A Reflection on Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is a heterogeneous endocrine condition that is present in 12-21% of women of reproductive age. This endocrine disorder can encompass excessive androgen secretion or activity, and many women display abnormal insulin activity. The Rotterdam diagnosis of PCOS is the criteria used.  This condition must display two of the three following criteria to be diagnosed with PCOS; oligo/anovulation, hyperandrogenism (clinical: hirsutism, or male pattern alopecia, or biochemical: raised free androgen index, or free testosterone) and polycystic ovaries on ultrasound. On an ultrasound polycystic ovaries are diagnosed when 10 small antral follicles are seen in each ovary.

The aetiology of PCOS is not properly understood. A main causative factor can be insulin resistance that leads to hyperinsulinemia. Obesity is often seen in PCOS with central distribution of adiposity.  This central obesity is particularly harmful to ovarian function as it is associate with increased luteinizing hormone (LH), fasting insulin, oestrone and androstenedione. However not all women with PCOS are obese, but commonly women with PCOS are more insulin resistant and display excessive hyperinsulinemia in comparison to women without PCOS who are the same age with the same weight. Thyroid imbalances, lifestyle factors, and potential genetic predispositions also can play a role in the development of PCOS.

Various body systems are affected in PCOS which can result in multiple health complications which can include menstrual dysfunction, infertility, hirsutism, acne, metabolic syndrome and obesity.  There is an increase of type 2 diabetes developing in those with PCOS.  There are also theories that there is an increased risk of cardiovascular disease in PCOS sufferers.  The physical symptoms that are linked to PCOS can cause a decline in psychological wellbeing and sexual satisfaction.  Women with PCOS are at a greater risk for suffering depression, anxiety, disordered eating, psychosexual dysfunction and poor self-esteem. PCOS can severely affect a woman’s reproduction by increasing the risk of anoovulatory infertility, increasing the risk of miscarriage and increasing the risk of pregnancy complications. These reproductive challenges can put a huge amount of emotional stress and financial stress if methods like in vitro fertilization (IVF) are being tried on a couple who are trying to conceive.

 Management of PCOS should intend to prioritize both short and long term goals of the reproductive, psychological and metabolic characteristics of the PCOS patient.  The severity of the condition needs to be understood in order to manage the treatment goals properly.  The psychological factors of PCOS need to be acknowledged primarily to enhance the patient’s willingness to change, improve lifestyle habits (long-term) and strengthen the motivation towards improved health. If there is anxiety, depression or a declined emotional wellbeing these factors need to be addressed and rectified if possible.  If obesity or excessive weight is present it is vital to get the patient within a healthy weight range.  Regulating the female hormone profile and the menses cycles is another focal point in the treatment.  Management of insulin resistance, and blood sugar levels may help in the management of the hormonal imbalances.  As there is a risk of metabolic complications, supporting associating factors like lipid profile, cardiovascular system and liver wellbeing is necessary. If conceiving is a goal of the patient optimizing her chances and providing an optimal preconception health plan is prominent.  If a woman is exploring the possibility of IVF the treatment therapy should include ways to support the patient through this both emotionally, and physically.

There is not a specific optimal diet for PCOS but it would be recommend that it covered weight management, fertility health, and management of long-term risks like diabetes, cardiovascular disease and various cancers. As insulin resistance and compensatory hyperinsulinemia are characteristic aspects of PCOS, engaging in a low glycemic diet is advised. The low glycemic index (GI) diet will classify carbohydrate foods by their postprandial glucose response. Along with dietary adjustments there are specific herbs and supplements that can be used in the management of PCOS. Guidance from a qualified Naturopath is advised when using herbs and/or supplements.

Those with PCOS should be encouraged to exercise daily for a minimum of 30 minutes a day.  Yoga, pilates or walking could be good options for the patient to try as they will aid in weight loss, and alleviate some of the stress she may be experiencing. Stress management is important as there is a link between the endocrine pathways and the effects of stress on HPA/HPO axes.  Practicing yoga, meditation or breathing exercises is also recommended.

*References available on request.