Do you have menstrual cycles lasting 35+ days or go several months without a period?

Do you have difficulty losing weight despite eating well and regular exercise?

Or are you having difficulties falling pregnant? Or have you experienced the heart-break of one or more miscarriages?

These are all issues associated with polycystic ovarian syndrome (PCOS), the most common endocrine disorder affecting reproductive aged women.^1-5 But many women (up to 75%) are estimated to have undiagnosed PCOS, meaning there are many living with general, reproductive and fertility health issues without knowing why or that much can be done about it.

What does PCOS look and feel like?

Common symptoms you can experience include:

• excess facial/body hair
• acne
• weight gain (especially around the abdomen)
• PMS-type symptoms
• sleep apnoea

It can also significantly influence your menstrual cycle and fertility.

How can it affect your menstrual cycle?

The hormonal imbalances associated with PCOS adversely affects the process of follicular and oocyte (egg) maturation into dominant follicles in your ovaries.

What does this mean? It physically affects ovarian tissue and impairs ovarian, endometrial and uterine function.

As a result, you can experience:

• oligomenorrhoea (infrequent periods – this is the most common menstrual disturbance in PCOS)
• an extended menstrual period (no. of bleeding days)
• anovulation (where ovulation hasn’t happened)
• amenorrhoea (absence of menstrual period)
• irregular bleeding (spotting)^{4, 6, 9,10}
  

How can it affect your fertility?

Because PCOS impairs the maturation of follicles and eggs, they do not develop and mature properly. This impairs egg quality which is associated with:

• difficulties conceiving
• early pregnancy loss
• recurrent miscarriages

So what is PCOS?

PCOS is a complex condition characterised by menstrual irregularities, hormone imbalances and particular differences in ovarian tissue structure compared to women without the disorder. Broadly speaking there are 4 different sub-types of PCOS, with each presenting with a particular profile of clinical characteristics.^1,6,7

Knowing the type of PCOS you have is important as the most effective treatment can vary because the underlying causes can differ between the subtypes.

What causes PCOS?

PCOS is a complex condition, both in regards to its clinical presentation and the many factors associated with its onset and severity, (and this is an area of ongoing research so more understanding of contributing factors will undoubtedly be discovered in the years to come).

So, there is no single cause.

What is currently understood is that is caused by a combination of the following factors (though the specific causes will vary between women with PCOS):

• Genetics
• Hormonal
• Metabolic (impaired blood glucose and insulin regulation, inflammation)
• Environmental
• Lifestyle (dietary intake)^4,8,10,11,12
  

This results in imbalances in reproductive hormones (androgens, SHBG, FSH, LH and AMH), endocrine hormones (insulin, cortisol) along with oxidative stress and inflammatory mediators in the body. ^{4,8,10,11,12-15}

The consequence? Along with affecting your menstrual cycle and fertility, on a systemic level it is associated with obesity/overweight, dyslipidaemia, blood glucose irregularities (insulin resistance, diabetes) and cardiovascular disease.

What can you do if you have diagnosed or suspected PCOS?

If you suspect you may have PCOS, or have been diagnosed with it and it is adversely affecting your general, menstrual or fertility health, the good news is that much can be done to help you!

The first step is accurate diagnosis which involves an extensive initial clinical assessment so we know what is happening in your specific individual situation and what areas need specific support.

Then, based on this information and your clinical health goals, we use a combination of dietary, lifestyle, herbal and nutritional supplementation to improve your symptoms and general health while also specifically targeting the identified factors that impairing your reproductive health and fertility.

If you feel you need some support or have questions, I am available for naturopathic and nutritional consultations at Fertile Ground Health Group or a free 10-minute chat if you’d like to find out how I can help in your individual case: https://www.fertileground.com.au/bookings/

REFERENCES

1. Wiweko B, Indra I, Susanto C, Natadisastra M, Hestiantoro A. The correlation between serum AMH and HOMA-IR among PCOS phenotypes. BMC Res Notes 2018; 11 (1): 114.
2. Wolf WM, Wattick RA, Kinkade ON, Olfert MD. Geographical prevalence of polycystic ovary syndrome as determined by region and race/ethnicity. Int J Environ Res Pub Health 2018; 15 (11): 2589.
3. Zhang Y, Ho K, Keaton JM, Hakonarson H, Williams MS, Lee MTM. A genome-wide association study of polycystic ovary syndrome identified from electronic health records. Am J Ob Gynecol 2020; 223 (4): P559.E1-P559.E21.
4. Tabrizi FPF, Hajizadeh-Sharafabad F, Vaezi M, Jafari-Vayghan H, Alizadeh M, Maleki V. Quercetin and polycystic ovary syndrome, current evidence and future directions: a systematic review. J Ovarian Res 2020; 13: 11.
5. Butler AE, Ramachandran V, Hayat S, Dargham SR, Cunningham TK, Benurwar M et al. Expression of microRNA in follicular fluid in women with and without PCOS. Sci Rep 2019; 9: 16306.
6. Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S. Comparison of the
7. different PCOS phenotypes based in clinical metabolic and hormonal profile, and their response to clomiphene. Ind J Endocrinol Metab 2019; 23 (3): 326-331.
8. Tang C, Li X, Tang S, Wang Y, Tan X. Association between circulating zinc-a2-glycoprotein levels and the different phenotypes of polycystic ovary syndrome. Endoc J 2020; 67 (3): 249-255.
9. Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence and phenotypes of polycystic ovary syndrome. Fert Ster 2016; 106 (1): 6-15.
10. Wojciechowska A, Osowski A, Jozwik M, Gorecki R, Rynkiewicz A, Wojtkiewicz J. Inositols’ importance in the improvement of the endocrine-metabolic profile in PCOS. Int J Mol Sci 2019; 20 (22): 5787.
11. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Association of Clinical Endocrinologists, American College of Endocrinology and Androgen Excess and PCOS Society Disease State Clinical Review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome – part 1. Endocri Prac 2015 Nov; 21 (11): 1291-1300.
12. Bellver J, Rodriguez-Tabernero L, Robles A, Munoz E, Martinez F, Landeras J et al. Polycystic ovary syndrome throughout a woman’s life. J Assist Reprod Genet 2018; 35 (1): 25-39.
13. Tabrizi FPF, Hajizadeh-Sharafabad F, Vaezi M, Jafari-Vayghan H, Alizadeh M, Maleki V. Quercetin and polycystic ovary syndrome, current evidence and future directions: a systematic review. J Ovarian Res 2020; 13: 11.
14. Kataoka J, Tassone EZ, Misso M, Johan AE, Stener-Victorin E, Teede H et al. Weight management interventions in women with and without PCOS: a systematic review. Nutrients 2017; 9 (9): 996.
15. Hajizadeh-Sharafabad F, Moludi J, Tutunchi H, Taheri E, Izadi A, Maleki V. Selenium and polycystic ovary syndrome: current knowledge and future directions: a systematic review. Horm Metab Res 2019; 51: 279-287.
16. Butler AE, Ramachandran V, Hayat S, Dargham SR, Cunningham TK, Benurwar M et al. Expression of microRNA in follicular fluid in women with and without PCOS. Sci Rep 2019; 9: 16306.
17. Daan NMP, Koster MPH, deWilde M, Dalmeijer GW, Evelein AMV, Fauser BCJM, de Jager W. Biomarker profiles in women with PCOS and PCOS offspring: a pilot study. PLoS One 2016; 11 (11): e165033.
18. Lindheim L, Bashir M, Munzker J, Trummer C, Zachhuber V, Leber B et al. Alterations in gut microbiome composition and barrier function are associated with reproductive and metabolic defects in women with polycystic ovary syndrome (PCOS): a pilot study. PLoS One 2017; 12 (1): e0168390.

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