Polycystic ovary syndrome

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Did you know that between 3 and 10% of women of childbearing age suffer from polycystic ovarian syndrome and that it is one of the most frequent causes of female infertility today?

PCOS, also called functional ovarian hyperandrogenism or hyperandrogenic chronic anovulation, is a common hormonal disorder among women of reproductive age.

Women with PCOS present a hormonal, metabolic and reproductive imbalance that causes the ovaries or the female adrenal glands to produce androgens in an exaggerated way, producing different alterations in the organism. These alterations manifest with very varied symptoms, which is why it is said that each woman has her own PCOS and this makes diagnosis very difficult.

Although to this day we still do not know the exact cause that causes it, we know that there is a genetic predisposition and that there is a close relationship between PCOS and insulin resistance.

If you want to learn more about SOP and what you can do to reverse this situation, I invite you to continue reading.

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1. PCOS Diagnosis

The first to recognize an association between polycystic ovaries and signs of amenorrhea, hirsutism, and obesity were Stein and Leventhal, between 1925 and 1935. Thirty years later, attention was drawn to the alterations in the hypothalamic-pituitary-gonadal axis in women who suffered from it and since then different criteria have been established for its diagnosis.

Today, the most current criteria we have to define pathology are those of Rotterdam. In which it is necessary that at least 2 of the following characteristics are met to affirm that we are dealing with a case of PCOS:

• Hyperandrogenism : it can be clinical (acne, hirsutism, androgenic alopecia) and/or biochemical (increased plasma androgens). Androgens are the well-known “male hormones” women also produce and need them but to a lesser extent. The excess of these hormones are the cause of masculine traits in women such as facial hair or hair loss, so characteristic of PCOS, in addition to other irregularities.
• Oligo-anovulation : Most women with PCOS suffer from menstrual disorders. The excess of androgens prevents the follicles from developing correctly inside the ovary and they remain encapsulated inside it without being able to be released, producing anovulatory cycles and/or menstrual irregularities.
• Polycystic ovaries : through an ovarian ultrasound, 12 or more follicles can be observed, with a diameter between 2-9 mm and/or ovarian volume greater than 10 mm.

The diagnosis of PCOS is a diagnosis by ruling out, there is no single test to identify it. Therefore, we must differentiate it from the physiological changes typical of age and from other hyperandrogenic disorders that may exist, and once these options have been ruled out, the Rotterdam criteria are applied.

Remember that at least 2 of the above conditions must be met to affirm that we are dealing with a case of PCOS.

2. Types of SOPs

We can talk about 2 types of SOP according to their characteristics. This is important because the approach is completely different.

2.1. PCOS due to insulin resistance

It is undoubtedly the most common type of SOP, the one that we find ourselves in consultation with the most. These women present resistance to insulin , they find it difficult to lose weight or they gain it easily but... What is happening?

The insuline is an hormon produced for the pancreas. It is released into the bloodstream when blood glucose levels rise.

People with this pathology do not respond optimally to the insulin released by the pancreas and as a compensatory response, the pancreas is forced to release higher amounts of insulin than normal to achieve the desired effect, thus producing hyperinsulinemia.

This excess insulin causes:

• An increase in androgen production in both the ovary and adrenal glands.
• It stimulates the pituitary gland to produce more luteinizing hormone (LH) and this drives androgen synthesis in the ovarian follicles.
• It decreases the synthesis of the SHBG protein , which is responsible for transporting androgens in the blood. This means that the lower its concentration in plasma, the more free androgens there will be in the bloodstream so that they can exert their function on the ovaries.

2.2. adrenal PCOS

They are thin women, with an athletic complexion, very perfectionists and want to have everything under control, they do everything "too well" and give their best in every situation.

That level of stress (remember that stress can be physical, emotional or energetic) causes excessive activation of the adrenal glands . Cortisol is chronically elevated, leading to increased androgen production and ovarian dysfunction (amenorrhea/oligomenorrhea).

Although initially this PCOS does not present insulin resistance, its relationship with it is not optimal. Maintaining high cortisol levels for a long time worsens insulin sensitivity and can eventually lead to cellular resistance .

There are other reasons why women may have exaggerated levels of androgens: after stopping the contraceptive pill, chronic low-grade inflammation, hyperprolactinemia, hypothyroidism, etc. To consider it PCOS, other criteria would have to be taken into account, not just hyperandrogenism.

3. Symptoms

PCOS can be observed in multiple ways, it can be said that each woman has her own symptoms. Some of the most common symptoms are:

• Irregular menstrual cycles.
• Profuse and long bleeding.
• Hair loss, acne, excessive hair or oily skin.
• Presence of cysts in the ovaries.
• Weight gain, especially in the abdominal area.
• Insulin resistance.
• Difficulty for pregnancy.
• Depression, anxiety.

PCOS often goes undiagnosed and untreated, perhaps because the symptoms are mild or seem unrelated. But not treating it can lead to future health problems such as type 2 diabetes, infertility or depression, and its symptoms can cause great suffering.

If you think you may have polycystic ovary syndrome , see a professional who can help you.

4. Treatment in PCOS

The drugs most used by conventional medicine to treat PCOS are the contraceptive pill, metformin and antiandrogenic drugs. With these treatments we manage to improve the symptoms but we do not solve the problem and the symptoms reappear if we stop taking the medication.

The good news is that PCOS can be addressed naturally in most cases, through nutrition, physical exercise, and natural supplementation.

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Most women do not need pharmacological medication to treat PCOS. This does not exclude that there are women who do need it, especially at the beginning if the symptoms are very acute. The professional must have knowledge of all the tools and strategies, both pharmacological and natural, and know when to apply them, this is the best way to approach health.

Let's start with the basics, improve diet, lifestyle habits and circadian rhythms .

4.1. natural supplements

A very high percentage of women with PCOS, up to 70%, have insulin resistance, and the best way to become sensitive to it is with physical exercise and diet. A diet low in carbohydrates decreases insulin levels in the blood and strength exercise also, since by building muscle mass we will have more insulin receptors. There will be less glucose circulating through the bloodstream.

Regarding life habits, it is important to lower stress levels and sleep well respecting circadian rhythms. Stress and lack of sleep raise cortisol, and elevated cortisol promotes insulin resistance and low-grade inflammation.

Natural supplements should be focused on improving insulin sensitivity and regulating hormonal imbalances caused by PCOS. Some of them are:

4.1.1. Myo-inositol

I emphasize Myo-inositol because within the inositols we have Myo-inositol and D-Chiro-inositol, both act as seconds to insulin but mediate different actions.

The "Myo" modality has the ability to capture glucose at the cellular level and improves the sensitivity of FSH in the ovarian follicle, favoring ovulation. While the "D-Chiro" is more involved in the synthesis of glycogen and is also an aromatase enzyme inhibitor. This must be taken into account because, by inhibiting this enzyme, there is an increase in androgens and this is not ideal for women with PCOS since they have more androgens.

On the market you can find multiple supplements to treat PCOS based on these inositols and the amounts differ from one product to another. In case they contain both "Myo" and "D-chiro" the ratio should be 40:1 in favor of Myo-inositol . The "D-Chiro" treatment can be beneficial when administered in low doses, but it loses all its advantages if its dose is higher and we would not achieve results.

4.1.2. Vitex agnus-castus

It is a plant known since ancient times, widely used in gynecological disorders such as premenstrual syndrome or PCOS. It helps us improve hormonal imbalances, favors ovulation, improves progesterone levels and decreases prolactin production.

4.1.3. berberine

It is capable of reducing circulating glucose levels and improves peripheral sensitivity to insulin.

4.1.4. Magnesium Bisglycinate

It regulates the hormonal axis and is a central nervous system relaxant that helps muscle relaxation.

4.1.5. N-Acetyl Cysteine

Stimulates ovulation and follicle maturation in women with PCOS.

4.1.6. Saw Palmetto

It has an anti androgenic effect. Improves acne, reduces facial hair and hair loss.

4.1.7. Licorice

It also helps reduce excessive androgen production but should be avoided if you have tension problems.

4.1.8. urtica dioca

It is a nettle that causes an increase in the SHBG transporter protein (remember that in PCOS they are low) and reduces hyperandrogenism.

PCOS is not a disease as such but rather a set of symptoms caused by different alterations. The variety of supplements after leaving the office can be very long if we want to address all the aspects that cause it, that's why I like FEM BALANCE from Be Levels so much, because the active ingredients most used to combat PCOS are integrated in the same shot. (Myo-inositol, Vitex Agnus Castus, Fenugreek, Ginkgo Biloba, Omega 3 etc.). It is an ideal product for hormonal regulation and as a nutritionist I usually recommend it.

As always, each case must be individualized, in PCOS we find very varied symptoms and a good diagnosis will be the key to the approach.

5. Conclusion

Polycystic ovarian syndrome is a common health problem that can affect both adolescents and young women. Its diagnosis can be complicated by the multiple alterations it causes and because there is no specific test to diagnose it.

With a comprehensive vision and a personalized study, we can treat it with improvements in diet, changes in lifestyle, natural supplementation and medication if necessary.

Bibliography

• “LH-FSH ratio and Pilycystic Ovary Syndrome: A forgotten test?” Saucedo de la Llata ​​E, Moraga-Sánchez MR, Romeu-Sarrió A, Carmona Ruiz IO. Gynecologist Obstet Mex. 2016 Feb;84(2):84-94
• “Diagnostic criteria and therapeutic integral treatment of polycystic ovary syndrome” Sixto Chiliquinga Villacis, Roberto Aguirre Fernández, Maritza Agudo Gonzabay, Ángel Chú Lee, Sylvana Cuenca Buele. Rev Cubana OBstet GInecol vol.43 no.3 City of Havana jul.-sep.2017
• Prevalence of insulin resistance in polycystic ovary syndrome using homeostasis model assessment. Catherine Marin DeUgarte el al. Fertile Sterile. May 2005
• Polycystic ovarian syndrome. Diagnosis and management. P.Teresa Sir, R.Jessica Preisler, N. Amiram Magendzo. DOI:10.1016/S0716-8640(13)70229-3. Sep 2013
• Vitex agnus-castus Extrats for female reproductive Disorders: A Systematic Review of Clinical Trials 2013 May;79(7):562-75. doi: 10.1055/s-0032-1327831. Epub 2012 Nov 7.
• Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings 2014 Dec 18;14:511.doi: 10.1186/1472-6882-14-511.
• The rationale of the Myo-inositol and D-Chiro-inositol combined treatment for polycystic syndrome. doi.org/10.1002/jcph.302. July 12, 2014