Polycystic Ovary Syndrome (PCOS): Symptoms and Treatment
Polycystic Ovary Syndrome, commonly known as PCOS, is a hormonal disorder that affects many individuals, primarily women of reproductive age. Characterised by a range of symptoms, PCOS can significantly impact physical and emotional well-being and quality of life. Read on as we dive into the various aspects of PCOS, from its symptoms and causes to the different “types of PCOS” or “drivers” and the available treatment options.
What is PCOS?
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that involves an imbalance of reproductive hormones - particularly increased levels of androgen hormones such as testosterone. This imbalance can lead to a variety of symptoms, including irregular periods, acne, excessive hair growth, and “cysts" on the ovaries. PCOS can also cause difficulties in getting pregnant and may lead to other health concerns if not properly managed.
What are the First Signs of PCOS?
The signs and symptoms of PCOS can vary widely among individuals, but some of the common early signs include irregular periods, heavy bleeding, acne, and excessive hair growth, especially on the face, chest, and back. PCOS weight loss can also be a challenge due to the hormonal imbalances, and many women may find themselves gaining weight easily, particularly around the mid-section. Weight gain, thinning hair, and darkening of the skin, particularly around the neck and underarms, can also be indicative of PCOS.
PCOS Diagnosis
Diagnosing PCOS involves a comprehensive assessment of your medical history, physical examination, and various tests. These tests can include blood tests to measure hormone levels, an ultrasound to examine the ovaries for cysts or a cyst-like appearance (polycystic ovaries), and an evaluation of other potential underlying conditions. It's important to consult a healthcare professional if you suspect you have PCOS, as proper diagnosis is crucial for effective treatment.
Based on the Rotterdam criteria, PCOS is diagnosed when you meet two out of three of the following:
High levels of androgens as shown on a blood test, or through symptoms like excess facial or body hair and acne
Irregular or absent menstrual cycles
Polycystic ovary appearance on ultrasound OR elevated anti-mullerian hormone (AMH) levels (after other causes of these features are excluded).
It’s important to know that where irregular menstrual cycles and high androgen levels are present, an ultrasound or high AMH levels are not required for diagnosis. This means that you do not need an ultrasound to be diagnosed with PCOS. In fact, many women with PCOS do not have any cysts on their ovaries at all. This can be confusing, especially when the name of the syndrome is based off cysts sounding like the appear on the ovaries. However, the ‘cysts’ shown on an ultrasound are not actually cysts at all, but instead are an increased number of follicles, driven by an imbalance of hormones. While it is possible to get ovarian cysts that can rupture, this is something entirely different to what is seen in PCOS.
PCOS Causes
The exact causes of PCOS are not fully understood, but a combination of genetic and environmental factors likely play a role. Insulin resistance, where the body's cells do not respond effectively to insulin, is well known to be a main a contributing factor. This can lead to an increase in insulin production, which in turn stimulates the ovaries to produce more testosterone. These hormonal imbalances are at the core of PCOS symptoms, driving acne and excess hair growth in androgen sensitive areas like the jawline, neck, chest and back especially. Along with insulin resistance, stress and low-grade inflammation are known to also play a role in the development of the condition.
What Type of PCOS Do I Have?
PCOS is not a one-size-fits-all condition. It is often categorised into four different types based on the primary symptoms and hormonal imbalances. Understanding the type of PCOS you have can help tailor your treatment plan more effectively. The types of PCOS include:
Insulin-Resistant PCOS:
Insulin resistance is by far the most common driver we seen in our PCOS patients. Characterised by high levels of insulin, this type often leads to weight gain and difficulties in losing weight, however it is also seen in 75% of women with “lean PCOS”.
Inflammatory PCOS:
This type of PCOS is associated with inflammation in the body which can also drive the ovaries to produce excess testosterone. Those with inflammatory PCOS often have issues with digestion such as IBS, food sensitivities or intolerances, skin issues like eczema, as well as symptoms like headaches, joint pain and fatigue. Autoimmune conditions or thyroid disorders are also common.
Adrenal PCOS:
Following insulin resistant PCOS, adrenal PCOS is the second most common PCOS type. Up to 30% of PCOS cases are attributed to adrenal androgen excess, stemming from an abnormal stress response. In this type of PCOS, an androgen produced in the adrenal glands known as DHEA-S is often elevated, whereas ovarian production of testosterone is often normal.
Post-Pill PCOS:
Unfortunately, many women are incorrectly diagnosed with PCOS after coming off hormonal birth control. In this type of PCOS, symptoms like acne and irregular or absent cycles arise (or worsen) in the 3-6 months after stopping the pill. Most often, these symptoms were not present prior to taking hormonal birth control at all. This is due to what’s known as an “androgen rebound” where the ovaries upregulate testosterone production after withdrawing from the synthetic hormones. Keep in mind this is not a true type of PCOS, but rather what’s known as “Post Birth Control Syndrome”. This is a temporary condition, and can take some time to resolve, but is more quickly addressed with the right nutrition alongside lifestyle changes and herbal medicine support.
How to Cure PCOS
While there is currently no known cure for PCOS, there are various treatments available to manage the symptoms and improve quality of life. Often, complete reversal of symptoms can be managed. Treatment goals often include regulating menstrual cycles, reducing insulin resistance and improving sensitivity, reducing androgen levels, regulating the stress response, improving energy levels and addressing any associated health concerns.
Can You Get Pregnant Naturally with PCOS?
PCOS is NOT an infertility diagnosis. But, for some individuals with PCOS who aspire to start a family, the path to pregnancy might present some challenges. The hormonal imbalances associated with PCOS can affect ovulation, making it harder to conceive. While PCOS can make conception more difficult, it's not impossible. Many women with PCOS do successfully become pregnant naturally. Maintaining a healthy lifestyle, managing weight, and tracking your cycles and understanding how to identify ovulation are crucial steps. If you're struggling to conceive, consulting with a fertility specialist can provide valuable guidance and options to enhance your chances of getting pregnant.
What is the main treatment for PCOS?
Medical treatment options and medications for PCOS include:
Birth Control Pills (“the pill”):
These temporarily regulate menstrual cycles and reduce androgen levels, however without addressing the underlying cause of your PCOS, symptoms will reappear and may worsen after stopping the pill.
Anti-Androgen Medications:
Medications like Spironolactone, also known as Aldactone, blocks the effects of androgens on the skin, reducing symptoms like excessive hair growth and acne. It's crucial to note that Spironolactone can result in birth defects, and therefore is not advised during pregnancy or if trying to conceive.
Metformin:
Often used to treat type 2 diabetes, Metformin can also help manage insulin resistance in PCOS. Unfortunately, Metformin comes with significant side effects such as nausea, diarrhoea, and vomitting, affecting gut function and the microbiome, and can also reduce levels of vitamin B12 in the body.
Ovulation Induction:
Fertility medications may be prescribed for those trying to conceive to stimulate ovulation, such as Clomiphene or Letrozole/Femara.
It's important to work closely with a healthcare provider to determine the most suitable medication for your individual needs.
Natural Treatment for PCOS
In addition to medications, there are several natural approaches to managing PCOS symptoms. These include lifestyle and dietary modifications such as sleep prioritisation, regular movement, a focus on whole foods, lean proteins and addressing carbohydrate tolerance. Natural supplements for PCOS such as inositol, vitamin D, magnesium, and adaptogenic herbs can also be fantastic additions to support better insulin sensitivity and adrenal function and help to regulate healthy menstrual cycles, enhance fertility and restore hormonal balance.
PCOS Self-Care
Engaging in self-care is paramount for managing your symptoms and improving overall well-being. Here are some self-care practices that can make a positive impact:
Mindfulness and Stress Reduction: Chronic stress can exacerbate hormonal imbalances. Incorporating relaxation techniques like meditation, deep breathing, and yoga can help manage stress levels.
Regular Check-ups: Keeping up with regular medical check-ups ensures that your health is monitored, and any potential concerns are addressed promptly.
Support Network: Surrounding yourself with a supportive network of friends, family, and possibly support groups can provide emotional support and practical advice.
Education: Educate yourself about PCOS symptoms, treatments, and lifestyle adjustments. The more you understand about your condition, the better equipped you'll be to manage it effectively.
Prioritise Sleep: Quality sleep is essential for hormonal balance and overall health. Aim for consistent sleep patterns and create a relaxing bedtime routine.
Maintain a Positive Mindset: Managing PCOS can be challenging, but maintaining a positive mindset and focusing on the aspects of your life that bring joy and fulfilment can contribute to your overall well-being.
I have PCOS. Where do I Start?
Being diagnosed with PCOS can be extremely overwhelming. It’s normal to feel frustrated, let down by your body, worried about your fertility and confused about where to begin to help your symptoms. If you’re struggling with PCOS symptoms like acne, irregular periods, excess hair growth or hair loss, or if you have recently been diagnosed, the best place to start is joining our PCOS Repair Program.
Created by Emily Jensen, a registered nutritionist (BSc Human Nutrition), naturopath, and medical herbalist (BNat Med) with over 10 years of experience in treating PCOS, this program is designed to help you identify your specific PCOS type and tackle the root causes of your symptoms. With tailored diet and lifestyle guidance, you'll learn how to reverse your PCOS naturally and achieve long-lasting results.
Take the first step toward healing —join the PCOS Repair Program today and start your journey to lasting change!
Ready to reverse your PCOS?
Join the PCOS Repair Program today and start your journey towards balanced hormones, clear skin, and better energy.
