What is PCOS?

Polycystic Ovarian Syndrome (PCOS) currently affects 15% of women of reproductive age, making it the most prevalent endocrine disorder in this population, and the most common cause of infertility and anovulation (the absence of ovulation) (1).  The Fertilitae crew knows how daunting and hopeless a diagnosis of PCOS can make one feel, so we are going to break down the facts! 

What is PCOS? It is characterized by menstrual irregularities, hyperandrogenism (high levels of testosterone), and polycystic ovaries on ultrasound (1). 

How do you get a diagnosis of PCOS? A diagnosis of PCOS is based on a clinical presentation that is consistent with the Rotterdam criteria (1).  Based on the Rotterdam criteria, a diagnosis of PCOS requires 2 of the 3 following clinical signs and symptoms:

1. Oligo-ovulation, or anovulation 
2. Biochemical and/or clinical signs of hyperandrogenism (acne, thick coarse hair growth in a male-like pattern, increased levels of total Testosterone, etc.)
3. Polycystic ovaries (12 or more follicles in each ovary, 2-9mm in diameter

Other clinical features that are not considered in the diagnostic criteria includes but is not limited to; obesity, insulin resistance, type 2 diabetes mellitus, increased risk of cardiovascular disease (high blood pressure, high cholesterol and triglycerides), anxiety, and depression (1). 

Insulin resistance is when cells of fat, muscle, and liver do not respond well to insulin (whose job is to help lower blood glucose levels by shunting it into the cells) (1,2).  In response, the body increases production of insulin, and the blood glucose levels stay elevated.  Okay.... so what if there is more insulin?  High levels of insulin is problematic in the pathogenesis of PCOS because it is able to increase the production of androgens within the ovaries, which in turn impairs the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) impairing ovulation (1,2).  Thus a lack of ovulation + hyperandrogenism = PCOS.

Several studies have found profound benefits of supplementation with myo-inositol, n-acetyl-cysteine, zinc, and vitamin D and omega 3 in improving insulin resistance and metabolic imbalances, egg quality, and hyperandrogenism (2-6).  Wondering which one you should be taking? Download the Fertilitae App and get your personalized Fertility Wellness Plan. 

Article written by: Dr. Cassandra. Piaino, ND

References:  

1. ESHRE, The Rotterdam, ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and sterility. 2004 Jan 1;81(1):19-25.
2.  Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials. Gynecological 
3. Song Y, Wang H, Huang H, Zhu Z. Comparison of the efficacy between NAC and metformin in treating PCOS patients: a meta-analysis. Gynecological Endocrinology. 2020 Mar 3;36(3):204-10.
4. El Refaeey A, Selem A, Badawy A. Combined coenzyme Q10 and clomiphene citrate for ovulation induction in clomiphene-citrate-resistant polycystic ovary syndrome. Reproductive biomedicine online. 2014 Jul 1;29(1):119-24.
5. Nasiadek M, Stragierowicz J, Klimczak M, Kilanowicz A. The Role of Zinc in Selected Female Reproductive System Disorders. Nutrients. 2020 Aug;12(8):2464.
6. Pal L, Zhang H, Williams J, Santoro NF, Diamond MP, Schlaff WD, Coutifaris C, Carson SA, Steinkampf MP, Carr BR, McGovern PG. Vitamin D status relates to reproductive outcome in women with polycystic ovary syndrome: secondary analysis of a multicenter randomized controlled trial. The Journal of Clinical Endocrinology & Metabolism. 2016 Aug 1;101(8):3027-35.