Title: Polycystic Ovarian Syndrome (PCOS): Overview
Polycystic Ovarian Syndrome (PCOS) is a bit of a misnomer. A common misconception is that those of us with PCOS have actual cysts in the ovaries. That's not actually the case. So what is PCOS and how do we know if we have it?
The first thing to understand is that PCOS is very common, effecting an estimated 5% to 20% of women during their reproductive years, and it is one of the most common causes of sub-fertility (2). It is estimated that up to 75% of women with this condition are undiagnosed (2). I will use the term women in this article to refer to those of us assigned female at birth who have and retain ovaries, with the understanding that we may not all identify as women.
The most common symptoms are irregular menstrual cycles, male pattern hair growth, and characteristic findings on pelvic ultrasound (sometimes, but not always) (1). The severity of these symptoms can vary from person to person and there are different presentation "types" of PCOS.
You see, every month follicles in our ovaries develop until one of them takes over (becoming the "dominant follicle"), which is then released as an egg when we ovulate. In PCOS, we see multiple large follicles developing, and these are referred to as "cysts". They aren't the cysts that most of us imagine when we hear that word, but really multiple follicles in our ovaries that are being stimulated all at once. Because of this hormonal dysfunction, one follicle isn't able to take over and mature, which often means that the body doesn't release an egg, and this can lead to irregular periods and menstrual cycles where no egg is released (called an anovulatory cycle).
The Rotterdam criteria is used to diagnose PCOS (1). A diagnosis can be made if any 2 of the following criteria are present, as long as other relevant diagnoses have been excluded (1). That is why it is so very important to see a Women's Health expert to ensure that we truly have PCOS and not something else. There are other things that can cause these symptoms and so a full work-up is recommended for anyone experiencing these symptoms to ensure that this is PCOS and not something else.
What is a "modified Ferriman–Gallwey score"? It is basically a subjective scoring of male pattern hair growth in women (image shown below). Due to the subjective nature of the scoring, there is a concern that any male pattern hair growth in a woman should be investigated (3). Why? Because male-pattern hair growth in women, referred to as Hirsutism, is strongly correlated with metabolic syndrome, which is at the core of why many of us may have PCOS (1)(2)(3). More on that in a coming blog!
Why should we care? "Women with PCOS also frequently suffer from metabolic dysfunction, obesity, infertility and are at an increased risk of pregnancy complications and long-term cardiovascular disease" (1). PCOS can increase the risk for diabetes during pregnancy (gestational diabetes), pregnancy-induced high blood pressure (pre-eclampsia), miscarriage or premature birth, fatty liver, chronic weight gain, high blood pressure, prediabetes and type 2 diabetes, depression, anxiety, and uterine cancer (5).
There is growing research to suggest that restoring insulin sensitivity and avoiding exposure to Advanced Glycation End Products (AGE's for short, or sometimes called Glycotoxins) in the diet can improve and potentially restore normal ovulatory function in both normal weight and overweight women (6)(7).
"Advanced glycation end products (AGEs) are proteins or lipids that become glycated after exposure to sugars" (8).
What should you do if you think that you have PCOS? The first step would be to see a medical provider who is trained to diagnose PCOS like your primary care provider or a Women's Health Specialist like an OB/GYN. They can run tests and order an ultrasound to ensure that PCOS is the correct diagnosis and not something else.
If you already have a diagnosis of PCOS and you are looking to make changes to your diet and lifestyle, then adopting a plant predominant dietary pattern can lower dietary AGE's and improve insulin resistance. That's where Lifestyle Medicine Maine can help!
Here at Lifestyle Medicine Maine, our clinician, Jessica Krol, FNP, DipACLM works with women who have a confirmed diagnosis of PCOS, to help with the transition to a plant-predominant, low AGE, dietary pattern. We do this through the 12 week therapeutic group programs that begin every 3 months. Together, with a group of like-minded peers, we engage in weekly dietary challenges that are specific and measurable. It's a fun group that is focused on health, wellness and weight loss that meets every Sunday from 10-11am EST in 12 week sessions.
Learn more our next 12 week program that begins on April 7th here. In addition to the Sunday virtual group meetings, clients also meet with me 1:1 for bi-weekly video tele-health visits to review progress, as well as optional short clinic visits to weigh-in or complete blood work offered weekly on Tuesday's at Root To Rise in Scarborough, Maine.
What should women engaging in the 12 week kickstart group who have PCOS except?
We track the rhythm of the menstrual cycle using the Natural Cycles App (FDA approved application that is HSA eligible), which is compatible with the Aura Ring for easy daily temperature readings.
We use at-home LH tests (urine tests) to detect the ovulatory surge when prompted by the App.
We monitor labs in the office: we typically start by screening for insulin resistance and measure baseline systemic inflammation. We track HOMA-IR (a blood test that monitors insulin resistance) every 6 or so weeks to monitor for improvements as we engage in the 12 week sessions. At the end of the 12 week session, we repeat a hs-CRP to monitor for changes in systemic inflammation.
After 12 weeks, you'll decide if you feel comfortable continuing on independently, or you'll have the option of staying with the group at an affordable monthly rate for as long as you need.
Want to learn more or have questions? Schedule a FREE consultation to discuss the 12 week program and make sure that we're a good fit. Here is a link to my calendar so that we can set aside time to chat. Talk to you soon!
References
Current Guidelines for Diagnosing PCOS. Christ and Cedars. Diagnostics. (2023) https://doi.org/10.3390%2Fdiagnostics13061113
Health Care-Related Economic Burden of Polycystic Ovary Syndrome in the United States: Pregnancy-Related and Long-Term Health Consequences. Riestenberg, et al. Journal of Clinical Endocrinology and Metabolism. (2022) https://doi.org/10.1210/clinem/dgab613
Modified Ferriman–Gallwey Score in Hirsutism and its Association with Metabolic Syndrome. Aswini and Jayapalan. International Journal of Trichology. (2017) https://doi.org/10.4103%2Fijt.ijt_93_16
Update on the management of hirsutism. Harrison, et al. Cleveland Clinic Journal of Medicine. (2010) https://www.ccjm.org/content/ccjom/77/6/388.full.pdf
Polycystic ovary syndrome (PCOS). Mayo Clinic. (2022) https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
Increased serum advanced glycation end-products is a distinct finding in lean women with polycystic ovary syndrome (PCOS). Diamanti-Kandarakis, et al. Endocrinology. (2008) https://doi.org/10.1111/j.1365-2265.2008.03247.x
Impact of dietary modification of advanced glycation end products (AGEs) on the hormonal and metabolic profile of women with polycystic ovary syndrome (PCOS). Tantalaki, et al. Journal Hormones. (2014) https://www.hormones.gr/pdf/Hormones_2014-65.pdf
Advanced Glycation End Products: Sparking the Development of Diabetic Vascular Injury. Goldin, et al. Journal Circulation. (2006) https://doi.org/10.1161/CIRCULATIONAHA.106.621854
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