Polycystic ovarian syndrome or “PCOS” is a loosely used term with a variety of interpretations. In this article, I will try to break it down and simplify the understanding of the signs, symptoms, and management options of PCOS or the “metabolic syndrome”.
WHAT
The symptoms of PCOS vary from zero to a hundred. PCOS is a spectrum and the pendulum swing can be controlled by the correct combination of natural, lifestyle and pharmaceutical approaches.
Various national and American educational societies have several classification criteria for PCOS diagnosis. The most commonly used criteria used are the Rotterdam Criteria. If any two of the three symptoms or signs are present then a diagnosis of PCOS can be made. The three criteria are hirsutism (excessive hair growth in unwanted areas), irregular periods, and polycystic ovaries on ultrasound.
That being said, PCOS is a syndrome and is always on a pendulum. The pendulum can swing from no symptoms to all the symptoms.
The picture can range from irregular periods, weight gain, excessive hair growth in unwanted areas, trouble losing weight, infertility, depression, low libido, pelvic pain, bloating, and much more.
WHY
An imbalance between estrogen and progesterone with or without high testosterone levels can occur during PCOS. This, in combination with insulin resistance puts you at a higher risk of diabetes, causes difficulty in losing weight, and makes you lose your body shape.
What comes first? We still don’t know.
New research shows that these imbalances can be caused by some inherent changes in our genome. On top of that several environmental toxins called Xenoestrogens may either trigger PCOS or make things way worse. Xenoestrogens are chemicals that are commonly found in plastics, detergents, pesticides, perfumes, and even food. They go into our body and cause symptoms of excessive estrogen which in turn worsens PCOS.
WHO
Any female can be affected by PCOS. Some ethnicities or populations may have a higher incidence than others.
WHEN
Many females may start having symptoms as they go through puberty while many others develop symptoms later on in life at any age.
HOW
How can we fix it?
There are several strategies. It can be controlled or reversed but needs a multi-pronged approach. The superstar of this approach has to be a lifestyle and diet change.
In addition, there are several alternative herbal therapies and branded medications that can help.
What is Metabolic Syndrome and how do I know I have it?
Metabolic syndrome is a group of clinical findings. You do not need to have all of the characteristics to have it. However, a person with one clinical sign is more likely to have others. Most expert groups define metabolic syndrome as the presence of three or more of the following characteristics in a person:
- Obesity, especially in the abdominal area (defined by some groups as a waist size greater than 94 to 102 cm (38 to 41 in) in men or greater than 80 cm (32 in) in women)
- Impaired fasting glucose (fasting blood sugar of 100 to 125mg/dLor 5.6 to 7 mmol/L)
- Increased blood pressure(130/85or higher) or if you take medicine for high blood pressure
- Increased fasting levels of triglycerides (bad cholesterol).
What increases my risk of developing Metabolic syndrome? Can I avoid it?
The following factors are thought to increase the risk of developing metabolic syndrome:
- Being overweight (body mass index of 25kg/m2or more)
- Menopause (in women)
- Increasing age
- Smoking
- Eating a high carbohydrate diet
- Lack of physical activity
- Family history of diabetes or metabolic syndrome.
Yes, by carefully monitoring your diet and having an active exercise regimen, you may be able to avoid the florid clinical manifestation of metabolic syndrome.
What are the long-term health risks of metabolic syndrome?
Diabetes — Type 2 diabetes is much more likely to develop among people with the metabolic syndrome. Healthy lifestyle changes, such as weight loss and exercise, can help to reduce the risk of developing type 2 diabetes.
Heart disease— People with metabolic syndrome are at increased risk for developing cardiovascular disease. Cardiovascular disease includes coronary artery disease (collections of fatty plaques inside the heart’s blood vessels), cerebrovascular disease (collections of fatty plaques inside the blood vessels leading to the brain), and high blood pressure. Cardiovascular disease can lead to heart attack, stroke, or angina (chest pain).
Can I get tested for PCOS or metabolic syndrome? How do I know I have it?
The metabolic syndrome is diagnosed based upon a physical exam and a blood test of your fasting (before breakfast) blood sugar, cholesterol, and triglyceride levels.
Your doctor will check your weight, blood pressure and perform a full physical exam
Your doctor will also run some blood tests to check your fasting cholesterol, blood glucose, liver function and HbA1c. Checking fasting Thyroid hormone levels is also helpful because sometimes-slow thyroid (hypothyroidism) can look clinically like metabolic syndrome. Slow thyroid can be easily fixed by thyroid hormone supplementation. We may also check other hormones such as estrogen, progesterone, cortisol, DHEA and 17 hydroxy progesterone.
Remember that many times, especially if you are in the early stages of PCOS your blood work may be completely normal. In that case, you still need to proceed with the full-service approach to avoid progression into full-blown PCOS with advancing age.
Is one exercise regimen better than another?
Endurance exercise is an effective strategy to prevent muscular insulin resistance. A new study published in the Journal of Physiology demonstrates that exercising in the fasting state is more effective than exercising after eating a meal. Again, it’s all about balance. Several strategies can be used to assist with endurance and aerobic exercise that can increase longevity and improve insulin sensitivity.
I have a very busy schedule and I don’t have time to exercise, can I just get liposuction?
Removal of abdominal adipose tissue with liposuction does not improve insulin sensitivity or risk factors for coronary heart disease, suggesting that the negative energy balance induced by diet and exercise is necessary for achieving the metabolic benefits of weight loss.
PHYSICAL, SOCIAL AND MENTAL WELLNESS PLAY KEY ROLES IN HELPING WOMEN GAIN VICTORY OVER PCOS
We and designed a comprehensive approach called the ‘LAMPS” approach.
L- Lifestyle: Diet/ exercise and routine
Studies have shown that even 10-15 lbs. of weight loss can help regulate the periods. Lifestyle changes such as diet, exercise and weight loss will help regulate periods even without medical therapy.
A-Alternative medicine: Herbal and natural supplements
A customized plan incorporating natural herbal remedies can help you in swinging the pendulum to the left. The process can seem daunting and slow at first. We specialize in a comprehensive functional approach to PCOS and we have seen amazing results without the use of medication while avoiding the side effects of traditional pharmaceutical drugs.
M- Mental wellness:
Reducing stress, increasing mindfulness, and focusing on self-care go a long way. Remember, our brains are connected intricately with the ovaries and adrenals. Stress and elevated cortisol can affect the delicate hormonal balance and influence the estrogen/ progesterone balance.
P-Pharmacological approach:
Medications such as oral contraceptive pills, metformin and spironolactone are the traditional medical approaches to managing PCOS.
S-Social wellness:
You are not alone. Surrounding yourself with friends and family who bring positivity into your life is key. Get out of negative situations if it is safely possible. And if it is not possible then at least start planning and taking baby steps towards a better situation. Feel free to utilize our framework tool kit to assist you with your journey.
WHERE SHOULD I START?
- Get your regular GYN check up and talk to your provider.
- Functional approach: If you are suffering from multiple symptoms and can’t figure out why, feel free to reach out to us for a holistic consult here.
- Support group: If you are already getting care and are in need of a support group, we host monthly sessions where we get a cohort together to try and assist you with the complexities of PCOS.
- Custom packages: Because PCOS has multiple causes, it cannot be fixed by one approach. Hence, we have designed customized packages that include a multipronged approach so you can achieve good outcomes with a guided journey.
As always, we are here to help. Here is a quick video where I explain the basics of PCOS.
Be safe, be strong and be prepared.
Dr. Adeeti Gupta