Polycystic ovary syndrome

Poly cystic ovary syndrome (PCOS) is a complex condition which can impact on a woman’s fertility, physical appearance, increase her risk of disease such as diabetes and heart disease, as well as influence her mental health and quality of life. Although this syndrome is indeed complex and associated with these negative symptoms in some women, the treatment is actually simple- diet and lifestyle strategies are considered the first line in treatment and result in an improvement in fertility, physical symptoms, decrease body weight and decrease the associated risk of disease. Sandra is an experienced practitioner in managing women with PCOS and can provide the appropriate dietary guidelines and lifestyle changes to help to achieve these improvements. There are some natural therapies including specific herbs and nutritional supplements which may be useful for some women, as part of the management of PCOS.

How common is PCOS

PCOS affects 12-21% of Australian women and girls. In a recent update of the guidelines of managing PCOS published in the medical Journal of Australia, it is estimated that 70% of Australian women with PCOS remain undiagnosed. PCOS is more common in women who are overweight or of indigenous background.

How do I know if I have PCOS?

PCOS is a condition which comprises a number of signs and symptoms which collectively make up the syndrome. A woman may be suspected of having PCOS if her periods are infrequent, or in some women absent. Women with excessive body hair (hirsutism) or acne may have PCOS. As PCOS is more common in overweight women, overweight women, whom have some of these other symptoms, may also be suspected of having PCOS. Women with PCOS are more susceptible to weight gain, and this can occur at any age. There are, however, some normal weight women with PCOS. Obesity intensifies the severity of the signs and symptoms of PCOS. It increases the hirsutism,  and other symptoms associated with high male-like hormones, infertility and  pregnancy complications. Obesity independently exacerbates these features of PCOS, as well as worsening the syndrome itself. Obesity is an added aggravating factor in the already increased risk for impaired glucose tolerance, type 2 diabetes and cardiovascular disease. Insulin resistance (see insulin resistance) is common in women with PCOS and contributes to many of features of PCOS and also increases the risk of Type 2 diabetes and cardiovascular disease.

The presentation of PCOS also varies depending on a woman’s age: for young women the signs of high male-like hormones are more common, so excessive body hair or acne may be the main concern that prompts a visit to a health practitioner. For women in their 20’s and 30’s, fertility issues and difficulty in falling pregnant are reasons to seek help (NB fertility is not impaired in all women with PCOS and some women conceive without medical intervention). (See fertility) In later life, what is referred to as metabolic features, which includes the propensity for excess weight gain, an increase in prediabetes and type 2 diabetes, are more prominent.

A diagnosis of PCOS requires the presence two of the following three features:

  1. Infrequent or absent ovulation (oligomenorrhoea or anovulation) which manifests as infrequent or absent periods.
  2. Hyperandrogenism which is either clinical signs of high levels of the male-like hormones (androgens), such as excessive body hair growth, loss of head hair, or acne; or high levels of these hormones detected in a blood test.
  3. Polycystic ovaries on ultrasound.

Although this condition is referred to as poly cystic ovary syndrome, a woman does not actually need to have polycystic ovaries- i.e. many “cysts” on the ovaries to be diagnosed with PCOS. The cysts are not actually cysts, but rather many follicles on the ovary. It is also important to note that not all women with polycystic ovaries actually have poly cystic ovary syndrome. About 20% of all Australian women have poly cystic ovaries on ultrasound but not all have the syndrome, and polycystic ovaries can be seen in women whom do not ovulate for other reasons.

What causes PCOS?

The cause of PCOS is remains unclear. It is thought that contributing causes include s genetics and environmental factors, combined with obesity, ovarian dysfunction and hormonal influences. The underlying hormonal imbalance it believed to include a combination of increased androgens and/or high insulin (hyperinsulinaemia) as a result of insulin resistance (see insulin resistance). Naturopathic treatment aims to address some of these underlying factors in the management of PCOS.

What is insulin resistance? (By Sofie Mikosa)

Insulin is a hormone in the body which functions primarily to regulate blood sugar levels. When blood sugar levels rise (typically after eating a meal) the body’s response is to secrete insulin from the pancreas.  Insulin acts to transport glucose (the form of sugar in the blood) from the blood stream and into cells by binding to insulin receptors. Glucose is then used by the cell as an energy source for a myriad of metabolic functions. With insulin resistance this process has become dysfunctional. The insulin receptors which allow insulin to transport glucose into the cell have become less sensitive to the effects of insulin (by either an inactivation of receptors or a decrease in receptor concentration), which results in increased sugar levels in the blood, rather than being transported in the cells where it is needed.