Polycystic ovarian syndrome (PCOS) is a hormonal condition that in my opinion is poorly treated in the medical model and is actually highly misunderstood. This leads to females being diagnosed with and treated for PCOS, when they may not have the condition at all. Therefore, I want to explain what PCOS IS and what it ISN’T!
What it is
PCOS can come in 2 forms.
1. Insulin resistant PCOS: Women who suffer from insulin resistance, metabolic syndrome and type 2 diabetes are at an increased risk of PCOS. Insulin resistance, diabetes and metabolic syndrome are conditions where a person’s blood glucose levels are chronically too high because insulin, a hormone secreted from the pancreas, can no longer effectively shuttle glucose in the bloodstream to cells. This leads to chronically high blood glucose levels and it is exacerbated by a diet high in carbs, especially processed/refined carbs, which eventually get broken down to flood the blood stream with high amounts of glucose that can’t be effectively cleared due to insulin resistance.
Over time high blood glucose levels and insulin resistance can wreak havoc on the brain, kidneys, eyes, nervous system, digestive system, and cardiovascular system (i.e. heart and blood vessels), therefore increasing the risk of many different chronic diseases. Women with insulin resistance also tend to have a higher BMI. Insulin resistance is driven by poor diet and lifestyle habits (e.g. alcohol, smoking, lack of sleep, chronic stress, lack of exercise, being overly sedentary, increased processed food intake). In females with a genetic predisposition towards PCOS, when they become insulin resistant, it leads to an up-regulation of an enzyme in their ovaries, which converts estrogens to androgens (male type hormones such as testosterone). Females naturally produce some small amounts of androgens from the ovaries and adrenal glands. They play specific roles in the body when produced in small amounts. However, in PCOS, there is excessive production of these androgens, causing abnormally high levels in a female’s blood stream. This leads to development of the hallmark PCOS symptoms, which include:
Abnormal and excessive hair growth (e.g. facial hair, thicker hair under the arms and on the legs).
Male pattern baldness (i.e. hair loss on the scalp)
Acne (androgens increase serum in the skin)
Depression and anxiety tend to be higher in these females as well.
The increased androgens decrease female’s ovulation causing infertility, as well as irregular periods or loss of periods all together. Once this happens, the decreased ovulation leads to a development of cysts on the ovaries, which can be seen on an ultrasound, hence the name PCOS. Cysts on the ovaries is merely a symptom of PCOS, which is caused by high androgens, driven by insulin resistance.
Cysts can occur on the ovaries for other reasons (that will be discussed below) not relating to increased androgen levels. This is why PCOS is often misdiagnosed when an ultrasound alone is used for the diagnosis. This happens due to a lack of understanding that other symptoms also need to be present in order to confirm PCOS. These other symptoms are things like acne, hair loss on the scalp, abnormal/excessive hair growth, as well as blood tests that confirm high blood glucose levels, insulin resistance and high levels of androgens in the blood. Just because a female has cysts on her ovaries, does not mean she has PCOS. She must also have the symptoms of PCOS and high androgen levels in the blood as this condition is a hormone issue, characterised by increased androgens. Cysts are merely just a symptom of the hormone disruption. This is why they should change the name of PCOS.
2. Adrenal driven PCOS: Increased androgens in the body can be driven by increased stress and anxiety. Females who are chronically stressed and anxious, pump out cortisol (stress hormone) from their adrenal glands. Along with cortisol, as part of the stress response, the body also produces various types of androgens that in high enough amounts, eventually accumulate in the ovaries causing PCOS. Adrenal driven PCOS can obviously coincide with insulin resistant PCOS. Adrenal driven PCOS has the same symptoms picture as insulin resistant PCOS.
What PCOS is not
As mentioned, just because a female has cysts on their ovaries, does not meant they have PCOS. Far too often I have women come into my practice who have missed their periods or have been getting irregular periods, so they get sent for an ultrasound to check for PCOS. The ultrasound then comes back with cysts on their ovaries and then they are diagnosed with PCOS. However, they don’t have any of the other symptoms mentioned above, such as acne, abnormal hair growth, male pattern baldness etc. This is why an ultrasound alone should not be used to diagnose PCOS.
When females don’t ovulate properly during their monthly cycle, the lack of ovulation leads to irregular or loss of periods. It also leads to cyst formation in the ovaries. Lack of ovulation can be due to many things, other than increased androgens. These include:
Inflammation resulting from poor diet and lifestyle habits
Inflammation resulting from chronic diseases in the body
Poor digestive/gut health
Post oral contraceptive pill use. Because the pill suppresses natural production of hormones from the ovaries, when women come off the pill, they can often suffer from a loss of periods or irregular periods. This is because their natural hormone production has been suppressed, which takes a while for the body to re-adjust and naturally produce their hormones again.
These women are often wrongfully diagnosed with PCOS and put on the pill, which even if a person does have PCOS, it is not an ideal treatment. The pill is merely a band aid treatment. It is supposed to treat the hormone imbalance by giving synthetic hormones, which are not the same as females natural hormones, hence the side effects.
As mentioned, the synthetic hormones in the pill suppress ovulation and natural hormone production by the ovaries. This can therefore exacerbate a hormone system where ovulation is already out of whack. This means that symptoms are likely to be worse when the person comes off the pill.
The pill does not address the underlying causes of the hormone disruption, it merely just suppresses symptoms. Symptom suppression if often pretty poor anyway and the side effect list of hormone replacement medications like the pill are endless.
Treatment of PCOS needs to address the underlying causes of hormonal disruption, which can be done via practical and sustainable diet and lifestyle changes, as well as evidence based herbal and nutritional supplementation. Also, if a female is getting irregular periods but they don’t have PCOS, investigation into underlying causes need to be addressed. Just like in PCOS, diet and lifestyle change, as well as supplementation can be very effective in bringing hormones back into a natural balance.
For more information on how Oak Health approaches PCOS treatment, check out the treatment page here.
Note: Some females with PCOS or irregular periods, when their periods do come, they can be heavy, painful, clotted and suffer a lot of premenstrual symptoms. These are all signs of hormone disruption (i.e. estrogen and progesterone imbalances). This can also be addressed via diet and lifestyle change, as well as supplementation.