Ljupka Peev Naturopath, Nutrition, Herbal Medicine for women's health and fertility.
PCOS

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a complex hormonal condition, which can impact on a woman’s menstrual cycles and fertility, metabolism, physical appearance, self-esteem, mental health, and quality of life. PCOS is a chronic condition that needs to be managed throughout life, in order to correct the hormonal disturbance and to prevent long-term consequences.

Signs & symptoms
Diagnosis
How common is PCOS?
Causes
Risk factors
PCOS and fertility
Long-term consequences
Management of PCOS
Management of PCOS with natural therapies
Self – help
Consultations & Ljupka Peev
References

 

What are the signs & symptoms of PCOS?

Women with PCOS can experience a range of signs and symptoms, some of which may include:

  • RazorsIrregular or absent periods
  • Infertility
  • An increase in body hair growth (perhaps on the chest, back, or face)
  • Thinning head hair
  • Acne
  • Polycystic ovaries (seen on ultrasound).

Not all women have all the symptoms and different women with PCOS will experience different symptoms.

 

How is PCOS diagnosed?

PCOS is a complex condition and its diagnostic criteria has been challenged and changed several times in the past. Currently, the most accepted diagnostic criteria both internationally and in Australia is the Rotterdam criteria, which states[1]:

A diagnosis of PCOS requires at least 2 out of the 3 features following:

1. Infrequent or absent ovulation resulting in infrequent or absent menstruation.
2. Signs of hyperandrogenism (increased ‘male’ hormones like testosterone) such as excessive body hair growth, loss/thinning of head hair, or acne AND/OR Hyperandrogenism detected by blood test.
3. Polycystic ovaries (PCO) on ultrasound.

AND exclusion of other conditions causing these features.

As you can see from this criteria, a woman does not need to have polycystic ovaries to have PCOS and she does not necessarily have PCOS if she has polycystic ovaries.

 

How common is PCOS?

PCOS is one of the most common conditions in women of reproductive age, affecting between 12-21% of these women[2]. It is estimated, however, that this could be many more women, because approximately 70% of women with PCOS are undiagnosed.[3]

 

What are the causes of PCOS?

Unfortunately, it is still unclear what exactly causes PCOS, but we do know that there are many factors that inter-relate and affect each other, to play a role in causing the syndrome. Genetics and environmental factors like diet and lifestyle have an important influence. The underlying hormonal imbalances that arise include increased androgens (‘male’ hormones that are normally produced in smaller amounts in women, such as testosterone) and/or high insulin. These changes affect other reproductive hormones like oestrogen, follicle stimulating hormone (FSH) and leutinising hormone (LH), causing disturbances in ovulation, menstrual function and fertility.

 

What are the risk factors associated with PCOS?

Family History

A woman’s risk of developing PCOS is 40-50% if her mother or sister is affected, and this genetic heritage is thought to be a main risk factor for developing PCOS.[4]  Outside of first-degree relatives, this risk may be contributed from either the maternal or paternal lines.[5]

This genetic link may be triggered by dietary and lifestyle aspects that cause insulin resistance and contribute to obesity. [6]

A family history of type 2 diabetes

Given the strong relationship between insulin resistance and PCOS, a family history of type 2 diabetes may increase your risk for PCOS.[7]

Long-term use of  Valproate

Valproate is a type of pharmaceutical seizure medication that is used treat epilepsy and bipolar disorder. Long-term use of this drug has been associated with an increased risk of PCOS.[8]

Obesity

Obesity (particularly abdominal obesity) is a major trigger for insulin resistance and additionally worsens its severity.[9] PCOS has been found in 28% of women with obesity compared with 5% of lean women.[10]

 

Does PCOS cause infertility?

It is important to note that although PCOS can be a cause of infertility, many women with PCOS are still able to conceive without difficulty and carry a pregnancy to full term. Also, not all women who have difficulty conceiving have PCOS. However, in women who have trouble conceiving because they are not ovulating (or ovulate sporadically), PCOS is the most common cause of this type of infertility. [11]

For women with PCOS who are also overweight or obese, there is a greater risk of infertility. Almost 70% of women with PCOS who have trouble falling pregnant have been found to be obese.[12]

In pregnancy, PCOS can increase a woman’s risk of gestational diabetes and hypertension as well as pregnancy complications and miscarriage.[13] Obesity during pregnancy further exacerbates these risks.

 

What are the long-term effects of PCOS on health?

Women who have PCOS and are not well-managed have an increased risk of type 2 diabetes and cardiovascular disease later in life.[14] The risk of type 2 diabetes was found to be 3-7 times greater in these women compared with the general population.[15] Obesity amplifies these effects, however insulin resistance and diabetes are also common in non-obese women with PCOS, though less so than in overweight women.[16]

Women who do not ovulate regularly for a prolonged period may be at an increased risk of overgrowth of the uterine lining (endometrium) that in rare occasions may progress to malignancy.[17]

 

Management of PCOS 

PCOS is first and foremost managed through dietary and lifestyle corrections (see self help below). This improves insulin resistance, normalises hormone levels and regulates ovulation, affecting all symptoms including acne, excess hair growth, irregular periods and infertility, and reducing the risk of developing diabetes and cardiovascular disease.

Additional treatments may or may not be used, depending on the severity of the condition and symptoms, the response to diet/lifestyle changes, and whether pregnancy is the aim.

Managing PCOS with natural therapies

Using a holistic model of health care, naturopathy allows time for individualised management and preventative care.

Dietary advice and support

Dietary advice and management, based on the current available evidence, is the first line of treatment of PCOS, regardless of your weight.

Your naturopath can assess your current eating patterns and give you specific individualised advice to help you make simple changes where needed. In this way, your diet is adapted to suit you, making it easier to maintain.

Specific dietary adjustments can address all aspects of PCOS management including:

  • Maintaining healthy glucose control
  • Normalising hormone levels
  • Regulating ovulation and menstruation
  • Improving fertility
  • Improving symptoms
  • Addressing nutrient deficiencies
  • Preventing chronic health condition
  • Maintaining a health weight
  • Optimising health of mother and baby, and reducing risks in pregnancy.

 

Exercise advice and support

Physical activity is as important as dietary intake in regulating blood sugar and hormone levels and managing PCOS. There are many ways to exercise and be physically active. It needn’t be structured but it should be sustainable and enjoyable. Your naturopath can provide you with guidelines and advice on the type and level of exercise you need to achieve your goal (whether that is weight loss, gain, or maintenance, pregnancy, prevention of diabetes or others) and offer plenty of resources and strategies to help you incorporate exercise into your life. See also Exercise – How? What? When?

Echinacea

Herbal medicine

Herbal medicine may additionally be used, if required, to:

  • improve insulin sensitivity – used to help regulate periods, address symptoms of excess androgens and improve fertility.
  • normalise hormone levels
  • reinstate and regulate ovulation and menstruation
  • improve fertility (see also fertility support and preconception care) and reduce risks of pregnancy-related conditions (see also pregnancy care).
  • improve symptoms

 

Nutritional medicine

Your naturopath can help you identify nutritional deficiencies and key nutrients that may impact on PCOS (such as magnesium, where deficiency has been found to worsen insulin resistance[18]). Nutritional supplementation may be required to correct deficiencies while dietary changes are made. Ideally a balanced diet will prevent deficiencies in the long-term.

 

Self Help

PCOS is a condition that is essentially managed by the woman herself, with individualised advice from her healthcare practitioner. There are, however, some general strategies that you can begin immediately:

Maintain a healthy weight.

Diet and lifestyle change are important for ALL women with PCOS, regardless of their weight. This is because women who are underweight may not ovulate regularly and because insulin resistance is also found in lean women. Underweight or slim women may need specific advice on how to gain weight and maintain it in a way that is healthy.

For women with PCOS who are overweight or obese (with a body mass index ?25kg/m2) weight loss is the primary aim of treatment. This will reduce androgen levels, improve insulin sensitivity, regulate the menstrual cycle and improve ovarian function and fertility.[19] In fact, just 5% of body weight loss is often enough to restore reproductive function and improve pregnancy rates.[20] 

Maintain a healthy, low-GI diet.

The glycaemic index (GI) is a way of describing the effect of food on a person’s blood glucose (or blood sugar). Eating a low-GI food or meal will release glucose more slowly and steadily in the bloodstream, whereas high-GI foods cause a faster rise in blood glucose levels. For more information on the glycaemic index, see the Australian government’s Better Health Channel website.

Eating regular meals is equally as important for maintaining good blood sugar control as is the components of your meals. Enjoy an appropriately sized, well-balanced breakfast, lunch, dinner with nutritious snacks in between.

As a general rule, avoid packaged and processed foods as much as possible and aim for fresh food with lots of different vegetables. Packaged foods are often high in sugar, even in products we often don’t think of (such as some canned tuna varieties, breakfast cereals and muesli, many “savoury” sauces such as tomato sauce and curry pastes), so it is important to be aware of the sugar content in packaged food.

If you are aiming to lose some weight, the CSIRO’s Total Wellbeing Diet  is a tried and tested low-GI diet program and provides lots of tools and support.

Enjoy regular physical activity and exercise

ExercisePhysical movement is very important to our health and wellbeing. This doesn’t simply mean that we have to exercise regularly, it also means we need to minimise how much time we spend sitting. So, incorporating physical activity into your life might initially be about taking steps (pardon the pun) to move from a sedentary lifestyle to an active lifestyle. Basically, any physical activity is better than nothing, so if you spend most of your time sitting, start by increasing your “incidental” activity (walking to the shop instead of driving, using stairs rather than elevators/escalators where possible, etc) and increasing your daily number of steps, then build on from there.

In terms of exercise, the Australian Government recommendations for adults are:

  • Be active ideally every day, or at least on most days.
  • Accumulate 150-300 minutes (2.5 – 5 hours) of moderate intensity or 75 – 150 minutes of vigorous intensity per week (or an equivalent combination of both moderate/vigorous intensity).
  • Incorporate muscle strengthening activities on at least 2 days per week.

For more information and help on getting started, see Exercise – How, What, When.

Track your menstrual cycle

Keeping track of when you menstruate provides you with lots of important information, but we often don’t realise we need this information until something changes. At the very least, noting when you menstruate will help you estimate when to expect your next period, so that you may be prepared when it arrives.

Keeping track will also help alert you and your healthcare practitioner to any changes that might need addressing, such as:

  • if you if experience a cycle longer than 35 days,
  • if you “miss” a period, or
  • if you experience bleeding any time outside of your expected cycle.

You might like to keep a menstrual diary or calendar, where you also make notes on the bleed (how heavy, any clots, any spotting, etc) and any other symptoms during menstruation or at any other time throughout the month (such as pain, breast tenderness, mood change, vaginal mucous type). There are many “Apps” available but beware that these may not be accurate in terms of ovulation dates and should only be uses as a electronic diary. Your practitioner can teach you how to interpret your menstrual cycle.

Have routine checks

Because PCOS can increase your risk for other conditions, all women with PCOS need to be screened for diabetes and cardiovascular risks. This assessments includes:

  • blood tests for fasting blood glucose, cholesterol profile and any other tests relevant to you.
  • Oral glucose tolerance test
  • Physical measurements of weight, height, waist circumference, and blood pressure.

This screening should be performed annually in order to help prevent any long-term consequences and to make any necessary changes to diet, lifestyle, supplementation or medication.

Get help

As you can see, there is lots of information available and lots of strategies to help you manage PCOS. While this is a great thing, it can be quite overwhelming when trying to decide what information is most appropriate for you and where to start. Remember, you are not alone! Seek out a practitioner who’s well-versed in PCOS and get some expert help, whether you are:

  • trying to get pregnant or not
  • wanting to deal with symptoms
  • wanting to lose, maintain or increase your weight
  • looking for help and advice on exercise.
  • Needing help with your diet.

 

About Ljupka

Ljupka was contributing author to Women, Hormones & the Menstrual Cycle, 3rd edition, a textbook providing naturopathic & medical information, and contributed to chapter 15 – Polycystic Ovary Syndrome, amongst others.

Ljupka is currently specialising in reproductive health in men and women through a Master of Reproductive Medicine. Read more about Ljupka Peev.

Consultation with Ljupka is available by appointment. Please call 0488 995 474 or email ljupka@naturopathy.melbourne for appointments.

References


[1] The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome: The Rotterdam ESHRE/ASRM- Sponsored PCOS Consensus Workshop Group. Fertility & Sterility, 2004. 81(1): 19-25.

[2] March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25(2): 544–51.

[3] Boyle, J. Teede, HJ. Polycystic ovary syndrome – an update. Aust Fam Physician. 2012 Oct; 41(10): 752-6.

[4] Kahsar-Miller M, Azziz R, et al. The development of the polycystic ovary syndrome: family history as a risk factor’, Trends Endocrinol Metab. 1998 Feb;9(2): 55-8.

[5] Kahsar-Miller M, Azziz R, et al. The development of the polycystic ovary syndrome: family history as a risk factor’, Trends Endocrinol Metab. 1998 Feb;9(2): 55-8.

[6]  Pasquali R, Stener-Victorin E, Yildiz BO, et al. Research in Polycystic Ovary Syndrome Today and Tomorrow. Clin Endocrinol. 2011;74(4): 424-433.

[7]  Ehrmann DA, Kasza K, Azziz R, et al. Effects of race and family history of tye 2 diabetes on metabolic status of women with polycystic ovary syndrome. J Clin Endocrin & Metab. 2005;9(2): 66-71.

[8] Morrell M, Montouris G. Reproductive disturbances in patients with epilepsy. Clev Clin J Med. 2004;71(supp2): S19-24.

[9] Vanketesan AM, Dunaif A, Corbould A. Insulin resistance in polycystic ovary syndrome: progress and paradoxes. Rec Prog Hor Research. 2001;56: 295-308.

[10] Alvarez-Blasco F, Botella-Carretero JL, et al. Prevalence and characteristics of the polycystic ovary syndrome in overweight and obese women. Archives of Internal Medicine. 2006;166(19): 2081-6.

[11]   Palomba S, Falbo A, et al. Efficacy Predictors for Metformin and Clomiphene Citrate Treatment in Anovulatory Infertile Patients With Polycystic Ovary Syndrome. Fertility & Sterility. 2009;91(6): 2557-2567.

 

[12] Haq F, Aftab O, Rizvi J. Clinical, biochemical and ultrasonographic features of infertile women with polycystic ovarian syndrome. J Coll Physicians Surg Pak. 2007 Feb;17(2): 6-80.

[13] Fica S, Albu A, et al. Insulin resistance and fertility in polycystic ovary syndrome. J Med Life. 2008 Oct-Dec;1(4): 415-22.

[14] Franks S. Are women with polycystic ovary syndrome at increased risk of cardiovascular disease? Too early to be sure, but not too early to act! Am J Med. 2001;111(8): 665-6.

[15] Kovacs G, Norman R, (eds). Polycystic ovary syndrome, 2nd ed. Cambridge University Press:UK. 2007, p.84.

[16]  Legro RS, Kunselman AR, et al. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab.1999;84(1): 165-9.

[17] The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1): 41-7.

[18] Dominquez LJ, Barbagallo M, et al. Magnesium responsiveness to insulin and insulin-like growth factor I in erythrocytes from normotensive and hypertensive subjects. J Clin Endocrinol Metab. 1998;83(12): 4402-7. Muneyyirci-Delale O, Nacharaju VL, et al. Divalent cations in women with PCOS: implications for cardiovascular disease. Gynecol Endocrinol. 2001 Jun;15(3): 198–201.

[19] Crosignani PG, Colombo M, et al. Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum. Reprod. 2003;18(9): 1928-1932.

[20]  Fica S, Albu A, et al. Insulin resistance and fertility in polycystic ovary syndrome. J Med Life. 2008 Oct-Dec;1(4): 415-22.

Articles
  • Subscribe to my newsletter
    to receive news and recipes
    straight to your inbox.
    * = required field