Challenges with Polycystic ovarian syndrome (PCOS)
Polycystic ovarian syndrome (PCOS), also referred to as Stein-Leventhal syndrome, affects up to 13% of women, according to an article in BMC Women’s Health. PCOS is not classified as a disease, as it is not a specific or constant set of symptoms and physical characteristics. PCOS is better described as a syndrome with a collection of symptoms such as menstrual changes and irregularities, infertility, pregnancy loss, and skin and hair changes. Those with PCOS may also see changes in bloodwork like elevations in testosterone or insulin resistance. The most common characteristics of PCOS are:
Almost all women who have all three of the classic signs of obesity, hirsutism, and/or irregular menses have PCOS. A challenge to identifying and diagnosing PCOS is that many women who have this syndrome don’t have all three classic signs. Not all women with PCOS are obese. Less than 50% are overweight, as Dr. Tori Hudson described in her blog post. To be able to diagnose PCOS, the patient must meet two of three criteria:
The etiology of PCOS is unclear and might be multi-factorial. It is thought that insulin resistance may lead to elevated insulin levels in the body, which stimulates excess ovarian production of hormones like testosterone leading to menstrual changes and anovulation. Insulin resistance is an inability of insulin to increase the uptake and utilization of glucose. Those with insulin resistance may also be at a higher risk for developing type 2 diabetes, high blood pressure, and elevated cholesterol.
Treatment goals for those with PCOS consist of improving insulin sensitivity and reducing testosterone levels if elevated. Diets that are low in sugar and refined carbohydrates are often recommended to improve insulin sensitivity and support a healthy weight. Moderate-intensity physical activity equating to 150 minutes per week or 75 minutes of vigorous exercise per week is recommended for adult women aged 18-64. Physical activity may include brisk walking (3-4.5 mph), jogging, cycling (5-9 mph), swimming, or aerobic exercise that can be done in 30-60 minute duration. These recommendations have been stated by the Center for Research Excellence in Polycystic Ovary Syndrome.
Managing PCOS and improving fertility outcomes may require an individualized treatment plan depending on the symptom severity and desire to become pregnant. Because this syndrome can prove challenging to diagnose, a case-by-case treatment approach might provide the most favorable outcomes. Knowing that insulin resistance is a crucial factor in causing hormonal changes, improving insulin sensitivity is a place to start.
Resources:
1. Women’s Encyclopedia of Natural Medicine. Tori Hudson, N.D., McGraw/Hill publishing
2. International evidence based guideline for assessment and management of PCOS
3. Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010 Jun 30;8:41. doi: 10.1186/1741-7015-8-41. PMID: 20591140; PMCID: PMC2909929.
4. Lebovitz HE. Insulin resistance: definition and consequences. Exp Clin Endocrinol Diabetes. 2001;109 Suppl 2:S135-48. doi: 10.1055/s-2001-18576. PMID: 11460565.
5. Azziz R, Carmina E, Chen Z, Dunaif A, Laven JS, Legro RS, Lizneva D, Natterson-Horowtiz B, Teede HJ, Yildiz BO. Polycystic ovary syndrome. Nature Rev Dis Primers. 2016;2:16057.
6. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004 Jan;81(1):19-25. doi: 10.1016/j.fertnstert.2003.10.004. PMID: 14711538.
