Polycystic Ovarian Syndrome (PCOS)
Polycystic ovaries (PCO) and Polycystic ovarian syndrome (PCOS) are reproductive issues.
PCO is defined by multiple cystic growths on the ovaries, whereas PCOS is a syndrome that mimics the same symptoms as PCO but without the cysts! Whilst the conditions present with quite a complex set of symptoms, there are various underlying factors which can drive PCOS in a women and these drivers can differ, for some it is related to inflammation, for others the adrenals play a big role and for others still insulin issues are the primary drivers. That is insulin resistance. Insulin is a hormone with many roles, but in particular it controls the metabolism of sugars and starches, and when the cells become resistant to insulin, the body can no longer control blood glucose.
Insulin increases circulating androgens, from being produced by the ovaries. Androgens are the male hormones (which women have too!) such as testosterone and androstenedione but this over stimulation of these hormones is the cause of PCOS signs and symptoms. Insulin also reduces sex hormone-binding globulin (SHBG) in the blood and this hormone is responsible in binding to some of our androgen so they don’t cause too many issues.
PCO SIGNS & SYMPTOMS
Common symptoms include:
- multiple cysts on the ovaries (not present in the syndrome)
- excess hair growth (hirsutism)
- acne, oily skin
- sleep apnoea
- irregular menstruation (amenorrhoea or oligomenorrhoea)
- lack of ovulation (can cause infertility)
- elevation of androgens (male hormones – testosterone, DHEAS, dehydroepiandrosterone, androstenedione)
- central obesity
- male pattern baldness
- enlarged ovaries
- chronic pelvic pain
- blood glucose dysregulation (hypoglycaemic, diabetes)
- skin tags
- hyperpigmentation of the skin (acanthosis nigricans)
Understanding Some Of The Causes
The syndrome encompasses a broad spectrum of signs and symptoms, and is considered a hyperandrogenic problem and ovarian failure. It is not uncommon to afflict women who are overweight or obese. Insulin is commonly elevated in these individuals, and as we pointed out insulin availability at the ovarian tissue can promote the production of androgens. Estrogen dominance, decrease in SHBG and increased activity of the opioid system of the hypothalamic-pituitary-adrenal axis may also be related.
Since body weight is related to improvements in insulin and closely related to the signs and symptoms, weight reduction is the focus of treatment, including strategies which further reduce insulin and lower androgens. Certain herbs really help with androgens and insulin lowering and a 2017 randomised controlled trial which combined magnesium and zinc showed a significant reduction in inflammation and increases antioxidant availability in PCOS sufferers over 12 weeks.
Ultrasounds will identify cysts, and there are many test that can be done to get a really good idea of what is happening in the body:
- antimullerin hormone (AMH)
- insulin, glucose, HBA1c
- sex hormone binding globulin (SHBG)
- inflammatory markers
This can be a complex issue but focusing on strategies which reduce insulin and manage weight are key.