PCOS: managing symptoms and addressing root causes

PCOS symptoms and signs

PCOS stems from hormonal imbalance and an excess of male hormones, called androgens.  Levels of these androgens, together with insulin are elevated in people with PCOS, causing a range of symptoms, from acne to stubborn weight and facial hair.

In addition to these symptoms, people with PCOS may not ovulate every month, resulting in irregular cycles. An ultrasound might reveal a large number of follicles containing under-developed eggs on the ovaries.

PCOS symptoms and signs to look for:

• Weight gain
• Anxiety, depression and low mood
• Difficulty losing weight
• Acne
• Excessive hair on the face, abdomen or back
• Thinning scalp hair
• Insulin resistance
• High blood glucose or Type II Diabetes
• High blood pressure 
• High cholesterol
• Irregular periods
• Infertility
• Ovarian follicles
• Sleep apnoea

PCOS will often look different for everyone, and not everyone with PCOS will experience all of these symptoms. PCOS symptoms can also change and evolve over time. The name polycystic ovary syndrome is misleading because the dark spots seen on ultrasound are not cysts, but follicles or underdeveloped eggs within the ovaries. For this reason, Australian-led PCOS guidelines for clinical diagnosis have been implemented universally, confirming diagnosis of PCOS when there is a combination of hyperandrogenism and ovulatory dysfunction. This means ultrasound examination of the ovaries is not required for diagnosis of PCOS in adult women.

It’s also worth noting that some women can receive a diagnosis of PCOS, when they really have hypothalamic amenorrhoea, a condition where menstruation is halted due to dysfunctional signalling in the brain. Often because women don’t menstruate for some time, it’s assumed that they have PCOS. The appearance of the ovaries on an ultrasound can be similar, however, treatments are different for both conditions.

Listen to Melbourne Functional Medicine practitioner Rebecca Hughes talk about the common signs and symptoms of PCOS below.

What causes PCOS?

The causes of PCOS are still not fully understood but a range of consistent factors has been identified among people with PCOS, as discussed earlier.

As many as 95 percent of people with PCOS also experience insulin resistance, which prevents insulin from effectively performing its function of transferring glucose from the bloodstream into the body’s cells where it can be used for energy. This results in elevated levels of insulin and glucose circulating in the blood, and higher amounts of glucose being stored as fat. More than half of all people with PCOS will also develop type-two diabetes by age 40.

People with a mother, aunt, or sister with PCOS are 50 percent more likely to develop the condition, and PCOS is more than twice as prevalent among women of Aboriginal and Torres Strait Islander populations.

Natural vs conventional PCOS treatments

The conventional medicine approach to managing PCOS often involves addressing each of the different signs and symptoms separately.

The conventional treatments used to manage PCOS symptoms such as irregular periods, fertility challenges, excess hair, acne and excess weight can include:

• Combined oral contraceptive pill: Current guidelines recommend the  COCP should be recommended in adults with PCOS for management of hyperandrogenism and/or irregular menstrual cycles.
• Metformin: An insulin-sensitising drug, used in combination with the OCP for management of metabolic features of PCOS such as high blood glucose and insulin resistance.
• Letrozole: Considered ‘first-line pharmacological treatment’ for ovulation induction in people with PCOS with anovulatory infertility and no other infertility factors, to improve ovulation, pregnancy and live birth rates, while reducing multiple pregnancies compared to clomiphene citrate.
• Gonadotrophins: Anti-androgen and testosterone-lowering drugs can be used as second-line pharmacological agents in people with PCOS who have failed first-line oral ovulation induction therapy and are anovulatory and infertile, with no other infertility factors.
• Surgery: Laparoscopic ovarian surgery can be a second-line therapy for people with PCOS, who are clomiphene citrate resistant.
• Weight loss drugs: People with PCOS are prone to weight gain due to insulin resistance, but can experience improvement of symptoms with sustained weight loss.
• Antidepressants and anti-anxiety drugs: People with PCOS experience higher rates of depression and anxiety, and a conventional medicine approach may extend to pharmaceutical treatments.
• Acne medication: A range of pharmaceutical and topical treatments may be explored for PCOS-associated acne.

The Melbourne Functional Medicine approach to PCOS

Personalised assessment and treatment of what’s causing your PCOS

The functional medicine approach to PCOS is also multifaceted, but instead of masking the symptoms, aims to address the underlying causes of the condition. Our PCOS specialists will first use functional testing methods to determine a range of contributing factors such as hormone levels, thyroid and adrenal function, and liver health, and then develop a protocol helping you with:

Balancing hormones

If hormone levels can be returned to balance, the ovaries can resume normal function, regulating periods, improving skin health and reducing new body hair growth. Our practitioners may support hormonal balance with anti-androgen herbal medicines like liquorice and white peony, which have been found to stimulate aromatase which converts testosterone to oestrogen. Inositol may also be used in conjunction with folate to reduce testosterone and hormone-mediated acne and hair growth. While Vitamin D can normalise Anti-Mullerian Hormone (AMH) levels, which are excessive in PCOS.

Supporting thyroid function

An underactive thyroid increases the risk of PCOS. Interestingly, some conventional medications used for PCOS like Metformin, can have a detrimental effect on thyroid function. Iodine is crucial to the health of both the thyroid and ovaries, so increasing iodine intake with supplements or foods, such as seaweed and salt-water fish, may be beneficial for PCOS.

Healthy weight loss

Weight loss can improve insulin resistance, thereby reducing blood glucose and aiding hormonal balance. Current PCOS treatment guidelines recommend 150-250 minutes of moderate intensity physical activity or at least 75-minutes of vigorous exercise per week, including strength training on two non-consecutive days each week. Healthy weight loss can also be supported with a low-GI diet rich in whole foods, while generally avoiding inflammatory foods like gluten, dairy and sugar.

Stabilise blood glucose

In addition to dietary and lifestyle changes, blood glucose can be lowered with the use of various supplements including cinnamon, chromium, magnesium and probiotics.

Reduce stress

Chronic stress leads to impaired adrenal function, releasing stress hormones which elevate androgens. This creates a vicious cycle which contributes to mood disorders, weight gain, acne and unwanted hair growth, while also causing fatigue and exhaustion, which makes it difficult to exercise. Our practitioners can work with you to personalise a protocol helping you reduce stress levels, re-energise and improve moods, which may include a combination of herbal medicines as well as lifestyle changes including improved sleep, relaxation and mindset activities.

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