PCOS Flashcards
Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Syndrome (PCOS) = an endocrine and metabolic pathology affecting 5–20% of women (reproductive age) worldwide.
Hallmark features:
* Ovarian dysfunction (irregular / absent periods). * Hyperandrogenism.
* Polycystic ovaries.
PCOS: Signs and symptoms
Amenorrhoea / oligomenorrhoea, weight gain, hirsutism, weight gain / inability to lose weight, thinning hair or hair loss, oily skin, acne and 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
Pathophysiology — insulin resistance is the most common and prominent mediator in the majority of PCOS cases.
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.
IR can lead to weight gain, which can make PCOS symptoms worse.
75% of lean women and 95% of obese women with PCOS exhibit IR.
Controlling blood glucose levels is therefore essential therapeutically.
PCOS: Causes and risk factors — obesity
- Consider factors such as overeating, undernourishment,
physical inactivity, poor sleep, intestinal dysbiosis etc. - ↑ IR and compensatory hyperinsulinaemia which in turn ↑ adipogenesis and ↓ lipolysis.
- Sensitises thecal cells to LH and ↑ androgen production.
- ↑ inflammatory adipokines (e.g., TNF- α) which ↑ IR and inflammation (see next slide).
- PCOS symptoms commonly improve with 5% to 10% weight loss.
PCOS: Causes and risk factors ― chronic low-grade inflammation
- Consider factors such as:
‒ A typical Western diet (high in refined carbohydrates, processed foods, trans-fats, a low omega-3 to 6 ratio etc.)
‒ Metabolic endotoxaemia (intestinal permeability / mucosal degradation).
‒ Obesity and a lack of exercise. - This all adds to insulin resistance and impaired ovulation.
- High levels of oxidative stress are common in PCOS and considered a risk factor. Studies have shown lower levels of glutathione (GSH), vitamin C and vitamin E in PCOS
PCOS: Causes and risk factors — gut dysbiosis
- Bi-directional: Gut bacteria may play a role in the
pathogenesis of PCOS, and PCOS may lead to composition changes in the gut bacteria as well. - Studies have shown altered microbiota compositions and reduced microbial diversity in PCOS.
- Proteobacteria, escherichia, and shigella have been correlated with PCOS in some studies.
- Dysbiosis influences the progression of PCOS by
altering hormone secretions, gut-brain mediators,
inflammatory pathways and islet β-cell proliferation.
PCOS: Causes and risk factors
- HPA-axis dysfunction (chronic stress) — increasing production of
adrenaline and cortisol, which increase insulin resistance. Stimulates production of DHEA / DHEA-S and androstenedione, which can convert to testosterone in peripheral tissues. - Genetics — polymorphisms in CYP genes (e.g., CYP11, CYP17 have been linked).
- Smoking — linked to hyperandrogenism.
- Vitamin D deficiency — vitamin D supplementation ↑ insulin sensitivity
and decreases androgen levels in PCOS
Common PCOS findings
PCOS: Therapeutic aims
Therapeutic aims — requires a combined approach to improve overall hormonal balance and regulate ovulation:
* 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
Natural approach to PCOS
Natural approach to PCOS — supporting blood glucose balance, insulin sensitivity and weight loss:
* 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 (later)
Natural approach to PCOS: nutrients
- 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
Natural approach to PCOS — supporting hormone balance
- Seed cycling (day 1‒14 1 tbsp each of pumpkin and flax;
Studies reveal that fenugreek seed extract reduces ovarian cysts.
day 15‒28 1 tsp each of sunflower and sesame). - Saw palmetto — inhibits 5-α reductase and the conversion of testosterone to DHT.
- Liquorice — may inhibit the conversion of androstenedione to testosterone.
- Spearmint tea — anti-androgenic.
- Nettle root — lowers DHT.
- Green tea — reduces blood glucose, insulin, testosterone and inhibits COX-1 and 5-LOX
- Support HPA-axis — adrenal adaptogens
(e.g., ashwagandha), magnesium, calming nervine teas (chamomile, passionflower, lemon balm), limit caffeine, sleep hygiene. - Microbiome, detoxification and elimination support — prebiotics and probiotics. Fermented foods and polyphenols. Fibre
(30–45 g / day) from whole foods. Cruciferous vegetables (1 cup). B complex, magnesium, NAC, silymarin, castor oil packs. - Other nutrients: Zinc (insulin signalling and 5-α reductase inhibition).
Carnitine (normalises metabolic profile in PCOS (400 mg / day)
PCOS: supplements
PCOS: exercise
- At least 45 minutes of exercise, four
times a week to enhance insulin sensitivity. - Tabata training / HIIT has been shown to effectively reduce IR, VAT fat and HbA1C.
- Tabata: Each exercise in a Tabata workout lasts only four minutes but is high intensity. The structure of the programme is as follows:
‒ Work out hard for 20 seconds, rest for
10 seconds, complete 8 rounds
