PCOS: What it is and How it Manifests
September is PCOS Awareness Month so over the next few weeks, I’ll be posting a series of blogs on PCOS to help shed light on this under-researched, under-diagnosed, and under-treated disorder. This week I’m talking about what we know about PCOS and how it manifests in the body.
What is PCOS? How is it Diagnosed?
Polycystic Ovarian Syndrome (PCOS) is very often thought of as a disorder of the reproductive system. While irregular periods and not ovulating are two common symptoms, it is actually a hormonal disorder related to genetics, environmental factors, stress, nutrition, microbiome, and metabolic function. In addition to symptoms related to fertility, other symptoms include irregular hair growth/loss, stubborn metabolism, sleep disturbance, mood disorders, and insulin resistance.
PCOS is diagnosed by a clinician using criteria set by experts in the field using evidence-based information. There are three sets of criteria available and they are all similar. What is considered to be the gold standard is the Rotterdam criteria, which says there must be 2 of the following clinical findings present:
hyperandrogenism - elevated testosterone
oligomenorrhea - irregular or missing periods
polycystic ovaries
What can make getting a diagnosis difficult is that there is not necessarily a clear indicator of when elevated testosterone becomes “too much.” A women can also have a completely regular cycle and because PCOS is so often considered a reproductive disorder, the disorder gets overlooked. That is why it is so important to advocate for yourself. You are the expert on your own body. If you feel your concerns are getting dismissed, get a second opinion.
What Causes PCOS?
It is hard to name an exact cause for PCOS but we do know that there are both genetic and environmental components. You could be exposed to excessive androgen in utero or you could carry a gene for PCOS then at some point in time due to stress or other external factors, this gene gets activated and you begin to manifest symptoms around PCOS. In women with PCOS, we often see higher levels of interleukin 18 and homocysteine, components that measure inflammation so we know that inflammation is also a major cause of symptoms related to hormonal imbalances and insulin resistance.
Insulin is a very important hormone that contributes to the criteria used to diagnose PCOS. There is a clear correlation between insulin not working properly in the body and a cascade of effects on ovaries and androgen production. Insulin is a hormone made by our pancreas that is produced in response to food. I love the way my friend and fellow dietitian, Casey Seiden MS, RDN, CDE, explains what happens after food gets broken down into glucose and goes into your bloodstream. She explains that insulin comes around to all of the cells in our body and acts as a key. It opens up those cells so the sugar from the food we ate can move into our cells and be used for energy. What happens in PCOS is your cells become resistant. The key doesn’t work so the doors on your cells remain shut and the insulin cannot get in. The extra sugar stays around in your blood and starts to cause some of the problems we see related to inflammation.
Insulin dysregulation has a big impact on the hypothalamus as well, a part of the brain that secretes hormones that regulate fertility such as luteinizing hormone and follicle stimulating hormone. Women need these for ovulation! Insulin resistance can also drive ovulatory dysfunction and result in an egg not releasing in a cycle, high androgen levels, and decreased levels of the sex hormone binding globulin that is really helpful to keep hormone levels stable.
Managing PCOS Symptoms
Once you get a diagnosis, the path may not be so straight forward. There is no cure for PCOS but it is possible manage your symptoms by reducing the inflammatory burden to mind and body, improving insulin sensitivity, regulating your cycle, improving fertility, and managing weight. There are 4 types of PCOS and identifying which you have is what is going to help you and your health care provider determine a targeted treatment plan.
Insulin-resistant*: As confirmed with blood and glucose tests
Post-pill: Meaning your periods were normal before taking the pill and high androgens only presented after coming off
Inflammatory*: Often brought on by chronic, acute stress - so burnout
Adrenal: DHEAS is the only androgen - a week form of testosterone
*Elevated inflammation and insulin dysfunction are associated with all types but is not always the root cause
Even though the root causes are categorized, women with PCOS often need to address multiple factors that include nutrition, self care, lifestyle behaviors, and exposure to environmental toxins. That is why instead of living in the dark, struggling, guessing, and taking extreme approaches to supporting your body, I HIGHLY recommend working with an expert to help you live, eat, move, and feel confident in the body you have. If you’re looking for help, I’m here. If you’re tired of fighting and feeling lost, ask for help. YOU are not alone in this fight, cyster.
Stay tuned for my next post where I will be diving deeper into the nutrition practices to help you manage PCOS symptoms.
Reminder: this post is for general education purposes only.
