PCOS 101
September is Polycystic ovarian syndrome (PCOS) awareness month, so what better way to do that than a PCOS 101. This blog covers what it is, how to get diagnosed and the PCOS Types.
What is PCOS?
PCOS is a metabolic condition that affects metabolic and hormonal health. PCOS cannot be diagnosed from having one symptom. A syndrome is a collection of symptoms that can present very differently in one woman compared to another.
A common misunderstanding is that a woman diagnosed with PCOS means she will have cysts on her ovaries, when that may not be the case. You do NOT need to have cysts on your ovaries to be diagnosed with PCOS
There is often discussion that the condition should be renamed due to this misunderstanding, as the focus is often on the presence of cysts, or not.
PCOS is the most common hormone disorder among you women.
You do not need cysts to be diagnosed with PCOS.
How is PCOS diagnosed?
PCOS is a syndrome, so there is no single diagnostic test. Diagnostic criteria have been developed known as the Rotterdam criteria and is widely adopted internationally.
Below is an image to help you understand how PCOS is diagnosed medically through different blood tests, an ultrasound to diagnosis if cysts are there or not, and identifying the corresponding symptoms. According to the current guidelines, you only need to meet two out of the three following criteria to be diagnosed:
Diagnostic criteria
Lets dive deep into the different criteria and what that means.
Polycystic ovaries
This refers to the presence of cysts on the ovary, as identified in an ultrasound. But remember you don’t need to have cysts on your ovaries to have PCSO and just because you have cysts on your ovaries this doens’t mean you have PCOS.
Anovulation
This refers to the absence of ovulation in a cycle.
Oligo-ovulation
This refers to irregular ovulation, meaning ovulation is not consistent or infrequent. This also can be referred to as the absence of, or irregular menstrual cycle (period). Note: just because you have a menstrual cycle, this does not mean you will have ovulated.
Some of my clients will experience irregular cycle lengths in the form of short cycles (14 – 24 days) or long cycles (32+ days). Some clients will have completely absent periods, so we work on regaining her cycle together in coaching.
I know having a regular menstrual cycle may not seem all that appealing, especially if you have painful periods, but a regular menstrual cycle is a monthly health check for us women that everything is working well and we have healthy hormones.
Clinical or biochemical hyperandrogenism
This is the result of high androgens (male hormones). This can be determined based on blood tests or the physical manifestation of symptoms such as:
acne,
male pattern baldness,
Hirsutism - excessive growth of dark or coarse hair in a male-like pattern — face, chest and back.
Another common misconception is that you need these ‘male’ characteristics to be diagnosed. You don’t.
PCOS types
As a useful reminder for you, PCOS contributes to metabolic and hormonal changes in our bodies.
There is a theory commonly used to understand the PCOS ‘types’. There is some debate if there are additional drivers.
Regardless, the most commonly accepted “types” or drivers of PCOS are:
1. Insulin Resistant PCOS
Insulin is the hormone that helps your body bring glucose (enerrgy) from digested food in your bloodstream, into your cells. This provides those cells with energy.
When your body is insulin resistant this can make the process above become inefficient or completely rejected.
If your cells reject the energy and the insulin, they will float around your bloodstream causing issues like low energy, strong cravings, irregular or absent menstrual cycles, high androgens causing hirsutism, oily skin, body odour etc.
It is thought that around 75% of women with PCOS have insulin resistance.
2. Inflammatory PCOS
Inflammation is your body’s ability to fight off danger or harm. The body’s inflammatory response is like setting off alarm bells that trigger pain and swelling, to go attack the danger. This isn’t always a negative thing either, think of when you get a cut, your body uses that as a defense mechanism to heal. The issue is when we have chronic (Long term) inflammation.
Unfortunately for some women, poor gut health, stress and certain food can make this worse. This can drive symptoms like IBS, bloating, cramping, constipation, diarrhoea, acne and ezcema.
3. Adrenal PCOS
Stress is a major player in PCOS and why it is so important to address your stress management and how you regulate your nervous system. Again, some stress isn’t all bad either, we need some stress for our bodies like when we exercise- that is a positive stress. The issue is when we are CHRONCIALLY stressed all the time- that is not as beneficial.
WHY?
Your stress response triggers the release of cortisol (the stress hormones) from your Adrenal glands. Cortisol will put your body into flight, fight/freeze stress mode, which means the blood flow moves from your digestion system to your muscles ready to run. Your body thinks it’s in danger, so you having healthy hair, skin and nails is not a priority. This can often drive hair loss, absent or irregular periods, poor body image and low mental health.
4. Post-Pill PCOS
Post-pill PCOS can be referred to as a temporary PCOS, where some women will experience PCOS symptoms after coming off hormonal contraception.
Some hormonal contraception suppress your natural hormones while you are on them. Once this suppression is removed, PCOS-like symptoms can be experienced and can take 6-12 months to resolve. The most common one is post-pill acne and coupled with an irregular cycle can make one assume that it may be PCOS.
On top of that some hormonal contraception can also deplete some of your nutrients (B vitamins, Zinc, Magnesium) and can affect your gut microbiome, your body will take some time to bounce back.
Don’t forget hormonal contraception like the pill is still medication, which can disrupt your gut bacteria.
What now?
In my next blog, I will dive deeper into the treatment and management of PCOS and what you can do if you have PCOS.
