Polycystic Ovarian Syndrome (PCOS)

We see it in our office all the time. A 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 a 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 upregulation 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 bloodstream (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.