A NEW PROGRAM FOR HEALING PCOS!
This is the second post in a series about PCOS (polycystic ovarian syndrome). Read the first post.
The Conventional PCOS Diagnosis
According to conventional medicine, you need to have two of these three criteria to qualify for a diagnosis:
- High androgens (DHEA and/or testosterone). Typically, free testosterone is high. Symptoms include hirsutism (male pattern hair growth), as well as alopecia (scalp hair loss).
Labs: DHEA, DHEA-S, Total testosterone, Free testosterone
2. Ovulation disorders. Anovulation is no ovulation, while oligomenorrhea is infrequent ovulation, which means you ovulate eight or fewer times per year. You may have long cycles, meaning your whole cycle is 35 days or longer, or irregular cycles.
Labs: progesterone taken approximately cycle day 21, or 7 days after ovulation is “supposed to” occur.
3. Ovarian cysts. The presence of 12 or more follicles in each ovary, measuring 2-9 mm in diameter, and/or increased ovarian volume (>ml); however, new ultrasound technology shows a larger number of cysts. Only 17-33% of women with PCOS actually have ovarian cysts.
Lab: Pelvic ultrasound
The Functional PCOS diagnosis
We Functional Medicine practitioners tend to dive deeper into assessment for PCOS. Some conventional doctors do as well. I’ve diagnosed PCOS in countless patients whose MD or ND did not find it, or even disagreed with my diagnosis at first, before coming around. Since there is such a wide spectrum of types of PCOS, I frequently screen for it. Additional markers and signs include:
- Metabolic markers: fasting glucose and insulin, glucose and insulin tolerance tests, triglycerides, cholesterol, hemoglobin A1C, liver detoxification, and hormone metabolism.
2. Hormones and their metabolites: SHBG (sex hormone binding globulin), progesterone, AMH (anti-mullerian hormone), estrogen, adrenal hormones (DHEA and cortisol), free testosterone, and thyroid.
3. Symptoms: pelvic pain, irregular or long cycles, history of ruptured cysts, hair and skin issues (see first post), abdominal weight, weight loss resistance, difficulty conceiving.
Why you should care if you have PCOS
Most women I see with polycystic ovarian syndrome come for fertility, or for weight loss. Sometimes it is an adolescent girl with period problems.
It’s often viewed as only a problem for conception. This is simply not true! Long or infrequent cycles over many years increases your chances for endometrial cancer.
Besides endometrial cancer, additional risk factors also include:
• Type 1, type 2, and gestational diabetes.
• Insulin resistance (50%–70% of women with PCOS), which can lead to metabolic syndrome, high blood pressure, high cholesterol and triglycerides, and glucose intolerance.
• Increased coronary artery plaque, and greater risk of CVD (cardio-vascular disease).
• Mental health disorders, such as depression, anxiety, bipolar disorder, eating disorders, and sexual and relational dysfunction. Patients with PCOS are at higher risk for developing significant psychological difficulties.
• Subfertility, which happens because of less frequent ovulation.
• Gestational risks, such as a higher incidence of gestational diabetes (40–50%) and associated high-weight babies, hypertensive disorders, such as pre-eclampsia and pregnancy-induced hypertension (5%), and the birth of small-for-gestational-age babies (10–15%).
Often, women first find out they have PCOS when they can’t get pregnant easily. Once they get pregnant, they don’t pay attention to their future health risk factors. Unfortunately, this is usually because they are not told about them by their providers!
Childfree women, and women over 40 slip through the cracks
This group has no reason to get an initial PCOS diagnosis if they are done having children, never had children, or are done with periods. Yet the risk factors remain.
This paper reports that it is not possible to properly diagnose PCOS after menopause. Nevertheless, post-menopausal women with high androgen hormones (testosterone and/or DHEA), and a history of menstrual irregularity have a larger number of cardiovascular events.
Unfortunately, there is very little knowledge of post-menopausal women with PCOS, such as how to diagnose them or treat them.
Researchers suspect that postmenopausal women with PCOS have increased rates of obesity, diabetes and cardiovascular events.
Adolescent girls are under-diagnosed
As this paper elaborates, there is no overall agreement as to how to diagnose PCOS in adolescence. Acne is common during these years for all girls. Hirsutism (male pattern hair growth) typically develops over time, well beyond adolescence. High androgen hormones may be a more consistent marker for teens.
In all young women, irregular menses are common. As many as 85% of menstrual cycles are anovulatory during the first year of menstruation, while up to 59% are still anovulatory during the third year. However, if girls are overweight before they start menstruating, then they have a greater risk for anovulation and PCOS.
Around 40% of adolescent girls with menstrual irregularity have polycystic ovaries on ultrasound. Researchers suggest that all three criteria (oligomenorrhea or amenorrhea, high androgens, and ovarian cysts) should be present for PCOS diagnosis in adolescents.
MEN with PCOS? Yup
There are different genes associated with PCOS, as described in detail in this paper. Men carry these genes as well as women. This research shows that brothers and fathers of women with PCOS also have elevated male hormone levels, and face the same long-term health risks, such as diabetes, obesity, and heart disease. Therefore, these men should be screened for early onset male-pattern alopecia and excess hairiness, as well as completing these labs:
• Fasting levels of glucose and insulin
• Glucose tolerance test
• Free testosterone and sex hormone-binding globulin levels
As a Functional Medicine practitioner, I add additional metabolic markers when I assess men.
Thanks for reading! In the third post I’ll discuss conventional and functional treatment for polycystic ovarian syndrome.
A NEW PROGRAM FOR HEALING PCOS!