Polycystic ovarian syndrome (PCOS) occurs in 7-15% of women of reproductive age

PCOS is the most common reason for infertility.

Most women (70-80%) with PCOS are infertile.

What Are the Symptoms of PCOS?

  • Irregular periods or no period
  • Difficulty getting pregnant
  • Excess hair growth
  • Acne or oily skin
  • Thinning hair
  • Weight gain

How is PCOS Diagnosed?

There is no concensus about PCOS diagnosis.

The 1990 NIH Consensus and the AEPCOS 2006 diagnostic criteria include androgen excess as part of the diagnostic criteria.

For those two organizations, you cannot have PCOS if you do not have signs of hyperandrogenism.

Hyperandrogenism means too much androgen.

Androgens are the male sex hormones including testosterone.

Females have these hormones, also, but they should be lower than males.

If the androgens are too high in women, they get secondary male characteristics like

  • Scalp hair loss
  • Increase hair growth on face and body
  • Acne/oily skin
  • Abnormal menstruation

To add to the confusion about how to diagnose PCOS,  the NIH Consensus does not require that you have polycystic ovaries to be diagnosed with PCOS!

Both of these organizations see PCOS primarily as a problem with androgen.

The Endocrine Society, however, does not necessarily see PCOS as a hyperandrogen issue, or as a polycystic issue.

The Endocrine Society advises using the 2003 Rotterdam Criteria.

What Are the Rotterdam criteria?

The Rotterdam criteria require two of the following signs or symptoms be present:

  • Infrequent or no ovulation (this usually is indicated if you have irregular periods, or if you bleed for a lot of days)
  • Physical or lab signs of having too much androgen hormones like DHEA and testosterone (this can cause you to have more hair on your face/tummy/nipples, or have elevation in lab values)
  • Many small cysts in ovary (this is diagnosed by doing a transvaginal ultrasound of the ovaries)

Does it Matter Which Diagnostic Criteria We Use?

For me, it doesn’t matter what the diagnosis is.

For me, I look at the physical signs, the lab findings, the imaging results, and the palpatory findings and try to fix them or at least improve them.

If you have androgen excess, we will address that.

If you have polycystic ovaries without androgen excess we will address that.

We will treat whatever we find, in an effort to help you bring your baby into this world.

The work-up for PCOS includes the following:

  • History
  • Physical
  • Lab
    • CBC/CMP
    • Vitamin D
    • HgA1c
    • C-Peptide
    • Thyroid hormones
    • Dutch periodic hormone testing over the course of a month
    • Adrenal Stress Index testing over the course of a day
  • Imaging

What is Insulin Resistance PCOS?

Although there are many reasons for the ovaries to make many small follicles that do not mature to release an egg, insulin resistance is the most common cause of PCOS.

Insulin resistance instigates PCOS in about half of the women with this diagnosis.

Insulin resistance means there is too much insulin in the system because the cells are resistance to allowing it in. This excess insulin sensitizes the ovary to luteinizing hormone, so that’s one of the reasons the ovary has so many little follicles. Another reason is that insulin can cause the ovaries to make too much testosterone, and the pituitary to make too much luteinizing hormone. Insulin also causes liberation of testosterone from its inactive bound state.

Other reasons for PCOS include post-Pill PCOS, inflammatory PCOS, and adrenal PCOS.

How to Treat Insulin Resistant PCOS?

The first goal of treating insulin resistant PCOS is to regulate blood sugar and insulin levels.

Usually this involves going on a whole food diet (I like the Whole 30 or the Mediterranean diet), doing some regular exercise, taking some supplements, and getting your Zzzzs.

Intermittent fasting can quickly decrease inflammation, but you need to have enough stability in your blood sugar to be able to eat food for only eight hours a day.

Choose movement activities that you enjoy and do something most days.

If progesterone if low, in the second half of the cycle we will supplement with a bio-identical progesterone to begin regulating your cycles by suppressing excess luteinizing hormone and optimizing communication between the hypothalamus/pituitary/ovarian axis.

Other nutritional support will be based on your complex profile.

The Ovaries Are the Handmaidens of the Uterus