Updated: Feb 9
Polycystic Ovarian Syndrome (PCOS), is a common condition in women. It is thought to exist in over 20% to 30% of women but is often overlooked by physicians. This condition can result in weight loss struggles, excess hair growth, difficult periods, absence of periods, acne, infertility, diabetes, and even depression. Insulin resistance is considered a key to treating this condition. Genes may play a role as may a family history of low progesterone.
Many of the younger women who suffer from this condition, including teenagers, will have heavier than normal menstrual flows, may have cramps, PMS and headaches. However, some will have no periods or erratic cycles and may not have excess body fat. Acne can be an associated symptom (due in part to higher testosterone). They may also excel in sports and have greater strength due in part to increased levels of testosterone.
Note: Difficult periods or no periods may be a sign of low progesterone and not PCOS. The important role of progesterone will be discussed in another blog. Progesterone.
Diagnosis of PCOS.
The diagnosis is generally easy to establish by a simple lab test. Symptoms are of course important. At Seeking Perfect Health, we check levels of LH (luteinizing hormone), FSH (follicular stimulating hormone), E2, testosterone, glucose, and fasting insulin. Other tests may include prolactin Levels and DHEAs. The LH should be tested during the period of bleeding or just before starting the period. This can be days 26 or 27 of the cycle or days 1 -6 of the cycle.
Note: An ultrasound may also be used with the caveat that cysts are not always present in PCOS.
In the case of PCOS, the lab test will show an increase in LH over the FSH every day (except during ovulation) and the ratio of FSH/LH will be reversed. Testosterone levels may be high and fasting insulin may be high.
Note: In the absence of PCOS, FSH will be higher than LH.
Note 1: High levels of fasting insulin may not always occur. The reason is that insulin resistance can occur at the cellular level and may not be reflected in a simple blood test.
Why is LH high throughout most of the cycle? In PCOS, LH is being produced by the pituitary on a daily basis, the follicles in the ovary are luteinized before they mature, sometimes forming, as seen on an ultrasound, what is known as a “string of pearls”.
The luteinizing hormone will also increase the production of testosterone from the ovary and will cause, in many cases, an increase in hair growth and often acne.
Some symptoms of PCOS. May have a few or many.
Missed periods, heavy cycles, and/or irregular or even light or no cycles.
Ovaries are larger and may have multiple cysts. An ultrasound is used at Seeking Perfect Health along with the other lab tests.
Excessive body hair.
Increase in weight, especially around the belly.
Acne or oily skin.
Female baldness or thinning hair.
Infertility or miscarriages.
Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts.
Small pieces of excess skin on the neck or armpits (skin tags).
PCOS in post-Menopausal women and women who have had hysterectomies.
These women of course have no periods. However, other symptoms can exist, and some can increase and be more problematic later in life. These include diabetes, thinning or loss of hair, and weight struggles.
“Even after menopause, women with PCOS often continue to have high levels of androgens as well as insulin resistance. This means that the health risks associated with PCOS are lifelong.” Jul 27, 2016
Treatments: The treatment favored by functional and holistic doctors include, if a woman has periods, the use of natural progesterone cyclically from days 14 to 28 of each cycle (if perimenopause), spironolactone for any increase hair and/or acne, and DCI (d-chiro-inositol) for insulin control. In some instances, metformin can also be used for the insulin resistance or berberine. Low inflammatory diets are essential.
It is a common practice for conventionally educated doctors to prescribe birth control pills to treat PCOS and sometimes metformin. We have seen this even in post-menopausal women despite the warnings of the Women’s Health Initiative Study (WHI) about the increased risks of cancer with synthetic estrogen and synthetic progestin. See blog on WHI study.
Note 2: A substitute for DCI is Berberine. These all-natural products help with insulin resistance, the hallmark of PCOS, along with low progesterone.
If you have any questions or feel you may be suffering from PCOS, please contact our staff at Seeking Perfect Health, Austin, Texas. Tel: 512-559-4350.
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