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Polycystic ovary syndrome (PCOS)

Women have likely had mild cases of PCOS since the dawn of humanity.

But given it’s unwanted symptoms, a useful question to ask is what evolutionary advantage would PCOS have given?

Estrogen, which tends to be elevated with PCOS, has protective roles in the body including increasing lean body mass, reducing abdominal fat, improving insulin resistance, lowering LDL to HDL cholesterol ratio and blood pressure, and maintaining the immune system. Lower estrogen is one of the reasons that these can worsen during menopause.

Women with PCOS tend to have elevated Testosterone, which is then converted into Estrogen. This may have provided our ancient female ancestors a survival advantage by limiting birth control and increasing physical strength.

From the list of estrogen’s roles, we can see the ‘reproductive system’ in the body is intimately linked with everything metabolic (blood pressure, weight, cholesterol etc.). Our hormones act as information systems in the body, with estrogen being a primary link to metabolic health.

And so the term polycystic ovary syndrome is somewhat misleading as it suggests the problem is only with the ovaries, and that you must have ‘cysts’ on your ovaries. When in fact, PCOS is a hormonal and metabolic condition, and exists as a sliding scale from mild to severe.

So why does PCOS tend to be associated with metabolic issues and obesity today?

Do you feel ‘hangry’ if you haven’t eaten? Blood sugar imbalances and insulin resistance tend to be associated with PCOS. In prehistoric times, this would have given women with PCOS an advantage as they were more able to store fat in times of plenty. The problem is that nowadays, we live permanently in times of plenty. Our high sugar, low quality diets are stored as body fat, often resulting in an increase in weight. This is exacerbated by the dramatic increase in the toxins in our environment, a sedentary lifestyle, and less diverse gut bacteria (our microbiome).

PCOS Effects

PCOS nowadays is common, probably affecting up to 25% of women. Thinning hair and acne, as well mood changes and depression, may be a sign of hormonal imbalances. Irregular or absent periods and metabolic dysfunction are symptoms of more overt PCOS.

The hormonal and reproductive effects of PCOS
The metabolic effects of PCOS

Optimising our Hormones

To optimise our hormones, it is useful to take a holistic Functional Medicine approach which considers everything that affects our hormonal health. This includes:

  • Diet and nutrients to support the body (supplements may include Inositol, B Vitamins, Vitamin D, Vitamin K, omega-3 fish oils)
  • Balance your blood sugar
  • Improve your gut health and support the gut microbiome
  • Reducing exposure to endocrine disrupting chemicals, particularly BPA
  • Healthy detox the body of toxins
  • Optimise the circadian rhythm, get natural light early in the morning. Intermittent fasting if tolerated
  • Manage stress
  • Quality Sleep and Quantity
  • Exercise mind and body
  • Passion and love for life

As a Functional Medicine practitioner, I’m qualified to support you in addressing all of these factors which may be contributing to your PCOS.

Diagnosis and Measuring our Hormones

PCOS is typically diagnosed when at least two of these present (note, that this means cysts on the ovaries may not be necessary for diagnosis) :

  • High androgens such as Testosterone
  • Absent ovulation or dysregulated cycles
  • Cysts on the ovaries from imaging

The DUTCH test provides a comprehensive overview of your sex and adrenal hormones, including Testosterone and it’s metabolites (these are important as the 5-alpha reductase metabolite is more androgenic), Estrogen and DHEA. If you would like to test your hormones, you can organise that through Fairfield Nutrition.

Gut Health and PCOS

A whistle-stop explanations of the impact of our gut health on PCOS is something like this:

  1. A typical high sugar diet, high in poor quality fats, and low in fibre creates an imbalance between ‘good’ and ‘bad’ bacteria.
  2. This imbalance affects the production of the protective mucus in our guts and the integrity of our gut lining is compromised. This is commonly known as ‘leaky gut’.
  3. Bacterial by-products (LPS) pass through the gut wall, initiating an inflammatory response. This inflammation contributes to insulin resistance which in turn drives Testosterone production in the ovaries.

Prebiotics and probiotics, as well as good sleep and managing stress etc., lead to more of the ‘good’ bacteria in the gut. These good bacteria produce short chain fatty acids that support the protective mucus layer and gut lining integrity. This results in a reduction in inflammation as fewer bacterial by-products cross the gut lining, which improves insulin sensitivity. This improvement in metabolic health tends supports a return to normal ovarian function and a lessening of PCOS symptoms.