Understanding PCOS

What is PCOS?

As the name implies, one common condition that occurs with Polycystic Ovarian Syndrome, or PCOS, is an ovary with many cysts. To understand a cyst, you need to understand the female menstrual cycle.

A woman’s menstrual cycle begins when the pituitary produces follicle-stimulating hormone (FSH). Follicles are where each egg resides in the ovaries. When FSH is produced it stimulates about 20 follicles to start growing and maturing. These growing follicles then start to release estrogen. Increasing estrogen levels encourage thickening of the uterine lining as well as stimulate the pituitary to start producing luteinizing hormone (LH). As you can see from the chart below, a spike in LH causes one or two maturing follicles to release its egg – ovulation. Estrogen drops because the follicles are no longer producing it, which allows progesterone to rise. This hormonal change encourages the uterine lining to be more nourished in anticipation of fertilization. If the egg is not fertilized, progesterone and estrogen levels drop resulting in the sloughing off of the thickened uterine lining – menstruation.

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In a healthy woman, the dominant follicle releases its egg each month. However, in a woman with PCOS, the mature follicle never gets the signal to release its egg. These unreleased eggs are considered cysts. As more and more mature eggs remain in the ovary, the more cystic that ovary becomes – increasing risk of PCOS.

The important thing to understand is that a polycystic ovary is not the cause of PCOS. It is only one of several symptoms that occur as a result of some underlying cause.

Other common symptoms of PCOS include:

• Irregular periods

• Excessive hair growth on face and body

• Thinning hair on scalp

• Acne

• Skin tags

• Darkening of skin, especially at nape of the neck

• Gray-white discharge of breasts

• Excess weight and inability to lose weight

• Sleep apnea

• Pelvic pain

• Depression and anxiety

What Causes PCOS?

Although there are several causes for the symptoms of PCOS, there are four probable causes – Genetics, Environmental Factors, Increased Testosterone, and Hypothalamus Dysfunction. All of these influence the following five hormones involved in the development of PCOS symptoms.

Estrogen – If your body is estrogen dominant, progesterone cannot balance the effects of estrogen. This leads to irregular periods, acne, excess weight and mood problems.

Luteinizing Hormone – If the hypothalamus is not working properly, it can send high levels of LH to the ovaries, stimulating them to secrete more male hormones. This leads to irregular periods, excessive hair growth, thinning hair, acne and anxiety.

Insulin – High insulin levels cause the ovaries to produce more male hormones. This leads to the same symptoms mentioned for elevated LH levels.

Cortisol – Excessive stress – from both mental and physical stressors – increases production of cortisol. Excess cortisol can lead to high insulin levels, irregular periods, excessive hair growth, acne, and weight gain.

Testosterone – Elevated male hormones such as testosterone increase insulin levels, which then stimulate the ovaries to produce more male hormones, creating a vicious cycle and leading to many PCOS symptoms.

Understanding Symptoms

A healthy body will be able to balance hormones and maintain a healthy menstrual cycle. However, it is hormonal imbalance that leads to the four common symptoms of PCOS.

• Irregular Menstrual Periods – Blood sugar dysregulation from high insulin levels creates excessive LH production which can blunt the release of the mature egg and create heavy bleeding or spotting.

• Excessive Hair Growth and Hair Thinning – Blood sugar dysregulation and high LH levels also increases production of testosterone. This imbalance of male hormones causes hair on the upper lip, chin, and upper back to become darker and thicker. Excess testosterone also leads to male-pattern baldness in women.

• Acne – Androgen hormones, such as testosterone, stimulates sebum production in skin follicles. Excess testosterone caused from blood sugar dysregulation increases sebum production, possibly leading to blocked pores and acne.

• Inability to Lose Weight – Estrogen dominance, excessive cortisol production and blood sugar dysregulation all contribute to increased fat storage and the inability to lose weight.

Insulin Resistance and PCOS

As you can see, controlling your blood sugar is very important for hormone balance and reducing PCOS symptoms. In fact, insulin resistance and PCOS are closely related, each influencing your risk of developing the other.

Chronic high levels of insulin eventually leads to insulin resistance. Cells no longer respond to insulin which further increases insulin levels. These high levels cause the ovaries to secrete more testosterone, leading to PCOS symptoms. As insulin increases PCOS symptoms increase, including weight gain. This weight gain creates more insulin resistance and thus the cycle continues. If insulin resistance is not corrected it can eventually lead to Insulin Resistance Syndrome (IRS) and Type II Diabetes.

Heart Disease and PCOS

When cells become insulin resistant, they can no longer get the energy they need, and glucose stays circulating in the blood. This excess glucose will become toxic to the body if not stored or converted, so the liver converts the excess to triglycerides. These triglycerides can eventually thicken blood and damage blood vessels. So becoming insulin resistant can lead to high triglycerides, high blood pressure and increased risk of heart disease. The established link between PCOS and insulin resistance makes it clear that women with PCOS also have a higher risk of heart disease.

Using Diet to Improve PCOS

The following dietary principles can help reduce PCOS symptoms and, in turn, reduce insulin resistance and heart disease risks.

Choose Carbohydrates Wisely – Eliminate sugars and refined carbohydrates which are associated with higher estrogen levels and insulin resistance. Instead, focus on moderate consumption of high fiber, low-glycemic whole grain carbohydrates which promote blood sugar regulation and hormone balance.

Consume The Right Fats – Eliminate trans fats and reduce unhealthy omega 6 fatty acids from vegetable oils. Instead, focus on consuming omega 3 fatty acids from fish oil and flax oil as well as other healthy fat sources such as olive oil, avocado, nuts and seeds.

Load Up on Vegetables – Leafy greens and cruciferous vegetables such as broccoli, kale and brussels sprouts help eliminate excess hormones and regulate blood sugar.

Eat Frequently – Consuming 4-5 smaller meals per day instead of 2-3 bigger meals will better regulate blood sugar.

Understand Proper Portions – Eating proper portion sizes can assist with weight loss and maintenance as well as reduce insulin resistance and PCOS symptoms.

Exercise and stress management are other lifestyle choices you can make to regulate blood sugar, reduce your risk of heart disease, improve PCOS symptoms and optimize your health and happiness!

RESOURCES:
A Patient’s Guide to PCOS, Walter Futterweit, MD

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