So you’ve been diagnosed with polycystic ovarian syndrome.  

Confused?  I was.  You may have been told it’s about cysts, excess male hormones or lack of ovulation.  All you really know is that something is not right.  It might be showing up for you as acne that persists well beyond your teenage years, excess hair on your belly, chin and upper lip, irregular periods, weight gain, or maybe you’ve decided it’s finally time to have a baby and the pregnancy test is negative month after month...

The pcos cycle

So what does this seemingly random collection of symptoms mean?  What is actually going on inside your body?  Well there is a perpetuating cycle that looks like this:

 Copyright Josephine Cabrall 2015

Meet the players

Unsure what the heck this diagram means?  Let’s meet the characters in this story:

1. Androgens.  Androgens are hormones responsible for male characteristics.  They are normally produced in females in small amounts but in polycystic ovarian syndrome (PCOS) there are excess androgens, which may lead to acne, male-pattern hair loss and excess hair growth in places such as the chin, abdomen, back, chest and groin.

2. Sex hormone binding globulin (SHBG).  This hormone binds a large percentage of the androgens in our blood stream, making them inactive.  If we have too little, then we have more free androgens and more of the above symptoms.

3. Luteinising hormone (LH).  A surge of LH is responsible for making us ovulate mid-cycle but with PCOS, high LH pulses tend to be sent out throughout the cycle.  This constantly high LH stimulates excess ovarian androgen production.

4. Follicle stimulating hormone (FSH).  In PCOS, there is often inadequate FSH to stimulate your ovary to release an egg.  Therefore, we don’t ovulate every month.  

5. Insulin.  Insulin is the hormone released by your pancreas in response to sugar in your blood stream.  It tells your cells to take in the sugar and use it for energy.  When we have a high sugar/high carb diet our pancreas has to pump out lots of insulin and our cells start to pay less attention to it (known as insulin resistance).  It’s like a knock on the door that doesn’t get answered.  But the sugar is still there.  So our pancreas sends out more insulin.  Insulin tells our ovaries to make androgens.  It also stimulates LH production and decreases SHBG.  So you can see, insulin is a major villain when it comes to PCOS.

6. Estrogen.  In PCOS, excess androgens are converted to estrogens, which inhibit FSH, perpetuating the cycle.

7. Progesterone.  Progesterone is secreted by a temporary gland in our ovaries, created by ovulation.  Therefore if we do not ovulate, we do not produce adequate progesterone.  Progesterone has many beneficial effects.   When we do not have enough we experience, PMS, acne and anxiety.

But I thought PCOS was caused by cysts

Your ovaries will have a bumpy appearance if you have not ovulated that month.  The bumps are actually immature follicles (little bags in your ovaries, containing eggs).  Having PCOS does not mean that your ovaries are being attacked by cysts.  It simply means that you ovulate less frequently, which leads to the symptoms of PCOS and the perpetuating cycle.  So you can see, PCOS is not a disease.  It is a syndrome: a set of signs and symptoms that are related to each other.

 Copyright Josephine Cabrall 2015

What can I do about it?

So, now you that know what’s going on in your body what do you do about it?  Well, it’s important to remember that your body and your hormones are not your enemy.  Everything is happening for a reason and really all your body wants to do is get back to optimal balance and function. There are a range of herbs, nutrients, foods and lifestyle changes that can assist this.  See your naturopath about the best treatments for your individual situation. 

All the best on your health journey,

Josephine

 

Josephine Cabrall is a Melbourne naturopath with a special interest in PCOS, consulting from her Carlton North clinic and via Skype.
Can't see Josephine for a consult? Get the best treatment solution and access to an exclusive support section, including email support from Josephine in her book The PCOS Solution.

 

 

References

Choudhary, S, Binawara, BK & Mathur, KC 2012, ‘Insulin Resistance and Polycystic Ovary Syndrome’, Pakistan Journal of Medical Research, vol. 51, no. 2, pp. 63–66, <http://press.endocrine.org/doi/full/10.1210/edrv.18.6.0318>.

Madnani, N, Khan, K, Chauhan, P & Parmar, G 2013, ‘Polycystic ovarian syndrome.’, Indian journal of dermatology, venereology and leprology, vol. 79, no. 3, pp. 310–21, <http://www.ncbi.nlm.nih.gov/pubmed/23619436>.

Martinez-Garcia, M a., Gambineri, a., Alpanes, M, Sanchon, R, Pasquali, R & Escobar-Morreale, HF 2012, ‘Common variants in the sex hormone-binding globulin gene (SHBG) and polycystic ovary syndrome (PCOS) in Mediterranean women’, Human Reproduction, vol. 27, no. 12, pp. 3569–3576, <http://www.ncbi.nlm.nih.gov/pubmed/23001781>.

Nestler, JE 2008, ‘Metformin for the treatment of the polycystic ovary syndrome.’, The New England journal of medicine, vol. 358, no. 1, pp. 47–54, <http://www.nejm.org/doi/full/10.1056/NEJMct0707092>.

Norman, RJ, Dewailly, D, Legro, RS & Hickey, TE 2007, ‘Polycystic ovary syndrome.’, Elsevier Ltd, Lancet, vol. 370, no. 9588, pp. 685–97, <http://www.ncbi.nlm.nih.gov/pubmed/17720020>.

Simó, R, Sáez-López, C, Barbosa-Desongles, A, Hernández, C & Selva, DM 2015, ‘Novel insights in SHBG regulation and clinical implications’, Trends in Endocrinology & Metabolism, vol. 26, no. 7, pp. 376–383, <http://www.ncbi.nlm.nih.gov/pubmed/26044465>.

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