In the US 5-10% of women of reproductive age (thats' about 5 million women!) have PCOS (or polycystic ovarian syndrome). Interestingly, recent studies have shown up to 50% of teenage girls exhibit signs of it (a sign of the times, or something that was there before and just hadn't been noticed remains to be seen).
Of course not all women who have PCOS have trouble with infertility, but it certainly isn't uncommon for it to take it's toll on fertility for many.
Sadly, I am always a bit baffled and disheartened when I see how many women with "a diagnosis" (of any type really) know their diagnosis, maybe a statistic or two about the implications for fertility and little else. Talk about a disempowering system... when doctors don't even take the time to educate women on what is happening in their own body and invasive treatments are given it just seems terribly sad and wrong to me.
So here is Part ONE of the PCOS mother load! In this post I will give you some basic info on signs and symptoms and the underlying mechanisms of PCOS. Look for Part TWO of this post coming soon, where I'll share lots of good research and hopeful statistics on how well DIY and TCM options can work for improving not only your chances of conception, but a healthy pregnancy and a healthier YOU. These are some pretty fabulous things for women with what is considered by most to be a stubborn and frustrating (and all too common) disease. And Part THREE will cover common western treatments and how they work (or don't) and where the side effects can be an issue.
How do you get diagnosed with PCOS
To receive a diagnosis of PCOS you should have 2 or more of the following:
-polycystic (sometimes called Pearl-like) appearing ovaries (diagnosed via ultrasound) (this means 10+ cysts on the ovaries and increased ovarian volume, not just individual or acute cysts on the ovaries which many women get occasionally) see picture below.
-a history of irregular menstruation and/or ovulation
-signs of biochemical hyperandrogenism (a fancy way of saying too many male hormones) which most often means excessive and male pattern body hair growth (on abdomen, face, etc), acne and male pattern hair loss.
-elevated lutinizing hormone, insulin (and obesity), and testosterone (via blood work sample)
so you can see, it is possible to get a diagnosis of PCOS without cysts on your ovaries... humph. And it is also possible to not have the typical "look" associated with PCOS (overweight with extra body hair) but still have the blood work and ultrasound and get the diagnosis... leading many people to tell you over and over how "atypical you are" (nice) or forget you have a diagnosis of PCOS only to have to have you repeat this fact repeatedly (most annoyingly when the person in question is your health care provider!)
What causes PCOS?
Well, statistics and the rise of problems associated with PCOS definitely seem to correlate to LOTS of lifestyle implications (exercise and diet in particular). These two things can definitely trigger or tip the scales for the worse for many. The good news about this is that lifestyle is a big big deal and can make a big difference for the better for many women.
That said, PCOS is highly linked to family history ie. there is a genetic predisposition and it is inherited (and can be from either side of the family) In fact, baby girls born to mothers who have PCOS at the time of conception have larger ovaries at the time of birth and a mom with PCOS impacts future rates of diabetes in adulthood for the children (all the more reason to really work on fixing the ROOT, instead of just taking clomid and trying to get pregnant despite having PCOS. (Let me be clear, I would NEVER suggest anyone with PCOS shouldn't want or try to have children, but I do feel strongly that if moms are more balanced they have more balanced children and visa versa, so I do think getting things improved in a reasonable and time sensitive way is an awesome benefit to the health of future children and worth doing in PCOS and in lots of other situations!)
Why would there be genes for this... is it a glitch?
PCOS genes are also sometimes called "thrifty genes" because having this genotype in times of famine help the overall population survive. When women without this issue become too thin and stop having healthy reproductive function the women in the "typical" PCOS group become more fertile and start being able to reproduce more easily. Cool for human beings as a whole, not so cool for modern day women struggling with this issue!
What is going on in PCOS (mechanisms)?
The bottom line for PCOS is that it all starts with too much insulin (from genetic predisposition and/or diet and lifestyle)! The extra insulin stimulates certain cells in the body called Theca cells to produce extra male hormones. The female body then converts extra androgens (male hormones) into estrogen, that's what it does with normal amounts of male hormones, it just does it more because there are more to start with... so then we have a situation where there is too much male hormone (testosterone mainly) AND too much estrogen.
The body doesn't have enough ways to handle the high levels of estrogen and it can't clear it out of the blood fast enough.
So the high levels of estrogen signal to the pituitary gland to increase lutinizing hormone (which is the hormone that normally surges prior to ovulation and triggers ovulation to happen).
But because the high levels of estrogen are constant and not happening in a spike the lutinizing hormone ends up being elevated chronically and never or rarely in big enough of a spike to actually trigger ovulation. UGH!
And if that weren't bad enough the low dose (but extra) estrogen inhibits FSH, so follicles don't grow well either, so even if the body does try to ovulate, the follicles don't look so hot, double ugh!
This is in fact, a TON like how birth control works. Low dose estrogen shuts down the whole system.
Why is the insulin high in the first place?
That goes back to the what causes PCOS question.
Insulin resistance is key and that comes from a combination of lifestyle choices and genetic tendencies.
Wait... explain the difference between high insulin and insulin resistance, they seem like opposites?
Although the terms make lots of people confused and they seem like they might be opposites they are actually two ways of saying the same thing. Because the body is insulin resistant (doesn't respond well to normal amounts of it) the body makes more and more and more (so the insulin levels are higher than they should be). So insulin resistance and high insulin are actually synonymous.
More to come....
Welcome to my blog!
I'm an acupuncturist, teacher, fertility specialist, patient centered advocate, mom, activist and more! This blog is a place for me to write down the things on my mind, the things I discuss over and over, and the things I find helpful, interesting, and inspiring all in the hope that someone else out there, maybe YOU, will find some of these things to be helpful, interesting and inspiring too. I love learning, I love sharing, and I am passionate about helping others lead more balanced, fertile, and healthy lives - while trying to do the same myself. So here goes... The Blogging Life...