A diagnosis of PCOS can leave you feeling overwhelmed

If you’ve just been given a diagnosis of Polycystic Ovary Syndrome (PCOS), or suspect you may have it, it is likely you are feeling overwhelmed, confused and apprehensive about what this means for your health and fertility. 

After all, with every new doctor’s appointment or conflicting online article, you get a little more confused, overwhelmed, and unsure of which advice is “right” for you.

Sometimes, being given a diagnosis can feel relieving.

You finally having a name for the pesky symptoms you have been dealing with for a long time. However, this can quickly be overrun by stress + feeling of overwhelm as you navigate this new diagnosis and try to figure out what is best for you.  

PCOS is responsive to simple diet and lifestyle tweaks. 

Although I do recommend you seek professional guidance on your path to healing, I want you to know there is support and guidance available to you. With the right advice + support for YOUR body, you can take back control of your hormonal health. 

Let’s Dive In…. 

What is PCOS and How Do You Know if You Have It?

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by hyperandrogenism and chronic an/oligoovulation (inconsistent or complete failure to release a dominant follicle from the ovaries).  Depending on what diagnostic criteria is used, 6% to 20% of reproductive aged women are affected by PCOS.  That is up to 1 in 5 women.  PCOS is a female syndrome of complex + interwoven pathophysiologies that disrupt the meticulously synchronized and tightly regulated hypothalamic–pituitary–ovarian (HPO) axis.  The HPO axis is responsible for reproduction on an individual level and for reproductive competence and ultimate survival of our species on a population level.  The HPO axis can be impacted in many different ways including both internal information (hormonal + neuronal) + external factors (environmental influences).

 Deep Dive into External Environmental PCOS Players: Epigenetic Mini-Lesson

Research over the past few decades suggests that internal and external factors during the preconception and gestational time period have an impact on the health of future generations.  We call this epigenetic; external and internal factors that modify gene expression (whether a gene is turned on or off) rather than altering the genetic code itself.  These modifications in gene expression are inheritable.  For example, if a woman had external influences, such as phthalate exposure, which modified the expression of a gene associated with increased risk of PCOS, that gene modification would be passed down to her offspring.  This may sound scary, but with proper education and awareness, this can also be an amazingly powerful tool to create health for future generations.

Why is this important?

First: I want to dispel the myth that your eggs are your eggs + there is nothing you can do to affect the long term health of your children, because that just is NOT true.  Your health today determines your children’s, your grandchildren’s, and your great grandchildren's health years in the future.

Second: Understanding what epigenetic is + how powerful external (environment, lifestyle, diet, etc.) factors can be on the expression of genetics that determine health is empowering + the educational foundation needed to truly understand why + how holistic, natural modalities (lifestyle and diet) work so incredibly well when addressing chronic health conditions, including PCOS.

Let’s Get Back to PCOS…

As I mentioned earlier, PCOS is a disorder primarily characterized by signs and symptoms of androgen excess and ovulatory dysfunction that ultimately disrupts HPO axis function. The persistent hyperandrogenism is associated with impaired hypothalamic–pituitary feedback, LH hypersecretion, premature granulosa cell luteinization, aberrant oocyte maturation, and premature arrest of activated primary follicles [1]. Typical clinical features beyond anovulation and infertility include hirsutism, acne, insulin resistance, androgenic alopecia, fatigue, depression, weight gain, irregular menses, and polycystic ovaries. The symptoms listed are by no means an exhaustive list, but are some of the most common.

How is PCOS Diagnosed?

Historically, there has been several PCOS diagnostic criteria used by health professionals. However, the most common criteria used today is the Rotterdam criteria. 

Based on the Rotterdam criteria, to be diagnosed with PCOS you must meet at least two of the following three criteria (with other causes ruled out):

1. Oligo-ovulation or anovulation

2. Clinical and/or biochemical hyperandrogenism

3. Polycystic ovaries on ultrasound

Let’s Break it Down

Oligo-Ovulation Or Anovulation

Oligo-ovulation means irregular +/or inconsistent ovulation, + therefore periods. This is most commonly seen as long cycles. Long cycles are > 35 days, but can even be up to 90-120 days between the start of one period bleed and the next. 

Anovulation means not ovulating at all, + therefore no period bleeds. Oligo-ovulation or anovulation are common + arguably the most common feature of PCOS. This is due to the effects that excess androgens have on the ovaries - follicles (immature eggs) become halted or stalled in their developmental process. 

Usually, this means your body gives its’ best attempt to ovulate (often many times in 1 ‘cycle’), + either achieves ovulation (followed by a period bleed ~2 weeks later), or fails to ovulation (no period). 

Clinical And/Or Biochemical Hyperandrogenism

Hyperandrogenism refers to an overproduction of androgens like testosterone and DHEAS. Clinical hyperandrogenism refers to physical signs that your body is making too many androgens. Acne (especially on your chin), alopecia on your head and/or hirsutism of the face and body are the most common clinical presentations of hyperandrogenism.

You can also meet this criteria for diagnosis through documentation of elevated serum androgen concentrations (including testosterone, DHEAS and androstenedione) on blood tests, also known as biochemical hyperandrogenism.  One caveat is the importance of measuring androgens using high-quality assays such as liquid chromatography–tandem mass (LC-TM) spectrometry or extraction immunoassays . Testosterone levels are confounded by several problems, including assay sensitivities that are inadequate to accurately measure low concentrations, sparsity in evidence-based normal ranges, and assay interference due to other steroid molecules and/or SHBG.. In view of these constraints, it is important to recognize clinical hyperandrogenism as equivalent to biochemical hyperandrogenism when making a PCOS diagnosis.

Polycystic Ovaries On Ultrasound

The final criteria for diagnosis of PCOS is polycystic ovaries on ultrasound. This refers to the appearance of multiple follicles that are semi-developed. You may hear it referred to as a ‘string of pearls’. This is due the large number of small follicles side by side on the ovaries.

Having growing follicles is normal + in a healthy cycle, we have up to 12 developing follicles at one time; racing to ovulation. One dominant follicle is released; the others stop growing and are reabsorbed. 

In PCOS, excessive ovarian and/or adrenal androgen secretion make it difficult to make it to this final stage of ovulation (hence why missing periods or very long cycles are a common feature of PCOS). If ovulation doesn’t occur, there is no dominant follicle and all follicles keep growing a small amount, producing many underdeveloped follicles which can be seen on ultrasound. 

Signs + Symptoms of PCOS

The overarching reason for all of PCOS symptoms is excess androgens.  There are different root causes that driving this excess in androgens and we will discuss those in the next blog post “PCOS Phenotypes”.  However, for now it is important to understand that all these seemingly unrelated symptoms of PCOS really are driven by the same thing…ANDROGENS!

A Bit More Detail - PCOS Symptoms

Missed or Irregular Periods

In the ovary, high circulating levels of LH, increased responsiveness to LH, + hyperinsulinemia contribute to premature arrest of antral follicle development + inhibits progression to ovulation. 

No Ovulation = No Period

Weight Gain

Insulin resistance is the biggest contributor when it comes to weight gain in women with PCOS. Other contributing factors may include suboptimal mental health + under active thyroid.

Mental Health Issues

PCOS is associated with an increased risk of depression, anxiety, bipolar, and obsessive compulsive disorder. 

Hair loss + Hirsutism 

Excess androgens in women with PCOS can cause thinning hair on the head ,aka androgenic alopecia, + atypical hair growth on the chin, chest, + back.

Excessive Fatigue

There are many contributing factors to fatigue in women with PCOS including hormone imbalances, nutrient deficiencies, under active thyroid, anemia, sleep apnea, + mental health

Acne

There are many contributing factors to acne in women with PCOS including excess androgens, hyperinsulinemia, gut dysbiosis, under active thyroid + inflammation.

if left untreated, PCOS can increase your lifelong disease risk

Beyond acute symptoms, PCOS can increase your lifelong disease risk of conditions like heart disease, diabetes, endometrial cancer and non-alcoholic fatty liver disease. Pregnancy complications are also increased in PCOS due to higher incidences of gestational diabetes, pre-eclampsia, hypertension and caesarean delivery. 

Luckily, there are so many natural solutions to managing your PCOS and reducing symptoms.

If you are looking for support or guidance…

Fully healing from PCOS requires a whole-body approach + Vibrant Revival is here to help!

Vibrant Fertility Revival 12-Week Program

Enrolling Spring 2022!

Sign up here + Dr. Jordan Dawson will personally reach out to you before enrollment goes live!

Spots are limited! Don’t miss out!

This is an incredible opportunity to come together with women, just like you, for this 12 week program that will revive your fertility + create vibrant health for you + your baby— now and forever.

My Promise to You 

I will listen to your goals, concerns, and fears — then address them fully in a kind + compassionate way.

I believe in the body’s intrinsic ability to heal and will explores natural modalities to support your hormone, fertility, and overall health.

I will make sense of modern medicine and holistic wellness, and their place in your health journey.  

I will collaborate with you to achieve and maintain your highest health potential.

Vibrant Fertility Revival 12-Week Program

Enrolling Spring 2022!

Sign up here + Dr. Jordan Dawson will personally reach out to you before enrollment goes live!

Spots are limited! Don’t miss out!

This is an incredible opportunity to come together with women, just like you, for this 12 week program that will revive your fertility + create vibrant health for you + your baby— now and forever.