Types of PCOS
Introduction
Polycystic Ovarian Syndrome (PCOS) is a set of symptoms and biochemical abnormalities that impair ovulation. Failure to ovulate causes a reduction in both oestrogen and progesterone (female hormones) and an increase in testosterone and other androgens (male hormones).
Physical Symptoms of PCOS
- Irregular or absent periods
- Infertility
- Weight gain
- Hirsutism (hair growth on the face, nipples and abdomen)
- Acne
- Hair loss
Blood test markers of PCOS
- High blood glucose and fasting insulin
- High free testosterone
- High DHEA
- High androstenedione
- Low Sex Hormone Binding Globulin (SHBG)
- High luteinising hormone
Types of PCOS
1. Insulin resistant PCOS
Insulin stimulates the ovaries to produce androgens instead of oestrogen which will block ovulation.
Insulin also reduces SHBG which binds testosterone. If your SHBG is too low, this results in too much “free testosterone”. This blocks ovulation and causes physical symptoms of hair loss, acne and hirsutism.
Insulin also increases luteinising hormone which will cause an increase in androgens, again blocking ovulation.
2. Inflammatory PCOS
Inflammation will cause oxidative damage to the follicles which results in the follicles not being healthy enough to release an egg (ie ovulate).
Inflammation also damages hormone receptors, thereby disrupting the proper messaging between the brain and the ovary.
Inflammation will also stimulate the release of androgens from the adrenal glands which can suppress ovulation.
3. Pill induced PCOS
If you have come off the pill and you have failed to establish a regular cycle within 4 months, and you had a regular cycle before you went on the pill, you may have pill induced PCOS.
Is there a link between MTHFR & PCOS?
Studies have shown an association between women with insulin resistant PCOS and homozygous MTHFR C677T.
MTHFR C677T is associated with high levels of homocysteine (>7umol/L) which contributes to insulin resistance
Treatment options
1. For insulin resistant PCOS
- A diet high in plant fibre, protein and good fats and low in sugar and refined carbohydrates is essential for stabilizing blood sugar and reducing insulin.
- Magnesium, zinc, chromium, inositol and berberine all help to sensitize insulin receptors which will help glucose go into the cell.
- The herbal combination of Glycyrrhiza glabra (liquorice) and Peonia lactiflora (peony) can be used to lower high luteinising hormone and androgens.
- Lower high homocysteine (< 7umol/L) with Activated B vitamins and methylfolate.
2. For inflammatory PCOS
- Reduce intake of inflammatory foods including alcohol, gluten, sugar and trans fats. Increase intake of anti-inflammatory foods including fresh fruit and vegetables, legumes, nuts & seeds, oily fish and water.
- Treating any gut issues (eg yeast, bacteria or parasite) is important to reduce overall inflammation.
- Supporting the beneficial gut microbiome with plant foods and prebiotic fibre is important as these good bacteria regulate the inflammatory processes in the gut.
- N-Acetyl-Cysteine is a key supplement for reducing inflammation as it supports the production of glutathione which is essential for stopping the oxidative damage to tissues that occurs due to inflammation.
3. For Pill induced PCOS
- If you have high luteinising hormone due to the pill, taking the herbal combination of Glycyrrhiza glabra (liquorice) and Peonia lactiflora (peony) can lower high luteinising hormone levels.
- Supplementing with zinc is also important as zinc is essential to form the communication between the brain and the ovary which is blocked when on the pill.
References
Nsrallah, AA, Abd-El Fatah, AH & Ahmed, HS, 2019, ‘Genetic polymorphism of methylenetetrahydrofolate reductase is associated with insulin resistance in Egyptian women with polycystic ovarian syndrome‘, The Journal of Gene Medicine, vol 21, no. 4. PMID: 30743312
