What is PCOS?
Polycystic ovarian syndrome (PCOS) is a hormonal disorder affecting between 8-13% of women in Australia. Previously, PCOS was diagnosed using only ultrasound. If a woman had multiple “cysts” on her ovaries she was diagnosed. However, these “cysts” are actually follicles which are the maturing eggs found in the ovary. As many of the women being diagnosed were young and in their fertile years, finding multiple follicles on the ovaries is quite common. We now know that the syndrome has less to do with “cysts” and instead is due to hormonal changes. To be diagnosed, a woman must have two of the following: excess androgen hormones, irregular or missing periods, and/or multiple “cysts” on the ovaries found on ultrasound.
The reason why women with PCOS may appear to have multiple “cysts” on their ovaries is because of a lack of ovulation and a build up of these follicles which would usually be released during ovulation each cycle. Women who have PCOS often have anovulatory cycles (no ovulation occurs) or are not cycling at all. This leads to many undeveloped follicles that never make it to the stage where they are released as eggs and therefore the ovaries look as though they have many (poly) “cysts”.
Do you have it?
To know if you have PCOS it is important to get an understanding of your symptoms. Pain is not a symptom of PCOS, it can certainly be something that women with PCOS can experience but PCOS itself will not cause pain. It is worth investigating the pain further so that you can have that treated. The most common symptom associated with PCOS is irregular periods. This could be long stretches of time between periods, unpredictable timing of the period or a period that has gone missing. It’s important to mention that if you have been menstruating for 5 years or less, having irregular cycles can be a normal part of your body maturing and PCOS should not be diagnosed during this time.
Other common symptoms include:
Male pattern hair growth (chin, moustache, cheeks)
If you have some or all of these symptoms I suggest speaking with your GP about getting your hormones tested. Having an ultrasound may also be suggested by your doctor but because this is the most unreliable diagnostic tool I recommend also getting blood tests if this has been offered to you. What we are looking for in the blood results is elevated androgens (testosterone, DHEA, androstenedione), elevated luteinising hormone (LH), elevated insulin, and reduced progesterone with elevated estrogen.
From a medical doctor’s perspective, the first line of treatment offered is the oral contraceptive pill. Many women are told that this will help to ‘regulate’ their cycles. The pill does not regulate menstrual cycles, it shuts down ovulation. Because the whole reason women have a menstrual cycle is to ovulate, it is essentially turning off the menstrual cycle. Off the pill, women have period bleeds after they have ovulated to shed their uterine lining, making way for the next ovulation and potential conception. This bleed happens due to their egg not being fertilised and a drop in both estrogen and progesterone hormones. On the pill, we do not get this fluctuation in hormones prompting a period. Instead, we take synthetic hormones for three weeks to stop ovulation then we swap to sugar pills for one week. This withdrawal from synthetic hormones causes the bleed that happens every 4 weeks on the pill. Therefore, taking the pill does not ‘regulate’ the menstrual cycle, it turns it off. Most women will decide to come off the pill at some stage in their life, often facing a return of the same irregular patterns or symptoms they experienced prior to going on the pill. If you are taking the pill for contraception, great, that is what it is intended for. If you are taking the pill to ‘regulate’ your menstrual cycle, you may be disappointed to know that this is unfortunately a misconception.
PCOS does not have a cure but it can be managed well resulting in many women having complete relief from their symptoms. As every woman experiences PCOS differently, it is important to approach treatment individually on a case by case basis. Having said that, there are some important dietary and lifestyle interventions that are safe for most people to try out. A large portion of women with PCOS also have some degree of insulin resistance meaning they are producing higher levels of insulin in the body to process incoming energy compared to the average person. Insulin’s job is to store incoming sugars in fat cells, which is why weight can increase. For this reason, high sugar, processed, and refined carbohydrate foods should be avoided or at the very least greatly reduced for anyone with PCOS. This will release some of the stress on the pancreas for continuously producing insulin to store and process this food. Choosing a diet made up of protein, healthy fats and high-fibre foods is going to help level out insulin levels, thus stabilising PCOS hormones. Particular nutrients that are important to consider are magnesium (found in dark green leafy vegetables, legumes), zinc (oysters, meat, nuts & seeds), essential fatty acids (fish, flaxseed), and vitamin D (sunlight).
If you have been diagnosed with PCOS or think that you may have PCOS, I highly recommend booking an appointment so that you can begin your individually tailored treatment plan. Managing PCOS is not a quick fix but it can be extremely rewarding when you find the right plan for you.