Polycystic Ovarian Syndrome – Part I

PCOS, or Polycystic ovarian syndrome, is one of the most common endocrine disorders in women. With a prevalence of 3-10% in women of reproductive age, PCOS is the most frequent cause of anovulation (lack of ovulation). Because the symptoms of PCOS aren’t always obvious and vary from woman to woman, PCOS often isn’t diagnosed until a woman struggles with fertility and further investigation is pursued. The effects of PCOS are far reaching and can include the cardiovascular system, metabolism, hormone levels, and the skin.

How is PCOS diagnosed?

Diagnosis is made based on the Rotterdam criteria which requires 2 of 3 to be present:

1. Anovulation/oligovulation: lack of or infrequent ovulation.
2. Hyperandrogenism: high levels of androgens (testosterone; DHEA; androstenedione) causing symptoms such as hirsutism (facial and body hair growth), male pattern hair loss, and acne.
3. Polycystic ovaries: multiple follicular cysts on transvaginal ultrasound.

Other causes of these symptoms must also be excluded in order for a proper diagnosis.

What are the symptoms of PCOS?

PCOS results in a variety of symptoms, but the most common are hirsutism, menstrual irregularity with anovulation, and infertility. Other symptoms include:

• Oligomenorrhea or amenorrhea: infrequent or complete lack of menstrual periods.
• Oligovulation or anovulation: infrequent or complete lack of ovulation.
• Dysfunctional uterine bleeding
• Obesity
• Acne
• Hirsutism: male pattern hair growth on the face or body.
• Polycystic or enlarged ovaries: multiple ovarian cysts present on ultrasound.
• Endometrial hyperplasia: thickening of the endometrium (inner lining of uterus).
• Infertility
• Glucose intolerance/insulin resistance
• Clitoral hypertrophy: enlargement of the clitoris.
• Acanthosis nigricans: grey-brown, velvety discolouration of skin in areas of body folds/creases. 

What are the risks of PCOS?

PCOS is a complex syndrome with multi-system involvement. Untreated PCOS can have the same long term consequences as metabolic syndrome and diabetes. Potential complications can include type II diabetes mellitus, obesity, dyslipidemia, hypertension, cardiovascular disease, endometrial hyperplasia and cancer, infertility, sleep apnea, gestational diabetes, pregnancy induced hypertension, non-alcoholic liver disease, and thyroid conditions.

How can naturopathic medicine help me?

Naturopathic medicine focuses on the root cause(s) of disease, and takes into account the individual presentation, history, lab work and goals. The root causes of PCOS focus on addressing insulin resistance and optimizing blood sugar levels, underlying inflammation in the body, gut health and diet changes, stress and HPA axis dysregulation, androgen excesses, hormone balancing, and removing negative environmental exposures.

Talk to your doctor if suspect you may have PCOS. Proper diagnosis is necessary for effective treatment of symptoms. Stay tuned for PCOS – part II for a more in depth look at the root causes and treatment of PCOS.

Dr. Michelle Hislop