The NHS defines Polycystic Ovary Syndrome (PCOS) as: “a common condition that affects how a woman’s ovaries work.”
The three main features of the condition are: cysts that develop in the ovaries (polycystic ovaries), ovaries do not regularly release eggs (ovulate) and having high levels of “male hormones” called androgens. Polycystic ovaries contain a large number of harmless cysts up to 8mm in size. The cysts are under-developed sacs in which eggs develop. Often in PCOS, these sacs are unable to release an egg, meaning ovulation doesn’t take place.
PCOS is considered the most common reproductive endocrine condition among women of childbearing age. It is estimated that about 1 in every 5 women in the UK has polycystic ovaries, but more than half of these have no symptoms. The exact cause of PCOS is considered unknown, but it’s thought to be related to abnormal hormone levels.
Symptoms typically begin in the late teens or early 20s and can vary in severity. It is also important to mention that not all of the symptoms will occur with every single case of PCOS.
The NHS have reported that “a diagnosis of PCOS is usually made if other causes of the same symptoms have been ruled out and you meet at least two of the following three criteria:
- You have irregular or infrequent periods – this indicates your ovaries do not regularly release eggs (ovulate)
- Blood tests show you have high levels of “male hormones” (androgens), such as testosterone (or sometimes just the signs of excess male hormones even if the blood test is normal)
- Scans show you have polycystic ovaries.”
Additional symptoms associated with PCOS may include:
- Excess facial or body hair (hirsutism)
- Oily skin and acne
- Thinning hair or hair loss from the scalp
- Weight problems including overweight, rapid weight gain, and difficulty losing weight
- Depression and mood changes.
A Frequently Unnoticed Condition
As symptoms are variable, an individual’s awareness of the presence of the condition is sometimes overlooked for extended periods of time. As many of the symptoms can be long-term and commonly associated with teenagers and youth as well (for example, acne, weight gain, low mood and changing mood frequently) it makes diagnosis especially difficult.
Additionally, irregular or light menstruation may not be seen as a concern and for many the menstrual cycle is modulated by the contraceptive pill.
One may become aware of the potential diagnosis of PCOS when a lack of ovulation impacts fertility.
A diagnosis will result in treatment by your GP or referral to a specialist: a gynaecologist or endocrinologist depending on your symptoms. As no cure is considered available for this condition treatments offered will vary according to your symptoms and may include: lifestyle recommendations for weight loss for those overweight, prescription drugs for those with irregular menstruation which may include the contraceptive pill or progesterone-only treatment. For those with fertility issues resulting from PCOS various hormonal treatments may be used including the antidiabetic drug metformin prescribed for the symptomatic management of PCOS by improving insulin sensitivity, resulting weight management and the normalising of the menstrual cycle.
Why is Insulin Relevant?
Insulin is a hormone produced by the β-cells of the pancreas. One of the major roles of insulin is maintaining blood sugar levels. High levels of sugar and refined carbohydrates trigger the release of insulin which then stimulates the uptake of glucose by muscle and adipose tissue. Diets high in refined, processed food and sugar result in a continual call upon on insulin production. This, in turn, increases fat stores of sugars and the risk of developing a lack of sensitivity to insulin (insulin resistance). Insulin resistance is considered progressive as a direct result of elevated insulin, further creating a compensatory chronic hyper insulin state. Hyperglycaemia (high blood sugar levels) and high insulin levels can contribute to weight gain and obesity.
Women with PCOS often show signs of insulin resistance. This elevated level of insulin in the bloodstream is thought to be one of the underlying reasons why PCOS develops due to hormonal imbalance, with higher testosterone levels.
Oestrogen and Testosterone
Sex Hormone Binding Globulin (SHBG) is an important regulator of oestrogen balance in the body. High levels of SHBG are associated with an oestrogen dominant environment. Lower levels of SHBG, which are more likely to be associated with a higher testosterone to oestrogen ratio, are often seen in those with PCOS. A diet high in processed refined foods, sugars and elevated insulin levels is commonly associated with a decline in the production of SHBG.
In some cases of PCOS ovulation is impeded due to higher levels of Luteinising Hormone (LH). The Follicle Stimulating Hormone (FSH) is the hormone responsible for the development of the egg and follicle whereas LH triggers the release of the egg from the follicle.
Some ovaries are known to develop multiple cysts due to undeveloped follicles but not all will lead to symptoms or impact negatively on fertility. It is only when hormonal imbalance occurs that this is shown, which is why ultrasound scans of the ovaries alone are not conclusive for PCOS.
Hair-related symptoms associated with PCOS (excess hair growth on the body, facial hair and thinning of the hair on the scalp) is considered to be a result of increased circulating testosterone blood levels.
Improving Your Own Health and Reducing the Risk of PCOS
When self-evaluating, bearing in mind links to insulin resistance, one should consider:
- Am I overweight?
- Do my meals and snacks consist of refined, processed and packaged foods?
- Do I consume too much sugar in soft drinks, tea, coffee, cakes, biscuits and confectionery?
Simple dietary changes could make you feel healthier and reverse imbalances associated with PCOS. Dietary causes of elevated insulin levels will respond to healthy dietary changes and resulting blood sugar and insulin balance will assist with weight loss and impact beneficially on hormonal levels.
Which diet works best?
We know that the Palaeolithic diet and the Mediterranean diet do not include refined or processed foods or foods high in sugar and this is the vital factor – natural unrefined diets promote good blood sugar control and increase insulin sensitivity. Vegetarian and vegan diets could be ideal if they follow the unprocessed and unrefined essential factors, however, some vegetarian and vegan diets are high in processed foods and follow a typical Western refined diet that simply excludes animal products.
Avoiding specific groups of foods is not essential (unless you have additional indications for food tolerances) but looking at your diet and ensuring dietary balance is important. For example, if you choose to include wheat in your diet, make sure you utilise wholegrains. It is also imperative to consider balance and include a variety of other grains. If you wish to avoid all grains and dairy then do look to include other food sources that provide important nutrients found commonly in wholegrains, dairy etc. Vegetarian and vegan diets need to ensure they consume adequate protein and address potential deficiencies associated with diets which avoid animal products.
Including spices into your diet such as cinnamon may provide assistance; this spice has long been considered supportive of blood sugar control. Garlic and onions have also been shown to be beneficial.
A General Guide to Supplement Support
A good quality multivitamin and mineral provides a balanced start to supporting your health and reduces the risk of potential dietary led deficiencies through providing essential micronutrients needed for optimum health. Many of the nutrients important for carbohydrate metabolism, blood sugar balance and insulin regulation will be found in a well-balanced multi-formula that includes the B vitamins, vitamin D, zinc and chromium.
Chromium is an extremely important mineral if you have insulin and blood sugar imbalances. Chromium encourages the formation of glucose tolerance factor (GTF) which is a substance released by the liver and an important part of carbohydrate metabolism and the maintenance of normal glucose levels. When chromium levels are low in the body, GTF levels are also low and the activity of insulin is blocked leaving elevated glucose levels in the blood. Note: if you are diabetic and on medication, you should speak with your doctor before taking chromium.
Low levels of magnesium are considered to be associated with a decreased level of insulin sensitivity.
Diets high in saturated fats and with a higher ratio of omega 6 to omega 3 are considered to increase triglycerides and have a detrimental impact on insulin resistance. Increasing intake of omega 3 from nuts, seeds and oily fish supports the healthier ratio of omega 3 to 6.
This is not a complete list of nutrients and herbs which many consider beneficial in support of conditions such as blood sugar control, energy distribution and PCOS.
If you have any questions regarding any of the health topics raised, or any other health matters please do contact me (Amanda) by phone or email at any time.
Amanda Williams, Cytoplan Ltd
[email protected], 01684 310099
Website: PCOS UK
NHS Website: Polycystic Ovary Syndrome
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Relevant Cytoplan Products
Wholefood GTF Chromium – GTF chromium is now being recognised as important in the maintenance of normal blood glucose levels. Wholefood GTF chromium is better absorbed and longer retained than isolated chromium, and is also significantly less toxic.
Biofood Magnesium – Biofood Magnesium tablets are effectively an organic matrix form of magnesium, complete with natural amino acid carriers to ensure transport to sites of need within the body. Biofood Magnesium is a potency of 100mg per tablet. This is the 60 capsule size – for 120 capsules follow the link.
Magnesium Citrate – Magnesium Citrate is the best of the non-food forms of magnesium. As a citrate it is readily absorbed into the bloodstream via the citric acid cycle. Easy-to-take gluten free capsules which are suitable for vegetarians and vegans.
Omega 3 Supplements:
Pure Krill Oil – Krill are the most bioeffective natural sources of beneficial Omega 3 fatty acids EPA/ DHA; Astaxanthin, a powerful antioxidant and Choline, an essential neurotransmitter. Krill Oil nutrients can help manage cholesterol and provide powerful antioxidant and anti-inflammatory properties. Research and studies support Krill Oil as having recognised physiological action.
Omega 3 Vegan – Vegan Omega 3 from Marine Algae – An ideal vegan source of the important Omega 3 essential fatty acids EPA and DHA. Two gluten-free capsules will provide 334.0mg DHA and 166mg EPA (on average). This supplement will therefore provide excellent daily levels of Omega 3 for a minimum of 30 days.