Not knowing when your cycle is coming can be annoying when you want to wear white pants, try for a baby or leave the house without the fear of not having a tampon. Whilst annoying, irregular cycles are a sign that our brain isn’t signalling our hormones at the right times in our cycle, and our hormone balance becomes out of sync. Whether you’ve got your first period or you’re entering menopause, it’s important to understand what is normal and what’s not, because while chronic anovulatory cycles have an impact on our fertility they also have bigger consequences on our overall health.
What is PCOS?
With all acronyms it’s much easier if we break it down, so we can really understand what’s going on. PCOS stands for Polycystic Ovarian Syndrome. Poly (Many), Cystic (Cysts- these are formed when ovulation doesn’t occur and the fully developed egg isn’t released), Ovarian (Ovaries), Syndrome (Caused by many interconnected systems that aren’t functioning properly).
So basically, PCOS is when your body is in a chronic state of anovulation (no ovulation), because some of the systems in your body aren’t working properly and so your brain can’t tell your ovaries to release an egg.
What does PCOS look like?
Typically someone with PCOS will have some if not all of the following signs and symptoms:
- Jawline Acne
- Chin, Nipple and Neck hair
- Head hair thinning
- Irregular periods
- Periods every 2 weeks
- Heavy periods (over 80mls roughly 8 tampons)
- Light periods (Less than 10mls)
Remember PCOS is a diagnosis of exclusion. Meaning, you’re diagnosed with PCOS when all other potential causes for hyperandrogegism (male features: nipple hair, deeper voice, jawline acne, facial hair, head hair thinning) and menstrual dysfunctions (irregularity, heaviness, lightness) are ruled out. If you’re experiencing any of the above symptoms, and in particular if they have come on rapidly, it’s a great idea to get checked by a doctor to make sure they’re not symptoms of something else going on.
If not PCOS What else could it be?
- Hypothalamic Amenorrhea (HA)
We know, that’s a big confusing daunting word! Basically what it means is that you’re not getting your period (amenorrhea) because the hormone signals from your brain (hypothalamus) are saying it’s not safe to fall pregnant. Why does it think this? Well in this case, it’s due to low carbohydrate and calorie intake. When our brain registers that we’re not eating enough, it’s famine protecting skills kick in… One of these skills is to stop us from ovulating so that we don’t fall pregnant in a famine, smart right?! Only thing is, when this happens we don’t get a period and we also develop weak bones, heart dysfunction and our brain cells don’t work as they should. Not great at all.
So what do we do about it?–> First if you’re suffering from an eating disorder, seeking help from a mental health professional is your first step. Then it’s about committing to increasing your calories to at least 2500 a day, and making sure you include lots of complex starchy carbs in there (150-200g/day), treat possible gut dysfunction with things like probiotics, ensure your living environment is not stressful, you have 25mg of Zinc a day and your insulin and iodine levels are up to scratch (a GP can test these for you)
- Polycystic Ovaries
Polycystic Ovaries occur when a dominant follicle isn’t released because ovulation isn’t triggered. The main difference between them and PCOS is that they’re not a characteristic feature of a specific hormonal disorder. They result from functional issues in the follicle development OR from prolonged internal ovarian androgen levels–> This happens when we haven’t ovulated in a while, and he cause for that could be numerous things.
There are many reasons why you may be experiencing menstrual irregularity, and they range from chronic stress to more serious issues with your organs. So let’s chat about what your doctor should be checking for when you have menstrual irregularity or loss:
- Are you pregnant?
- Thyroid disorders (Blood test) Have trouble with weight loss, or gain, feel tired, constipated or diarrhoea
- Hyperprolactinemia (Blood test) Can have vaginal dryness, lactation and loss of libido
- Androgen excess causes such as (Issues you were born with, androgen secreting tumours (rare), severe insulin resistance, cushings syndrome, and male pattern hair growth/loss that is for unknown reason) –> All of these can be tested for by your doctor, and ruled out with specific history and examination tailored to you.
Main differences between PCOS and HA...
- Absent or irregular cycles
- Polycystic ovaries
- Normal or high fasting insulin
- Bleed from a progesterone challenge
- Hirsutism and elevated androgens
- Period or two when first stopping the pill
- Any age can out grow it
- High LH to FSH ratio
- Absent or irregular cycles
- Polycystic ovaries
- Low fasting insulin
- No bleed from progesterone challenge
- Possible mild hirsutism
- No period when stopping the pill
- More likely under 30 but can happen at any age
- Low LH to FSH ratio
What tests should i be getting done?
You want to simultaneously rule out any nasty causes as well as figure out the driving force causing this dysfunction, so in that case here are something you can get tested:
- At home pregnancy test
- Thyroid (TSH, TPO antibodies, TBG) (Blood)
- Prolactin levels (Blood)
- Iodine levels (Urine)
- FSH and LH levels
- Internal ultrasound for ovarian cysts
- 2 hour oral glucose tolerance test
- Fasting lipid profile
- Serum testosterone (if you have moderate to severe hirsutism) (be sure to see DHEA-s levels to see if the main cause is stress)
There also some other tests that can be done but these are dependent on your specific history and your doctor will help you through those.
Source: Clinical Gynecologic Endocrinology and Infertility 8th Edition pg. 522
Doctor of Naturopathy
PCOS is not one disease, PCOS is androgen excess
What do i Do about it?
PCOS isn’t one disease, it’s androgen excess caused by chronic dysfunction in your body. These dysfunctions can be categorised into 4 different subgroups, you can categorise yourself, based on the results of the tests above.
- Insulin Resistance
Main focus here is to reverse your insulin resistance, you can do this through:
- Movement and strength training
- Metformin (prescribed by your doctor)
- Berberine (Talk to a naturopath)
- Magnesium (Liquid is the best absorbed, we recommend this one
- Make sure you’re eating plenty of protein (good quality, try not to overdo the animal protein)
- Reduce high-dose fructose (Crappy food, and try and limit sugary fruits)
Post-pill causes of androgen excess can occur because the synthetic hormones in your pill can be derived from testosterone, and work to actually up-regulate your androgens, which causes higher amounts of sebum than before you started the pill
- Make sure you’re getting enough zinc (around 25mg/day)
- Avoid dairy and gluten
If you’re someone who has achy joints, eczema or suffers from an autoimmune disorder, the chances are that your inflammation is the main cause of your androgen excess
- Omega 3’s are a great anti-inflammatory and have been shown to help women with PCOS
- Avoid inflammatory foods (Wheat, dairy, eggs, corn, high fructose foods)
- Get on top of your stress (reading the SD Protocol is a great place to start)
- Consider taking adaptogens to help regulate stress gland function, we recommend these ones
- Meditating and practicing other stress relief techniques (You may need to tell someone to F off and we’re all for it.
- Taking a good quality magnesium is important for adrenal function too.