What is Polycystic Ovary Syndrome?

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting about 1 in 10 individuals with female reproductive organs worldwide. PCOS develops as a result of hormonal signal disruptions between the ovaries, the hypothalamus, and the pituitary gland. The disruption leads to excess androgen hormone levels (hyperandrogenism), presence of cysts on the ovaries (polycystic ovarian morphology), and irregular menstrual cycles (ovulatory dysfunction).

Symptoms

Symptoms for PCOS vary with age; the severity of the disorder can also be affected by environmental and geographical factors, which influence the genetic variants of how PCOS manifests in different races.

1–5 Common symptoms include:

• Acne

• Irregular menstrual cycles (few, irregular, or long)

• Infertility

• Hirsutism (excessive growth of hair on the face, back, abdomen, legs in a male pattern)

• Weight gain around the abdomen, larger waist circumference in women (typically caused by some insulin resistance)

• Appearance of small cysts on the ovaries

PCOS is also associated with an increased risk for:

• Endometrial hyperplasia (a pre-cancerous condition due to abnormal thickening of the uterine lining)

• Cancer (endometrial and ovarian cancer being most common)

• Dyslipidemia (e.g., high cholesterol)

• Type II diabetes mellitus

• Obstructive sleep apnea

• Depression

• Anxiety

Diagnosis

PCOS diagnosis is difficult and often delayed due to symptom overlap with other chronic conditions and disorders such as diabetes, Cushing's syndrome, thyroid disease, hyperprolactinemia (elevated prolactin levels), non-classic congenital adrenal hyperplasia (genetic disorder affecting adrenal glands) and hypogonadotropic hypogonadism (low production of sex hormones). 

To date, there are three different classification systems for PCOS: 

1. The Rotterdam Criteria (most widely used system for diagnosing PCOS);

2. National Institutes of Health Criteria

3. Androgen Excess and PCOS society.

Using the Rotterdam Criteria, PCOS is confirmed when at least two out of the following three conditions are present: 

• Hyperandrogenism

• Polycystic appearing ovaries

• Ovulatory dysfunction

There are no specific diagnostic tests to confirm PCOS. Most commonly, PCOS is determined by an endocrinologist through clinical observation of physical symptoms, ultrasound imaging of the pelvis, and optionally a pelvic exam performed by a gynecologist (for adult patients), and blood tests for hormone levels:

• Estrogen (estradiol) to detect levels during menstrual cycle

• Progesterone to detect ovulatory dysfunction

• Testosterone and dehydroepiandrosterone sulfate (DHEAS) to detect hyperandrogenism

• Cortisol to test for Cushing’s syndrome

• Thyroid stimulating hormone (TSH) to test for thyroid disease

• Prolactin to test for hyperprolactinemia

Treatment

Once PCOS is diagnosed, treatment options are tailored to the individual’s needs to manage symptoms and improve their quality of life. Treatments can include one or more of the following therapies:

Hormonal Treatments:

• Estrogen-progestin oral contraceptives

• Progestin therapy

• Progestin-releasing intrauterine devices (IUDs)

Other Drug Treatments:

• Spironolactone (anti-androgen medication, can help hinder androgen production in PCOS patients)

• Clomiphene (a selective estrogen receptor modulator (SERM) that stimulate the ovaries to release an egg)

• Letrozole (stimulates the ovaries to release an egg)

• Insulin sensitizers (e.g., metformin)

Acne Treatments:

• Topical treatments

• Oral antibiotics

• Oral isotretinoin

Surgery:

• Bariatric surgery (for weight reduction of morbidly obese PCOS patients)

• Laparoscopic surgery (ovarian drilling to remove some ovarian tissue to improve symptoms and ovarian function)

Natural Health Products and Herbal Remedies: 

• Inositol (Myo-inositol and D-chiro-inositol) this is particularly effective and used by naturopaths to regulate menstrual cycles and insulin resistance

• True cinnamon tree (Cinnamomum verum) to reduce insulin resistance

• Chasteberry or monk’s pepper (Vitex agnus-castus) for normalized menstrual cycles and increased progesterone

• Liquorice (Glycyrrhiza glabra) to decrease testosterone

• Spearmint tea (Mentha spicata) to decrease testosterone and appearance of hirsutism

• Flaxseed (Linum usitatissimum), Hemp Hearts and Chia Seeds as sources of lipo-flavonoids

 For some herbal remedies, there has not been enough clinical research to prove the health benefits such as for Ginseng saponin and aloe-vera, which have only been tested in mouse models thus far.

 Lifestyle changes:

• Adequate sleep

• Daily physical activity of moderate intensity (e.g., walking, yoga, weight training)

• Balanced nutrition (e.g., sustainable eating patterns, managing sugar intake, food-tracking app to stay consistent and aware of what you are eating)

 Wellness Treatments:

• Meditation and relaxation therapy

• Hair removal treatments such as waxing, electrolysis, laser

• Hair transplantation

• Acupuncture

PCOS symptoms and severity of the disorder varies from one individual to the next. Consult with your doctor to choose the most appropriate symptom management strategy according to your symptoms, health history and personal preferences.