Is It Really PCOS? | with Dr Hazel Batten

[Image credit: May May Images]

Polycystic ovarian syndrome (PCOS) is a condition characterised by androgen excess, which can be detected through blood tests or clinically diagnosed by observing symptoms such as jawline acne or excessive hair growth.

Polycystic ovarian syndrome (PCOS) is a condition characterised by androgen excess, which can be detected through blood tests or clinically diagnosed by observing symptoms such as jawline acne or excessive hair growth.

It's important to note that PCOS cannot be accurately diagnosed or excluded based solely on pelvic ultrasound findings or irregular periods. A normal ovary contains fluid-filled sacs called follicles, and the number and size of these follicles can vary significantly over a few months depending on ovulation. If ovulation does not occur or has been absent for some time, the number and size of these immature follicles can increase. Once ovulation takes place, the ovaries may appear normal again. One study found that women with normal hormone levels had PCOS-like ultrasound findings 30% of the time, and younger women tend to have more follicles than older women.

Consequently, it is possible to receive a PCOS diagnosis when the underlying issue is simply a lack of ovulation. This can be particularly concerning for women who have lost their periods due to hypothalamic amenorrhea and relative energy deficiency syndrome (RED-S), conditions related to under-fuelling. Treatment approaches for PCOS often involve exercise and carbohydrate restriction, which can exacerbate these conditions.

Different Types Of PCOS

To effectively manage PCOS, it is crucial to identify the underlying causes contributing to the condition. PCOS encompasses a group of disorders with distinct biological drivers. There are four main types of PCOS:

1. Insulin-Resistant PCOS

This type is associated with insulin resistance, a condition where the body's cells become less responsive to the effects of insulin. Insulin resistance can lead to elevated insulin levels, which in turn can stimulate androgen production.

2. Post-Pill PCOS

This type occurs when high androgens are present after discontinuing certain types of oral contraceptive pills (OCPs), especially those containing eostrogen and/or drospirenone or cyproterone (e.g., Yas, Yasmin, or Slinda). These OCPs have a low androgen index, suppressing androgen and sebum production while taken. However, when stopped, the body compensates by up-regulating androgen production, resulting in higher levels than before. Post-pill PCOS typically manifests about three months after stopping the pill and can cause insulin resistance, weight gain around the abdomen, hair loss, acne, and irregular periods.

3. Inflammatory PCOS

In this type, chronic low-grade inflammation in the body contributes to the development and persistence of PCOS symptoms.

4. Adrenal PCOS

This type is characterised by elevated androgen production from the adrenal glands, which can lead to an imbalance of hormones.

Understanding Post-Pill PCOS

Now that we have more of an understanding of what the different types of PCOS are, we'll explore Post-Pill PCOS in more detail. Post-pill PCOS specifically refers to the development of PCOS symptoms after discontinuing certain oral contraceptive pills. These symptoms arise due to the rebound effect of androgen upregulation. While taking the pill, androgen and sebum production are suppressed, leading to reduced acne and weight loss. However, upon cessation of the pill, androgen levels increase, causing insulin resistance, weight gain, hair loss, acne, and irregular periods.

Treating Post-Pill PCOS Naturally

When it comes to addressing post-pill PCOS, it is crucial to focus on supporting the withdrawal process and addressing the underlying causes. Initiating androgen-suppressing medications like spironolactone may provide temporary relief, but they do not address the root problem. Natural treatments can aid in this process, and their effectiveness is enhanced when started before discontinuing the OCP. These treatments should be continued for at least six months. I follow the advice of Lara Briden, an incredibly knowledgeable naturopath, who recommends the following treatments:

• Zinc: Taking 30-50mg of zinc daily after food can help regulate androgen activity by reducing the conversion of testosterone to dihydrotestosterone (DHT), the active form of testosterone. Zinc also possesses antimicrobial properties.
• Avoiding dairy and sugar: These dietary changes can lower insulin-like growth factor 1 (IGF-1), potentially preventing post-pill acne.
• Berberine: This compound, which is known for its antimicrobial properties, can lower IGF-1 levels, improve acne, reverse insulin resistance, and lower androgen levels.
• DIM 100mg daily: Derived from vegetables such as broccoli, DIM is a phytonutrient that can block androgen receptors and improve post-pill acne.
• Myo-Inositol: Taking 2-6g of myo-inositol daily can help regulate androgen levels by improving insulin sensitivity and enhancing the follicle-stimulating hormone (FSH) signal inside the ovarian follicle, promoting ovulation. Restoring regular ovulation is crucial as it allows the body to produce its own anti-androgen hormones, such as eostrogen and progesterone.
• Oral Micronised Progesterone: Taking 200mg of oral micronised progesterone (Prometrium) for 2 weeks on and 2 weeks off for 3-6 cycles can help reduce androgen levels by lowering luteinising hormone (LH) and DHT. Progesterone can improve androgen-related symptoms like acne, hair loss, and weight gain while promoting regular ovulation, allowing the gradual discontinuation of external hormone supplementation.

Managing post-pill androgen symptoms can be challenging, but with time, most women experience improvement within a year as the withdrawal process subsides. Patience and persistence are key.

In conclusion, PCOS is a complex condition with various underlying causes. By understanding the different types of PCOS and addressing the specific drivers, such as post-pill PCOS, through natural treatments, it is possible to manage and alleviate symptoms effectively. Remember, be patient with the process and consult with a healthcare professional to determine the most suitable approach for your individual situation.

Dr Hazel Batten can work with you and help you to treat PCOS naturally.

Dr Hazel Batten is an Integrative Doctor with over a decade of clinical experience and a keen interest in all aspects of women's health.