Could you have PCOS?

Polycystic ovary syndrome affects up to 25 per cent of women of childbearing age and is much more than just a gynaecological condition – it can adversely affect your whole wellbeing says Professor Nadir Farid

Victoria Beckham and Jules Oliver have both talked about their struggles with polycystic ovary syndrome (PCOS) and they’re far from alone. It seems it’s on the increase; so much so that I’d say we’re in danger of seeing an epidemic. So what is PCOS, what does it mean for your health and what can you actually do about it if you suffer from the condition?

PCOS explained
When ovaries are described as polycystic, it means they contain many small cysts (about twice the number you’d expect to see) just below the surface of the ovaries. The cysts are egg-containing follicles that, because of hormonal abnormalities, haven’t developed properly. On a scan, the polycystic ovaries look a bit like a bunch of grapes. Some women have no symptoms apart from polycystic ovaries, but sometimes they have additional symptoms that include:

• Irregular or no periods
• Irregular ovulation, or no ovulation at all
• Reduced fertility – difficulty becoming pregnant, recurrent miscarriage
• Unwanted facial or body hair (hirsutism)
• Oily skin, acne
• Thinning hair or hair loss (alopecia)
• Being overweight, rapid weight gain, or difficulty losing weight
• Depression and mood changes.

Nowadays PCOS is seen as more than just a gynaecological condition, as the hormonal abnormalities affect nearly every system in the body, leading to a wide array of symptoms.

Who gets it?
PCOS is the most common hormonal disorder in women of childbearing age. Up to one in four women in industrialised countries has certain features of the condition and most of them don’t even know it. Symptoms of PCOS typically start in puberty and continue through adulthood, and can range from very mild to severe. Women with a family history of type 2 diabetes and a history of gestational diabetes are at higher risk of PCOS, as are women on anti-epileptic medication.

Pinpointing PCOS
Conventional diagnosis combines an ultrasound scan to check for polycystic ovaries and blood tests to monitor levels of luteinising hormone (raised in PCOS women) and progesterone (to determine whether you’re ovulating). But it’s not just the hormonal imbalances that we check for. We are now aware that PCOS patients can also suffer from:

• Unexplained fatigue
• Hypoglycaemia (low blood sugar) after meals
• Excess weight around the waist
• Sleep disorders such as sleep apnoea
• Inappropriate lactation
• Skin tags and darkened areas of skin in the neck folds and armpits, known as Acanthosis nigricans.

All of these are signs of insulin resistance (IR), which often goes hand in hand with PCOS. In IR, the body isn’t able to use the hormone insulin effectively, so blood sugar takes longer to normalise after eating. It’s now known that women with PCOS are five to 10 times more likely to have IR than non-PCOS women, because of the imbalance of male hormones, so sufferers should also have their blood sugar levels checked regularly.
Left unmanaged, IR can eventually lead to diabetes, raised cholesterol levels and heart disease. It’s also an important risk factor for obesity, depression and non-alcoholic fatty liver. Some doctors even suspect PCOS will turn out to be a risk factor for Alzheimer’s disease. This is why it’s a good thing that PCOS is no longer considered just a gynaecological issue – the implications beyond potential infertility (the main reason women seek treatment for it) are huge. If left untreated, symptoms such as irregular periods could progress into the ‘full house’ syndrome – lack of periods, infertility, heavy body-hair growth, obstinate body fat, cardiovascular disease and diabetes. We don’t yet know how often women who have just the cysts go on to develop a range of symptoms, nor how common it is for those with mild PCOS to progress to having the severe disease.

Your PCOS action plan
Conventional treatment options include the contraceptive Pill for regulating periods and improving acne and hirsutism, eflornithine cream for reducing facial hair growth, clomiphene citrate for restoring ovulation and fertility, and statins for improving blood fats. You may also be given insulin-sensitising medication such as metformin. However, I believe that as it’s a condition that potentially affects the whole body, PCOS responds best to a holistic approach that doesn’t have to involve drugs.
Firstly, I recommend that people with PCOS follow a low-glycaemic index (GI) eating plan. Studies suggest that a low-GI diet, focusing on carbohydrates that don’t overly raise blood sugar and insulin levels, may be the best choice. I also advocate exercise for weight loss and to improve the action of insulin, and stress reduction to help the adrenals and combat the overproduction of testosterone. Patients who’ve tried this approach have benefited in many ways, from improved PCOS symptoms (more regular cycles, reduced acne, less excess hair growth) and better weight control to better blood sugar balance and improved fertility.
Given the far-reaching consequences of PCOS and the fact that it affects up to 25 per cent of women of reproductive age, it’s important for them to know that with a few lifestyle changes, they can be firmly in control of their PCOS.

Super supplements
Chromium
Chromium deficiency can lead to insulin resistance, a key problem in PCOS. Chromium helps to encourage the formation of glucose tolerance factor (GTF), which is released by the liver to make insulin more efficient in the body. Chromium also helps to reduce hunger and control cravings.
Vitamin D
People with PCOS are often deficient in vitamin D. One study found that on supplementing with vitamin D, sufferers developed normal periods within two months and some even became pregnant. Low vitamin D has been linked to insulin resistance and obesity.
Calcium
Calcium appears to improve insulin sensitivity. In one study, people taking calcium supplements had reduced insulin levels and improved insulin sensitivity compared with those who didn’t take supplements. Recent studies also show that taking extra calcium helps with weight loss.
Cinnamon
A recent study at Columbia University showed that consuming cinnamon reduced insulin resistance in women with PCOS.
B Vitamins
These are vital for people with PCOS. Vitamin B2 helps to turn fat, sugar and protein into energy, while B3 is a component of glucose tolerance factor (GTF), which is released each time blood sugar goes up. Vitamin B5 helps to control fat metabolism and is therefore important for weight loss, while B6, together with B2 and B3, is vital for normal thyroid hormone production, and therefore essential for the metabolism.
Agnus castus
This herb helps to stimulate and normalise the function of the pituitary gland, which controls the release of LH (luteinising hormone), a hormone that’s raised in women with PCOS. A study found that when agnus castus was used for menstrual cycle abnormalities, acne was either eliminated or improved during treatment.

- For more, visit Professor Farid’s website www.diagnosemefirst.com. Visit Verity, the charity for women whose lives are affected by PCOS at www.verity-pcos.org.uk.

Expert: Professor Nadir Farid
Professor Nadir Farid is an endocrinologist whose special interests include polycystic ovary syndrome. He is also the co-author of The Low GI Guide to Managing PCOS (Hodder Mobius, £8.99).

Compiled by: Martha Roberts