Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal health issues in women, affecting an estimated 1 in 10 women of reproductive age. Many women are first diagnosed when they are having difficulty trying to conceive, but PCOS presents with many other symptoms, like hair loss, acne, hirsutism, and weight gain. These symptoms can affect a woman's health even beyond trying to get pregnant. What Causes PCOS? The exact cause of Polycystic Ovary Syndrome is unknown, though it is thought that genetics play a major role. PCOS is a complex disorder that presents itself as a group of symptoms resulting from hormonal imbalances -- usually an excess of androgens like testosterone and high levels of insulin. These symptoms include:
Irregular menstrual cycles. Typically, women with PCOS will have long cycles (often longer than 35 days), missed periods, or no period at all. Some women may have shorter cycles.
Ovarian cysts.
Hirsutism is abnormal hair growth on the chin, face, and other areas usually seen in men but not in women.
Male-pattern hair loss on the scalp.
Acne on the face, chest, and upper back. It may be cystic acne.
Darkening of skin on neck creases, under the arms, under the breasts, and in the groin.
Skin tags
Weight gain and difficulty losing weight.
Insulin Resistance and PCOS Androgens – sometimes referred to as "male hormones" – are produced by both men and women. Women produce androgens in smaller amounts. Higher-than-normal levels of androgens are a common indicator of PCOS, and often attribute to the symptoms of hirsutism and acne. When women start producing androgens, like testosterone, in higher than normal amounts it can lead to metabolic interference, an inability to lose weight, and weight gain. Excess weight is highly correlated to insulin resistance. Between 65-70% of women with PCOS will experience insulin resistance [1]. What Is Insulin Resistance? Insulin is a hormone that regulates the level of glucose in your blood. Upon eating, insulin is released to allow the cells to absorb sugar from food to either use it for energy or store it for later use. When a person is insulin resistant, their body ignores the signals, ultimately leading to further insulin release and a worsening of the vicious cycle. When sugar isn't utilized and stays high in the bloodstream, it ultimately gets stored as adipose tissue, also known as fat. Insulin resistance can lead to:
Type 2 Diabetes
Cardiovascular disease
Non-alcoholic fatty liver disease
Higher risk of developing certain types of cancers, like uterine and bladder cancer
Fat and PCOS One thing to remember is that fat is not just storage tissue but in fact an "endocrine organ". We're good a storing fat, since fat ultimately is an efficient way to store energy. It actually regulates our appetite through a hormone called leptin. It regulates inflammation, as well as our sensitivity to insulin and blood sugar control. Believe it or not, healthy fat tissue actually provides us benefits, such as hormones like adiponectin and cytokines that reduce inflammation. However, dysfunctional fat cells, commonly seen in PCOS, are enlarged and sometimes necrotic. As a result, the dying fat cells produce inflammatory markers with affect our immune system and hormones. What Tests are Essential in PCOS The following lab markers should be tested in PCOS to help understand the root of the problem, your likelihood of fertility, and your course of treatment. All these markers can be ordered via your MD, endocrinologist, or naturopath.
FSH (day 3 of the cycle, if cycling)
LH (day 3 of the cycle, if cycling)
Estradiol (day 3 of the cycle, if cycling)
Progesterone (day 21, or 7 days post-ovulation)
Cortisol
Free testosterone, total testosterone
Prolactin
DHT – dihydrotestosterone
SHBG – sex hormone binding globulin
HbA1C, fasting glucose, fasting insulin
DHEAS
Ferritin
TSH, free T4, free T3
25-hydroxy Vitamin D
Managing Insulin Resistance and PCOS Weight loss is evidently a key component to PCOS management. This becomes a large source of frustration for many patients with PCOS since as previously mentioned, one of the primary symptoms of this disorder is an inability to lose weight. Fortunately, treating a major root of the problem – insulin resistance – can mitigate many of the other symptoms of polycystic ovary syndrome. While diet and exercise are critical, the first step to losing weight for PCOS and insulin resistance is to understand what foods raise insulin levels rather than glucose levels. Furthermore, the inflammatory properties of foods also matter. A specialized diet is often required to get insulin levels back to normal, such as a ketogenic diet, a low glycemic index diet, or even a food insulin-demand diet. No one diet works for everyone, which is why I will always make suggestions based on individual needs and situations. Supplements can also aid the progression of insulin sensitization by reducing inflammation and optimizing glucose absorption. N-Acetyl-Cysteine, which is a precursor to glutathione in the body and is a powerful antioxidant and protector of inflammatory stress from insulin, ultimately shows benefits in PCOS. Inositol is one of my favourite therapies, as it has the ability to improve insulin sensitivity, and is one of the main intracellular messengers for insulin use within the cell. Clinic studies show higher doses of vitamin D improve glucose metabolism in lipid profiles in individuals with PCOS vs standard dosing recommendations [2]. Minerals like magnesium, calcium, and zinc have also been shown to improve inflammation. Ahmadi et al. (2017) also recently determined that probiotics, which promote beneficial effects on immune function and inflammation, have been shown to have favourable effects on weight loss, insulin resistance, TG and cholesterol [3]. Vitex, also known as Chaste Tree, contains the constituent Agnugol, which affects opiate receptors in the brain as well as dopamine. Menstrual cycle regulation from Chaste Tree has been shown to be as effective as metformin in clinical trials with fewer reported side effects [4]. Lastly, stress management is critical. High levels of cortisol affect insulin control and thyroid function. A treatment plan that overlooks stress and anxiety is missing a large piece of the puzzle. As you can see, PCOS is a complex, multifaceted syndrome. Managing PCOS symptoms and insulin resistance requires a multifaceted approach. If you suspect you have PCOS or are experiencing any of the symptoms of PCOS, please feel free to contact Toronto naturopath, Dr. Courtney Holmberg at 647-351-7282 to schedule a consultation today. References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277302/
https://www.ncbi.nlm.nih.gov/pubmed/28679142
https://www.ncbi.nlm.nih.gov/pubmed/28142296
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296515/
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