What is Polycystic Ovary Syndrome (PCOS)?
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that leads to abnormal menstruation, problems with ovary function, cosmetic issues and infertility. PCOS is recognised as one of the most common disorders among reproductive aged women and is considered to be the leading cause of female infertility. By some estimates, one in every five women may meet diagnostic criteria.
Most often, symptoms first appear in adolescence, around the start of menstruation. However, some women do not develop symptoms until their early to mid-20s. Although PCOS presents early in life, it persists through and beyond the reproductive years. In PCOS, there is an imbalance in the hormones that control the menstrual cycle, often in combination with insulin resistance, which then prevent ovulation and decrease fertility.
Importantly, PCOS is not a clear-cut disorder, each person can experience varying degrees of the symptoms below- some may have just one or two while others have many.
What are the symptoms of PCOS?
The main symptoms of PCOS include, and can be varying combinations of:
- Infrequent, irregular or lengthy menstrual cycles (30–50% have no periods at all)
- Difficulty falling pregnant and low fertility(>90% are infertile)
- Heavy bleeding (irregular periods can lead to heavier bleeding when menstruation does occur)
- Weight gain or difficulty losing weight
- Abnormal hair growth, often on the upper lip, chin, around the nipples and in a line beneath the navel (60-95% of persons)
- Thinning hair or male-pattern baldness
- Darkening of the skin, particularly along neck creases, the groin and underneath breasts
- Skin tags (small growths or bumps of skin, especially in the armpits or neck area)
- Ovarian cysts (multiple ‘cysts’, or small, fluid filled sacs in the ovary). Only your doctor can check for this
What disorders are associated with PCOS?
PCOS is primarily a metabolic and reproductive disorder. Specifically, PCOS is very similar to another chronic, metabolic disorder – Metabolic Syndrome (MetS), as well as a number of conditions associated with reproduction. Polycystic ovary syndrome, especially in the presence of obesity, increases the risk of both gynaecological conditions and a wide variety of many other diseases. The main ones are:
MetS associated disorders:
- More than half of women with PCOS develop diabetes or prediabetes before 40
- High blood pressure and cardiovascular disease
- Non-alcoholic fatty liver disease
- Chronic, low-grade systemic inflammation
- Difficulty conceiving and infertility
- Gestational diabetes
- Pregnancy-induced high blood pressure (preeclampsia)
- Pregnancy abnormalities
- Abnormal bleeding in the uterus
- Abnormal thickening of the lining of the uterus (endometrial hyperplasia)
- Cancer of the uterus (a three times higher risk than those without PCOS)
- Sleep apnoea. Sleep apnoea is more common in women who are overweight and have PCOS, and is associated with numerous negative health outcomes, including increased risk for heart disease.
- Depression and anxiety. Hormonal changes and symptoms like unwanted hair growth can negatively affect emotions.
What is the link between weight gain, insulin resistance and PCOS?
Approximately 70% of women with PCOS are overweight or obese. Excess weight, especially central obesity, is strongly associated with insulin resistance and systemic inflammation, both contributing factors to PCOS and other health conditions. In teenagers, obesity is the highest cause of anovulation (not ovulating) that continues into adulthood.
During PCOS, the ovaries produce abnormally high levels of androgen (male) hormones. These control the development of male characteristics and prevent the ovaries from releasing eggs, and can trigger extra hair growth (hirsutism) and acne. High androgen levels also contribute to insulin resistance through causing weight gain, resulting in the same metabolic outcomes as MetS. At the same time, increasing insulin leads to further androgen production, preventing menstruation and ovulation. It is therefore thought that high androgen levels together with insulin resistance creates a snowball-effect where increased insulin leads to higher androgen levels, which in turn increases insulin resistance and worsens PCOS.
What is an ovarian cyst?
An ovarian cyst is any collection of fluid, surrounded by a thin wall, within an ovary. Small ovarian cysts, called follicles, are normal and occur in both ovaries. A follicle that is larger than about 2cm is termed an ‘ovarian cyst’. Such cysts range in size from as small as a pea, to larger than an orange.
The diagnosis of polycystic ovaries is made when there are either 12 or more ovarian cysts, or when one or both ovaries are bigger than 10cm3.
Although 20% of all women have ovarian cysts, it does not mean you necessarily have polycystic ovary syndrome or vice versa. These cysts are only one of the components of PCOS.
What are the treatments for PCOS?
Due to PCOS being a complex disorder resulting from many different underlying factors, there are no pharmaceutical drugs specifically designed for the condition. Rather, medications and treatments are prescribed to address specific symptoms, such as high blood sugar or unwanted hair growth.
Principles of the treatment of PCOS
- Treatment is focussed on symptoms
- Patients with mild symptoms might only require lifestyle modification and supplements
- Treatment should be chronic and adapted to the changing circumstances, personal needs and expectations of the patient
Drugs that are used for PCOS and its treatment include:
- Hormonal therapies, including combination birth control pills, progestin, clomid (an anti-oestrogen medication) and gonadotropins. These therapies can work to reduce androgen production, or stimulate ovulation and menstruation.
- Metformin, used to improve the insulin related aspects of the condition
- Topical drugs, like creams, which act to prevent hair growth, acne, etc.
Lifestyle modification should be recommended to every woman with PCOS or any of its symptoms. Maintenance of healthy habits might reduce insulin resistance and its consequences, restore ovulation and improve fertility. These include:
- Maintaining a healthy weight. Weight loss can reduce insulin and androgen levels and may restore ovulation. Even slight reductions (as little as 5%) can make a difference and improve fertility.
- Avoidance of processed, high-carbohydrate foods. Diet should be centred upon plant-based, minimally processed foods comprising complex carbohydrates, healthy fats and proteins.
- Staying active. Exercise helps lower blood sugar levels, reduce inflammation and improve hormonal regulation.
- Avoiding toxic substances, such as tobacco and alcohol. Not only can these cause direct damage via oxidative stress, but also affect hormonal regulation and inflammation.
Due to the complex nature of PCOS and MetS, many underlying deficiencies and imbalances develop and, in turn, contribute to these conditions getting worse. These are often in vitamins, minerals and compounds which the body naturally makes and uses, but due to metabolic imbalance, is making too little, getting rid of too much, or using incorrectly. For this reason, providing your body with these substances can prove highly beneficial to improving outcomes and symptoms of PCOS and MetS. Some of the most well-researched and effective supplements are:
- Inositol, a naturally occurring nutrient which exist in the body in two forms: myo (MI) and D-chiro-inositol (DCI). Both act in fertility, reproduction and metabolic health. Problems in the balance between these two forms of inositol results in reduced insulin sensitivity and poor ovary function. Clinical studies have shown that inositol, especially at the ratio provided by OviVance™, improves regulation of insulin and insulin sensitivity, ovulation and follicular maturation, egg quality and quantity and restores menstrual cycle regularity.
- Vitamin D is well known to assist in MetS and PCOS through reduction in insulin resistance, dyslipidaemia and obesity.
- Magnesium assists metabolic aspects of female health, especially in terms of MetS, PCOS and reducing the risk of gestational diabetes.
- Selenium has well established roles in MetS and PCOS, insulin sensitization, and an inverse relationship with androgenic hormone levels
- Zinc is important to addressing PCOS and MetS, especially through reducing inflammation and oxidative stress, improving insulin sensitivity, blood sugar regulation and dyslipidaemia.
OviVance™, a unique blend of vitamins and minerals specially formulated by MNI to aid in improving fertility and PCOS, contains all of these vital substances in optimal amounts, helping you to enhance your reproductive ad metabolic health and ovary function, whether you suffer from PCOS or just wish to improve your fertility. Try OviVance™ to take control of your reproductive health today.
- Hursting SD, PhD, MPH. Obesity, Energy Balance and Cancer: Trends, Targets and Transgenics. 2003. Department of Carcinogenesis, University of Texas
- Linkov F, PhD. Cancer Epidemiology: The Need for Global Information Sharing in obesity and cancer? World Congress of Epidemiology, Aug 2011
- Pazaitou-Panayiotou, K., Polyzos, S. A. and Mantzoros, C. S. (2013), Obesity and thyroid cancer: epidemiologic associations and underlying mechanisms. Obesity Reviews. doi: 10.1111/obr.12070
- Yehuda-Shnaidman E, Schwarts B. Mechanisms linking obesity, inflammation and altered metabolism to colon carcinogenesis. Obes Rev. 2012 Dec: 13(12): 1083-95. Epub 2012 Sep 3.
- Birk S, Peeters A, Mackholder K, O’Brien P, Brown W. A systemic review of the impact of weight loss on cancer incidence and mortality. Obesity Review, Vol 13, Issue 10, pgs. 868-891, Oct 2012
- Gallagher EJ, MB BCH BAO MRCPI, LeRoith D, MD, PhD. Epidemiology and molecular mechanisms tying obesity, diabetes and the metabolic syndrome with cancer. Diabetic Care, Vol36, Sup 2, Aug 2013
- Messiah SE, Lipschultz SE, Natale RA, Miller TL. The imperative to prevent and treat childhood obesity: why the world cannot afford to wait. Clinical Obesity
- The Cancer Association of South Africa. http://www.CANSA.org. Accessed 16 October 2013
- Krygsman, A. Can restriction of carbohydrate and/or omega fatty acids prevent breast cancer development? Dept. of Physiological Sciences, University of Stellenbosch.
- Albrecht, C MD. Cancer stakes its Territory- Causes and Link to Stress. Head of research, CANSA, Aug 2012
- Herbst MC, Prof. Fact sheet on Colorectal Cancer. Cancer Association of South Africa. June 2013
- Donna Kerrigan, M.S. Jeanne Kelly. Brian Hollen. Understanding Cancer and Related Topics, Understanding Cancer Genomics. National Cancer Institute.
- Shmoop Editorial Team. “The Cell Cycle, Cellular Growth, and Cancer” Shmoop.com. Shmoop University, Inc., 11 Nov. 2008. Web. 17 Oct. 2013.
- Chow AY, PhD. (2010) Cell Cycle Control by Oncogenes and Tumour Suppressors: Driving the Transformation of Normal Cells into Cancerous Cells. Nature Education 3(9):7
- National Cancer Institute at the National Institutes of Health. Fact Sheet: Obesity and Cancer Risk. www.cancer.gov/cancertopics/factsheet/risk/obesity Accessed 18 October 2013
- Nissen MJ, Shapiro A, Swenson KK. Changes in weight and body composition in women receiving chemotherapy for breast cancer. Clin Breast Cancer, 2011 Mar;11(1):52-60
- The Cancer Association of South Africa. Breast Cancer – Big & Small Let’s save them all. www.cansa.org.za Accessed 16 October 2013
- National Academy of Sciences. The Role of Obesity in Cancer Survival and Recurrence: Workshop Summary 2012
Talk to an expert
Get the advice you need from an expert in the medical field. Fill in a few forms and we’ll put you in touch with an expert.