Dr. Nedic’s integrative approach to PCOS – Spring 2015 issue, A2…
Polycystic Ovarian Syndrome (PCOS )
Epidemic of the Modern World
PCOS is an endocrine and metabolic disorder, which in recent years has become an epidemic that affects one in 10 women at a childbearing age. Since this is a leading cause of infertility in the modern world, women suffering from it need to have a profound understanding in order to combat this disorder. Fifty percent of women suffering from PCOS are being misdiagnosed worldwide – despite the fact that according to American statistics, a massive 4.3 billion dollars is used yearly to diagnose and treat PCOS.
“PCOS is a complex hormonal disorder, affecting young women at a reproductive age. While obesity, hypertension and insulin resistance are a few of the symptoms of PCOS, it is also the leading cause of infertility… and has now become an epidemic.” Dr Sly Nedic elaborates Criteria for PCOS
- Irregular/absence of menstrual cycle
- The production of excess androgen (male hormones)
- Lack of other reasons for irregular or absence of menstrual cycles and excess androgens (male hormones)
A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the body manufactures more androgens (testosterone, DHEA, Androstendion) than normal. Androgens are male hormones which females also produce. High levels of these hormones affect the development and the release of eggs during ovulation. Increased levels of androgens in a woman’s body are responsible for the majority of symptoms, however many symptoms are coming from an underlying insulin resistance (this seems to be detrimental for modern PCOS epidemics). One will notice that this syndrome is called Polycystic Ovarian Syndrome because it is not necessary to have identified cysts in the ovaries in order to diagnose this disease. In fact they are often absent during an ultrasound diagnosis.
Symptoms and signs
- Irregular or absent menstrual cycles
- Infertility or recurrent miscarriage
- Hirsutism (excessive facial hair and body hair)
- Oily skin/acne
- Obesity /abdominal fat
- Male pattern baldness
- Insulin resistance
- Depression and / or anxiety
- Sleep apnea
All of the above affect young women who are at a reproductive age. Statistics show that 50% of these women, if left untreated, can develop diabetes type 2 by the age of 40. Meanwhile, their chances of suffering from a cardio metabolic syndrome, heart attack or cerebrovascular insult is 5-7 times higher, while the risk of contracting endometrial cancer is also increased by three fold.
PCOS Epidemic – what is the reason for it and what went wrong?
Twenty to thirty years ago PCOS was a sporadic disorder, mostly present in women with a strong family history of PCOS. Nowadays it often gets diagnosed in females as early as 11 years old (in the onset of puberty). Recent supportive literature explains that PCOS is a hormonal disorder which can be initiated by a stress related cortisol imbalance and insulin resistance. The reasons for developing insulin resistance can be either from genetic predisposition, environmental toxicity, a high carbohydrate diet – or even a cortisol-insulin miss-match. Hormonal imbalances become complicated as a result of an increase in testosterone production and a decrease in progesterone. Whenever there is case of insulin resistance in an individual, there are underlying inflammation and lipid problems present due to the nature of this syndrome. Insulin resistance is an epidemic in itself and is hugely involved in causing a PCOS epidemic. Sporadic cases of PCOS that materialized 20, 30, or even 40 years ago are replaced with modern epidemics of PCOS due to life style changes. Scientific proof also shows that there is a gene (called folistatin) that triggers higher than normal levels of androgen or insulin. Women who have first degree relatives that are suffering from PCOS, in turn, have a higher risk of developing it themselves. Here is a take home message for all women who are PCOS sufferers (simplified):
One will notice that this syndrome is called Polycystic Ovarian Syndrome because it is not necessary to have identified cysts in the ovaries in order to diagnose. In fact they are often absent during an ultrasound diagnosis.
Firstly, it’s vital to take control over 3 things:
- Sugar Overload
- Environmental Toxicity (non-organic food, pesticide, herbicide etc.)
Women who are at a reproductive age usually find out about PCOS when they hit an infertility problem. Some may have irregular cycles and are able to address this problem earlier, however the majority of women have a wide spectrum of symptoms, so they only receive treatment for isolated signs. For instance, I often have women in their 30’s wanting to treat their belly fat with aesthetic procedures (high waist to hip ratio – typical for insulin resistance) and finding they have either been prescribed glucophage (a glucose lowering drug), lipid lowering drugs or the contraceptive pill by their GP, psychiatrist or gynecologist. While all these chronic medications have its place in treating the above symptoms, none of them addresses the root of the problem – which is crucial for combating PCOS.
Diagnosis and Treatment
Your doctor will prescribe numerous tests to ascertain PCOS – and although PCOS cases with underlying genetic predispositions are difficult to improve, many cases of this modern epidemic needs an integrative holistic medical approach in order to combat the effect of a hormonal imbalance. It is necessary to help patients understand that a conventional approach to PCOS may no longer deliver adequate results. Patients suffering from PCOS needs to take active participation in changing their life style habits, predominantly carbohydrate overload, toxic food and other environmental toxicity, stress levels, lack of exercise etc. I found this very challenging in my practice due to the stressful life style in Johannesburg. Majority of patients are resistant to life style interventions, or they seem to view it as something temporary. In addition, integrative medical practitioners will prescribe numerous supplements that modifies insulin resistance on a receptor level, improves the function of adrenal glands, modifies androgen receptors, combat the stress effects, add supplements to enhance their liver detoxification and gut function while treating inflammation. All these interventions need to start early in the process of developing PCOS in order to deliver a successful outcome, but patients compliance to life style changes remains crucial.