PCOS:
Demystifying Polycystic Ovarian Syndrome

The topic of PCOS, an acronym for the common endocrine disorder Polycystic Ovarian Syndrome, is appearing more and more in the media.  Several social media influencers and blogs are solely dedicated to increasing awareness of the women’s health concern by sharing personal struggles with the disorder.  PCOS was even featured in an episode of the tear-jerker network series “This Is Us”. Although PCOS is common and certainly nothing new, it is a health concern that has been diminished and swept to the side for far too long.  Unfortunately, when any health issue turns into a hot topic, the wave of information also pulls clickbait and misrepresentations into the tide. Women are hungry for more information and this article aims to provide some basics on PCOS, help deepen an understanding of the broader health concerns associated with it, and demystify some common queries.

OVARIAN CYSTS AND PCOS:

The term PCOS is quite honestly a poorly chosen and confusing way of describing the condition.  The appearance of cysts on a woman’s ovaries does NOT automatically mean that she has PCOS. During ovulation, from time to time a follicle is not properly reabsorbed into the ovary after an egg is released.  As a result, the follicle becomes congested and inflamed and one or many cysts form. Chances are this phenomenon has happened during some of your cycles and you were blissfully unaware because most often ovarian cysts are non-symptomatic and resolve themselves in a few days.  The difference between having ovarian cysts and having PCOS is all about hormonal response.

PCOS IMPACT ON OVULATION AND MENSTRUATION:

More accurately, PCOS is a collection of hormonal imbalance that have a ripple effect on fertility, metabolism, and overall health.  One important hormonal distinction in PCOS is elevated androgens. The most well-known androgens are aldosterone and testosterone. Although these chemicals are commonly thought of as “male” hormones, they are vital and abundant in all healthy women.  Androgens are synthesized in the ovaries, fat cells, and adrenal glands and under typical conditions, they are mostly converted into estrogens. Androgens are necessary to usher in puberty, and with it come tell-tale physical markers such as acne and pubic hair growth.  During the ovulation cycle with PCOS, several follicles form but none are able to mature to ovulation. A hormonal cascade follows causing luteinizing hormone, estrogen, progesterone, follicle-stimulating hormone become unbalanced and normal function is stunted. Because ovulation is disrupted, the endometrial lining grows and sheds irregularly which can mean infrequent or heavy periods.  Read here for a refresher on ovulation and menstruation.

PCOS AND METABOLISM:

Another important hormonal marker associated with PCOS is insulin resistance. Insulin resistance describes the inability of cells to appropriately respond to insulin. As a result, blood glucose increases which prompts the pancreases to synthesize more insulin.  This forces more and more glucose to enter cells which makes overall blood glucose to drop which initials the cycle to begin again.  When this state becomes chronic, the pancreas becomes exhausted and can no longer make enough insulin which leads to diabetes. In order to support the energy demands associated with the glucose highs and lows, the body adapts by engaging the liver to convert glucose into fat.  As a result can contribute to unwanted weight gain and can be a risk factor to heart disease, hypertension, diabetes, and other metabolic issues.

PCOS STATS AND STIGMA, AND CHALLENGES:

Unfortunately, there are many cultural challenges when it comes to PCOS and its problematic name is only the beginning.  For starters, there seems to be a discrepancy with how many women are affected by PCOS. In the US the stats have been as low as 10 percent of post-pubescent women to as high as 25 percent or more.

Is it possible that this significant woman’s health issue was sidelined as a result of an emphasis on appearance?  Thanks again, medical patriarchy! For many years the medical field was at odds with what criteria should be used to diagnose PCOS.  For too long an emphasis was placed on superficial indications like acne, body hair, BMI, and hair loss. However, like many other conditions, there is a spectrum when it comes to symptoms where some people might not have any visible symptoms, while others might have an intense experience with symptoms, and many others fall somewhere in between.  This means that many women may have been unfairly dismissed while looking for help, while other women feel marginalized or ashamed by their symptoms which could prevent them from seeking care. The 2012 National Institute of Health’s PCOS Workshop came to a consensus to recommend blood-work and ultrasound to identify 2 out of three criteria in order to diagnose PCOS: ovulation dysfunction, elevated androgen levels, and polycystic ovaries.  Of course, then challenge persists if these diagnostics are not widely available or covered by insurance.

I think it’s important to remember that nothing exists in nature without some function.  For example, sickle-cell anemia is an evolutionary adaptation to protect against malaria.  In the same vein, PCOS could be seen through a lens of benefitting a population. PCOS can be traced back through our genetic history seemly for all time with benefits that include reduced risk in maternal mortality during pregnancy, increase strength, and improved energy.  Perhaps it is not the curse it’s been framed as all along.

We strive to pull PCOS out of the shadows and help women feel empowered.  We are working on creating a series with more information about exciting and accessible solutions for PCOS including Medical Nutrition Therapies and Lifestyle techniques.  Stay tuned for more!

 

RESOURCES:

https://www.nichd.nih.gov/newsroom/news/020218-PCOS

https://www.nature.com/articles/nrendo.2018.24

https://www.healio.com/endocrinology/reproduction-androgen-disorders/news/online/%7B5f4e58f1-80c8-456e-ae5c-720088df761f%7D/recent-updates-on-pcos-research

https://www.sciencedirect.com/topics/medicine-and-dentistry/polycystic-ovary-syndrome