What is it PCOS or Polycystic Ovary Syndrome?
PCOS or Polycystic Ovary Syndrome is the most common endocrine disorder in women of reproductive age worldwide (1). Studies suggest shocking numbers of somewhere in between 3 and 15% (depending on their ethnic origin) (2)(3) of females experiencing PCOS symptoms at some point during their life stage.
Originally, the condition was only associated with overweight women experiencing infertility, amenorrhea, hirsutism, enlarged and/or cystic ovaries. However, the condition is equally known to appear in all body type women today(3).
The European Human Reproduction and Embryology and American Solitary of Reproductive Medicine in 2003 agreed that at least two of the following criteria must be present to diagnose PCOS:
1. Irregular or lack of ovulation
2. Signs of excess androgen activity
3. Polycystic ovaries on ultrasounds
What is special about the Functional and Metabolic Medicine approach is that it always looks for the root cause of the condition. In fact, it also identifies a set of other conditions associated with PCOS, such as Cushing’s syndrome, congenital adrenal hyperplasia and even ovarian and adrenal tumours (3), that may be often ignored if the PCOS treatment program focuses exclusively on attenuating symptoms.
My clinical experience confirms the scientific literature (3) which suggests that PCOS has a heterogenic nature and first-line therapy, initial assessment, functional medicine testing, and nutritional and lifestyle prescription are essential. PCOS healing plans should involve an in-depth investigation of the Hypothalamic-Pituitary-Ovarian Axis (4), as well as the Thyroid health and Gut-Brain Axis.
What looks like the normal menstrual cycle?
In a healthy body, pulsatile release of the gonadotropin-releasing hormone (GnRH) from the hypothalamus stimulates the pulsatile release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary. Every menstrual cycle begins when FSH levels rise in response to decreasing estrogen and progesterone levels at the end of the previous luteal phase. Responding to rising FSH, a cohort of follicles begins to grow and develop. The theca cells within the follicles respond to LH by producing androgens (androstenedione and testosterone), which are converted to estrogens (estrone and estradiol) in the granulosa cells influenced by FSH. As estrogen levels rise, FSH secretion from the pituitary is inhibited, and most follicles undergo atresia. The single, dominant follicle that emerges has increased FSH receptors on the granulosa cells and is, therefore, able to maintain growth even as central FSH concentrations decline. The rising estrogen level triggers the onset of a mid-cycle LH surge, resulting in ovulation 34 to 36 hours later. The granulosa cells, influenced by estrogen, acquire LH receptors as the cycle progresses. Following ovulation, LH stimulation of the granulosa cells results in progesterone production. Rising estrogen levels during the first half of the cycle (the proliferative phase) stimulate increased endometrial thickness and vascularity. Progesterone production following ovulation (the secretory phase) stimulates increased glandular secretion and vessel tortuosity within the endometrium. In the absence of pregnancy, progesterone and estrogen levels fall after about 14 days, the endometrium is sloughed, and a new cycle begins (3).
How is PCOS diagnosed?
PCOS is the most common endocrine health problem in women. What is worrying is that, in my Functional Medicine practice I get to work with both women who had been diagnosed with PCOS, and many women that experience obvious PCOS symptoms such as weight gain, hypothyroidism, insulin resistance, alopecia, acne, dyslipidemia, hypertension, or infertility (4), but have never been diagnosed or screened for PCOS
What is even worse is that 46% of women with PCOS pose an increased risk of metabolic syndrome, which itself attracts increased risk of type 2 diabetes and cardiovascular disease (4). Nearly 75% of women with PCOS would experience a lack of period, also known as amenorrhea and 85% of women are believed to be affected by excess body hair, also called hirsutism. 40% of women with PCOS have a sister with PCOS and 35 % women’s with PCOS mothers have the condition themselves.
The diagnosis of PCOS as mentioned is heterogenic, hence often missed.
Other less known symptoms associated with PCOS?
Depression, oily skin, skin tags, grey-white breast discharges, sleep apnea, pelvic pain, thinning scalp hair, epilepsy connection, tension can all be signs of PCOS.
Functional Laboratory Testing
I personally encourage correct diagnosis through Functional Laboratory evaluation as an important part of the PCOS healing journey. However, your GP should fearfully evaluate your medical history, family history of oligomenorrhoea, amenorrhea, hirsutism, infertility and diabetes (4).
At Daria Tiesler Wellness, we use an advanced blood profile and 28 days Saliva Hormonal Panel to support the PCOS therapy plan. If you have an existing blood panel from your GP, we always encourage you to bring it with you for your first consultation.
Therapeutic approaches for PCOS management
Traditional treatment often recommends:
1. Oral contraceptives for acne, excess hair growth and the regulation of the menstrual cycle
2. Metformin for the management of blood sugar
3. Other drugs
On the other side, Functional, Metabolic and Nutritional Medicine is rather an integrative approach. It promotes finding the root cause of your illness as a first step. The process implies paying great attention to your medical and family history. Only afterwards, your practitioner identifies the unique root cause of PCOS and designs the most appropriate therapy plan to address it. The plan may include:
1. Medical therapy in conjunction with other integrated therapies
2. Herbal Remedies
3. Nutritional Therapy
4. Personalized weight loss programs
5. Stress reduction strategies
8. Movement and Exercise
11. Dietary supplements
As mentioned before, each body is unique and weight loss and fertility, in particular, imply more than mainstream diets or supplements. Yes, I am sorry to break it to you! That Youtuber’s strategy may become your worst enemy. We are all different and it is so important to be mindful of our own bodies and history. Anyway, there are a few guidelines which, as a baseline therapy, are great for women with PCOS:
1. Increasing fibre in your diet has a positive effect on blood sugar regulation and lowers cholesterol ;
Soluble fibre sources are oats, berries, pears, broccoli, carrots, beans, pulses, seeds, nuts, brussel sprouts, sweet potato.
Insoluble fibre can be found in vegetables and whole grains.
2. Following a Low GI menu was proven to decrease central fat storage and to improve insulin sensitivity ;
3. Eating good fats, especially polyunsaturated fatty acids such as walnuts, salmon, sunflower seeds, chickpeas, almonds, is a must;
4. Drinking water;
5. Checking your vitamin D level and supplementing accordingly.
Bear in mind that the PCOS strategy that we promote at Daria Tiesler Wellness include without exception lifestyle interventions. There is no magic injection or magic pill that will do the job. Becoming mindful and starting a process of inner transformation and healing will make living with and healing PCOS symptoms so much easier. Lifestyle interventions play an important part in creating sustainable and healthier behaviours (7).
I encourage you to practice a few simple lifestyle interventions from the following for a few weeks:
1. Stress reduction techniques
Most women with PCOS display a decreased ability to process cortisol effectively. This leads to the elevation of cortisol in the body which has such a negative impact on reproductive health.
We offer the option to join our one to one, 30 minutes online Mindfulness class to learn two simple techniques that will help you to balance your stress response.
2. Sleeping cycle
Women with PCOS have been shown to be predisposed to sleep disturbances and, although not valued enough in the busy society today, sleep has a profound effect on your hormonal health.
A few tips for a healthy sleep are:
· Lavender oil on your pillow;
· Stopping electronic devices at least 1 hour before bedtime;
· Air out your room;
· Magnesium oil before sleep could also be very helpful;
· Cut alcohol and high sugary foods.
Tai Chi, Qi- Gong, and Weight Training have all been shown to help with female hormonal balance, so they could be of great help for such an endocrine/ hormones related condition as PCOS. Both Tai Chi and Qi- Gong could help you be more mindful, more connected to your breathing. As for Weight Training, it will help with insulin resistance and changing body composition. Other benefits of exercise include improvement in metabolic profile, cardiovascular protection and weight loss.
Finally, remember that any movement is welcome! So, get your friend and go for a walk!
During the years, we have learned that our clients are worried about feeling lonely or not fully understood at times, when on their way to a better health. When joining Daria Tiesler Wellness, you will feel supported all the way through the process.
Book your 20 min free initial consultation and discuss with us your health story and together we can create your PCOS Personalised Program that will support your health and life.