All About Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome is the most common endocrine disorder among women of reproductive age. The current estimate is ~10% of women have PCOS, but it is widely under-diagnosed and under-treated so the prevalence is likely much higher.
The exact cause of PCOS is unknown, but we know there are several root causes of PCOS including genetic and environmental factors. It is a unique condition, as women will often present with different (but similar!) symptoms.
Symptoms include:
- weight gain
- absent/irregular menstrual cycles
- infertility
- hirsutism
- strong cravings
- acne
- hair thinning
- anxiety and depression
Diagnosing PCOS
According to the Rotterdam criteria, you must have 2 of the following 3 criteria in order to diagnose PCOS:
- Oligo- or anovulation (irregular or absent menstruation)
- Clinical and/or biochemical signs of hyperandrogenism (acne, hirsutism, and/or blood tests showing high androgens)
- Polycystic ovaries (12 or more peripheral follicles) Did you know… they are not actually cysts, they are immature follicles!
PCOS has variable phenotypes, which we will not get into today, but it is important to know that there are four different Rotterdam phenotypes (Class A – D). In other words, women can have different presentations. Some women with PCOS actually get regular periods, and others don’t have any cysts on their ovaries. So as you can imagine, there is not one cookie-cutter approach to treating PCOS!
Part of figuring out YOUR root cause and symptom management of PCOS involves analyzing your hormones…
Hormones are chemical messengers made by endocrine glands, such as the hypothalamus, pituitary gland, ovaries, adrenal glands, thyroid, and pancreas.
- Hypothalamus – dopamine, GHRH, GnRH
- Pituitary Gland – prolactin, LH, FSH, oxytocin, TSH
- Ovaries – estrogen, progesterone, testosterone, AMH
- Thyroid – T4, T3
- Adrenals – cortisol, DHEA, DHEA-S, androstenedione, testosterone, epinephrine/norepinephrine
- Pancreas – insulin, glucagon
- Liver – main producer of sex-hormone binding globulin (SHBG)
All of these hormones are interconnected in various ways. For example, in the first half of your cycle (start of period until you ovulate), estrogen should be your dominate hormone. Rising estrogen triggers the release of FSH and LH, which leads to ovulation. After ovulation, progesterone takes over as dominant hormone. Another example would be insulin, testosterone, and sex-hormone binding globulin. Insulin stimulates the ovaries to release testosterone, and furthermore can inhibit the liver from producing SHBG (which therefore results in more circulating testosterone). Elevated insulin levels can also stimulate the adrenals to produce more androgens. Elevated levels of androgens can lead to symptoms such as facial hair, acne, and male-pattern hair loss.
PCOS Treatment
When working with women with PCOS, I think it is crucial to help them understand WHAT is happening in their body and WHY. It is so empowering to understand how each change you make is positively impacting your health and well-being.
A large component of PCOS nutrition therapy is healing your relationship with food, increasing nutrient-dense foods in your diet, and adding supplements as needed. Many women are told to lose weight or go on restrictive diets – you do not need to do this! In fact, this can often be MORE harmful to women with PCOS.
There is a lot of information out there about PCOS that can unfortunately be overwhelming and confusing. If you want an evidence-based treatment approach to your health and nutrition, book an appointment with Stephanie today.
Questions? Comment below!
