With infertility on the rise, so is PCOS or polycystic ovarian syndrome. As the name implies, it is a syndrome rather than a condition with one definitive cause. However, insulin resistance is intricately linked to PCOS as well as metabolic syndrome. Let’s focus on PCOS as it is directly linked to fertility issues. Keep an eye out for the next blog which will shed light on endometriosis.
Polycystic ovary syndrome (PCOS) is characterised by excessive levels of androgens, insulin resistance and ovulatory dysfunction and is a common endocrine disorder in women of reproductive age. Depending on diagnostic criteria, 6% to 20% of reproductive aged women are affected.
PCOS arises as a result of polygenic susceptibility in combination with environmental influences that might include epigenetic alterations and in utero programming. Symptoms usually commence presentation during the early pubertal years.
Its pathophysiology is characterised variably by high levels of androgens, insulin resistance, and ovulatory dysfunction. Allopathic and naturopathic communities have adopted their own classifications for the variations in PCOS presentations. PCOS is heterogeneous condition and patients will present differently; it is predominantly characterised by:
Hyperandrogenism – Elevated total or free testosterone or free androgen index (FAI)
Oligomenorrhoea or amenorrhoea – Cycles >35 days apart or <8 menses per year
Polycystic morphology (confirmed via transvaginal ultrasonography)
≥20 follicles per ovary (in either ovary) ≥10cm3 ovarian volume
Excessive Gonadotropin-Releasing Hormone (GnRH) pulsatility increases Luteinizing hormone (LH) secretion, this drives ovarian androgen production and disrupts folliculogenesis. Insulin acts as a co-gonadotropin, further stimulating androgen synthesis, while ovarian thecal cell hypersensitivity amplifies LH effects. Adrenal and adipocyte-derived androgens also contribute to systemic androgen excess.
Excess androgens promote abdominal fat deposition, which increases insulin resistance and hyperinsulinism. Elevated insulin further stimulates androgen production in the ovary, lowers sex hormone binding globulin (SHBG) levels, disrupts GnRH regulation and ovulation, which perpetuates a cycle of worsening androgen excess. This process also deprives the body of progesterone’s beneficial anti-androgen effects.
Polycystic ovary syndrome (PCOS) is characterised by excessive levels of androgens, insulin resistance and ovulatory dysfunction and is a common endocrine disorder in women of reproductive age. Depending on diagnostic criteria, 6% to 20% of reproductive aged women are affected.
PCOS arises as a result of polygenic susceptibility in combination with environmental influences that might include epigenetic alterations and in utero programming. Symptoms usually commence presentation during the early pubertal years.
Its pathophysiology is characterised variably by high levels of androgens, insulin resistance, and ovulatory dysfunction. Allopathic and naturopathic communities have adopted their own classifications for the variations in PCOS presentations. PCOS is heterogeneous condition and patients will present differently; it is predominantly characterised by:
Hyperandrogenism – Elevated total or free testosterone or free androgen index (FAI)
Oligomenorrhoea or amenorrhoea – Cycles >35 days apart or <8 menses per year
Polycystic morphology (confirmed via transvaginal ultrasonography)
≥20 follicles per ovary (in either ovary) ≥10cm3 ovarian volume
Excessive Gonadotropin-Releasing Hormone (GnRH) pulsatility increases Luteinizing hormone (LH) secretion, this drives ovarian androgen production and disrupts folliculogenesis. Insulin acts as a co-gonadotropin, further stimulating androgen synthesis, while ovarian thecal cell hypersensitivity amplifies LH effects. Adrenal and adipocyte-derived androgens also contribute to systemic androgen excess.
Excess androgens promote abdominal fat deposition, which increases insulin resistance and hyperinsulinism. Elevated insulin further stimulates androgen production in the ovary, lowers sex hormone binding globulin (SHBG) levels, disrupts GnRH regulation and ovulation, which perpetuates a cycle of worsening androgen excess. This process also deprives the body of progesterone’s beneficial anti-androgen effects.
Naturopathically, patients typically fall into 4 phenotypes and once their individual drivers have been identified, treatment can be targeted more specifically:
Insulin resistant PCOS – high androgens with insulin resistance Inflammatory PCOS – High androgens + symptoms of inflammation (no insulin resistance and no recent cessation of hormonal contraception) Post Pill PCOS – High androgens + symptoms start after cessation of hormonal contraception (no insulin resistance) Adrenal PCOS – High DHEAS (no insulin resistance or inflammation)
PCOS has been long recognised as a reproductive disorder, however it is now also established as a metabolic condition associated with long term health risks including:
Infertility Metabolic syndrome Obesity Impaired glucose tolerance Type 2 diabetes mellitus Increased cardiovascular risk Mental health – depression, anxiety, disordered eating Obstructive sleep apnea Endometrial hyperplasia and cancer Metabolic dysfunction-associated fatty liver disease Hypothyroidism
If you have been diagnosed with PCOS there is a lot you can do to manage and treat this syndrome. Your natural medicine professional is trained to support your body in a holistic manner, supporting your individual needs.
Support the production of SHBG as it binds to testosterone, this can be done by reversing insulin resistance The cornerstone of improving blood glucose regulation and insulin sensitivity is diet and exercise Prioritise protein with each meal Increase vegetables and fibre intake Put some clothes on your carbs! Complex carbohydrates always alongside protein or good fats ACV or bitters before meals A quick walk or 10 squats after each meal to blunt glucose spike Daily 30-minute walk Ability appropriate strength training Reduce exposure to endocrine disrupting chemicals (see my book for more information).
PCOS can be successfully managed with the assistance and guidance of a qualified naturopath. For more information in relation to environmental toxins, get a copy of my book (available on Amazon) and follow the above instructions.
