Misnamed, Misunderstood, Misdiagnosed and Mismanaged:Sep 01, 2021 09:15PM ● By Mark Fergeson
PCOS is Problematic for Today’s Healthcare System
Polycystic Ovary Syndrome (PCOS) is a medical condition that affects up to one in three women, but 70 percent of those women are never diagnosed. PCOS is problematic for today’s healthcare system because the name is misleading. Polycystic Ovary Syndrome implies that it is a gynecological disease, but it’s not. Ovarian cysts are a common symptom of the disease, but about 25 percent of women with the condition never get cysts.
PCOS is an endocrine disease, the system that controls hormones. In fact, it is considered to be the most common endocrine disorder in women of reproductive age. There are no clear-cut criteria for the diagnosis. It is a complex, multi-system disease process that has at least four variations. The percentage of women with PCOS is somewhere between 3 and 30 percent. The most commonly accepted numbers are between 5 and 15 percent.
What Causes PCOS?
The relationships and interactions between insulin, testosterone, estrogen, progesterone, follicle stimulating hormone and luteinizing hormone are extremely complex and complicated to explain. This is a simplified overview.
PCOS is a hormone imbalance caused by the overproduction of androgens. Although androgens are considered “male hormones”, women have these same hormones, but at lower levels. The androgens primarily associated with PCOS are testosterone (produced by the ovaries), DHT (a byproduct of testosterone), and DHEA & DHEA-S (secreted from the adrenal glands and are precursors to both testosterone and estrogen production). To be diagnosed with PCOS, a patient must have at least two of the following three symptoms: hyperandrogenism (above normal androgens), ovulatory dysfunction (failure to release an egg, often associated with irregular periods) and polycystic ovaries.
How and Why PCOS Causes Symptoms
PCOS is related to hyperandrogenism (above normal testosterone). Testosterone does something called aromatization, which means it converts into estrogen. Estrogen plays a key role in the menstrual cycle, but the body doesn’t actually monitor estrogen levels. The body monitors the hormones that regulate the menstrual cycle, follicle stimulating hormone (FSH) and luteinizing hormone (LH).
In PCOS the extra estrogen from testosterone aromatization can disrupt the effects of the LH surge causing the egg not to be released (ovulatory dysfunction). This disruption is often responsible for irregular, heavy and painful periods. Estrogen is responsible for uterine lining buildup—the more estrogen, the more uterine lining, resulting in heavier and likely more painful periods. The extra estrogen can also be responsible for the irregular periods by preventing, or delaying, the transition from the first half of the cycle into the second half.
Another mechanism in PCOS causes a chronically elevated LH level. It can stay two to three times higher than the FSH. This will also cause ovulatory dysfunction and irregular periods. Higher LH levels also stimulate more testosterone production. This can cause increased facial hair, decreased scalp hair and severe acne. Because of this hormonal imbalance, women with PCOS have a much more difficult time getting pregnant, and a first trimester miscarriage rate three times higher than non-PCOS women. Even women that have no obvious symptoms of PCOS but have a history of difficulty conceiving and multiple first trimester miscarriages should be evaluated for PCOS.
Five Underlying Medical Conditions
These medical conditions cause high androgen levels in PCOS. The most common cause (about 70 percent) is Insulin Resistance PCOS. The next three leading causes are Inflammatory PCOS, Post-Pill PCOS and Hidden Cause PCOS. The final and least common (less than 10 percent) is Adrenal PCOS.
Insulin is the key that unlocks the cells so sugar can move from the blood into the cell. Some cells become “resistant” to unlocking so the sugar remains in the blood. The body then makes more insulin, or keys, to unlock more cells. This higher-than-normal level of insulin causes the ovaries to produce extra testosterone. Insulin resistance also makes it difficult to lose weight and causes chronic fatigue.
Inflammation causes the ovaries to over-produce testosterone. Prolonged stress, autoimmune diseases and chronic or recurrent infections are just some of the causes of chronic inflammation.
“Post-pill PCOS” relates to all hormonal birth control, including dermal implants, intramuscular injections and all IUDs except the Copper IUD. This type of PCOS is generally self-limiting, but it can last for a year or more. It is caused by the body trying to restore the sexual hormonal balance after they were suppressed by birth control.
Hidden medical conditions can cause PCOS. This includes thyroid disease because hypothyroidism affects ovulation and can worsen insulin resistance. Deficiencies in vitamin D, zinc or iodine can also contribute.
Adrenal PCOS is caused by overproduction of the adrenal androgen DHEA-S. It can be caused by prolonged stress, poor nutrition and excessive physical activity. Women with high DHEA-S levels should check their prolactin levels and rule out other conditions like non-classic congenital adrenal hyperplasia (NCAH).
Treatment of PCOS
All of the various types of PCOS can overlap, making treatment of the underlying cause more complicated. It can seem like a vicious cycle that is difficult to break. But the cycle can be broken. Proper control of the underlying causes will resolve the symptoms, improving fertility and decreasing miscarriages.
While no single treatment plan is correct for everyone, there are some general rules women can follow. Improving insulin resistance can be accomplished by switching to a Mediterranean diet and incorporating 16/8 intermittent fasting. Several supplements can improve insulin resistance and reduce inflammation, like curcumin and magnesium. There are several supplements that help overall PCOS symptoms. Iodine and zinc are both needed by the ovaries as well as the thyroid. Vitamin D3 improves overall metabolism and helps with weight loss. It decreases inflammation and fatigue. Treating autoimmune diseases, managing stress and identifying hidden causes like thyroid, adrenal and pituitary disorders are also important to treating PCOS.
The most important step is to find a healthcare provider that understands PCOS. They will help figure out what combination of PCOS a patient has and start addressing the underlying issues.Family Nurse Practitioner Mark Fergeson is the director of operations and primary medical provider at Fulcrum Hormone and Wellness Center, 1601 SW 89 St., Ste. D-100, OKC. For more information or to make an appointment, call 405-546-7888. See our business listing with map here Business-Listing or visit Fulcrum-Clinic.com