Could You Have Polycystic Ovarian Syndrome (PCOS)?

Polycystic ovarian syndrome (PCOS) is the most common hormonal problem in women in the reproductive age group; one in every six women has the genetic tendency to develop PCOS.

In a normal ovary, a single egg develops and is released from the ovary each month. The release of the egg from the ovary is called ovulation. In polycystic ovarian syndrome (PCOS), normal ovulation is inhibited, and the eggs become trapped in the ovaries. This results in small fluid-filled sacs (cysts) in the ovaries. It is however possible for a woman to have PCOS without ovarian cysts and in this case, we diagnose it from the symptoms and the blood hormone test results. If ovulation does not occur, there will be a deficiency of progesterone production in the ovary.

Possible symptoms of PCOS

Weight excess – Up to 70 percent of patients with PCOS are overweight. Excess weight tends to accumulate in the abdominal area. A minority of women with PCOS are not overweight, and indeed may be underweight.
Hair loss – Excess levels of androgens (male hormones) can result in male-pattern hair loss and the hairline can recede at the forehead and temples and the hair thins at the crown of the head. This male pattern of hair loss is called androgenic alopecia and can often be helped with natural 10 percent strength progesterone cream and a topical hair lotion containing minoxidil and finasteride.
Acne and other skin problems – Skin tags may form in the armpits or on the neck. Skin discoloration with dark patches around the groins, neck and under the arms may occur and this is called acanthosis nigricans; it is a sign of insulin resistance (Syndrome X).
Excess hair growth – This may be noted on the face and around the nipples.
Ovarian cysts – Most women with PCOS, have multiple small cysts on their ovaries. An ultrasound scan of the ovaries will show an enlarged ovary with a circlet of small follicles around the outside of the ovaries. Severe cases may have larger multiple cysts.
The chemical imbalance of Syndrome X – PCOS is often associated with the metabolic imbalance called “Syndrome X.” Syndrome X is caused by insulin resistance and is found in around 60 percent of diagnosed PCOS cases. If the insulin resistance gets worse, the control of blood sugar levels becomes impaired, and this may lead to raised fasting blood glucose (sugar), elevated blood pressure and eventually type-2 diabetes.

Diagnosis of PCOS

It is recommended that all women diagnosed with PCOS should have a glucose tolerance test (GGT), in addition to a fasting blood glucose test. This is because many will meet the diagnostic criteria for prediabetes or diabetes based on the GTT, although their fasting glucose test registers normal levels. This is the more frightening aspect of this syndrome – the fact that a serious and undiagnosed condition such as diabetes or prediabetes, can be slowly brewing over many years when something could easily be done about it.

Blood tests to diagnose PCOS should include levels of:

Total testosterone and free testosterone and/or the Free Androgen Index (FAI)
Estrogen
SHBG (Sex Hormone Binding Globulin)
LH (Luteinising Hormone)
FSH (Follicle Stimulating Hormone)
A glucose tolerance test with accompanying insulin levels
Cholesterol and triglyceride levels
Fasting insulin

Is PCOS curable?

With proper diagnosis and treatment, most PCOS symptoms can be adequately controlled or eliminated.

Infertility can be corrected, and a healthy pregnancy achieved in most patients, although in some, the hormonal disturbances may recur, especially if the patient returns to an unhealthy lifestyle and dietary habits and becomes overweight.

The aims of treatment are to:

Reduce the levels of body fat, if the patient is overweight
Reduce elevated insulin levels and improve insulin sensitivity
Decrease elevated androgens
Reduce the effects of unopposed estrogen (estrogen dominance)

Diet for PCOS

Although insulin-sensitizing drugs, such as Metformin, can help those with PCOS, it is generally agreed that dietary changes remain the best strategy for long-term success. The achievement of a normal healthy body weight has been continually shown to be the most effective long-term approach in relieving the symptoms of PCOS. In many cases, it is not necessary to lose a lot of weight and it may be possible to regain regular ovulation and normal fertility with as little as an 8 percent reduction in body fat. The best diet to follow is one that is low in processed starchy carbohydrates and refined sugars. It can be most effective to avoid all added sugar and all grains such as wheat, rye, barley, oats, rice and corn. The diet should contain adequate amounts of first-class proteins from eggs, seafood, fresh meat, cheese, whey protein powder and organic poultry. The diet should be high in vegetables of the raw and cooked variety.

Orthodox treatment for PCOS

Metformin

Metformin has been shown in some studies to have a beneficial effect on menstrual regulation and has shown promising results in PCOS patients with hirsutism, but its effects on infertility and other PCOS symptoms are unknown. Whether the addition of insulin-sensitizing drugs like Metformin to a healthy diet and lifestyle changes, is of significant benefit, is still under debate. The herb berberine is effective in reducing insulin resistance and promotes weight loss and unlike metformin does not have any potential side effects. Talk to your weight loss detective about Berberine.

Hormone balancing for PCOS

Natural progesterone

Most women with PCOS are deficient in progesterone. Many of these patients can benefit from the use of natural progesterone in the form of creams, troches or capsules. Natural progesterone does not aggravate insulin resistance or cholesterol problems, whereas synthetic progestogens do. Natural progesterone does not increase weight and may help to relieve many of the symptoms of PCOS. Natural progesterone can help some women to lose weight, especially around the buttocks, hips, and thighs. Natural progesterone can restore a regular monthly menstrual bleed and reduce anxiety and depression that occurs during the premenstrual weeks. The use of natural progesterone will confer a protective effect on the lining of the uterus (endometrium) and thus reduce the risk of uterine cancer. Natural progesterone does not provide contraception and may increase fertility. For more information on progesterone talk to your Weight Loss Detective.

The oral contraceptive pill (OCP)

Many women diagnosed with PCOS will be put on the OCP to produce a regular menstrual bleed. The OCP can prevent the overgrowth of the uterine lining (endometrium) associated with progesterone deficiency; however, natural progesterone can achieve the same benefit. Unlike natural progesterone, the OCP does provide effective contraception. However, the choice of OCP is very important. Many OCPs on the market contain masculinized synthetic progestogens that actually worsen the excess androgen component of PCOS. Progestogens that are best avoided include norethisterone, norgestrel, and levonorgestrel because they are particularly androgenic. These androgenic progestogens will also worsen the other aspects of PCOS, such as insulin resistance and weight gain in some women.

Drospirenone is a new age progestogen that has anti-androgenic activities – it is combined with synthetic estrogen in the brand of the OCP called Yasmin and is useful in managing the symptoms of PCOS.

Other suitable feminine brands of the OCP for women with PCOS are – Diane, Brenda, Juliet, Femoden, Minulet and Marvelon, which contain a synthetic progesterone that acts against testosterone and can reduce acne.

Anti-male hormones (anti-androgens)

These drugs act by reducing the body’s production of androgens and reduce the effects of androgens in the body. Anti-androgen drugs may be used when androgenic symptoms (such as facial hair, excess body hair, balding and acne) are unresponsive to body fat reduction or oral contraceptive pills. It is vital that pregnancy is avoided when taking anti-androgen medications. It is for this reason that anti-androgens are usually combined with or are part of the OCP.

Examples of anti-androgens are Cyproterone acetate and Spironolactone (Aldactone) and require a prescription.