What is PCOS?
PCOS stands for poly-cystic ovarian syndrome:
Poly = many
Cystic = fluid-filled sack
Ovarian = in the ovaries
Syndrome = a collection of symptoms
Essentially, theunderlying reason for why the ovary is producing excessive numbers of cysts isdue to an excessive production of two key hormones: androgens and insulin.Androgens are male sex hormones that are produced in only small amounts inwomen.
What is a hormone?
A hormone is a chemical messenger produced by glands. The messages that hormones send make the cell respond.
There are 2 types of glands: endocrine and exocrine. Endocrine glands are positioned far from the cell they are sending messages to, and exocrine glands are positioned close to the cells they are sending messages to.
Hormones can be cyclical, such as melatonin (our sleep hormone) or the sex hormone cycle, or they can be adaptive to our life choices like our food and stress levels. Another hormone type you may not have heard of are prostaglandins. Prostaglandins are responsible for managing inflammation, clotting and immunity.
Hormones have been a part of evolution since time immemorial. The most important factor to understand is that hormones respond to our life choices, they are inter-linking systems that help bring about balance and vitality.
For the hormone to tell the cell what it needs to do, it binds to a receptor on the surface of the cell.
What is a receptor?
Every cell in the body contains receptors: tiny locks on the cell's surface. A hormone binds to the receptor and triggers the cell to do something, such as grow, secrete, make something or divide.
Can there be an issue with receptors?
Receptors can get blocked or not work efficiently. Sometimes there is too much hormonal noise and the cell gets tired and tries to shut itself down. Other times there aren't enough receptors on the cell surface, so there is a lot of hormone but the message isn’t getting through… We call this resistance.
Symptoms of PCOS
Some women can have multiple cysts on their ovaries, but not have the associated symptoms of the syndrome.
Common symptoms include:
- Irregular or no periods
- Excessive facial and body hair
- Hair loss from the head
- Acne on face or body
- Difficulty achieving pregnancy
- Small pieces of excess skin on the neck or armpits (skin tags)
- Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts (acanthosis nigricans)
As well as these, issues can occur for women that go beyond the regular definition due to the psychological response, behavioural response, lifestyle habits and social impact of the condition. Anxiety and depression are common, easy weight gain - especially around the abdomen, poor body image and sugar cravings can be issues. Many women with PCOS also suffer from fatigue, poor sleep and can feel easily stressed.
Understanding the root causes and physiology (this is a fancy term for the way cells work), can help you understand the flow on effects of prolonged and excessive secretion of androgens and insulin and the overall implications of this syndrome, and most importantly, what you can do about it.
How can some women have multiple cysts and not have PCOS?
Some women have PCOS and don't have ovarian cysts and others can have multiple ovarian cysts but not have the syndrome. Aint medicine confusing?
One of the key criteria for PCOS is having multiple cysts. By definition, we say that having over 12 cysts in either one or both ovaries is considered polycystic. But you need to also have the key features of excessive androgen or excessive insulin. You need 2 out of the 3 symptoms to be diagnosed.
Insulin and ovulation
Insulin is one of the key factors signalling the nutritional status of an individual. When there is excessive production due to imbalances in food choices, gut biome health, exercise, genetics, stress and the like, the key hormonal cascades in the brain are impacted, blocking the effective and healthy cycling of the sex and thyroid hormone pathways. It's a bit like nature’s way of telling the body, “hey girl- we don’t have enough nutrition to support a pregnancy right now so let’s wait until you get some and then we can work on reproduction”. Make sense?
The same goes for stress. Cortisol also can block the healthy sex hormone cycle for the same reasons.
Insulin is the driver that blocks healthy ovulation. When the correct signalling for ovulation is blocked, the ovaries fail to bring one of its eggs to full maturation. No mature egg, means no ovulation.
When this happens, cysts are formed instead. The cysts then make androgens. Because there are multiple cysts, there are too many androgens. Hence the hairiness, acne and male-pattern balding.
Taking a broad look beyond the fundamentals of the PCOS diagnosis, we can get a more complete picture of how PCOS develops and most importantly, how it impacts a person's life.
From the words of the father of Western Medicine: “it is more important to treat the person who has the disease, rather than the disease itself”.