What is Poly Cystic Ovary Syndrome (PCOS)?

Poly cystic ovary syndrome (PCOS) is a common hormonal condition that affects up to 1 in 10 girls and women in their reproductive years. PCOS is a whole body (endocrine) disorder. Despite the name, PCOS has absolutely nothing to do with cysts on the ovaries. Poly cystic ovaries are different from ovarian cysts, which are abnormal structures that can burst and cause pain.

Ovarian cysts are not poly cystic ovaries. The things you and your doctor saw on your ultrasound are follicles or eggs, which are normal for the ovary. You can have many eggs and still have normal hormones, and that’s why ultrasound cannot diagnose (or rule out) the hormonal condition PCOS.

The most common sign of PCOS is infrequent, irregular or prolonged menstrual cycles. Pain is not associated with PCOS although most people report pain as one of their symptoms.

"PCOS is the endocrine condition of having high androgens or male hormones—when all other causes of high androgens have been ruled out. It’s not a gynecological disease affecting the female reproductive organs." Lara Briden

To treat PCOS, you need to know what’s driving it. In other words, you need to know your functional type of PCOS.

There are four functional types of PCOS

1. Insulin-resistant PCOS
2. Post-pill PCOS (which is temporary)
3. Inflammatory PCOS or
4. Adrenal PCOS which is far less common than the other types

Determining your PCOS type is to ask the question “Is it really PCOS?”

It is really PCOS if you have some signs of androgen excess, such as:

• Irregular menstrual cycle 
• Excess body and facial hair 
• Acne and oily skin 
• Mood changes and fatigue 
• Fat storage around the mid-abdomen 

PLUS other reasons for androgen excess have been ruled out such as:-

• Oral contraceptives (birth control pills)
• Congenital adrenal hyperplasia (which accounts for up to 9 percent of cases of androgen excess) and
• High prolactin levels interfere with the normal production of other hormones, such as estrogen and progesterone. This can change or stop ovulation (the release of an egg from the ovary). It can also lead to irregular or missed periods. Some women have high prolactin levels without any symptoms.

Insulin Resistance PCOS

70 percent of PCOS diagnosis are insulin resistant PCOS. Insulin resistance means having high levels of insulin in your system. It’s also referred to as metabolic syndrome or pre-diabetes. The best way to test for insulin resistance is to measure the hormone insulin (not glucose).

If your insulin is high, then you have insulin resistance and insulin-resistant PCOS. This causes weight gain and belly fat - it can be difficult to lose this weight as nothing you can do seems to shift it.

Insulin testing is one of the tests that I organise through my clinic as insulin resistance is a concern in women over the age of 40. Insulin resistance is very common in perimenopause and heading into menopause.

A blood test for blood glucose or HbA1c is not a test for insulin resistance these are important and insulin needs to be ordered as well. 

Post Pill PCOS

Post pill PCOS is also know as Post Birth Control Syndrome (PBCS) which I also treat in clinic. This is pretty common for women coming off birth control and is usually a temporary condition as your body is processing (detoxing) the side effects of being on birth control.

It’s pretty common to experience a temporary surge in androgens when coming off a drospirenone or cyproterone pill like Yasmin, Yaz, Diane, or Brenda.

Under current diagnostic guidelines, that temporary surge in androgens is enough to qualify for the diagnosis of PCOS or post-pill PCOS. 

If you have had irregular periods being prescribed birth control is not the answer as it does more harm than good. We need to find the 'real' reason why you are having irregular cycles. Some girls can take up to twelve years to have a normal, regular menstrual cycle. 

Inflammatory PCOS

Chronic inflammation can stimulate the ovaries to make too much testosterone (androgens) and is a contributing factor for every type of PCOS.

When chronic inflammation is the primary factor or driver, it’s inflammatory PCOS.

The treatment for inflammatory PCOS is to identify and correct the underlying source of inflammation. That could mean avoiding a food sensitivity such as dairy, or fixing an underlying gut problem or addressing chronic mast cell activation or histamine intolerance. 

If you have a history of a viral infection/s such as, Epstein-Barr Virus (EBV)  (Glandular Fever), Varicella Virus (Chickenpox, Shingles), Ross River Virus, Herpes Simplex 1 & 2 (Cold Sores and/or Genital Herpes), Human Papillomavirus infection (HPV), Corona Virus and many more you will have an history of inflammation as your body is continually fighting the effects of those viral infections. Please note that your body cannot get rid of viral infections such as the above as they lay dormant in your body until a 'stressor' triggers a flare up.

Stress and long term stress is inflammatory and can definitely affect your menstrual health.

You have inflammatory PCOS if you meet the criteria for PCOS, plus you do not have insulin resistance, plus you’re not in a temporary post-pill phase, plus you have signs and symptoms of inflammation, as follows:

• Unexplained fatigue
• Bowel problems like IBS (irritable bowel syndrome) or SIBO (small intestinal bacterial overgrowth)
• Headaches or migraines
• Joint pain
• A chronic skin condition like psoriasis, eczema, or hives

Adrenal PCOS

Adrenal PCOS accounts for 10 percent of PCOS diagnosis and is not driven by insulin resistance or inflammation. Instead, it’s an abnormal response to stress. In response to stress, the adrenal glands are stimulated to produce cortisol, adrenaline, and noradrenaline, as well as adrenal androgen hormones, including DHEA, DHEA-S, and androstenedione.

As mentioned above, elevated androgen levels is one of the primary diagnostic criteria for PCOS. Most women with PCOS have a hormonal elevation of all androgens including testosterone and androstenedione from the ovaries and DHEA-S from the adrenal glands.

Hypothalamic Amenorrhoea  

Having irregular periods (or no periods) could mean you have PCOS, or it could mean you have hypothalamic amenorrhoea, which is lack of periods due to under eating or under eating carbs. This is common in female athletes, models or women with an eating disorder.

You can have polycystic ovaries with hypothalamic amenorrhea or under eating. That means you could have been mistakenly told that you have “lean PCOS” when you actually have hypothalamic amenorrhea.

Pain and PCOS

As mentioned above, pain is not caused by PCOS even though some women report pain prior to getting their period. Possible causes of pelvic pain include:

• Primary dysmenorrhea (normal period pain)
• Endometriosis 
• Adenomyosis 
• Fibroids
• Ovarian cysts
• Interstitial cystitis
• STDs
• Pelvic Inflammatory Disease (PID)
• Pelvic floor dysfunction
• Digestive problems.

These will need to be diagnosed by your GP or specialist. Once diagnosed they can all be treated naturally through diet, lifestyle, herbal medicine and supplements. 

I have worked with several women over the past 12 months who have had PCOS and have successfully fallen pregnant which has been a beautiful outcome for all involved. 

Programs available in clinic

• PCOS Dietary Program
• Hormonal Balance Program

• Plant Based
• Vegan
• Pescatarian
• Meat Lovers

Are you wanting to find out how I can help you overcome your PCOS?

You are welcome to give me a call - book your 15 minute Health Information call through my booking link or if you're ready to get on top of your PCOS please book your consultation - in clinic or online via zoom.

Book Your Consultation Today – Katrina Froome Naturopathy

Yours in health and wellness

Katrina xxx