The Many “Faces” of Polycystic Ovary Syndrome (PCOS)
Updated: Jul 15, 2020
In the past, medicine has painted a picture of the “classic” PCOS female. In this classic picture, they usually have a higher body mass index (or weight struggles), irregular ovulation and menstrual periods, and frequently experience acne and facial hair growth. What we have learned more recently, however, is that there are many “faces” of PCOS, and each individual’s expression of this hormonal syndrome may vary greatly.
The variation in phenotypes (physical presentations) of PCOS may be partly responsible for the fact that 50% of women will see at least three separate doctors before receiving a diagnosis, and nearly one-third of women will wait over two years to get a diagnosis. In addition, even after receiving a diagnosis, only 16% of PCOS patients are satisfied with the health information and education they receive.
This is why I am so passionate about sharing helpful, accurate information about PCOS and ultimately helping patients navigate this complex hormonal condition.
What is PCOS?
Targeting Treatment with Evidence-Based, Naturally Focused Solutions as the central features of menstrual irregularities, hyperandrogenism (high testosterone), and cystic ovaries.
In addition, some women may experience blood sugar irregularities, weight gain, and infertility. There are many contributory factors in PCOS, and each underlying cause seems to differ widely in those experiencing polycystic ovary syndrome. These causes may include insulin dysregulation, inflammation, endocrine-disrupting chemical exposures, dietary and lifestyle factors, genetics, and prenatal exposures.
Most important to recognize, however, is that each women's motivation for seeking treatment of their hormonal imbalances as this can be quite unique and personal to their experience of PCOS.
One woman may be experiencing primarily the effects of hyperandrogenism (high testosterone and other androgens) and may want to reduce their acne and facial hair growth,
Another may be concerned about their weight control and improving their metabolic health and blood sugar regulation,
While yet someone else may be most concerned with regulating their menstrual cycle and ultimately improving their fertility.
While all three of these examples ultimately have a PCOS diagnosis, their treatment plans would be rather different. It would be reasonable to offer birth control to a woman with PCOS experiencing acne, who also desires contraception (two birds with one stone), but it would not be a reasonable approach for someone wanting to improve their ovulation rates and fertility or for someone wanting to prevent cardiovascular and metabolic complications. This is why it’s so important to understand each person’s underlying hormonal picture and to effectively target a treatment plan at those underlying causes, thereby addressing the main treatment goals.
Finding Commonalities in PCOS
As mentioned above, what most women with PCOS do have in common are at least 2 of 3 key components:
Ovulatory dysfunction. This is usually an abnormally long menstrual cycle, where the time between each menstrual period is greater than 35 days. Some women with PCOS will not ovulate every month and will have nine or fewer menstrual periods per year.
Polycystic Ovaries. As the name implies, many women with PCOS will have evidence of multiple cysts on their ovaries, though having cysts is not a requirement for a diagnosis of PCOS.
Hyperandrogenism. This is having excessive amounts of circulating testosterone levels and other androgens in the body as supported by blood work or clinical signs such as moderate to severe acne, male pattern hair loss, or facial hair growth (hirsutism).
In addition to these basic criteria, many women with PCOS tend have higher blood sugar levels and more insulin resistance, though this is not always the case.
Hormone Imbalances Implicated in PCOS
The end result of the ovulatory irregularities and blood sugar abnormalities are:
Elevated estrogen levels relative to progesterone, as a result of anovulation (lack of ovulation)
Increased “Free” or bioavailable (active) testosterone
Elevated LH greater than FSH (LH:FSH > 3:1)
Increased insulin production
The Health Effects of These Hormone Imbalances:
Increased estrogen/progesterone ratio increases estrogen exposure to the uterus which may contribute to endometrial hyperplasia (uterine lining stimulation and growth) and even increase the risk of developing endometrial (uterine) cancer.
Increased testosterone can cause moderate to severe acne, male pattern hair growth (facial hair, chest and back hair), and male-pattern hair loss (cul-de-sac bald spot)
LH and FSH imbalances contribute to cystic ovaries and ovulation/menstrual irregularities impacting fertility.
Elevated insulin levels promote ovarian androgen (testosterone) secretion, reduces ovarian sensitivity to LH and FSH signals and interrupts proper ovulation, thus promoting estrogen and progesterone imbalance
Elevated blood sugar levels and insulin resistance can increase the risk of developing type 2 diabetes as well as heart disease.
Long story short, the hormone imbalances involved in PCOS are complex and intricate.
You can think of these hormones and their relationship to one another as a large spider web with thousands of weaves all intertwined and connected. If you pull or tug one spool of the web the rest of it moves with it, changing and distorting the entire hormonal picture.
It’s also important to understand the very real health consequences of delayed diagnosis and treatment of PCOS, and how early diagnosis, treatment, and adequate health information can improve the quality of life of those with PCOS.
Targeting Treatment with Evidence-Based, Naturally focused Solutions
The first step to identifying the “type” of PCOS you have is to have a complete assessment of the signs and symptoms you experience as well as supportive diagnostic blood work and testing. From there, an integrative treatment plan can be used to suit your individual needs and treatment goals.
There are numerous (quite literally too many to count) natural and integrative treatments for PCOS, but knowing which ones are best to use, when, and how can be a daunting process to sort out. This why I am passionate about supporting hormonal health and improving care for those with PCOS. Whether you want to improve your body composition and metabolic health, reduce your acne and facial hair, prevent uterine complications, or improve your chances of conception, there is an integrative treatment plan out there for you!
If you’d like to learn more about the hormone services I offer please visit my services page by clicking here, or book a discovery call to discuss how natural, integrative care can help support your hormonal health.
Dr. Randi Brown, ND
Gibson-Helm, M. E., Lucas, I. M., Boyle, J. A., & Teede, H. J. (2014). Women’s experiences of polycystic ovary syndrome diagnosis.Family practice,31(5), 545-549.
Gibson-Helm, M., Teede, H., Dunaif, A., & Dokras, A. (2017). Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome.The Journal of Clinical Endocrinology & Metabolism,102(2), 604-612.
Legro, R. S., Arslanian, S. A., Ehrmann, D. A., Hoeger, K. M., Murad, M. H., Pasquali, R., & Welt, C. K. (2013). Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.The Journal of Clinical Endocrinology & Metabolism,98(12), 4565-4592.
Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., ... & Norman, R. J. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome.Human reproduction,33(9), 1602-1618.