Polycystic Ovarian Syndrome (PCOS) and its Full Implications

PCOS We see it in our office all the time. Patient can’t lose weight- they have thyroid symptoms but their blood tests are normal. They’re on hormone replacement therapy for abnormal menstrual cycles, they’re pre-diabetic, and have cysts on their ovaries. But they’re not in our office for any of it. They’re in for “Fibro,” chronic fatigue, thyroid meds that don’t work for them, peripheral neuropathy, weight loss, and female pattern hair loss. Sounds like you have PCOS. “Yeah- I’ve been told I have it but I was told it’s not a big deal.” “Not a big deal?!?” It’s causing or contributing to all of your problems in addition to being the number one cause (estimated to be involved 50% of the time) of infertility in this country! “Oh, nobody told me.”

So- A quick primer on PCOS- though some doctors- ok a lot of doctors- won’t diagnose it unless you are over 300lbs and have grown a beard from too much testosterone. That patient has already had PCOS for a long time. PCOS affects upwards of 15-20% of women. That’s a lot. And it should be diagnosed when a woman has elevated testosterone, abnormal menstrual cycles (20, 30, 45 day altering cycles) and cysts on the ovaries, or at least two of these three. PCOS should always be suspected and diagnostically investigated when a woman has these symptoms and any of the conditions listed in paragraph one.

So how does this all fit together to affect you the reader? Well for starters too much PCOS related testosterone (and stress) throws off your menses but your told most of the time you need to take estrogen in order to correct the hormone imbalance between testosterone and estrogen. How does testosterone get too high? There’s debate on this. Some say it’s the adrenal glands (too much stress) that cause the adrenals to produce too much DHEA- an adrenal hormone that can be converted into testosterone.

Others say obesity may be a main player in the mechanism. People who are obese frequently develop insulin resistance (pre diabetes, syndrome X, metabolic syndrome) causing a process called “aromatization” of a female’s estrogen into testosterone due to their elevated body mass. This is because the aromatization process occurs in the body’s adipose tissue (fat cells). When testosterone is high in a woman many things happen- all bad. Abnormal cycles, impossible to lose weight, unwanted facial hair, poor conversion of inactive thyroid hormone to active thyroid hormone (producing thyroid symptoms when your thyroid is actually normal), ovarian cysts, and infertility.

Another cause of too much testosterone and the above resulting symptoms can also be a genetic abnormality when you produce too much DHEA from up regulation of an enzyme called 17, 20 lyase. This should be checked if a patient has PCOS and the above symptoms and doesn’t respond to stress reduction or weight loss. And lastly the “gut” can cause increased testosterone. Genetically predisposed individuals (upwards of 2/3rds of the female population) can develop something called small intestinal bacterial overgrowth (S.I.B.O.) which causes endotoxemia (toxic poisons in the small intestine.) This is usually accompanied by intestinal permeability (leaky gut), which allows these toxic bacteria into the blood stream (where they don’t belong) and, in mechanisms beyond the scope of this article, cause insulin resistance and the process of aromatizing estrogen to testosterone.

There’s so much more to this topic- but this should suffice for now. So- If you have PCOS (increased testosterone, abnormal menstrual cycles and ovarian cysts) in an isolated diagnosis or in combination with any of the conditions listed in the 1st paragraph of this article just know that all of the above abnormal chemistry and accompanying symptoms are very modifiable almost always without hormone replacement therapy. Don’t let anyone tell you its okay to have PCOS, that it’s not a big deal, that you don’t have it (and you have all or most of the above symptoms) or that you have to live with it. You don’t. Because now you know better.

 

References:

Epidemiology, diagnosis, and management of polycystic ovary syndrome.
Sirmans SM, Pate KA.
Clin Epidemiol. 2013 Dec 18;6:1-13. eCollection 2013. Review.
PMID: 24379699 [PubMed – as supplied by publisher] Free PMC Article

 

Obesity, adipokines and metabolic syndrome in polycystic ovary syndrome.
Carmina E.
Front Horm Res. 2013;40:40-50. doi: 10.1159/000341840. Epub 2012 Oct 18. Review.
PMID: 24002404 [PubMed – indexed for MEDLINE]
Related citations

 

3.. Insulin sensitizers in polycystic ovary syndrome.
Pasquali R, Gambineri A.
Front Horm Res. 2013;40:83-102. doi: 10.1159/000341837. Epub 2012 Oct 18. Review.
PMID: 24002407 [PubMed – indexed for MEDLINE]

10 Comments

  1. I have pros and can’t lose weight what can I do. What’s the process to do so.

  2. We have found that for PCOS a gut centered approach has worked extremely well for our patients. We place great emphasis on finding the right diet for the individual and taking them through diagnostic procedures to determine if there is excessive absorption of bacterial components, termed lipopolysaccarid (LPS), from the gastrointestinal tract. We also assess barrier integrity in the gut to determine if that is the issue behind excessive bacterial component (LPS) absorption.

    We have found this to be so significant as the LPS issue is being demonstrated as a driver for insulin resistance, which many PCOS patients have, and as a result can negatively affect weight as well as elevate testosterone levels in a female.

    Please let us know if you have any other questions or if you would like us to set you up for a consultation to discuss this further.

  3. Thank you for posting this great information!

    I’m 29 and I was diagnosed with “mild” PCOS a couple of years ago. I was told that I don’t have the Metabolic Syndrome associated with it. I do have ovarian cysts and really abnormal menstrual cycles. I also have constant fatigue and brain fog. I have trouble losing weight, and I have a lot of anxiety and headaches.

    My Thyroid has been checked before and its normal. I have had many blood tests done (for other reasons) and they come back normal as well. My main concern is the fatigue and brain fog. Is there another test that I can ask my Ob/Gyn to run to figure this out? Do you have any other recommendations?

    Thanks so much in advance!! 🙂

  4. Thank you for watching our videos. We have not evaluated you to date, so I can’t give you any formal recommendations. However, if I were you I would ask the OBGYN to test thyroid antibodies. These are commonly not tested for with routine thyroid testing and we feel they are significant for patients with brain fog and fatigue.

  5. Hello!

    I absolutely love your website, your videos give me hope. If I lived in NV I would be at your office in a heartbeat. Unfortunately, I live in upstate NY. Is there any place/doctor that you might be able to recommend in NY.

    Thank you,
    Sam

  6. Hi Sam,

    Thank you for your kind words. We hope that our videos are helping to educate people on their health conditions and give them hope that there are solutions in many cases.

    We do not know of anyone in that area. Our office is so unique where we have both a certified functional medicine practitioner and a board certified chiropractic neurologist who combine these disciplines together. You can start to search for a functional medicine doctor in your area by going to http://www.functionalmedicinedoctors.com and then doing some further research on them from there. We also work with some patients long distance if the patient is a candidate for that. You can find out more about that at http://powerhealthreno.com/brochure

  7. I had pcos…well…I mean I had alot of problems with it, then had a hysterectomy…..about ten years ago….was finally diagnosed with fibro just this year.
    Does PCOS go away when you have a total hysterectomy?

  8. The underlying cause of PCOS may or may not go away with a total hysterectomy. If insulin resistance is causing the ovaries to make excessive testosterone, then without ovaries a PCOS patient may feel better. However, if the excessive testosterone is coming from the adrenal glands, then the underlying factor for the condition will still be there. Let us know if you want us to evaluate your case.

  9. Hi, I was diagnosed with pcos when I was 17 but had it much longer, probably since I was between 13-15. I am 19 now and have been struggling incredibly. I’ve watched video after video, read article after article, talk to doctors, the whole shabang. All of them basically said I probably won’t beat it and that I’ll struggle the rest of my life….but today I came across your YouTube video talking about this bacteria or whatever and it was the first time I’ve heard something different than ” stay on a low carb, low dairy, high protein and vegetable diet regime. Exercise regularly, don’t excersize too much, don’t do cardio, don’t just lift weights, don’t do this, don’t do that, eat this, don’t eat this” I am just so done and desperate for help…I’ve gone through the pain and depression of having this…people say it’s nothing…well if it’s nothing then why is it taking over my life.

    When I was in the 7th grade I began weight watchers and it worked but then two weeks before my sophomore year I randomly gained 10 pounds….I never lost anything ever again and am now at my highest at 240 and only about 5″3 in height. I went from u confident to somewhat confident to the most depressed I’ve been. I just want someone to help me….please…give me advise. I’m in jersey so I obviously can’t visit you guys …I just want help..

  10. We are sorry to hear about your struggles with PCOS, and we receive comments similar to yours from other PCOS sufferers across the globe. Given the popularity of our content, we do have protocols for evaluating patients in other states. Let us know if you wants us to evaluate your case. You can find out more about how we do that here http://powerhealthreno.com/brochure

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