone
- Sex hormone binding globulin (SHBG): 24 hr. urinary free cortisol
- Dehydroepiandrosterone sulfate (DHEA-S)
Glucose Tolerance Test
Blood Lipid Profile
Now let’s see how PCOS affects the Menstrual cycle?
In a normal menstrual cycle
The hypothalamus produces GnRH (gonadotrophin-releasing hormone) which signals to the pituitary to produce LH (luteinising hormone) and FSH (follicle stimulating hormone).
The release of GnRH i signals some of the follicles in the ovary to begin maturing and for the ovaries to release estrogen and progesterone.
This estrogen/progesterone signal is recognized by the pituitary gland and that inturn signals the maturing follicles to increase the oestrigen levels.
In turn the rising estrogen level signals the pituitary gland to curb the release of FSH.
This communication allows for ovulation to occur.
In women with PCOS the menstrual cycle follows a different pattern of endocrine function and communication.
Firstly in women with PCOS the cycle is irregular, with the hypothalamus releasing GnRH in a higher than normal.
This allows for increased LH and decreased FSH, which in turn leads to excessive production of the androgens androstenedione and testosterone.
This causes the follicle to only mature some, but not enough to achieve full maturity in order to be released for ovulation.
This also allows for continued increase of estrogen,
( typically during the reproductive age oestrogen levels are low)
The higher levels of androgens and estrogen create a chronic state of low to very low progesterone and anovulatory cycles.
Excessive levels of estrogen may also cause uterine hypertrophy, also known as endometrial hyperplasia.
Endometrial hyperplasia may cause heavy menstrual bleeding or prolonged bleeding during menstruation.
The uterus may become bulky and larger than normal.
Medical management of PCOS
when Anovulatory Cycles are seen
Oral Contraceptive Pills (birth control) are the most prescribed medication to regulate menstruation.
This helps to regulate the cycle but does not solve the root cause of the problem and may actually cause longterm reproductive health problems.
Ovarian drilling done with the intention to stimulate ovulation specially in women who are trying to conceive.
For Insulin Resistance
Metformin – is the drug of choice even if they are not insulin resistant or have any signs of type 2 diabetes. Metformin helps to control the amount of glucose in the blood.
Metformin comes with risks and side effects, Long-term use of Metformin has been shown to cause malabsorption of vitamin B12 in some patients.
Important considerations for management of PCOS
It takes at least 6-12 months of consistent lifestyle and diet changes, along with natural therapies to bring about real change in the body when living with PCOS.
- In addition to making changes in the diet, supplements have shown to be effective.
- The overall goal with PCOS is to balance blood sugar levels, maintain hormonal balance, promote healthy digestion for improved estrogen metabolism,while also working to promote regular ovulation and menses.
- Changes in diet should include consumption of adaptogens , adaptogens are known to reduce the oxidative stress and help to normalize body functions.Adaptogen herbs are also important, this is because adaptogens increase resistance to mind-body stress and enhance overall vitality and health through non-specific adrenal (known as stress glands) support. Plants recognized as adaptogens help to normalize the body’s functions, most importantly the endocrine system, even during diseased states, are non-toxic, nutritive, and have been deemed safe for long term use.
Medicines and supplements are not meant to be a substitute for dietary and lifestyle changes! If diet and lifestyles changes specific to PCOS are not followed , it is difficult to reverse the changes.
As we have already seen PCOS is a result of multiple factors and addressing only one issue and prescribing for it is not going to help we need to go to the root cause.
What we need is an holistic approach.
A holistic approach is an integrated approach to health care that treats the “whole” person, not simply symptoms and disease.
Mind and body are integrated and inseparable. What ever one feels at an mental emotional level, the food you eat the amount of physical work out you do all this has a huge impact on the wellbeing of an individual.
An holistic program consists of nutritional correction, lifestyle changes and homoeopathic medicines.
Supplements That Are Beneficial for PCOS…
This trace mineral enhances the action of insulin.
Foods that are high in chromium are onions, tomatoes, whole grains, and bran.
Calcium and Vitamin D
calcium protects the cardiovascular health, and prevents osteoporosis and vitamin D play significant roles in glucose metabolism.
Good food sources of vitamin D are cod liver oil, eggs, salmon,.
Vitamin D can also be obtained for free by sitting out in the sun for 15 to 20 minutes per day
Cod Liver Oil
Cod liver oil is a rich source of omega3
omega-3 helps to lose weight, balance hormones, and creates a healthy environment for conception.
reduces insulin resistance by slowing the movement of the food from the stomach to the small intestine.
Gymnema (Gymnema sylvestre)
This herb has sugar blocking action on the taste buds and small intestines.hence it blocks the typical paths that sugar molecules take during digestion, delaying the absorption of sugar.
Diet considerations in PCOS
- Eat Organic
Non organic food can contain lot of preservatives and hormones , when you have PCOS it is best to switch to organic food .
- Balance your daily protein and carbohydrate intake
Taking equal amount of carbohydrate and protiens helps you to balance your insulin levels
Chose whole grain or sprouted carbs.
Avoid processed carbs like white flour, potato and bakery products as they are low nutritive value & fibre and cause a spike in insulin levels.
It is best to eat locally grown and locally available food.
- Choose food with low glycemic index.
your blood sugar level rises when you eat carbs, and how long it will remain high will depend on the kind of carbs that you eat.
Low glycemic index foods are carbohydrates that break down slowly in the body, and don’t cause such a dramatic spike and then drop in insulin levels.
Some examples of low glycemic index foods are:
- broccoli, asparagus
- Beans and lentils
- Grapefruit and apples
- Walnuts and almonds
Some examples of high glycemic index foods –
potatoes, jams, scones, white bread products, pasta, soda, alcoholic beverages,pancakes, syrups, sugar. It is best to avoid them .
- Eat a diet high in fiber
Fibre slows down the digestion of sugars ( so lesser spikes inn insulin levels)
Fibre helps in promoting healthy oestrogen balance hence reduces the level of androgens.
- Eat essential fatty acids daily
Eating essential fatty acids (EFA’s) helps you to lose weight, aids hormonal balance, and are important building blocks for the body to create a healthy environment for conception.
The best source of omega 3 is codliver and evening primrose oil.
- Quit Coffee
Caffeine increases estrogen levels.
Women who drink 4-5 cups of coffee a day produce 70% more estrogen in the follicular phase of the menstrual cycle
- Exercise for 45 minutes, 5 days a week
Adequate exercise is must to improve insulin sensitivity Exercise helps PCOS by improving insulin sensitivity, increasing metabolism and helping to shed any excess weight.
Both aerobic and resistance exercises are required .
Avoid excessive exercise programs because too much exercise overworks the adrenal glands which increases inflammation and in turn makes PCOS worse.
Restorative exercise programs are best. You could walk and lift weights, or take a Pilates class and run on the treadmill, or do some Zumba and then Fertility Yoga.
One day of complete rest is also essential for the body to recover.
Dr Abhay Talwlakar