Polycystic Ovarian Syndrome (PCOS): The Basics
Polycystic ovarian syndrome, or PCOS, is one of the most common menstrual cycle disorders, affecting anywhere from 4-20% of reproductive-age women worldwide. Yet despite its prevalence, it is considered to be poorly understood, is often un- or misdiagnosed, and in the conventional medical world, effective treatment is lacking. That’s where naturopathic medicine comes in.
In order to receive an official diagnosis of PCOS, on has to meet at least two of the following three conditions:
Hyperandrogenism — high levels of androgen hormones that can be measured with blood work, but can also present symptomatically as jawline acne, oily skin, facial hair growth, and hair loss.
Ovulatory dysfunction — presenting as anovulation (not ovulating during a menstrual cycle), irregular or absent periods.
Polycystic ovaries — the presence of cysts growing on the ovaries, as seen on ultrasound.
However in practice, it has become clear that PCOS is more of a spectrum, with many folks who don’t meet the official criteria getting left behind despite having a very similar constellation of symptoms related to an underlying process that is much the same as that which causes PCOS.
What is that underlying process?
It’s complicated! PCOS is one of those syndromes that affects (and is affected by) many systems within the body. It is part endocrinopathy, meaning it’s related to hormone imbalance, part metabolic disorder, meaning it’s related to blood sugar instability and insulin resistance, and part reproductive dysfunction, meaning it’s related to issues at the level of the ovary. To break it down even further, the latest research has identified that there are really four main types of PCOS:
Insulin-Resistant PCOS — High levels of insulin that drive androgen production, leading to hyperandrogenism and PCOS. It’s also a risk factor for developing diabetes! Insulin can be measured in the blood, as well as other markers such as hemoglobin A1c, which is an average of blood glucose over a three month period and can be a helpful predictor of pre-diabetes and diabetes.
Adrenal PCOS — Adrenal PCOS is not related to insulin-resistance, and is due to the excess production of the androgen hormone DHEA by the adrenal glands. If DHEA is elevated but other androgens like testosterone are in a normal range, this indicates adrenal PCOS.
Inflammatory PCOS — Chronic inflammation can stimulate the ovaries to produce excess testosterone, and in fact inflammation is a factor that is common to each type of PCOS. If the other types of PCOS have been ruled out as the cause, inflammation due to diet and lifestyle, autoimmune disease or other health conditions may be the culprit.
Post-Pill PCOS — If your periods were normal before starting the pill, you may have post-pill PCOS. It’s not unusual for hormones to swing out of balance after discontinuing hormonal contraceptive use. The good news is that they will typically return to normal over time.
Conventional Treatment vs. a Naturopathic Approach
The conventional treatment of PCOS, regardless of which type of PCOS one presents with, is to prescribe oral contraceptives and/or metformin, a diabetes medication that helps improve insulin sensitivity. If insulin resistance is part of the problem, metformin can help to keep blood sugar well-managed, which is absolutely an important goal to address. However, metformin is not a solution for those who are experiencing non-insulin resistant PCOS. It also doesn’t get down to the underlying cause of insulin resistance. It’s a bandaid that can keep blood sugar stable temporarily, but if a change isn’t made with diet and lifestyle, the patient will be dependent on metformin for life. What’s more, they may develop other chronic health issues related to diet and lifestyle such as cardiovascular disease.
Oral contraceptives or birth control pills aren’t a solution either. Sure, they can make it seem like you’re having a regular period, but because birth control suppresses ovulation, the monthly bleed is not a true period, but a withdrawal bleed. Meanwhile, the underlying process(es) contributing to the development of PCOS is still present, and can even worsen over time.
These bandaid solutions are a problem because not only do they allow for the underlying issue to continue, but they are not without side effects, and they may not meet the needs of the individual patient and their goals.
If your goals include avoiding pharmaceuticals when possible, getting down to the root cause of dysfunction to manage your cycles naturally, improving your overall health, or becoming pregnant, then a naturopathic approach is for you. My approach as a naturopathic doctor includes the following:
Thorough testing to identify area(s) of dysfunction that may be contributing to PCOS or irregular cycles.
Improving insulin sensitivity through diet, lifestyle, herbal therapies and nutraceuticals.
Supporting thyroid and/or adrenal function as needed.
Promoting blood circulation to the pelvis and ovaries to support ovarian function.
Balancing hormones and regulating the menstrual cycle with diet, lifestyle, herbal therapies and nutraceuticals.
Whatever else the individual may need!
Are you ready to get down to the bottom of your menstrual cycle irregularities? Schedule a free 15 minute discovery call today!
