What is Polycystic Ovarian Syndrome (PCOS)?
PCOS is a highly prevalent disorder. Currently, it affects 1 in 10 women of childbearing age. It is the most common endocrine-metabolic disorder in reproductive-aged women. It is a condition where your ovaries may produce high levels of androgen (testosterone, DHEA). Having too high of androgen levels interferes with ovulation. This means that eggs don't develop on a regular basis and are not released from the follicles where they develop.
What’s important to note is that metabolic syndrome is twice as common in patients with polycystic ovary syndrome compared with the general population, and patients with polycystic ovary syndrome are four times more likely than the general population to develop type 2 diabetes mellitus. This is why it is really important your strategy with your healthcare provider focuses on your long-term health and not just addressing your current symptoms.
What causes PCOS?
The exact etiology of PCOS is unclear. What we know is that it is currently thought to emerge from a complex interaction of genetic and environmental traits. It is a highly genetic condition, therefore you did not “cause” your PCOS.
Signs of PCOS
Here are some common signs of PCOS:
irregular periods or no periods at all
difficulty getting pregnant (because of irregular ovulation or no ovulation)
excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks
thinning hair and hair loss from the head
oily skin or acne
An irregular menstrual cycle is normal in the first year post menarche (first period) as part of the pubertal transition. Irregular menstrual cycles are defined as:
• 1 to < 3 years post menarche: < 21 or > 45 days
• 3 years post menarche to perimenopause: < 21 or > 35 days or < 8 cycles per year
• 1 year post menarche: > 90 days for any one cycle
PCOS Diagnostic Criteria
The Rotterdam Criteria is used to diagnose PCOS. The Rotter Criteria states that you must have 2 of the following 3 to be diagnosed with PCOS:
Hyperandrogenism (on blood work or clinically)
The most common signs of hyperandrogenism include hirsutism (excessive growth of dark or coarse hair), alopecia (hair loss) and acne.
Oligomenorrhea (irregular menstrual cycles)
This is defined as a cycle length longer than 35 days. It may be assumed that chronic anovulation is present. No special tests are needed.
Polycystic ovaries (seen on transvaginal ultrasound)
Therefore, you do not need to have polycystic ovaries in order to be diagnosed with PCOS.
PCOS can be diagnosed anytime in the reproductive years. It is important to note that if you are on birth control, you cannot diagnose PCOS as birth control will “regulate” your cycle and help with a lot of the symptoms we see occur with PCOS such as hirsutism, acne, etc. Therefore, you wouldn’t be presenting with a lot of the symptoms we see in PCOS.
Why are we concerned about endometrial cancer when it comes to PCOS?
Those who experience extended periods of amenorrhea are at a higher risk for endometrial hyperplasia and cancer. What happens when we don't have regular cycles and we don't ovulate frequently is that the endometrium (lining of our uterus) is exposed to estrogen without any progesterone (we need to ovulate in order to produce progesterone). Exposure of the endometrium to estrogen without concomitant progesterone can stimulate endometrial cell proliferation that can increase the likelihood of genetic errors and malignant transformation (cancer).
Therefore this is one of the main concerns with PCOS - endometrial cancer. This is one of the main reasons doctors prescribe the birth control pill, because they are trying to PREVENT endometrial cancer. Again, this may not have been explained to you which is why it's important to ask your provider questions and learn more.
Those who experience extended periods of amenorrhea (absent periods), or those who have not had a period for 3 months or longer, are at a higher risk for endometrial hyperplasia and cancer. If you are not on birth control and have not had a bleed for at least 3 months, it is really important that you visit your medical provider in order to get a proper assessment and treatment.
Side note: The birth control pill does not cause your PCOS. You were put on it because the pill prevents our pituitary hormones (FSH/LH) from being secreted from the brain - which means you will stop making hormones at the level of the ovaries, including testosterone, and this is why those with PCOS can find symptom relief while on the pill.
Are there lifestyle and supplement recommendations that can help with cycle regularity in those with PCOS? Absolutely.
I wanted to explain why you were prescribed the birth control pill. It's important to know that your doctor prescribed this for a really good reason. However, it is not your only option.
What does a PCOS diet plan look like?
Your PCOS nutrition recommendations will be individualized to you and the symptoms that you are experiencing. For example, if you are experiencing cystic acne, then we will have a conversation about dairy and the research we have behind dairy intake and acne occurrence and severity. I always like to focus on the foods to include in a diet as opposed to take away. I don’t want you to feel restricted when it comes to your diet. You should look forward to eating and have a varied diet. We will talk about how to have a balanced meal and I will give you examples of meals so that you do not feel overwhelmed when it comes to your nutrition.
Lab testing to consider for PCOS
Here are some commonly run labs that are used to assess PCOS:
Blood sugar markers (Fasting Glucose, fasting insulin and HbA1C)
Serum Luteal phase hormones to assess ovulation (progesterone)
LH/FSH ratio (pituitary hormones)
Serum androgens (Total and free testosterone)
SHBG (Sex Hormone Binding Globulin)
Inflammatory markers (CRP, ESR)
What is inositol and how can it help with PCOS?
Inositol is a “B-vitamin” that improves insulin sensitivity by increasing glucose uptake independent of insulin. Inositol deficiency is noted in PCOS, and may be part of the pathogenesis. The role of inositol is to correct underlying metabolic disturbances, improve ovulation, and reduce the health effects of PCOS. Inositol can help to restore ovulation as a sole intervention and has evidence for improving the outcomes of all fertility interventions. Talk to your health care provider if inositol can be beneficial for you and about an appropriate dosing strategy.
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