Everything You Need to Know About PCOS

Polycystic Ovarian Syndrome (PCOS) affects 1 in 10 women of reproductive age worldwide, and 8-13% of Australian women of reproductive age.

Most of my clients who have been diagnosed with PCOS (or suspect having PCOS), have very little idea about what it actually is, or how it may impact their health. Aside from the obvious symptoms they experience - irregular periods, acne, infertility, weight gain or difficulty losing weight, unwanted hair growth, alopecia (hair loss on the scalp).

Whilst PCOS is the most common endocrine (hormonal) condition worldwide, most Doctors don't understand it and generally only give their patients 3 options - Metformin, the oral contraceptive pill, or "come back when you want to fall pregnant" - none of which are long-term solutions for PCOS. 

On top of that, The Journal of Clinical and Endocrinology & Metabolism states it can take 2 years and multiple Doctors to even get a diagnosis for a lot of women.

There is no cure for PCOS, however it is possible to reverse the symptoms of PCOS so it no longer rules your life.

In this article, I'll share with you everything you need to know about PCOS so you understand your body better. Because knowledge is power. And with knowledge you can take action on transforming your life.

What is PCOS?

PCOS doesn't just affect the ovaries but is a systemic metabolic, endocrine and inflammatory disorder of hormone imbalances, which genetics, environmental and lifestyle factors play a role. PCOS women have excess levels of androgen hormones which cause the symptoms of PCOS. 70-80% of PCOS women also have high insulin or insulin resistance, which can cause weight gain and difficulty losing weight. The hormone imbalances in PCOS can lead to infertility and increase the risk of type 2 diabetes, metabolic syndrome and cardiovascular disease. 

However, nutrition and lifestyle strategies can restore the balance of hormones to not only reverse PCOS symptoms and lower the risk of chronic diseases, but also support a regular healthy menstrual cycle and ovulation to help you fall pregnant with PCOS and have a healthy pregnancy and baby.

What are the symptoms of PCOS?

PCOS shows up differently for each woman. It is often categorised into 4 "PCOS types" that help us understand and manage the underlying causes. These are the most common symptoms:

• Irregular or infrequent menstrual cycles (>35 days). Periods might also be light or heavy.
• Weight gain and difficulty losing weight
• Acne and hormonal skin breakouts
• Darkening of hair and unwanted hair growth
• Alopecia (thinning hair/loss on the scalp)
• Skin tags
• Acanthosis Nigricans (thickening/darkening of skin patches)
• Fatigue
• Difficulty falling pregnant
• Pregnancy complications including higher risk of gestational diabetes
• Anxiety, depression, mood changes
• Low stress tolerance
• Difficulty sleeping / insomnia

How to get formally diagnosed with PCOS

A Doctor will need to formally diagnose PCOS (a GP may refer you to an endocrinologist, or diagnose it themselves following tests). Diagnosis is based on the presence of at least 2 of the following 3 (called the Rotterdam Criteria):

1. Hyperandrogenism: excess levels of androgen hormones (testosterone, DHEAs, androstenedione or a combination), found either via blood tests or symptoms of androgen excess (acne, facial hair or alopecia).
2. Oligomenorrhoea: irregular menstrual cycles longer than 35 days, sometimes no periods for months or years (hypothalamic amenorrhea or other causes needs to be ruled out here).
3. Polycystic ovaries: found via ultrasound. This could be one or both ovaries with 12 or more follicles, or measuring 10mL or more.

PCOS isn't the same as ovarian cysts. In fact, the name is misleading - there are no "cysts" on the ovaries, but excess follicles (eggs) that haven't matured due to hormonal imbalances. 

Further tests for PCOS

There are a number of other tests that can (and should in my opinion) be done to:

1. rule out other causes of irregular periods and symptoms (I often see hypothalamic amenorrhea, thyroid conditions such as Hashimoto's and Endometriosis alongside PCOS);
2. Understand the underlying causes of PCOS so we can effectively manage those for PCOS symptom reversal.

These tests include:

• fasting insulin and fasting glucose (having both means calculating HOMA-IR score which is a score of insulin resistance - which 70-80% of PCOS women have)
• FSH:LH ratio (taken day 2-3 of the menstrual cycle) - ideally this should be 1:1 ratio but most PCOS women will have higher LH which increases androgen production in the ovaries
• oestrogen (taken day 2-3 of the menstrual cycle) - PCOS women often have high or low oestrogen
• progesterone (taken 14 days before expected next period / after ovulation if you are charting your cycle and know how to check for suspected ovulation
• free and total testosterone, DHEA-S, androstenedione (androgen hormones) - knowing which androgens are high helps us understand whether excess androgens are being made in the ovaries (often triggered by high insulin) or adrenal glands (triggered by stress) so we can treat the underlying causes
• Sex Hormone Binding Globulin (SHBG) - this binds up excess hormones so if this is low, excess hormones are free to roam the body and cause more symptoms
• Prolactin - symptoms of high prolactin are similar to PCOS symptoms
• Thyroid panel (TSH, T4, T3, reverse T3, TPO Ab, Tg Ab)

How to manage PCOS

PCOS can feel overwhelming and stressful. It can feel like your body is working against you. But nutrition and lifestyle strategies are the first line treatment for PCOS. Even small to modest changes can help to lower androgens and insulin, restore hormone balance and ovulation to reverse the symptoms of PCOS. So you don't need to feel like PCOS is ruling your life.

For qualified advice and support for PCOS, Heal Your PCOS will give you everything you need to manage and reverse your PCOS and transform your health and life. I'd be honoured to guide you on your journey.