PCOS: Much More Than a Gynecological Problem

Updated: Jan 11, 2022

You would be shocked if you knew how many medical practitioners misdiagnose and, in many cases, completely miss this very common problem! In fact, most women suffer for years before they are properly diagnosed and treated.

If you're a woman with cystic ovaries, how do you know if you actually have PCOS??

Does it even matter?

Absolutely, positively yes...and here's why...

PCOS is a complex medical problem affecting far more than female reproduction. Thorough testing must be done to make sure you are not one of the 25% of women who have ovarian cysts without having PCOS.

It is extremely important that the correct diagnosis is established with the proper diagnostic work up. Benign ovarian cysts typically require no treatment. But, PCOS is a complex problem that wreaks havoc on a woman’s hormones and can lead to the development of other diseases and even cancer.

What is PCOS?

Polycystic ovarian Syndrome (PCOS) is the most common hormone imbalance affecting women of reproductive age. In fact, one in every ten women ages 18 to 44 suffer from this condition.

PCOS is the MOST common cause of no ovulation and infertility arising from not ovulating.

While it’s true that PCOS can be inherited as a genetic condition, environmental factors, such as being overweight and eating an unhealthy diet, can increase the risk of developing PCOS.

it’s crucial women are correctly diagnosed with PCOS (discussed below) because hormonally normal women can have ovarian cysts but also because there are other medical conditions which have some of the features of PCOS but are completely different medical problems (see below).

What are the Symptoms of PCOS?

1. Anovulation. Because women with PCOS do not ovulate, they suffer either from irregular periods or no periods at all. This is the main reason why reproductive women with PCOS have the highest rate of infertility. Since women with PCOS don't ovulate, they don't make progesterone, the body’s natural estrogen balancing hormone. This progesterone estrogen imbalance causes a state of chronic estrogen dominance.

2. Hyperandrogenism. Women with PCOS may also overproduce ‘male hormones’, DHEA and testosterone. Elevations in these hormone levels can lead to physical changes such as excessive facial hair growth, acne, and hair loss. Darkening of the skin under the arms and in the groin areas is also commonly seen, a condition called Acanthosis Nigricans.

3. Other Symptoms. Obesity affects nearly 60% of women with PCOS (but...40% of women with PCOS are not overweight!). Abnormal weight gain is fueled not only by the imbalances in female hormones but also because the levels of insulin rise abnormally. High levels of circulating insulin subsequently causes inflammation and impairs the way the body uses glucose in a way that promotes fat storage. PCOS can also coexist with thyroid issues. In this situation, women can also experience symptoms of underactive thyroid (i.e. weight gain, depression, fatigue, etc). PCOS patients are also at significantly higher risk of developing sleep apnea which typically results in chronic fatigue, brain fog, and memory problems.

Much More Than a Gynecological Problem

While the short term chaos PCOS creates is problematic in its own way, the potential risk of developing more dangerous health conditions is an even greater concern.

The baseline hormonal imbalances found in PCOS patients are the foundation from which future health risks arise. Let's first summarize the overall hormonal imbalances:

Estrogen excess
Progesterone deficiency
DHEA excess
Testosterone excess (sometimes but not always)
Insulin excess

These hormonal imbalances then give rise to other hormone imbalances (mainly with cortisol and thyroid), increase blood glucose levels, and increase levels of inflammation. They also cause an increase in body fat deposition which promotes the development of obesity, and obesity further fuels the hormone imbalances and inflammation.

The result? A viscious cycle....and a long list of negative health effects. Take a look:

75% develop insulin resistance, high insulin levels, and/or obesity
PCOS patients develop diabetes at a rate of 10% per year.
Higher incidence of high blood pressure
Higher incidence of abnormal cholesterol profile (high triglycerides, high LDL, low HDL)
Increased risk of developing sleep apnea 30 times greater.
4% increased risk of developing uterine cancer
PCOS are 7 times more likely to suffer from a heart attack.
Ovarian cancer risk increases by up to 3 fold.
Higher incidence of breast cancer, especially in patients with a positive family history.
60% of PCOS patients are obese.

Now you can see why getting the correct diagnosis of PCOS as quickly as possible is so important. There are things that can be done to prevent and treat PCOS and to improve associated symptoms.

Speaking of diagnosis...

How is PCOS Diagnosed?

Proper diagnosis is critical! Not all women with cystic ovaries have PCOS, and many women with PCOS do NOT have ovarian cysts.

According to the new Rotterdam criteria formulated by the European Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine,

two of three criteria have at least to be met in order to fit the diagnosis of PCOS.

These criteria are:

Lack of ovulation
Androgen excess (high levels of DHEA +/ testosterone)
Polycystic ovaries on ultrasound assessment.

So...unless a woman has at least two of these three criteria, she does NOT have PCOS.

It's also important to point out that there are other medical conditions which have overlapping symptoms with PCOS but are NOT PCOS. Proper testing MUST be done to exclude these conditions BEFORE a diagnosis of PCOS can be established.

These other conditions include:

- Hypothyroidism

- Hyperprolactinemia

- Congenital Adrenal Hyperplasia

- Primary ovarian failure

- Hypothalamic amenorrhea

- Cushing’s Syndrome

- Androgen secreting tumors

Treatment of PCOS

Because PCOS affects women differently depending on many different factors (discussed above), it is crucial that women with suspected or definitive PCOS work with a highly experienced medical practitioner who has thorough knowledge and understating of the complexity of this condition.

Overall treatment requires a multidimensional approach and should include not only correcting the underlying hormone imbalances but also modifying negative contributing factors, such as diet and exercise.

With regards to hormonal therapy, most conventional medical practitioners will recommend birth control pills. However, in my extensive clinical experience, the use of bioidentical progesterone in combination with certain supplements has been equally effective and does not prevent pregnancy in women suffering from infertility. Doctors may also prescribe Metformin which has been shown to improve ovulation and insulin resistance. However, Metformin does have side effects which include abdominal bloating, diarrhea, fatigue, and B-vitamin loss.

There are nutritional supplements have been studied and have been shown to be effective in preventing and treating some of the metabolic and hormonal problems in PCOS patients. (Please note, supplements alone will not improve PCOS. A multidimensional treatment approach is mandatory!)

1. Omega 3 has been shown not only to prevent but also to improve including anti-obesity, glucose and hormonal balance, anti-inflammatory, and regulation of inflammation.

2. Vitamin D and probiotics have been shown to improve mental health parameters, lower serum total testosterone, improve hirsutism (excessive hair growth), and reduce inflammation.

3. Natural anti-inflammatory, anti-oxidant herbals, including Curcumin and Quercetin, have been shown to improve many of the hormonal and inflammatory issues found in PCOS patients.

4. Melatonin reduces inflammation and may promote ovulation.

5. Supplementation with EGCG, a supplement derived from green tea extract, by overweight and obese women suffering from PCOS leads to weight loss, a decrease in fasting insulin, and a decrease in the level of free testosterone.

6. Other supplements found to be beneficial for one or more aspects of PCOS include Cinnamon, Berberine, Chasteberry, and Chiral Inositol.

Patients should be careful to make certain they are taking pharmaceutical grade nutritional supplements obtained from a reputable source. The patient's medical provider should provide recommendations for proper dosages based upon the patient's lab results, symptoms, and health goals.