PCOS – the often undiagnosed barrier to optimal reproductive health.
Polycystic ovarian syndrome (PCOS) is said to be the leading cause of female infertility. However not all cases of PCOS are the same. Some women may struggle and need assistance to achieve successful pregnancy, while others are able to conceive naturally.
PCOS is a condition that is estimated to affect the hormone levels of one in ten women. These women are usually producing higher amounts of the hormone testosterone. Although generally considered to be a male hormone, testosterone is in fact normally present in women, but in lower amounts than is observed with PCOS. The elevation of this hormone, along with imbalances in female reproductive hormones accounts for many of the symptoms experienced by women with PCOS.
However there is no single test to identify PCOS. Instead, practitioners need to examine what’s been going on in a woman’s body. Usually, symptoms start to manifest soon after puberty, but because they may be attributed to other causes or go unnoticed, it is not unusual for PCOS to remain undiagnosed for some time.
In fact some women don’t realise they have PCOS until they are trying to conceive. The most common and obvious symptom of PCOS is in fact, irregular or missed periods. This is due to an imbalance in female sex hormones preventing the development and release of mature eggs. Without a mature egg, neither ovulation or pregnancy can occur.
Other symptoms may include: excessive weight gain especially on the waist area, fatigue, sleep apnea, excessive hair growth or hair loss, adult acne, skin tags in the armpits or neck area, mood disorders, pelvic pain, headaches, ovarian cysts, diabetes and infertility.
Even if ovulation occurs, an imbalance in hormones may prevent the lining of the uterus from developing properly to allow for implantation of the mature egg. Furthermore, if a woman with PCOS does become pregnant, studies have found an associated higher risk of pregnancy complications such as miscarriage, preeclampsia, gestational diabetes, premature delivery and high blood pressure during pregnancy. Babies born to women with PCOS are also more likely to be delivered via c-section.
Studies show that PCOS may run in families. It is not uncommon for sisters or a mother and daughter to be diagnosed. Although there is some genetic association, environmental factors during pregnancy appear to be key contributors to these generational influences. In fact, genetic expression of disease in general, appears to be more heavily influenced by environmental factors than by the genes themselves. With regards to PCOS, smoking and poor diet during pregnancy is associated with increased risk of PCOS development in a daughter exposed to these factors in-utero.
Clearly, addressing PCOS early, is important for women wanting to achieve healthy pregnancy. Mainstream medicine does not offer a ‘cure’ for PCOS, but prescribes medications that help reduce symptoms and health problems associated with the condition. Holistic practitioners, like myself, use nutrition, herbal medicine and lifestyle modification instead.
Improving carbohydrate metabolism, reducing insulin levels and increasing insulin sensitivity, through dietary modifications is an essential part of this approach. Although PCOS appears to be more common in women who have insulin resistance or who are obese, many diagnosed women are in fact quite lean. Those who do carry excessive weight may significantly improve hormonal and metabolic abnormalities by reducing their BMI. In fact weight loss associated with a healthy fertility diet and exercise appears to favour spontaneous ovulation and improve fertility rate in most clients.
However, improving the body’s metabolic health appears to be key to overcoming fertility challenges associated with PCOS, regardless of whether a woman is overweight or not.
All my PCOS clients need significant help to get their nutrition and exercise optimised, not only to improve metabolic health but also to protect their fertility. Careful attention needs to be given to diet and lifestyle changes to ensure other aspects of fertility are taken care of as well. It’s also important to remember the months prior to conception are an important preparation time for optimal pregnancy health as well as the future health of your unborn child.
Bibliography
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2. Palomba, S., et al., Pregnancy complications in women with polycystic ovary syndrome. Human Reproduction Update, 2015. 21(5): p. 575-592.
3. Pasquali, R. and A. Gambineri, Role of changes in dietary habits in polycystic ovary syndrome. Reprod Biomed Online, 2004. 8(4): p. 431-9.
4. Smyka, M., B. Grzechocinska, and M. Wielgos, The role of lifestyle changes in the treatment of polycystic ovary syndrome. Neuro Endocrinol Lett, 2018. 38(8): p. 521-527.
5. Unluturk, U., et al., The Genetic Basis of the Polycystic Ovary Syndrome: A Literature Review Including Discussion of PPAR-gamma. PPAR research, 2007. 2007: p. 49109-49109.
6. Valgeirsdottir, H., et al., Prenatal exposures and birth indices, and subsequent risk of polycystic ovary syndrome: a national registry-based cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 2018.
