PCOS Flashcards
PCOS
Polycystic Ovarian Syndrome (PCOS) =
an endocrine and metabolic pathology affecting 5-20% of women (reproductive age)
worldwide.
PCOS: Hallmark features
- Ovarian dysfunction (irregular / absent
- Hyperandrogenism.
- Polycystic ovaries.
PCOS: Signs and symptoms
- Amenorrhoea / oligomenorrhoea
- hirsutism
- weight gain / inability to lose weight
- thinning hair or hair loss,
- oily skin, acne
- infertility.
If severe: ↑ muscle mass.
PCOS: Complications:
- T2DM , gestational diabetes, hypertension, dyslipidaemia, NAFLD and metabolic syndrome.
- Endometrial cancer, anxiety, depression, autoimmunity, e.g., Hashimoto’s thyroiditis.
PCOS: Pathophysiology
- Amplitude and pulses of LH = anovulation and androgens.
- LH stimulates ovarian theca cell production of androgens.
- Reduced FSH relative to LH reduces aromatisation of androgens to oestrogen leading to anovulation.
- Follicular development ceases during maturation = anovulation.
PCOS: Insulin resistance (IR) and
hyperinsulinaemia
- Decreases hepatic SHBG synthesis = ↑ active testosterone & DHT.
- Increases ovarian (theca cell) androgen production.
- Increases adrenal androgen secretion.
- Leads to leptin resistance, increasing obesity risk.
PCOS: Causes and risk factors
- Obesity
- Chronic low grade inflammation
- Gut dysbiosis
- HPA axis dysfunction
- Genetics polymorphisms
- Smoking
- Vitamin D deficiency
Common PCOS Findings
Elevated:
Testosterone with DHT
DHEA
Androstenedione
Oestrogen
Luteinising hormone (LH)
Prolactin
HbA1c
Fasting insulin
Tumour necrosis factor alpha (TNFa) / CRP
Anti- mullerian hormone (AMH)
Low:
Progesterone
Follicle stimulating hormone (FSH)
Sex hormone binding globulin (SHBG)
PCOS: Therapeutic Aims
- Decrease insulin resistance and glucose intolerance to lower androgens.
- Decrease central obesity and improve muscle composition.
- Reduce oxidative stress and inflammation.
- Promote optimal liver detoxification and intestinal oestrone clearance.
- Support HPA axis; reduce stress and cortisol levels.
PCOS: Natural Approach
- CNM Naturopathic Diet with a ‘hormone balancing approach’ focus on low GI foods. Low saturated fat, no trans fats and processed foods. Increase fibre .Limit snacking to improve insulin sensitivity.
- Quality protein from predominantly vegetable sources, eggs and fish.
- Optimise omega 6:3 ratio (1:1 1:3) wild fish, flaxseeds, chia seeds etc.
- Increase chromium rich foods for insulin receptor function
- Cinnamon improves insulin sensitivity, downregulates testosterone and insulin; decreases IGF 1 levels.
- Berberine insulin sensitising action (500 mg x 3 daily).
- Alpha lipoic acid antioxidant, reduces insulin resistance and increasing glucose metabolism ( 600‒1200 mg / day).
- Vitamin D helps address insulin resistance (test to dose).
- Magnesium improves insulin resistance (200 500 mg daily).
- Omega 3 fatty acids anti inflammatory, insulin activity.
- CoQ10 beneficial effect on serum blood glucose, insulin levels, IR and total testosterone. 60 mg daily researched.
PCOS: Natural Approach
- CNM Naturopathic Diet with a ‘hormone balancing approach’
- Limit snacking to improve insulin sensitivity.
- Quality protein
- Optimise omega 6:3 ratio
- Increase chromium rich foods
- Cinnamon
- Berberine
- Alpha lipoic acid
- Vitamin D helps
- Magnesium
- Omega 3 fatty acids
- CoQ10
- Seed cycling
- Saw palmetto
- Liquorice
- Spearmint tea
- Nettle root
- Green tea
- Support HPA axis
- Microbiome, detoxification and elimination support
- Other nutrients: Zinc, Carnitine
Myo-inositol (MI) and D-chiro inositol (DCI):
- Myo-inositol improves insulin sensitivity and supports a healthy body weight.
- It decreases LH, androgens and increases SHBG to reduce bioavailable testosterone.
- Also improves menstrual cycle regularity, oocyte quality and overall female fertility.
- Dosage: 4 g MI alone daily, or MI combined with DCI at a 40:1 ratio, for at least a 6 month period.
Chromium
Chromium picolinate reduces IR, cardiovascular disease and T2DM. Chromium increases the sensitivity of the enzyme ‘tyrosine kinase’.
