Polycystic Ovary Syndrome (PCOS) is a ‘riddle wrapped in a mystery inside an enigma’ (with thanks to Winston Churchill). This condition of hormone imbalance affecting up to 10% of women is widespread, poorly understood, under-diagnosed, under-researched and yet the cause of significant problems with health, fertility and mental well-being.
What is PCOS?
PCOS is a complex and yet common medical condition. PCOS symptoms include menstrual cycle irregularities, increased facial and body hair growth, acne, ovarian cysts, sub-fertility, metabolic issues that can lead to early onset Type 2 diabetes and significant psychological problems including depression and eating disorders such as bulimia (over-eating followed by purging or vomiting).
PCOS is the most common hormonal disorder in women of child-bearing age and it affects women of all ages from pre-puberty through to post-menopause. The mystery is why this condition, which would seem to be so disadvantageous for ‘Natural Selection’ and hence over Millenia of human evolution should have disappeared, has continued to be so common. Modern research is possibly helping to explain the enigma and suggests that although there is a genetic link ,as about one-third of women with PCOS have a female relative with the condition, life-style and other factors may influence whether this tendency develops into PCOS.
Possession of the ‘thrifty gene’, a genetic trait that permits a woman to derive much more energy from the food she consumes and therefore a tendency to put on weight easily that proves difficult to lose, may help to explain why PCOS has persisted in the human genome.
How can you tell if you have PCOS?
PCOS is sometimes difficult for even professional medics to diagnose because PCOS symptoms can be so varied and confusing, so making your own PCOS diagnosis may be challenging. The major signs and symptoms are infrequent or absent periods associated with anovulation, excess body hair, severe acne or male-pattern baldness associated with elevated levels of androgens (like testosterone) and an ultrasound scan may show multiple small cysts in the ovaries.
Many women who develop PCOS have problems with their weight and the severity of their symptoms of PCOS tends to increase as their weight increases. If you have PCOS losing weight can be extra difficult and this situation can rapidly spiral down into a vicious cycle of weight gain, comfort eating and, if it is an issue, sub-fertility.
Some women with PCOS do not have weight problems, they are known as ‘lean’ PCOS but they may still have the same issues with irregular periods, sub-fertility and excess hair growth.
The underlying problem is Insulin Resistance which affects 85% of PCOS women and this occurs when the body produces insulin but it cannot be used effectively. Insulin is a hormone that helps regulate blood sugar by moving glucose into cells for energy. High insulin levels can cause the ovaries to produce too much testosterone and this disrupts hormone signals from the brain that normally trigger ovulation.
What to do if you think you have PCOS?
According to the World Health Organisation (WHO) as many as 70 % of women with PCOS go undiagnosed and many wait too long for a diagnosis. If you think you may have PCOS, even if your symptoms are quite mild, it is important to speak to your GP. Many disorders can mimic PCOS symptoms such as thyroid disease and over production of Prolactin hormone and so it is important to get the right diagnosis.
A complete medical history and physical exam are critical for diagnosing PCOS and your GP can arrange the blood tests (for oestrogen, Follicle-stimulating hormone, Luteinising hormone, Testosterone and Progesterone). The GP may also test your blood sugar, thyroid hormone and prolactin levels and arrange a pelvic ultrasound scan to look at your ovaries and check for cysts.
Having PCOS is a life-time diagnosis, but if you maintain a normal weight (BMI 20-25), take regular exercise and avoid high fat and high sugar foods in your diet you can expect a normal healthy life.
Share your knowledge about PCOS with female members of your family and your friendship group as everyone needs to know how to avoid the Type 2 diabetes, high blood pressure and cardiovascular problems that are associated with having PCOS.
What could help if you have PCOS?
Treatment for PCOS aims to reduce the health risks, improve lifestyle and deal with specific problems such as hirsutism and subfertility.
Dietary and physical therapies and lifestyle changes are highly recommended for PCOS and are very effective. Exercise and calorie-restrictive diets are the best first-line interventions for weight loss in overweight PCOS women and adolescents. Exercise can help reduce insulin resistance, body weight and glucose levels and, importantly boost self-esteem.
Many studies have shown that a reduction in BMI of about 10% (i.e. from 34 to 30) is enough to re-start ovulation in the majority of overwight PCOS women.
If menstrual irregularity and symptoms of hirsutism or acne are your major problem then a hormonal contraceptive containing an anti-androgen will be helpful. If fertility is your biggest concern then anovulation can be treated surgically with laparoscopic ovarian drilling (which requires a general anaesthetic) or with tablets such as Clomiphene Citrate which boost ovulation by raising FSH levels.
Many women with PCOS choose to take a more natural approach to managing their symptoms. Women with PCOS often experience widespread inflammation, which is linked to heart disease and other health issues. The Mediterranean diet, which excludes saturated fats, processed meat and refined sugars is an effective way to combat inflammation. The ketogenic diet is a high fat, low carbohydrate diet and a recent study showed that a short-term keto diet may help improve hormone balances associated with PCOS.
Medicinal herbs such as Chasteberry (agnus castus), turmeric (curcuma) and flaxseed (Linum) have shown some small evidence of benefit in PCOS, but of the nutritional supplements, Inositol or Inofolic Alpha and Inofolic AlphaPlus has been shown to help reduce BMI and significantly reduce the risks associated with PCOS in pregnancy.
Inofolic Alpha and Inofolic Alpha Plus both have a unique formulation that includes ‘alpha-lactalbumin’ a whey milk protein, which improves the intestinal absorption of myo-inositol in PCOS women. Up to 38% of PCOS women struggle to absorb myo-inositol from food sources or supplements alone, which is why the addition of alpha-lactalbumin is so important.
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Conclusion
If you have PCOS you are not alone! You have inherited the genes that predispose you to PCOS just as your genes determined the colour of your eyes. Your problems with weight, irregular periods, mood swings and hair growth are not your fault. But you can take some measures to minimise the symptoms. Avoid smoking and excessive drinking, maintain a healthy weight, eat a balanced diet and reduce sugar, salt and caffeine and exercise regularly, ideally getting 150 minutes of exercise a week.
