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Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting approximately 5-10% of this population. The diagnostic criteria, known as the Rotterdam criteria suggests a diagnosis if 2 or more of the following are present:

  • Oligo-ovulation or Anovulation – Oligo-ovulation is irregular ovulation, which is typically characterized by menstrual cycles longer than 35 days in length. Anovulation is the lack of ovulation, and therefore absent menstrual cycles.
  • Hyperandrogenism – this can be biological (increased androgens on serum blood testing – testosterone, DHEA-S and androstenedione) or clinical (having symptoms associated with increased androgens such as acne, abnormal hair growth or thinning hair on the scalp)
  • Polycystic Ovaries on Transvaginal Ultrasound – this is typically characterized by 25 or more cysts per ovary or an ovarian volume of 10mL or more.

Because only two of these criteria are required in order to be diagnosed with PCOS, there are several combinations that can occur. For example, you can have Ovulatory PCOS in which you have normal ovulatory cycles, but have symptoms of hyperandrogenism and have confirmed polycystic ovaries. Another example includes Non-Polycystic Ovaries in which someone may have abnormal ovulation and hyperandrogenism, but do not have confirmed cysts on their ovaries. Therefore, you are able to meet the criteria of Polycystic Ovary Syndrome without having polycystic ovaries.

It used to be thought that there was a specific phenotype for PCOS that included obesity, abnormal hair growth, acne male pattern baldness etcetera. However, today there are many presentations of PCOS which may include all or very few of these characteristics. Some of the common symptoms of PCOS include:

  • Irregular menstrual cycle
  • Acne
  • Weight gain
  • Hirsutism – abnormal hair growth in areas of the body which may include the chin, neck, abdomen, chest, back, hands etc.
  • Oily skin
  • Thinning hair on the scalp
  • Acanthosis Nigricans – dark patches of skin in the armpits, on the neck or between the breasts

The “cysts” that are often visualized in PCOS aren’t actually fluid filled cysts, but are rather clusters of immature follicles in the ovary. In a normal cycle, each month there are follicles that develop, grow and mature and the dominant follicle contains the egg that is then ovulated and is either fertilized or shed through the menstrual cycle. Since the follicles never fully develop in PCOS, ovulation often does not occur and therefore fertility is reduced.

Additionally, women with PCOS may experience some level of insulin resistance. This means our cells are not as sensitive to insulin as they should be and therefore it is not utilized appropriately. This leads to blood sugar dysregulation in which glucose is not adequately transported into cells via insulin, leading to higher than normal blood sugar levels after meals, similar to what is seen in a patient with diabetes. Because of this imbalance, women with PCOS often experience weight gain or difficulty losing weight. There is also an increased risk for cardiovascular disease and the development of type 2 diabetes.  Insulin resistance may also have negative effects on ovulation, which is often already suppressed in patients with PCOS due to hormonal imbalance and elevated androgens.

Another risk factor that should be taken into consideration in patients with PCOS is endometrial cancer due to endometrial hyperplasia. Basically, because these patients are not ovulating, or aren’t ovulating as frequently as they should be there is often a low level of progesterone . Progesterone is the hormone that is released from the corpus luteum – which is the empty follicle in the ovary after the egg has undergone ovulation out of the ovary. When there is low progesterone relative to estrogen, our uterine lining builds but is never shed (hence, no menstrual cycle). After several months of the lining building and not shedding there is an increased risk for abnormal cellular growth. Therefore, these women are often recommended to shed their lining approximately every 3 months through a drug-induced cycle prescribed by their Medical Doctor to reduce this risk.

The conventional treatment options for PCOS include metformin which is a drug often used in diabetic patients and can address insulin resistance, the birth control pill which will create a menstrual cycle but still suppresses ovulation and drugs that lower androgens such as spironolactone to reduced symptoms of hyperandrogenism such as acne and hirsutism (abnormal hair growth).

There are also many Naturopathic treatment options that have shown to be successful in cases of PCOS. These include:

  • Diet – a low glycemic diet is beneficial in PCOS patients because it helps to control blood glucose levels, which is important when there is insulin resistance or insensitivity. Often times this diet includes no added sugars, especially processed sugar, processed foods and refined carbohydrates such as white breads, rice or pasta. A diet rich in healthy fats (coconut oil, avocados, nuts – almonds and walnuts have been studied to be beneficial, olive oil, salmon etc), vegetables (especially green leafy veggies), fruit (try to focus on low glycemic fruit such as berries rather than sweeter fruit such as grapes or pineapple), and lean protein (chicken, turkey) or legumes will help keep blood sugar levels stable. Flax seeds can be beneficial as they are phytoestrogenic and can help decrease symptoms of hyperandrogenism. Soy can also be consumed in moderation as it may regulate female hormone levels by increasing a hormone that binds testosterone. It is recommended to lower the carbohydrate intake and focus on healthy carbs such as sweet potato, quinoa or brown rice, and there also may be benefit in reducing or eliminating the amount of dairy in the diet.
  • Supplements – There are many supplements that can be used for PCOS patients, however they are individualized depending on the case, so it is important to visit a Naturopathic Doctor before changing anything about your daily routine. A few include:
    • Myo-inositol – can improve insulin resistance and can improve egg quality and ovulation rates.
    • N-Acetyl-Cysteine – assists in regulating the menstrual cycle, improves insulin resistance, improves egg quality and improves lipid profiles. In some studies NAC has been shown to be comparable to Metformin at improving hyperandrogenism and insulin resistance, and may be superior at improving blood glucose, insulin and lipid profiles.
    • CoQ10- supports egg quality
    • Vitamin D – low levels are associated with metabolic and endocrine disturbances.
  • Botanicals
    • Vitex agnus castus – this herb can help to increase progesterone that is often low in PCOS patients and can assist in achieving more normal ovulatory patterns.
    • Tribulus terrestris – assists in inducing ovulation
    • Spearmint tea – lowers androgen levels which assists in the reduction of acne lesions
  • Exercise – moderate intensity physical activity can improve insulin resistance, assist in weight loss, improve ovulation and elevate mood. It is also beneficial for overall wellbeing and cardiovascular health.
  • Avoid Endocrine Disrupting Chemicals – Although it is extremely hard to avoid endocrine disrupting chemicals such as parabens, phthalates, BPA, propylene glycol, triclosan, sodium laurel sulfate etc. it is important to make an effort to reduce your exposure because these chemicals can worsen endocrine imbalances. Try to reduce the amount of plastic you use and use more natural, chemical-free cleaning products and cosmetics. Environmental Working Group is a great resource for finding safe products that don’t contain these endocrine disruptors.

PCOS is a very complex condition that can manifest differently in every individual. Some people may have more metabolic imbalances while others may have more emphasis on hyperandrogenism, inflammmation, environmental toxic exposure or stress. It is important to seek appropriate care from your Medical Doctor and Naturopathic Doctor in order to receive a treatment protocol that is specific to your case. *This article is for educational purposes only. Do not change anything in your daily routine without the recommendation from a healthcare professional.*


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