POLYCYSTIC OVARIAN SYNDROME
Many women are quite vigilant when it comes to menstrual health. Often, questions plague us
when we are anticipating our next cycle. Will the flow be consistent or, will it increase? Do I have
enough menstrual products to get me through the next menstrual cycle? Will I need extra pain
killers for my cramps? And, most importantly, will my periods be on time? Will my cycles be
A menstrual disorder that significantly impacts the homogeneity of our menstrual cycle is
Polycystic Ovarian Syndrome (PCOS). PCOS is the number one menstrual disorder in women within the reproductive age group. The multiple cysts on the ovaries lead to hormonal imbalance and menstrual irregularities. Women typically experience anovulatory cycles, menstrual cycles in which ovulation does not occur. However, the cysts are not the cause of this syndrome. The exact origin of it is unknown, but
what is known; is that several factors band together to cause the symptoms of PCOS.
The hormonal changes that occur in PCOS are:
Low to normal estrogen
High testosterone levels
Increase in Luteinizing Hormone (LH)
Elevated or normal Follicle Stimulating Hormone (FSH)
An increase in LH to FSH ratio
The symptoms of PCOS are:
Menstrual cycle longer than 35 days (oligomenorrhoea) - menstrual irregularities leading to an inability to ovulate
No menses (amenorrhea)
Heavy periods (menorrhagia)
The increase in testosterone leads to an increase in facial hair growth (hirsutism), acne, male pattern hair loss, deepening of the voice, and an enlarged clitoris
Presence of ovarian cysts
Imbalances of the hormones testosterone, insulin, and progesterone play a critical role in the various symptoms of PCOS and the other conditions that may be associated with it. Managing PCOS involves treating these symptoms with lifestyle modifications and medications.
Hormonal Influences on PCOS Symptoms
Many of the problems associated with PCOS revolve around hormonal imbalances of testosterone, insulin, and progesterone.
Testosterone is one of the many sex hormones and is an androgenic sex hormone. Androgens (from the Greek andro, meaning “male”) are found in higher concentrations in men than in women, and play a role in the development of male characteristics. Testosterone is produced when the reproductive system is stimulated by LH.
PCOS patients present with many adverse reactions associated with abnormally high testosterone levels:
Hirsutism (the growth of long, coarse, dark hair), develops in androgen-sensitive areas such as the chest, upper lip, chin, back, and abdomen.
Insulin resistance and obesity are most commonly associated with PCOS. About 80% of women
with PCOS have insulin resistance, and approximately 70% of women are obese. Obesity is
known to aggravate most of the symptoms of PCOS and also impedes the treatment regime.
PCOS affects multiple systems in the body, and it also increases the risk of:
Type 2 diabetes mellitus
Increases lipid levels
Cardiovascular diseases and hypertension (increase in blood pressure)
Depression and anxiety
Endometrial and Breast Cancer
Because of its many negative implications on health, it is imperative to treat PCOS promptly.
The first step in the treatment of PCOS is to maintain healthy body weight. Weight loss is known
to improve reproductive outcomes in women with PCOS. Other options for those seeking fertility
include assisted reproductive techniques (ART) or consuming medications that induce ovulation
(clomiphene). Patients experiencing irregular menstrual cycles may be prescribed oral contraceptives containing progestins. However, synthetic progestins themselves may have negative effects on a woman’s health.
Metformin is a medication that reduces insulin resistance and improves the sensitivity of tissues
to insulin. Metformin and OCPs are often used in combination for the treatment of PCOS in
women not planning a pregnancy.
Dr. Jerilynn Prior, a Professor of Endocrinology and Metabolism, has spent her career studying menstrual cycles and the effects of the cycle’s changing estrogen and progesterone hormone levels on women’s health. She explains: Progesterone is the hormone made by the ovary after an egg is released. Patients with [PCOS] have sporadic or absent ovulation, so they are not making progesterone for two weeks every cycle. This lack of progesterone leads to an imbalance in the ovary, causes the stimulation of higher male hormones, and leads to irregular periods and trouble getting pregnant. Progesterone is usually missing—replacing it therefore makes sense.
In an article for Gynecological Endocrinology, Dr. Helen Buckler et al. write that progesterone appears to normalize the heightened LH levels associated with PCOS. Raised LH is one of the mechanisms that stimulate testosterone production. In addition, Dr. Prior notes that progesterone inhibits the enzyme that allows testosterone to convert into dihydrotestosterone, the androgen that contributes to acne, hirsutism, and (as mentioned previously) male pattern baldness.
Compounded bioidentical progesterone may have a variety of benefits in the treatment of PCOS and its symptoms. According to Dr. Prior, progesterone signals to the HPG axis when to stop production of androgens, which prevents testosterone overproduction. If progesterone deficiency is addressed by supplementing compounded bioidentical progesterone for two weeks every month, it “may help the brain develop the normal cyclic rhythm that is missing in PCOS.”
PCOS is a complex syndrome that involves multiple systems and a motley of hormones. The
repercussion of the malfunction of one hormone echoes to other hormones. However,
sometimes the remedy for distressing ailments is as simple as consuming a balanced healthy
diet and regularly exercising.
6) Buckler HM. Vaginal progesterone administration in physiological doses normalizes raised luteinizing hormone levels in patients with polycystic ovarian syndrome. Gynecol Endocrinol. 1992 Dec;6(4):275-82.