Polycystic Ovarian Syndrome (PCOS)

PCOS is the most common endocrine disorder found in women, affecting 6 to 9% of all females.

The name PCOS isn’t very helpful because the ovaries in PCOS aren’t actually cystic. What is being referred to, is an increase in immature follicles in the ovary as seen on ultrasound. To complicate things even further, many women with PCOS don’t actually have “polycystic” ovaries, and it isn’t necessarily a requirement for diagnosis. That said, 16-25% of women without PCOS have polycystic appearing ovaries without consequence.

So, what is PCOS?

PCOS is a syndrome encompassing a constellation of symptoms with hyperandrogenism (male hormones) at its centre, often leading to menstrual cycle disturbances such that ovulation doesn’t occur, is delayed, or occurs infrequently resulting in irregular periods and fertility issues. In many cases, but not all, insulin resistance is present making matters worse.

To make a diagnosis of PCOS, only 2 of the 3 criteria need to be present:

  1. Oligo-ovulation (infrequent/irregular ovulation) and/or anovulation (absent ovulation)

  2. Symptomatic features, or biochemical evidence (bloodwork), of excess male hormones

  3. Presence of multiple follicles or “polycystic ovaries”

Common signs and symptoms of PCOS include:

  • Irregular or absent periods

  • Excessive unwanted hair growth on the face, chest, back, thighs, etc.

  • Hair loss from the head

  • Cystic acne or acne affecting the jawline

  • Weight gain

  • Difficulty getting pregnant due to infrequent ovulation

Untreated PCOS may also be associated with an increased risk for other conditions such as:

  • Diabetes, insulin resistance, and impaired glucose intolerance

  • High cholesterol, high blood pressure, and heart disease

  • Hypothyroidism

  • Endometrial cancer and ovarian cancer

And conditions other than PCOS can present with similar symptoms:

  • Adrenal hyperplasia

  • Hypothyroidism

  • Prolactinemia

  • Hypothalamic amenorrhea

  • Post-pill syndrome (related to oral contraceptive use)

Treating PCOS

During your initial visit your Naturopathic Doctor will develop a complete picture of your symptoms and order any necessary bloodwork to confirm a diagnosis.

A step-by-step plan will begin to take shape with specific recommendations designed to have the most impact for you, taking into consideration any other health concerns you may have - connected or not to PCOS. Strategy building may include nutritional counselling and meal planning to treat/prevent deficiencies, evidence-based herb or supplement recommendations to address hormones, digestion, etc. as well as lifestyle wellness recommendations.

 

Androgens are “male hormones” produced by the ovaries, adrenal glands, adipose (fat) tissues, and skin.

They include hormones such as testosterone, androstenedione, DHEA/DHEAs, and DHT, and they are often at the root of symptoms such as excess hair growth (hirsutism), hair loss, and cystic acne for patients with PCOS.

Lab Tests

A thorough work-up is an integral part of establishing a clear diagnosis and determining the best treatment strategy.

Blood and lab work may include:

  • Day 3 LH and FSH

  • Estradiol

  • Progesterone

  • Prolactin

  • Total and free testosterone

  • Androstenedione

  • 17-OH progesterone

  • DHEAS

  • am cortisol, 24 hour urinary cortisol, or late night salivary cortisol

  • Sex Hormone Binding Globulin

  • Fasting glucose and insulin

  • HbA1c

  • Thyroid panel including TSH, free T4, free T3, and thyroid antibodies

  • Anti-mullerian hormone

  • CA-125

  • Salivary hormones

  • Urinary hormone metabolites

  • Vitamin D status