PCOS – is a set of symptoms

Polycystic Ovarian Syndrome is best defined as ‘androgen excess’, and diagnosed once other causes of elevated androgens have been ruled out.  However, PCOS is not just one disease, it’s an umbrella term used to describe a set of symptoms, the key ones being elevated androgens and impaired ovulation, but both these can result from various causes.

PCOS is a condition that does not have to be fixed or permanent.

These causes are often modifiable environmental factors, i.e. lifestyle choices that can impact hormone balance and production. This means if the cause can be identified, addressing it might bring about resolution.  So PCOS is a condition that does not have to be fixed or permanent.

For any one individual given a diagnosis of PCOS, identifying the cause is necessary to ensure the treatment is tailored and appropriate.

4 Different Types of PCOS

• Insulin-resistant PCOS
• Post contraceptive-pill PCOS
• Adrenal PCOS
• Inflammatory PCOS

Insulin-resistant PCOS

This dietary, metabolic cause of PCOS is the most common form. You may have had a glucose tolerance test done, and been told you have elevated blood glucose, maybe diagnosed ‘pre-diabetic’. Chronically elevated blood glucose leads to high insulin and weight gain, although some lean body types can also present with the same markers.  Having a diet high in glucose and fructose, leading to elevated insulin and leptin (an appetite hormone) impedes ovulation and stimulates the ovaries to make more testosterone.

This metabolic cause of PCOS is therefore within your power to change. The lifestyle change required is to be more active and reduce sugar intake. That’s not just the white granules you might add to tea and coffee, or the sweets, sodas and confectionary we all know contain sugar, it means consume less of the simple starches too (white bread, pasta, rice, and baked goods), because once digested, these starches metabolise to sugar and cause the chronically high blood glucose that leads to insulin resistance and the metabolic derangement that can lead to type 2 diabetes and (insulin-resistant) PCOS.

Post Contraceptive-pill PCOS

The Contraceptive pill works by suppressing ovulation, so even if you’ve had a ‘cycle’ and a bleed every month whilst taking a contraceptive pill, you were not ovulating. For many women, coming off the pill will cause a temporary surge in androgens, so if the menstrual cycle fails to resume immediately, it may just be a transitory drug-withdrawal situation.  You have ‘post-pill PCOS’ if you have androgen excess, without the insulin resistance.  Other factors can exacerbate this form of PCOS, for example if the stress hormone cortisol is elevated, maybe from an excess of high impact exercise or a life beset with chronic stress, both can contribute to androgen excess.

Adrenal PCOS

PCOS tends to cause elevations of all the androgens: testosterone and androstenedione from the ovaries,  and DHEAS from the adrenal glands. DHEAS is a precursor androgen hormone that gets converted into both oestrogen and testosterone. Adrenal PCOS accounts for 10% of cases and sees DHEAS elevated, but not testosterone nor androstenedione. It’s similar to the genetic condition congenital adrenal hyperplasia, but its not caused by either insulin resistance nor inflammation, it’s an epigenetic change to adrenal function that produces androgen excess from an up regulation in the production of adrenal androgens.

Inflammatory PCOS

Ovaries don’t just produce oestrogen, they produce tiny amounts of testosterone too, but chronic inflammation can stimulate more testosterone.  Treatment requires the identification of the underlying source of the inflammation. Possible triggers might be food sensitivities like gluten or dairy, gut problems, chronic mast-cell activation or histamine intolerance. So inflammatory PCOS presents with elevated androgens, mainly testosterone, but no insulin resistance, no preceding use of the contraceptive pill, but symptoms that may include fatigue, joint pains, headaches, a chronic skin condition like psoriasis or eczema, and maybe an autoimmune condition. Identifying the source and addressing the cause of the inflammation is essential to restore healthy hormone production and balance.

Of course it’s possible to have overlap, an inflammatory condition may exacerbate the body’s ability to resume the healthy balance of hormone production after a prolonged period on the contraceptive pill, or a diagnosis of PCOS may have been arrived at purely from the ultrasound evidence of cysts visible on the ovaries. These can have other causes, so without elevated androgens, your lack of ovulation and menstruation may actually be the result of Hypothalamic Amenorrhea.

Hypothalamic Amenorrhea

Hypothalamic Amenorrhea can cause cysts on the ovaries and periods to become irregular or cease altogether but it is due to under-eating and/or other stressors. It can also produce similar symptoms of mild acne and facial hair, so it is often mistaken for PCOS.  The first difference to spot is that a fasting insulin blood test will be low, not normal or high as it is with classic PCOS, but the crucial identifier is the ratio of luteinising hormone (LH) to follicle-stimulating hormone (FSH) which will be low with Hypothalamic Amenorrhea, whereas the LH : FSH ratio will be high with PCOS. Best measured on day 2 of the cycle.

Hypothalamic amenorrhea can occur in females who over-exercise and follow carb-free diets, leading to a loss of body fat below 17%.  Fat tissue is not just a passive insulating tissue, it works dynamically in support of the endocrine system too, in that is converts androgen hormones into Oestrogen. Oestrogen has myriad uses around the body, and is not just involved in reproductive health, an important one is that it helps prevent bone loss, so if Oestrogen levels are insufficient to maintain menstruation persists, you increase the risk for osteoporosis.

So whereas the treatment for insulin resistant PCOS requires a person to eat less and exercise more, the patient with Hypothalamic Amenorrhea needs to eat more and exercise less. Which neatly illustrates why body literacy is so important and the CAUSE of polycystic ovaries and loss of periods needs thorough investigation, not just an ultrasound image of your ovaries. Diet investigation along with the judicious use of well-researched supplements can greatly enhance the journey back to fertility.

Book in to my online clinic if your diagnosis of PCOS could do with some closer examination.

 

Reference: Dr Lara Briden – The Period Revolutionary –  www.larabriden.com