What is Polycystic Ovary Syndrome (PCOS)?
Polycystic Ovary Syndrome (PCOS) is a common heterogeneous endocrine disorder affected by irregular menstrual periods, hyperandrogenism and polycystic ovaries. The prevalence of PCOS changes according to the criteria used to make the diagnosis. According to the diagnostic criteria of the National Institutes of Health (ie, hyperandrogenism plus ovulatory dysfunction), "classic" Polycystic Ovary Syndrome (PCOS) affects approximately 6-10% of women of reproductive age, but the prevalence may be twice as large according to the Rotterdam criteria. Polycystic ovary syndrome is the most common cause of female infertility.
Diagnostic criteria for Polycystic Ovary Syndrome (PCOS)
The three basic criteria are: hyperandrogenism, oligo-ovulation or anovulation and polycystic ovarian morphological characteristics.
Many aspects of PCOS are still being discussed, for example, what criteria can be adopted to make a diagnosis during adolescence? During adolescence, up to 85% of menstrual cycles are anovulatory during the first years after menarche (the first menstruation) and up to 59% are anovulatory up to three years after menarche. In addition, only 40% of adolescents with irregular cycles showed polycystic ovary on ultrasound. It is for this reason that it was suggested that the three affected criteria had to be present to diagnose PCOS in adolescents and that the irregularity in menstrual cycles, should persist for at least 2 years after menarche.
What symptoms does PCOS have?
The clinical manifestations of PCOS include oligomenorrhea or amenorrhea, hirsutism and, often, infertility.
Irregular menstrual cycles
A woman with PCOS may show symptoms of amenorrhea (total absence of menstruation), oligomenorrhea (long cycles greater than 35 days), polymenorrhea (short cycles, less than 24 days) or hypermenorrhea (abundant period), due to hormonal imbalance.
More than 80% of women with symptoms of androgen excess suffer from PCOS. Hirsutism is a common clinical presentation of hyperandrogenism, which occurs in up to 70% of women with PCOS. Hirsutism is evaluated using the Ferriman-Gallwey scoring system.
This tool is used to assess hair growth at seven sites: upper lip, chin / face, chest, back, abdomen, arms and thighs. A score of 0 is given in the absence of terminal hair growth and a score of 4 is given for extensive growth. A total score of 8 or more is indicative of hirsutism. More than 90% of women who usually menstruate with hirsutism are identified through ultrasound with polycystic ovaries. In addition, PCOS also occurs in 50% of women with a less severe distribution of unwanted hair growth.
Acne may also be a marker of hyperandrogenism, but it is less frequent in PCOS and, less specific than hirsutism. Approximately 15% to 30% of adult women with PCOS have acne. The difference in the prevalence of hirsutism and acne can be attributed to the difference in the expression of 5α-reductase in the sebaceous gland and the hair follicle, and the result is a higher level of dihydrotestosterone in the hair follicle. Some experts recommend that women with acne should be asked about their menstrual history and evaluated to see if the show other signs of hyperandrogenism.
Infertility affects approximately 40% of women with PCOS. It is the most common cause of anovulatory infertility, around 90%. In fertility clinics 95% of anovulatory women that show up are diagnosed with PCOS. Women with PCOS have a normal number of essential follicles and the primary and secondary follicles are greatly increased. However, due to disorders in the factors involved in normal follicular development, follicular growth stops when the follicles reach a diameter of 4-8 mm. As a dominant follicle does not develop, ovulation does not occur. In addition, spontaneous abortion occurs more frequently in women with PCOS.
Physiopathology of PCOS. Why does it manifest?
Many hypotheses have emerged overtime trying to explain the pathophysiology of PCOS. Initially, it was thought that the main blameworthy developing the syndrome it was the excess of intrauterine hydrogen. However, recently, the studies made on humans did not show an association between excessive prenatal androgen exposure and the development of PCOS in youth.
Another hypothesis is the expandability of adipose tissue, that suggested that babies with intrauterine growth restriction (RCIU) and spontaneous recovery growth could develop a decreased tissue expansion capacity, which means that they cannot store lipids properly in their fatty tissues. Consequently, insulin resistance could continue to contribute to the development of PCOS and hyperandrogenemia.
Although science has provided an idea of the origins of PCOS, it is still not understood. Nowadays we still do not know for sure the origin of this pathology.
There is a genetic component for a woman to develop high androgens and PCOS. However, these genes can be activated and deactivated by environmental factors. It is what we know as epigenetics. Women with PCOS genes become more susceptible to developing the condition when adequate environmental factors are present. Therefore, if we eliminate these environmental factors, meaning we treat the root cause of PCOS, then the symptoms could be reversed.
PCOS as a multifaceted pathology
PCOS is treated as a multifaceted pathology that involves uncontrolled ovarian steroidogenesis, aberrant insulin signalling, excessive oxidative stress and genetic/environmental factors.
The lifestyle of a woman with PCOS plays a fundamental role in minimizing the possible associated symptoms.
Women with PCOS, show a decrease in insulin sensitivity, attributable to a defect in the post-receptor binding in insulin signalling pathways. This has been identified as an intrinsic component of PCOS, regardless of obesity.
Studies have shown that up to 70% of women with PCOS have insulin resistance. If these studies are 100% correct and women with Polycystic Ovarian Syndrome have insulin resistance or sensitivity, could we reverse this factor?
The great answer is: Yes! Making lifestyle changes that help regulate blood insulin levels through food, supplementation and sports.
Improving PCOS through diet
How many times have you heard the phrase "we are what we eat"? If it was always in our hands to choose the best quality food, completely eliminating processed food, many modern pathologies would resolve themselves. PCOS is one of them.
Living with PCOS or Polycystic Ovarian Syndrome can be one of the most difficult things you have to face in your life, especially when you are lost and do not understand anything. As recent studies and several experiences of women with PCOS have shown, proper nutrition and regular physical activity are the two main ways to achieve symptomatic remission.
Polycystic Ovarian Syndrome can be improved and even reversed by ending all those triggers of the hormonal storm that characterizes it.
How do we achieve this goal? The food diet is conscious and educational, select the most natural foods, closest to the origin. This is the first step to restore hormonal balance, the first step that every woman with PCOS should take.
The reason why food is so important is very simple, it has a great influence on our body. The lifestyle, the food we eat, set in motion our genes and who we are. Through food, we control our appearance, our behaviour and our health.
The only foods that help us promote proper hormonal functioning are those for which our genes were built.
Broadly speaking, starting with a lifestyle that helps reverse PCOS symptoms means eating vegetables, fruits, meats, fish, fats (the good ones), nuts and seeds. It involves eliminating cereals (bread, pasta, rice, etc.), dairy products, certain vegetable oils, sugar and, in general, ultra-processed products.
Learn to choose foods that will help you reverse the symptoms that PCOS brings.Do you have doubts? Leave us a comment and we will help you solve them. Do not forget to follow us on social networks such as Facebook and Instagram or join our private Facebook group "Female Health and Wellness by Aura".