Polycystic ovarian syndrome (PCOS) is a metabolic condition which impacts the menstrual cycle. It is usually caused or driven by a number of underlying factors. Despite the name, PCOS actually has nothing to do with cysts on the ovaries. Instead, it can be characterised by an excess of male hormones, called androgens, and anovulatory cycles (where ovulation does not occur in the menstrual cycle and an egg is not released – causing irregular or absent periods). The so-called “cysts” that can be seen on ultrasound are not ovarian cysts but are actually follicles or eggs, which are normal for an ovary to have. There is currently discussion within the medical community around whether or not the name will be changed to something less misleading.

Symptoms of PCOS include:

  • Long, irregular or absent menstrual cycles
  • Hirsutism – unwanted facial hair
  • Significant acne – especially around the jawline
  • Weight gain – though you don’t need to be overweight to have PCOS
  • Hair thinning or hair loss/male pattern balding
  • Infertility

Diagnosis of PCOS can be confusing as there are two different diagnostic criteria’s: The Androgen Excess and PCOS Society Criteria; and the Rotterdam Criteria.

The Androgen Excess and PCOS Society Criteria says that a woman qualifies for PCOS when she meets all three of the following:

  • Irregular periods OR polycystic ovaries on ultrasound
  • High androgens (male hormones – i.e. testosterone) on blood testing, or symptoms of high androgens such as hirsutism (excess facial hair growth), acne, or hair loss/male pattern balding
  • Exclusion of other conditions which would cause high androgens – such as ovarian/adrenal tumours and Cushing’s syndrome.

The Rotterdam Criteria is a broader set of criteria which says that a women qualifies for PCOS when she meets only two of the following:

  • Irregular or absent ovulation (causing long menstrual cycles or no periods at all)
  • Polycystic ovaries on ultrasound
  • High androgens (male hormones – i.e. testosterone) on blood testing, or symptoms of high androgens such as hirsutism (excess facial hair growth), acne, or hair loss/male pattern balding
  • As well as the exclusion of other conditions which would cause high androgens

Once you have obtained an accurate diagnosis of PCOS, its time to find our which one of the four types of PCOS you have. This will enable you to effectively treat the underlying cause of the PCOS in order to alleviate the symptoms. There are different tests to determine your type of PCOS – speak to your healthcare practitioner about undergoing appropriate testing based on your diagnoses and symptoms.

The four types of PCOS are as follows:

Insulin resistance PCOS: this is the most common type of PCOS. High levels of the hormone insulin stimulate the ovaries to make testosterone, and inhibit ovulation. Insulin resistance is caused by sugar, environmental toxins, smoking and trans fats (found in processed/fried foods). Typically people with insulin resistant PCOS are overweight, though you can still be a normal weight and have insulin resistance and PCOS. Normal weight insulin-resistance typically can occur after a history of an eating disorder or long term stress.

Post-pill PCOS: the contraceptive pill works by suppressing ovulation, thereby preventing pregnancy. PCOS is characterised by a lack of ovulation, which distorts hormone levels. For some women, after coming off the pill, ovulation does not come back for many months or even years. This can cause PCOS.

Inflammatory PCOS: inflammation inhibits ovulation, stimulates androgen hormones (male hormones) such as DHEA and androstenedione (A4), and disrupts hormone receptors. Inflammation can result from environmental toxins, stress, intestinal permeability (leaky gut), and inflammatory foods such as gluten, dairy and sugar. Other symptoms of inflammation and immune dysregulation can coincide this type of PCOS, such as joint pain, headaches, recurrent infections, or inflammatory skin conditions such as eczema or dermatitis.

Adrenal PCOS: this type of PCOS is characterised by elevated levels of the hormone dehydroepiandrosterone sulphate (DHEA-S). Testosterone levels can be normal, and ovulation can still occur regularly. This type of PCOS is caused by chronic stress.

If you think you may have PCOS, obtaining a correct diagnosis is imperative to enable proper treatment to ensue. Once diagnosis has been confirmed and you have identified which type of PCOS you have, you can then work with your healthcare practitioner to devise an appropriate treatment protocol from there. There are many different natural, evidence-based and effective treatments for each of the four types of PCOS, and your treatment will depend on you as an individual. Treating holistically and individually is the most effective way to manage PCOS. In most cases, PCOS is reversible – you just need the right treatment. Ovulation, regular periods, clear skin, healthy hair, balanced weight and pregnancy is possible.


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