Polycystic ovarian syndrome (PCOS) is now thought to be the most common endocrine disorder found in women¹, with prevalence in Canada of about 10%. As many as 75% of those with PCOS are unaware that they have it but it is an important underlying cause of insulin resistance and infertility.

The most common symptoms are irregular menstrual cycle (periods), increased facial and body hair, and cysts located on the ovaries. These three symptoms make up what is known as the “Rotterdam Criteria” and a patient requires two out of three of them to qualify for a diagnosis of PCOS².  

Rotterdam Criteria for PCOS – Patients require two out of the following:

1. Hyperandrogenism: increased hair growth, acne, male-pattern baldness
2. Oligo- or anovulation: irregular menstrual cycles possibly with no ovulation
3. Polycsytic ovaries: multiple cysts located on the periphery of the ovaries

A female’s eggs are stored in follicles within her ovaries. The pituitary gland located within the brain directly instructs your ovaries to release and egg by secreting luteinizing hormone (LH) and follicle stimulating hormone (FSH). When these hormones reach the ovaries, immature eggs start to mature and expand the follicles in which they are encased. These growing follicles then secrete the hormone estrogen. Once levels of estrogen reaches a certain threshold, it triggers the pituitary gland to send a surge of LH to the ovaries. This surge, causes the dominating follicle to burst open and release its egg in a process called “ovulation”. This cycle helps maintain an appropriate and healthy hormonal balance in females. 

In PCOS, the pituitary gland releases abnormally high amounts of LH, therefore disrupting the menstrual cycle . As a result, follicles do not mature and ovulation will not occur. This leads to the infertility commonly seen amongst those with PCOS. Some of the follicles do not dissolve and remain as fluid-filled sacs on the ovaries called cysts. These follicles are capable of growing in size and consequently lead to considerable pain, especially if they burst.

In addition, there is a heavy correlation with PCOS and hyperinsulinemia (high levels of insulin)¹. Insulin is a hormone produced by the pancreas that helps control our blood sugar levels. Chronic release of insulin can lead to the body no longer responding to it in a process known as “insulin resistance”. This is problematic for a number of reasons including an increased risk of type 2 diabetes, heart disease and dyslipidemia³.

Together, elevated levels of LH and insulin can also increase the body’s production of the hormone testosterone. Although testosterone is normally found in females in trace amounts, too much testosterone can prevent ovulation. The higher levels of testosterone can also cause many of the physical symptoms associated with PCOS such as acne and unwanted hair growth, especially around the jawline, chest and abdomen.

Understanding the hormonal and metabolic changes allows us to help correct the imbalances seen in PCOS and those commonly masked by birth control pills. Naturopathic medicine can address these disruptions through appropriate supplements, acupuncture, as well as dietary and lifestyle changes. These treatments have been shown to significantly improve overall health and fertility. If you have PCOS or think you might qualify for a diagnosis consider talking to a naturopathic doctor about what they can offer to support you.

References:

1. AG N, KA A. Polycystic Ovarian Morphology is Associated with Hyperandrogenemia and Insulin Resistance in Women with Polycystic Ovary Syndrome (PCOS). J Steroids Horm Sci. 2016;07(01). doi:10.4172/2157-7536.1000169
2. Lee H, Sung Y. Diagnosis and Treatment of Polycystic Ovary Syndrome. Journal of Korean Endocrine Society. 2007;22(4):252. doi:10.3803/jkes.2007.22.4.252
3. Otaghi M, Azami M, Khorshidi A, Borji M, Tardeh Z. The association between metabolic syndrome and polycystic ovary syndrome: A systematic review and meta-analysis. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2019;13(2):1481-1489. doi:10.1016/j.dsx.2019.01.002