Melbourne Holistic Health Group

Published in Articles - Women's Health & Fertility on 01 December 2011 by Sandra Villella

Polycystic ovary syndrome is a complex condition which can impact on a woman’s fertility, physical appearance, increase her risk of disease such as diabetes and heart disease, as well as influence her mental health and quality of life. Although this syndrome is indeed complex and associated with these negative symptoms in some women, the treatment is largely based on diet and lifestyle strategies. These first line treatments result in an improvement in fertility and physical symptoms, and are associated with a decrease body weight and a diminished risk of developing cardiovascular disease and diabetes. Our naturopaths at MHHG are experienced in helping women with PCOS to manage the syndrome and can provide the appropriate dietary guidelines and lifestyle changes to help to achieve and maintain these improvements. There are some natural therapies including specific herbs and nutritional supplements which may be useful for some women, as part of the management of PCOS.

How common is PCOS

PCOS affects 12-21% of Australian women and girls. In a recent update of the guidelines of managing PCOS published in the medical Journal of Australia, it is estimated that 70% of Australian women with PCOS remain undiagnosed. PCOS is more common in women who are overweight or of indigenous background.

How do I know if I have PCOS?

PCOS is a condition which comprises a number of signs and symptoms which collectively make up the syndrome. A woman may be suspected of having PCOS if her periods are infrequent or absent. Excessive body hair (hirsutism) or acne are other signs of possible PCOS. As PCOS is more common in overweight women, overweight women with these symptoms might have PCOS. Women with PCOS are more susceptible to weight gain, and this can occur at any age, but being overweight is not an absolute prerequisite and some normal weight women also have PCOS.

Obesity is commonly associated with PCOS and weight reduction is a treatment priority. There are many reasons for this. In a cyclic and self-perpetuating way, obesity both intensifies the severity of many aspects of PCOS while at the same time, a woman who has PCOS has an increased risk of obesity. Obesity increases the hirsutism, and other symptoms associated with high male-like hormones, such as acne. There is also an increased the risk of infertility because of the impact of insulin resistance on ovulation when a woman is obese. The incidence of pregnancy-related complications is also higher in obesity. And finally, obesity is an added aggravating factor in the already increased risk for insulin resistance, impaired glucose tolerance, type 2 diabetes and cardiovascular disease.

The presentation of PCOS tends to vary depending on a woman’s age. Young women more commonly develop signs of high male-like hormones and so excessive body hair or acne can be the reasons for a visit to a health practitioner. For women in their 20’s and 30’s, fertility issues and difficulty in falling pregnant become the common reasons to seek help (see PCOS and Pregnancy). In later life, the metabolic features, which include the propensity for excess weight gain, an increase in prediabetes and type 2 diabetes, are the more prominent reasons to seek advice from a health care practitioner. Because the management of many of these problems is life-style focused, many women are referred to, or independently seek the advice from the naturopaths at MHHG.

How is PCOS diagnosed?

A diagnosis of PCOS requires the presence two of the following three features:

1. Infrequent or absent ovulation (oligo-ovulation or anovulation) which manifests as infrequent or absent periods.
2. Hyperandrogenism which is manifested by either clinical signs of high levels of the male-like hormones (androgens), such as excessive body hair growth, loss of head hair, or acne; or by high levels of these hormones detected in a blood test.
3. Polycystic ovaries on ultrasound.

Although this condition is referred to as polycystic ovary syndrome, a woman does not actually need to have polycystic ovaries- i.e. many ‘cysts’ on the ovaries to be diagnosed with PCOS. The cysts are not actually cysts, but rather many follicles on the ovary. It is also important to note that not all women with polycystic ovaries actually have the syndrome PCOS. About 20% of all Australian women have polycystic ovaries on ultrasound without having PCOS. In fact, polycystic ovaries are commonly seen on ultrasound of women who are not ovulating for other reasons.

What causes PCOS?

The cause of PCOS remains unclear. Contributing causes are thought to be genetics and environmental factors, combined with obesity, ovarian dysfunction and hormonal influences. The underlying hormonal imbalance arise because of these precipitating factors and include increased androgens and/or high insulin (hyperinsulinaemia) as a result of insulin resistance (see PCOS, Insulin Resistance and a Low GI Diet). 

Related articles:

• PCOS, Insulin Resistance and a Low GI Diet  by Sofie Mikosza
• Improving PCOS Symptoms Through Exercise and Weight Loss by Ljupka Peev
• PCOS and Pregnancy by Ann-Maree Bortoli
• Fertility Treatments at MHHG by Ruth Trickey (Director)