PCOS: Insulin resistance, nutrition, and myths.
Polycystic ovarian syndrome or PCOS is a common endocrine disorder involving multiple symptoms including cysts on the ovaries, elevated androgen hormone levels (hyperandrogenism), irregular or absent ovulation (anovulation), and high insulin levels (hyperinsulinaemia). The specific criteria for PCOS diagnosis can be found here and follows the Rotterdam diagnostic criteria. This can be a little confusing, so let's look at some of things someone with PCOS might experience. Handmade healthy uterus art by Joelie Croser. Photograph by Lauren Bezzina.
PCOS is a syndrome which means it has a set of symptoms which may vary in severity from person to person. The following list includes the symptoms of PCOS but the main one to note is failure to ovulate regularly or at all (anovulation) - this is what leads to the hormonal imbalances that drive symptoms.
Irregular cycles
Long bleeds
Irregular ovulation or anovulation
Acne
Excess facial hair (hirsutism)
Hair loss
Infertility
Cysts on the ovaries
Signs of abnormal hormone levels that can be detected through testing include
High glucose
High insulin
High androgens such as testosterone
High luteinising hormone (LH) relative to follicle stimulating hormone (FSH).
These hormonal involvements impact not just the menstrual cycle but the whole body.
Insulin resistance is the inability of insulin to do its normal job of opening the door of cells to let in glucose for energy. This means we are left with high levels of glucose circulating in the blood which can be harmful to our cells, our gut bacteria and our organs. High blood sugar levels from intake of refined sugar combined with poor sugar regulation can drive up androgens that lead to symptoms of PCOS and in the long-term, metabolic disease and chronic illness. Some of the best intervention here is a personalised diet and exercise plan. It's never too late or early to start making changes.
High androgen levels lead to hair loss, jaw-line, back and chest acne, and hirsutism.
As mentioned high androgen levels can be driven by high blood sugar and poor regulation.
(Besides the baby-making part) What's so important about ovulation?
When an egg leaves the ovary i.e. the point of ovulation, the remaining follicle forms a hormone-secreting tissue called the corpus luteum. The corpus luteum is what allows levels of progesterone and estradiol, the dominant form of oestrogen in non-pregnant females of reproductive age, to rise. Estradiol builds the uterine lining (also called endometrium) in preparation for implantation of a fertilised egg, while progesterone helps to hold that endometrium in the uterus until the next period when it sheds (if the egg is not fertilised). Of course important for pregnancy but these hormones also benefit many other parts of the body.
Natural estrodiol is responsible for a healthy libido, making cervical mucous and natural lubrication, energy, focus, communication with the brain to signal the hormone LH for ovulation, healthy hair and skin.
Natural progesterone stimulates thyroid function triggering a rise in body temperature, it induces calming of the nervous system, assists sleep, bone and muscle growth.
If ovulation doesn't occur the corpus luteum does not form and these hormones do not rise. Whether you are wanting to have children or not these hormone are so important for overall health which is why treatment should be considered regardless of the desire to get pregnant or not.
MYTHS ABOUT PCOS
Only overweight people get PCOS
Anyone of any body mass can have PCOS
Everyone with PCOS has the same set of symptoms
Symptoms and their severity can vary from person to person so try to avoid comparing yourself with others. You are unique regardless of a diagnosis.
People with PCOS can never have children
While it may not be as straight forward as it can be for someone without PCOS due to irregular ovulation or chronic anovulation, pregnancy is not impossible. Tackling the drivers of PCOS with diet, specific herbs, and emotional support is key. Talk to a health professional about the right management plan for you.
Treatment and management is the same for everyone with PCOS
There are a variety of drivers of PCOS. For example one person may have developed the condition after being on the pill i.e. 'post-pill PCOS', another due to hyperthalamus-pituitary-adrenal (HPA) axis and thyroid hormone changes. Everyone is different.
Hormonal contraceptives such as the pill, ring, hormonal IUD, injection will fix your PCOS
The pill can mask period symptoms. This does not mean they go away but simply put on the back burner to be dealt with when the pot boils over. Adding synthetic hormones to the body disconnects the brain-ovary axis. This is not a cure and can lead to further unwanted symptoms such as nutrient deficiencies, gut microbial imbalance, fungal overgrowth, and mental health concerns. If you have been offered the pill simply for 'management' of PCOS (not for contraception) you may want to think twice or ask for more information about your options.
PCOS cannot be managed with diet and lifestyle changes
Diet and lifestyle plays a key role in PCOS management due to the ability to manage blood sugar levels, stress, and hormones with these things.