The most common cause of infertility in women is Polycystic Ovarian Syndrome (PCOS). PCOS affects one in five women in the U.S., however around 70% of them are not aware they have it. It can interfere with fertility by blocking regular monthly ovulation. Women with PCOS typically develop many small cysts on their ovaries – often between ten and one hundred small cysts. The cysts are believed to develop as a result of disturbed hormones and ovulation. These cysts however are not dangerous in that they do not require surgical removal and are not associated with an increased risk of ovarian cancer, unlike other types of cysts. 

The exact cause of PCOS is unknown, however it has two main hormonal underpinnings, the latter is especially under appreciated – high androgens (such as testosterone) and high insulin levels. It can be quite a complex topic because it is often hard to diagnose. Its symptoms are varied and present differently in different women, making a precise and uniform definition difficult. Some women with other symptoms of PCOS do not have polycystic ovaries, whereas some women with polycystic ovaries do not have symptoms of excess androgens such as increased hair growth where it does not belong. 

That said, nearly all women with PCOS share these symptoms:

  • Difficulty losing weight – This is likely due to the high insulin levels, which alert the body to store fat at all costs, as well increase hunger and carbohydrate cravings.
  • Rogue hairs – Too much circulating androgens in your bloodstream can stimulate hair follicles to thicken and grow leading to hair on the upper lip, chin, breasts, etc. This is present in around 80% of women with PCOS.
  • Inflammation – a chronic low-grade inflammation occurs with PCOS. 

PCOS is also linked to increased risk of heart disease, stroke, hormone-dependent cancer such as breast cancer, mood disturbances and abnormal liver enzymes. As mentioned previously, the diagnosis can be tricky, but in addition to a comprehensive history and physical exam, its important to have your androgen (testosterone), insulin and progesterone levels checked by your physician. Leptin is also an important hormone in relation to appetite and weight that can be checked.

Most conventional treatments offered for PCOS include birth control pills and metformin which can be useful in some instances for the condition however do not address the root cause which is insulin resistance and chronic inflammation. A more comprehensive approach is necessary to fully address this condition and some of the following recommendations are included in that.

  • Diet – eating a low-glycemic index, high-fiber diet is very important. Glycemic index (GI) is a measure of how much the carbohydrates in a food raise your blood sugar. A low GI is less than 55 (out of 100). Eating foods containing zinc is also important in sexual development, menstruation and ovulation. Avoid diary, eat more protein, omit sugar and avoid processed, inflammatory oils are other important recommendations.
  • Yoga – Yoga has been shown to be more effective than other forms of exercise to improve insulin resistance in PCOS.
  • Supplements – Chromium, Inositol, Vitamin D, Cinnamon, Saw palmetto have all been shown to improve insulin resistance in PCOS. 
  • Bio identical hormones – if you are taking testosterone replacement or DHEA as a supplement, you may develop cystic acne, head-hair loss, excessive sweating etc. as side effects if taking too high a dosage. Checking your androgen levels and working with your physician to reduce your dosage of testosterone or stopping DHEA will be an important aspect of reduce androgen levels.

More women need to be educated about this very common condition called Polycystic Ovarian Syndrome (PCOS)!

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