PCOS - A Naturopathic Perspective
Polycystic Ovary Syndrome is a complex endocrine disorder affecting up to 15% of women and AFAB people of reproductive age. It’s the most common endocrine disorder in people of this age group and a major cause of infertility. It also increases the risk of other health conditions, including cardiometabolic disorders and mental health issues, and even increased risk of endometrial cancer. Unfortunately, PCOS is also poorly understood and often misdiagnosed. So, what is it really and what causes it? This blog post takes a deep dive into all things PCOS, to help you better understand this syndrome and how it affects your health.
What is PCOS?
It’s important to remember that PCOS is a syndrome, not a disease. This means that rather than being a clearly defined condition, it is actually a constellation of different symptoms that often co-occur. There isn’t a single clearly defined cause and the condition can present quite differently for different people. Even the name “PCOS” is misleading, as it suggests ovarian cysts are a major manifestation of the disease (spoiler alert: PCOS and ovarian cysts aren’t even the same thing!)
So, what is PCOS? PCOS is essentially an imbalance of oestrogen and androgens, with elevated androgens leading to a variety of symptoms that affect reproductive/ menstrual function, metabolism and physical appearance. The signs and symptoms of PCOS are diverse and can vary widely, but some of the most common include:
Irregular menstrual cycles (or no menstruation at all)
Hirsutism (facial and chest hair growth)
Acne
Hair loss
Weight gain or difficulty losing weight, especially around the abdomen
Fertility issues
An Important Note on The “Cysts” in PCOS
The name PCOS derives from the common finding of polycystic ovaries seen via ultrasound, where many small, fluid-filled sacs (follicles) develop on the ovaries. However, the “cysts” in PCOS are not true ovarian cysts and, in fact, pain (which is common with ovarian cysts) is not a symptom of PCOS. The “cysts” in PCOS are immature ovarian follicles - these follicles are what usually mature and develop into eggs during the menstrual cycle, but the imbalance of hormones in PCOS means the follicles stop developing midway through their life cycle, and appear like cysts on the ovaries in an ultrasound.
Not all women with PCOS have polycystic ovaries on ultrasound, and not all women with polycystic ovaries have PCOS. Immature follicles on ovaries are common in young people in the first few years of menstruating and don’t necessarily indicate PCOS, which is a reason why ultrasound alone is not diagnostic of PCOS.
What Causes PCOS?
The exact cause of PCOS remains unknown, but it is believed to involve a combination of genetic, hormonal, and environmental factors. Insulin resistance is a key factor in many cases, leading to elevated insulin levels that can trigger high production of androgens. These high androgen levels disrupt ovulation and normal menstrual function.
Causative Factors in PCOS
Genetics - research indicates that PCOS is a highly heritable condition
Chronic low-grade inflammation
Insulin resistance - up to 75% of people with PCOS have insulin resistance, although it is unclear if this is a cause or a symptom of PCOS
Environmental factors, such as exposure to endocrine-disrupting chemicals (EDCs)
It’s likely that multiple underlying causes are often to blame for the development of PCOS, rather than a single cause. This is one reason why PCOS is such a complex condition to understand.
Diagnosis of PCOS
Diagnosis of PCOS is currently based on the Rotterdam criteria. For a diagnosis of PCOS, you must have 2 of the 3:
High androgens on blood test
Cystic ovaries on ultrasound
Signs and symptoms of PCOS, such as irregular periods, hirsutism, hair loss, and acne
A Naturopathic Perspective on PCOS
Naturopathic medicine seeks to treat the whole person. As a naturopath, I recognise the intricate balance between body, mind and environment. People with PCOS are more than just their symptoms, and their symptoms don’t occur within a vacuum. It’s always important to look at the whole person and treat accordingly. PCOS is a condition that is particularly important to approach from a functional point of view, because standardised treatments aren’t going to work for every person diagnosed with PCOS. “PCOS” is really an umbrella term for multiple different presentations that can vary quite a bit from one another, which is why I always prioritise looking at the whole person, hearing their story and assessing any testing from a functional perspective. This way, we can come up with treatment strategies to suit you, taking the guess work out of treatment.
So, how do we begin to approach PCOS from a functional point of view? Comprehensive testing beyond androgens alone can give us a great look into what is happening for you. Naturopathic testing might include:
Androgens - serum testosterone, DHT, DHEAs
Fasting insulin/ glucose tolerance test with insulin - insulin resistance is one of the biggest drivers of PCOS symptoms for the majority of people with PCOS, so we want to know if you have insulin resistance or not. A blood glucose test alone does not tell us if you have insulin resistance.
Thyroid panel - studies show that high TSH is associated with high androgens and insulin resistance in people with PCOS
Vitamin D - frequently low in people with PCOS and can exacerbate symptoms - if low will need correcting
CRP - a marker of inflammation - frequently high in people with PCOS
Other tests may also be indicated for you, depending on your presentation.
The Importance of a Personalized Approach
Naturopathic medicine emphasizes the importance of a personalized approach, recognizing that each individual's experience of PCOS is unique. A comprehensive assessment that includes a detailed history, dietary habits, and lifestyle factors is essential for creating a treatment plan that is truly going to work for you. By taking a functional, holistic approach to PCOS we can take the guess work out of treatment, helping you to find relief from PCOS symptoms.
I’m so passionate about helping people with PCOS and other hormonal conditions achieve better health. If you’re living with PCOS and want help managing your condition, let’s work together. Click here to book your consultation or to arrange a free 20 minute chat to see how I can help you navigate your PCOS.
Want to know more about PCOS? Try these blog posts:
Magnesium: A Secret Weapon for PCOS
About the Author
Lizzie Stow is a clinical naturopath from Newcastle, Australia.
To find out more about Lizzie, click here.
Book an appointment with Lizzie click here.
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