I recall not all that long ago mentioning to other primary care providers about my diagnosis of Polycystic Ovarian Syndrome (PCOS) and receiving a plethora of blank stares. However, slowly but surely PCOS has gained more attention and in turn, more research has been done. One part of my practice that I’m very passionate about, is locking arms with other women who deal/have dealt with endocrine imbalances. Since PCOS is still in its infancy of being fully understood, protocol for treating this issue is also still in the beginning stages. This means that there are a lot of different views and suggestions on that matter. But before diving into that, let’s discuss what PCOS even is, for those of you that are unfamiliar with this issue.
PCOS is a hormonal based problem that typically affects women of childbearing age (even as young as 10-11 years old). It is the most common cause of infertility in women, although it’s known to bring a whole host of other problems with it as well. Women typically experience enlarged ovaries that are accompanied by multiple small cysts (fluid filled pockets) within the ovaries. The ovaries themselves are only about the size of a small walnut. On average, a cyst can range from ¼ inch to 4 inches. There are several different kinds of cysts, but functional cysts are the most common. These are the cysts that develop during the menstrual cycle. An egg will grow inside a sac located within the ovaries. When the sac breaks open, an egg is released. However, if it doesn’t break open, additional fluid can develop, and a more aggressive type of cyst can form in the ovary. These are the kind of cysts that typically begin to cause chronic pain.
While many times women don’t even know that they have a cyst, when it progresses, some women can experience: abdominal bloating or swelling, pelvic pain, pain in the lower back or thighs, painful bowel movements, nausea and vomiting, and painful intercourse. If you ever experience sharp or severe pelvic pain, continued vomiting, increased sweating, fever, faintness or dizziness, or rapid breathing, these are causes for concern and you should seek medical attention right away. These symptoms can indicate something called ovarian torsion (where the ovary can twist and the blood supply to the ovary is cut off) or a ruptured cyst (causing severe pain and internal bleeding).
While there is a lot more to it, including the added complications of issues such as endometriosis, my goal is to keep this focused in on one area rather than feeling like a course in Endocrinology. So in keeping to the point of this article, let’s narrow back in on PCOS.
What happens in PCOS is that more often than not, the follicles (or sacs) are typically immature. This means that the sacs contain fluid, and can expand in size, but they don’t fully mature and release an egg. These immature sacs can begin to accumulate in the ovaries, as abnormal hormone levels continue to signal the development of these follicles but prevent the full maturation of them. Because of this, women can experience difficulty conceiving and are often at an increased risk of both complications and loss of pregnancy.
A large part of the issues that arise in PCOS are the hormone imbalances. Women typically experience an excess of the male sex hormones, or androgens. When there is too much of this hormone, women can experience excessive growth of body hair, acne, increased weight gain around their stomach, and male pattern baldness. Additionally, women typically experience increased levels of insulin. Insulin is a hormone that is made by the pancreas. It helps the body to not only store, but also use glucose (sugar). Insulin is responsible for delivering that glucose from the bloodstream into the liver, muscle, fat, and a majority of your other cells so that your body can use it for fuel. So insulin is extremely important! However, with insulin resistance, the body has a hard time pulling in the glucose to use it for energy. This can result in increased blood sugar levels and even increased obesity, which can lead to further PCOS complications. Insulin resistance is a large part of PCOS and can be the root cause of many of the issues that women with this condition face. Again, in an effort to prevent this from becoming an endocrinology course, I’ll save the full explanation of insulin resistance for another article.
Women with PCOS can also be at increased risk for fatty liver and metabolic syndrome. In metabolic syndrome women can see high blood pressure, increased belly fat, and high levels of the “bad” fat in the blood stream, in addition to those high blood sugar levels. Sleep apnea is also not an uncommon thing seen in this condition either. PCOS can also cause increased incidences of mood disorders like depression and anxiety, as compared to the general population.
The causes of PCOS are complex. Ranging from health, lifestyle, and genetic factors with many of which still not having been fully identified. Some research suggests that different variations in several genes have been associated with the risk of PCOS development. Other research suggests it could be triggered by factors such as adrenal fatigue, or even contribute to, the development of these other conditions. There is a strong possibility that the main contributor is a genetic variant that increases the production of androgen and other sex hormones that play main roles in the ovulation process. Insulin production and regulation, immune system responses and inflammation, energy production, and pathways that involve the production of fats, are also all contenders in the battle of the hormones.
So what do we do about this?? A common practice is the prescribing of birth control pills and Metformin. Birth control to help with hormone production and control, and Metformin for the insulin resistance. While some women have experienced some success with this, many women have seen a slight reduction in their symptoms, but still experience many of the unfortunate side effects of PCOS. To make matters worse, there is a hormonal axis in the body that PCOS just loves to mess with. The Ovarian-Adrenal-Thyroid (OAT) axis. Just like a 3-legged stool, if one of the legs is affected then the whole thing falls over. So, in the case of PCOS, if a woman is experiencing issues with the ovarian portion, you can bet she’s going to have trouble with her adrenals and thyroid as well. I see and speak to a lot, and I mean a lot of women who just know they have thyroid problems but never test “positive”. Or, women who do show the right numbers in their lab work, get prescribed medication, take said medication, and then see little to no improvement in their overall condition. But that should solve it, right? Oh yeah, did I mention there are two other main hormonal axes? The Hypothalamic-Pituitary-Adrenal (HPA) axis and the Hypothalamic-Pituitary-Thyroid (HPT) axis. So now you’re a woman that has an issue in the OAT axis and because the adrenals become affected, that begins to affect the HPA axis. And because the thyroid becomes affected, that begins to affect the HPT axis as well. I’m sure by now you can see how this can become very complicated very quickly.
So in order to truly treat PCOS, and it’s symptoms, you can’t just address one part of it. When caught early enough, treatment can be fairly simple. However, as with most women dealing with PCOS, treatment takes time and patience. Every piece of the condition must be thoroughly addressed. By approaching treatment from a holistic point of view, women can not only find relief from their symptoms, but live a happy, healthy life full of vitality.
Dr. Stewart is a Chiropractic Physician, Integrative Nutritionist, and Paramedic. Having personally dealt with Polycystic Ovarian Syndrome, Ovarian Torsion, Estrogen Dominance, and Adrenal Resistance, Dr. Stewart has a passion for helping women of all ages regain a strong grasp on their health to live the best life possible.