PCOS facts, symptoms & treatment - South Africa

What is PCOS?

PCOS – Polycystic ovary syndrome (sometimes called Polycystic ovarian disorder (PCOD)) is one of the most common endocrine and metabolic disorders in South African women of child-bearing age. It is commonly overlooked and unfortunately misunderstood. Approximately 15-20% of women (1in 7 women) will have the condition.

PCOS includes an imbalance of many female hormones and other hormones; and is part of a complex multi-system illness which has genetic and environmental components.

Women will often present to doctors with scanty to no periods or with difficulty falling pregnant. Women with PCOS will have minimal ovulation (oligo-ovulation) to no ovulation (anovulation). There is poor maturation of the growing egg and it is not released, preventing conception. Women will have high male hormone effects (hyperandrogenism) presenting as acne and unwanted hair growth, and thinning or loss or head hair. Weight gain and depression and anxiety may also occur.

PCOS Symptoms

Symptoms of PCOS may begin shortly after puberty, but can also develop during the later teen years and early adulthood.
Because symptoms may be attributed to other causes or go unnoticed, PCOS may go undiagnosed.
Women with PCOS typically have irregular or missed periods as a result of not ovulating.
Although some women may develop cysts on their ovaries, many women do not.

NOTE:
Irregular periods, ovarian cysts and excess hair growth are classic clinical PCOS symptoms which directly point to excessive male hormones. However, holistic practitioners follow a more elaborate list when they look for PCOS symptoms. Because they look for ‘the story behind the story’, they consider a wider range of symptoms to diagnose PCOS-like conditions and treat them, often before they become full blown PCOS or PCOD.

If some of these PCOS symptoms seem familiar, please take the time to understand PCOS and if needed book for a check up with health care professional.

Irregular Periods

Irregular periods is often the first tell-tale sign that all is not well with your hormones, making this as one of the most important symptom of PCOS. Some women have delayed periods that are more than 35 days apart, while others have completely absent/missed/skipped periods. Quite a few PCOS patients have less than 10 periods a year. Some women also experience issues with ovulation. In some women, the ovaries fail to release an egg. While in others the ovaries release a mature egg only infrequently.

Ovarian Cysts

A trans-vaginal ultrasound (a type of pelvic ultrasound test) can reveal numerous cyst-like growths on the ovaries. A woman’s ovaries contain tiny, fluid-filled sacs known as ‘follicles,’ which hold the eggs. Every month, one mature egg is supposed to be released by the follicles and it makes its way into the uterus. If it meets a sperm there, it will undergo successful fertilization to form a baby. After the one mature egg is released from the ovary, the other follicles are meant to disintegrate naturally. When this does not happen, it can be a symptom of PCOS. Immature follicles bunch together to form cysts, which makes it difficult for one egg to mature correctly or release itself. This is one of the reasons why PCOS patients find it difficult to conceive.

High Levels Of Male-Sex Hormones In Lab Tests

The underlying cause for PCOS is an excess of male sex hormones circulating through a woman’s body. Testosterone, DHEA, androstenedione, or DHT are some examples of male sex hormones. If your lab tests show high levels of these hormones, you will be diagnosed with PCOS.

Excess Body Hair Growth

Excess body hair or hirsutism is one of the most dreaded PCOS symptoms. PCOS is considered as the most common cause of hirsutism. You may start to notice thick, dark, masculine pattern hair growth on various parts of the body. These parts include the chin, along the jawline, around the mouth, arms, legs and torso. Again, the underlying cause of excess hair growth is hormonal imbalance with high androgen levels.

Scalp Hair Loss

Along with excess hair on the skin, a common PCOS symptom is male-pattern baldness. Scalp hair loss or Androgenic Alopecia is also caused by excess androgens.

Pimples Or Acne

Another commonly-experienced PCOS symptom is cystic acne (a more severe form of general acne.) PCOS acne is characterized by tender knots under the skin instead of surface bumps. These cysts are concentrated along the more “hormonally sensitive” areas of the skin – namely the jawline, cheeks, chin and upper neck, but can also occur on the chest and back. These under-the-skin cysts are often very painful and get especially worse at period onset.

The above PCOS symptoms are what regular medical doctors are supposed to use to diagnose confirmed cases of the condition. However, in my own practice and in my discussion with other holistic practitioners, I have found that there are other tell-tale symptoms that can help confirm a PCOS-like condition. Since holistic medicine addresses root causes, patients who come in with these PCOS-like symptoms will also benefit hugely from the right diet, dietary supplements, acupressure, and exercise.

Body Weight Gain

PCOS patients notice unexplained weight gain, especially excess fat around the shoulders, neck, and arms. This PCOS symptom is often caused by high levels of androgens coupled with insulin resistance and a reduced BMR (Basal Metabolic Rate).

Inability To Lose Weight

The biggest problem with PCOS-related weight gain is that it’s rather hard to lose. Usual low fat-low calorie diets simply do not work for such weight gain. Since these diets don’t help balance out your hormones, they don’t assist in weight loss. If you don’t have the right fats in your diet, you cannot produce good hormones. If you have been gaining weight despite making healthy lifestyle changes, it can be a symptom of PCOS.

Stretch Marks

If you are not pregnant but are noticing stretch marks, these could be caused by a sudden increase in fat storage underneath the skin cells. Usually noticeable around abdomen, buttocks, thighs, and arms, these unexplained stretch marks could be another PCOS symptom.

Weight Loss

Unexplained weight loss can also be a PCOS symptom. Most people, doctors included, don’t realize that up to 1/3rd of patients with PCOS are of normal weight or are underweight. The weight loss is usually a result of too much stress – physical or mental. Younger women, often in high-stress jobs or too concerned about their figure and are going on crash diets, are more prone to this PCOS symptom. The condition is sometimes called “Adrenal PCOS”. The stress that causes the weight loss also causes the PCOS.

Darkening & Thickening Of Skin

PCOS can also lead to darkening and thickening of skin, also known as acanthosis nigricans. This condition is characterized by black velvety skin in the neck, armpits, elbows or groin area. This is a skin pigmentation disorder that is often caused by insulin resistance and can be another symptom of PCOS. These dark patches of skin can sometimes also be found on knees, knuckles, soles of feet and palms, and may also itch.

Skin Tags

Another common symptom of PCOS is skin tags, also known as Acrochordons. These small skin growths form in skinfolds, especially around armpits, neck, and groin. You’ll notice flaps of extra skin with a small stalk.

Tiredness/Fatigue

Fatigue is another leading PCOS symptom. Imbalanced hormones are the reason behind fatigue in women with PCOS. For some women, fatigue can present itself in the form of an afternoon slump, but is often more severe than normal sluggishness. If you notice an intense desire to sleep post lunch, have severe muscle fatigue, shakes, sweating and nervousness, PCOS could very well be the cause.

Mental health issues

Mood disorders like anxiety, depression, panic attacks, mood swings, somatization (the conversion of psychological distress to physical symptoms), interpersonal sensitivity as well as eating disorders can all be caused by PCOS. These are often the result of imbalanced hormones wreaking havoc on your mental health and wellbeing.

Breathlessness Or Wheezing

This is a much lesser known symptom of PCOS. It is seen more commonly in women who may be contraceptive medication. You may also notice excessive yawning, despite leading an active lifestyle. PCOS can also increase the risk of asthma, making it crucial to get an early diagnosis. In some cases, the body attacks its own organs (something called autoimmune disease). These diseases happen for unknown reasons and can increase inflammation in the body. Asthma is one such condition. These diseases can often be a symptom of hidden hormonal imbalances. Since PCOS is also caused by hormonal imbalances, some practitioners feel this may be the underlying connection.

Swelling In Legs Or Feet

Fluid retention is another symptom of PCOS, and it often causes abdominal bloating and swollen, tender breasts. Some women could also notice swelling in legs and feet. Imbalanced, fluctuating hormones are often the culprit.

Migraines Or Headaches

Women with PCOS often report an increase in the frequency of headaches or migraine attacks. Hormonal imbalances are often the cause, since many women with PCOS are estrogen dominant. Nutritional deficiencies caused by PCOS can also be a contributing factor to headaches.

Body Pain

While a moderate amount of pain in legs, thighs and back is common during menstruation, PCOS patients may experience more regular episodes of body pain. In particular, they may experience this pain in their neck, back, legs and joints. Low-grade chronic inflammation, which is commonly noticed in PCOS, is often to blame.

Inability To Gain Height

PCOS can affect any woman post puberty, and a common symptom seen in younger girls is the inability to gain height. Early onset PCOS can cause weight-height discrepancy in growing girls, when imbalanced sex hormones affect growth hormones.

Brain Fog

Brain fog or the inability to concentrate is another common symptom of PCOS. Imbalanced hormones coupled with insulin resistance, high blood sugar levels and chronic low grade inflammation can all affect your ability to focus and concentrate. If your thoughts feel muddled and foggy and you have difficulty concentrating on simple tasks, PCOS could be to blame.

Moon Face

If your face has gradually become rounder and looks swollen, it’s called as moon facies or moon face. This happens due to excess fat deposits around the face and neck, giving your face a rounder appearance. Hormonal imbalances result in excess cortisol (the stress hormone), which causes abnormal fat deposits around face.

Buffalo Hump

Excess cortisol can also lead to abnormal fat deposits around shoulders and arms, referred to as a buffalo hump. While moon face and buffalo hump are typically associated more with Cushing’s disease, increased levels of testosterone, DHEA-S, and cortisol can be another cause.

Oiliness Of Face

Excess androgens in the body can send the oil-producing glands into overdrive, so that they produce more oil. If you notice sudden oiliness of the face, imbalanced hormones could be the reason. Left unchecked, this can lead to clogged pores causing acne and pimples.

Long And Heavy Periods

Heavy periods that last for more than 7 days are another PCOS symptom. Clinically known as Menorrhagia, large blood clots may be passed during periods. In some cases, the bleeding may be heavy enough to restrict daily activities. Many women with menorrhagia report shortness of breath and fatigue as well.

Painful Periods

If your periods are accompanied by pain that’s beyond a little discomfort, this could be another warning sign of PCOS. Known as Dysmenorrhea, painful periods are characterized by abdominal cramping with a dull deep ache in the lower abdomen. Pain may radiate to your back, hips and thighs as well.

Infertility

Menstrual irregularities with absent/missed/skipped periods are the hallmark of PCOS, causing problems with fertility. As PCOS affects ovulation, it can make it difficult for you to conceive a baby. Regulating your period and promoting healthy, natural ovulation may be the key to getting pregnant with PCOS.

Gestational Diabetes

Women with PCOS can also notice Gestational Diabetes or diabetes during pregnancy. PCOS increases the risk to gestational diabetes, thanks to glucose intolerance and insulin resistance.

Miscarriages

PCOS also increases the risk of miscarriages. Scientists believe that insulin resistance and higher Lutenizing Hormone (LH) levels in PCOS patients are often to blame. Altered hormone levels caused by PCOS can result in miscarrying of less than 90 day-old fetus in pregnant women. If you have had a fertility problem and miscarried in the past, get checked for PCOS.

Hypertension During Pregnancy

Normal blood pressure (BP) before pregnancy but elevated BP during gestation may also be a symptom of PCOS. Left untreated, it can cause preeclampsia and other birth-related problems. Talk to your healthcare provider and get screened for PCOS.

Pelvic Pain / Painful Intercourse

PCOS can also cause pelvic pain and inflammation. In some women, it is the reason behind painful intercourse and can also negatively affect sex drive.

Psychosexual Dysfunction

Inability to become sexually aroused or achieve sexual satisfaction in the appropriate situations because of mental or emotional reasons. Although psychosexual dysfunction is not life threatening, it can have a major effect on your relationships and self-esteem.

PCOS Treatment

Empirical treatment for most conditions suggests lifestyle modification inclusive of a diet and exercise regime. PCOS treatment is no exception. Since insulin resistance is a major driver of ovarian dysfunction and hyperandrogenism, lowering carbohydrate intake and all sugar foods through a ketogenic-like diet, in itself will help lower insulin levels, lower fat mass, lower the risk of diabetes improve ovulatory function. Some women have even fallen pregnant on a ketogenic diet alone. A ketogenic diet can act as a supportive metabolic anchor for PCOS supplement and or drug treatment.

After receiving a diagnosis for PCOS from a doctor or specialist, there are a number of treatments available. Glucophage and the oral contraceptive pill are often trialed first. Glucophage is an old anti-diabetic drug, which still remains effective front line treatment for Type 2 Diabetes. It sensitises the insulin receptor and through second messenger effects lowers ovarian androgen production easing pituitary hormone imbalance and an overall improvement in the condition. However not all persons respond to it. The drug does improve fertility in some patients but not all. A proportion of patients react with gastrointestinal side effects which can be debilitating and have to stop.

The Pill may help with hyperandrogenism but since PCOS is a condition of hyperoestrogenemia, adding a pill with additionally potent synthetic oestrogens may worsen symptoms. Other forms of contraceptive pills or devices are sometimes used.

If conception is desired clomiphene cyclic treatment may be offered. This has a high successful of inducing ovulation by raising FSH levels, but conception rates stay low. Repeated cycles of clomiphene can increase the risk of ovarian cancer.

High oestrogens in PCOS increase the risk of endometrial cancer. Sometime a synthetic form of progesterone the ‘Mini Pill’ which is a progestin is offered to protect to uterine lining.

Is there a place for nutritional supplements when treating PCOS?

Let’s look at the major drivers of the condition: Genetics teaches us that in PCOS there are genetic polymorphisms at a pituitary level (gonadotrophin releasing hormone receptor (GnRHR) and at an ovarian level follicle stimulating hormone receptor(FSHR), Steroidogenic acute regulator gene (StAR), which is the starting point of hormone synthesis. The StAR gene encodes StAR gene product (the StAR protein), which regulates the transport of cholesterol through the mitochondrial membrane in the first step of androgen biosynthesis. increased production or concentration of StAR may be responsible for the increased ovarian and adrenal androgen found in PCOS of some patients.

There are also a number of insulin receptor (IR) /insulin receptor substrate (IRS) and other metabolic gene single nucleotide polymorphisms (SNPs) have been found in the fat mass and obesity-associated (FTO) gene, the methylene tetrahydrofolate reductase (MTHFR) gene, the peroxisome proliferator activated receptor gamma (PPARG) the gene product PPAR-γ plays an important part in the management of energy storage and insulin sensitivity.

Other gene polymorphisms include the vitamin D receptor gene (VDR) the gene product of which not only affects bone metabolism but can also affect insulin sensitivity and appears involved in PCOS insulin resistance.

Immunological gene SNPs in PCOS include lnterleukin 1 beta (IL-1b). and interleukin 1 receptor antagonist (IL-1RA) (Chen 2018). PCOS is a pro-inflammatory condition and many pro-inflammatory immune mediators have been found including excessive cytokines. Interestingly, IL-1β has also been reported as a crucial moderating element in ovulation, fertilization, embryo implantation and tissue restructuring Another important member of the IL-1 family is IL-1RA; which is able to minimize the inflammatory response. However, polymorphisms of these gene result in dysfunctional proteins poor ovarian function and heightened inflammation.

From the above it can be seen that there are hormonal, metabolic and immunological gene SNPs which encode proteins which are dysfunctional in their actions and which are all part of this complex condition involving hormonal, metabolic, immunological, inflammatory and oxidative events., resulting in ovulatory failure, follicle ‘stuck’ in an undeveloped phase unable to reach maturity and are not selected for ovulation, hyperproduction of androgens and oestrogens, weight gain, insulin resistance and the onward march to Metabolic Syndrome, Type 2 Diabetes and cardiovascular disease. The high androgens and oestrogens keep the hormonal and metabolic dysfunction ‘on track’, but hyperoestrogenemia also has more sinister complications potentially for PCOS sufferers, that being an increased risk of endometrial cancer.

Hence there are a multitude of natural supplement PCOS treatment opportunities to aim to bring some degree of balance and functional organization to effect better ovarian function through multiple mechanisms, as well as improvement of hormone levels which ease up on perpetuating the cycle of hypothalamic, pituitary and ovarian hormone imbalance.

From a genetic perspective is there anything that can be done correct the imbalances caused by PCOS?

PCOS SUPPORT SUPPLEMENT – Metabolic Balance, uses a unique group of herbal and mineral ingredients. Gynostemma pentaphyllum also known by its traditional name Jiaogulan or Southern Ginseng is indigenous to South East Asia. It has been drunk as a tea for centuries and is known as the Herb of Immortality as it is reputed to prolong life.

Gynostemma has been found to sensitise the insulin receptor, lower insulin resistance through raising AMPK which lowers glucose secretion from the liver. It lowers blood glucose and lowers the long term marker of blood glucose HbA1C better than Glucophage. In a 2012 research article by Hirst et al, maximum HbA1C reduction with Glucophage was 1.1% units. However, a study on Gynostemma found a 2% unit drop in HbA1C (Vu Thi Thanh Huyen 2011).

Chromium has similar insulin sensitizing properties lowering blood insulin and glucose levels.

Chromium facilitates insulin signaling at many points of the insulin signaling cascade. When insulin ‘docks with the insulin receptor, it binds to a part called the alpha subunit. For signal transduction to occur, the beta subunit needs to be activated. Chromium activates the beta sub-unit which in turn phosphorylates (activates) the insulin receptor substrate (IRS) molecules. At this stage chromium stops the breakdown (ubiquination) of IRS-1. Chromium also blocks a molecule which inhibits insulin signally called PTP 1B (protein tyrosine phosphatase 1B). Chromium also promotes other ‘downstream’ signaling molecules like P-I-3-kinase(PI3K) and the Akt. (Hua 2012).

Chromium supports AMPK (5’adenosine monophosphate activated protein kinase) which helps GLUT4 vesicles translocate from inside the cell to the cell surface.

Chromium is a very’ talented’ team player in combatting insulin resistance (IR) and the consequences of IR being glucose intolerance and a higher risk of type 2 diabetes. High blood sugar results in the oxidative damage of proteins (glycosylation or glycation). Chromium is also has antioxidant functions lowering glycosylation of proteins and lowering oxidation of fats (lipid peroxidation).

Chromium boosts glutathione and glutathione peroxidase (premium antioxidants in the body’s antioxidant armory.

Furthermore, chromium is effective in reducing food cravings which of itself could increase weight.

Inositol is a member of the B group of vitamins There are 9 stereoisomers (forms) of inositol. The molecular formula of inositol is identical to that of sugar (C6H12O6) however the 3 dimensional arrangement of the atoms and attachments are different to sugar. It is a sugar alcohol and when taken as a supplement lowers blood sugar levels. Myo-Inositol (MI) is most abundant of all inositols and high amounts are required for oocyte maturation. A German study of 3602 PCOS patients given MI for 3 months restored ovulation in 70% of patients and had a fertility rate equivalent to or better than reported for Glucophage.

How can Myo-inositol be so effective?

Approximately 99% of all inositols is MI and is used interchangeably with inositol. Small amounts of MI are metabolized to D-chiro-Inositol (DCI) by the enzyme epimerase. DCI maintains insulin sensitivity. In PCOS urinary DCI levels are very low. The worse the insulin resistance the lower the DCI in urine of PCOS patients.

Studies have reported improved oocyte function, the start of regular periods after just 34 days treatment with 2grams MI daily. In one study 10 out of 22 women fell achieved biochemical pregnant within 6 months. Another study of 50 PCOS with 2g MI reported lowered LH, lowered LH/FSH ratio, prolactin, androstenedione and insulin. MI resulted in larger quality oocytes and higher pregnancy rates, with 10/50 women falling pregnant and 8 successful deliveries compared to 3 deliveries in non MI treated patients

It has been suggested that MI and DCI reduce insulin resistance, improve ovarian function and reduce androgen levels in women with PCOS.

DCI as a sole agent has also been used. 600mg DCI daily decreased insulin and testosterone levels. Even a higher dose of DCI 500mg bd improved the quality of oocytes.

Supplemental DCI bypasses defective epimerase activity and achieves downstream metabolic effects of insulin in DCI deficient tissues. However in nature epimerase is unidirectional meaning giving DCI cannot fulfil any of the functions of MI. Hence a physiological combination of both Mi is able to enhance oocyte maturation and small amounts of DCI are available with needing epimerase for insulin sensitivity and hormone regulation. Research suggests that lower doses of MI may suffice if co-administered with DCI.In arandomised controlled study of MI/DI versus Mi alone showed a better ovulation, endocrine, metabolic with better insulin sensitivity and lipid profiles than MI alone (Minozzi 2013)

PCOS SUPPORT SUPPLEMENT - Hormone Balance

The formulation of PCOS SUPPORT Hormone Balance was developed out of a clinical recognition that PCOS women suffer symptoms of hyperoestrogenism which having low progesterone as a consequence of hypothalamic, pituitary and ovarian dysfunction. Inflammation is interwoven into the fabric of PCOS likely due to immune gene polymorphisms but also epigenetic effects.

The formula is Calcium-D-Glucarate, Chaste Tree, Cyperus rontundus and Curcumin (95% curcuminoids)

Hyperoestrogenemia can via second messenger effects suppress FSH, and thereby prevent immature follicles I from reaching individual dominance and growth to a mature egg, perpetuating the poor ovulation. Hyperoestrogenemia also induces auto-immunity, which aggravates weight gain, glucose intolerance and immune dysfunction affect thyroid function, slowing metabolism further with concomitant weight gain.

Women with PCOS often have a range of emotional symptoms- anxiety and depression are common. Clinical proven oestrogen metabolizing nutritional treatments improve mood, help PCOS sufferers who have fluid retention lose fluid, lessen headache and mastalgia and sleep better. Lowering oestrogen may have indirect beneficial effects of the ovaries via negative feedback through the hypothalamus and pituitary. Both cyperus and Calcium-D-Glucarate working through different mechanisms may lower oestrogens. Chaste Tree or Chaste berry has been shown to improve progesterone levels in the blood and female genital tract. Chaste Tree improves dopamine and has been shown to lower prolactin level almost as effectively as the standard drug treatment for hyperprolactinemia, bromocriptine.

Often overlooked in PCOS management is the inflammatory effects of genetic driven immune dysfunction. Where we can change the genes, we can modulate inflammation. Curcumin, is a ‘one stop shop’, being a potent anti-inflammatory similar in its effect to non-steroidal anti-inflammatory drugs (NSAIDs) but without the gastric and duodenal sideeffects of NSAIDs. Curcumin blocks the COX and LOX pro-inflammatory enzymes but also lowers excessive pro-inflammatory cytokines which are released from fat cells which drive the inflammatory response. PCOS patients suffer inflammatory overdrive from immune system genetic polymorphisms (IL-1b and IL_1RA), but also being overweight or obese have increased inflammatory cytokines released from fat cells. Curcumin has been found to lower TNFalpha, IL-1Beta which may be raised in PCOS interleukin 6 (IL-6). TGFb, MCP-1. It also lower NFKB a potent nuclear inflammatory generator. It lowers C reactive protein (CRP).

However, its anti-inflammatory also to reduces Metabolic Syndrome. Curcumin improves insulin sensitivity suppressing fat deposition triglycerides and cholesterol and elevates good cholesterol (HDL).

Curcumin is also a powerful antioxidant lowering reactive oxygen species (ROS), nitrosative stress, malondialdehyde (MDA) a marker of lipid oxidation while supporting ‘on board ‘ antioxidant defense (glutathione, catalase and superoxide dismutase (SOD) (Hawlings 2017)

Vitamin D is actually a hormone not a vitamin at all. It is anti-inflammatory, immune supportive, bone enhancing, muscle supporting. Genetic polymorphisms of the vitamin D receptor, are a component of PCOS metabolic and hormone dysfunction has been shown to play a role in insulin resistance and egg development. Getting some safe sun (early mornings or late afternoons is a great way to get your daily dose. Check your 25 hydroxy vitamin D (25-OH Vit D) level and aim for an optimal high normal reference range level.

Environmental exposure to chemicals

Prevent xenoestrogen (toxic environmental oestrogens) exposure by avoiding fumes off all descriptions (car exhaust fumes, cleaning fumes, ‘Braai’ fumes, cigarette fumes, nail polish fumes, nail polish remover fumes, cleaning products, sprays, hair products.These and other polycyclic aromatic hydrocarbon fumes and chemicals have a potent oestrogenic effect and are potentially precarcinogenic.

PCOS treatment with Exercise

Exercise is a great lifestyle tool to help women treat PCOS. Have a religious exercise program with both aerobic and anaerobic components. Exercise lowers glucose levels, insulin levels, burns fat mass and improves AMPK – all of which will help manage PCOS symptoms.

To maximize the benefits of exercise also participate in a ketogenic diet with most of your eating between 10am and 6pm. Periodic fasting for 16-18hours also improves insulin sensitivity and drives up AMPK.

Diagnosis of PCOS

Diagnosis of PCOS is based on the Rotterdam Criteria at least two out of
three signs and symptoms:

Oligo/Anovulation (minimal to no ovulation)
Hyperandrogenism (high male hormone signs)- not caused by other endocrine diseases
Ultrasound Proven polycystic ovaries

It may be difficult to fall pregnant with PCOS, and there is a higher chance of miscarriages. One of the hormones which play an important role in PCOS is insulin. High levels of insulin as a result of insulin (receptor) resistance can be one of the reasons that people with PCOS often have weight gain. Sustained high insulin can result in Type 2 Diabetes with a higher risk of cardiovascular disease and fatty liver disease.

Many gene polymorphisms are thought to be responsible for PCOS. Brain derived hormone receptors (gonadotrophin releasing hormone receptors[GnRHR], follicle stimulating hormone receptors[FSHR]), metabolic genes (like FTO, PPARg, MTHFR), Insulin receptor genes (IR/IRS) polymorphisms of Vitamin D receptor and immunological genes like interleukin 1(IL-1 genes).(Chen 2018: Potential genetic polymorphisms predicting polycystic ovary syndrome).

Researches have also now found a link between PCOS and autoimmune conditions. Why the body makes antibodies to attack its own tissues is not well understood. However antibodies have been detected against thyroid, the insulin producing cells of the pancreas, the ovaries, DNA. Thyroid dysfunction and pancreatic dysfunction can result in obesity and Type 2 diabetes along with associated inflammation and oxidation. In PCOS oestrogen is raised and is linked to auto-immunity and increases inflammatory cytokines (IL-1,IL-4,IL-6). Higher oestrogen may also be linked to a higher risk of endometrial cancer.(Mobeen2016: Polycystic Ovary Syndrome may be an Auto-immune Disorder) ( click her for link)

Evidence support of the presence of chronic low-grade inflammation in women with this syndrome is also emerging. There is raised blood markers like raised white blood cell count (WCC),raised C Reactive Protein (CRP) interleukin 18 [IL-18 and monocyte chemoattractant protein-1 (MCP-1). Inflammation in PCOS may also be related to obesity and cardiovascular disease risk. Their is also a link with low grade infectious agents like Chlamydia and Helicobacter and increased gum disease (Duleba 2013 : Is PCOS an inflammatory process?) (click here for link)

The exact collection of symptoms will vary from person to person, and many women can go for years without knowing they have the condition. They have have irregular periods, and some acne or may gain some weight. Since this is such a complex condition with so many features, if you feel your cycle is not right, you are having difficulty losing weight, you have issue s with acne or unwanted hair growth and have mood changes, then visit a health care practitioner to discuss your issues. You may need specialist care through a gynaecologist or endocrinologist. Drug therapy can help resolve some of PCOS symptoms, but some people are intolerant or the treatment is unsuccessful.

Additional information on PCOS

For more information on Polycystic Ovarian Syndrome in South Africa, clicks the links below to visit our resource pages.

PCOS FAQ PCOS FACTS PCOS STATISTICS PCOS GUIDANCE & SUPPORT

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