Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects 12-21% of women of reproductive age (1); however, there's so much more to a PCOS diagnosis than meets the eye.¹

Its main characteristics are high androgens (male sex hormones, e.g., testosterone), irregular menstrual cycles and cysts on the ovaries. Women with PCOS can experience long period cycles, acne, weight gain (2), excess hair growth and depression.

How does PCOS get diagnosed? 

PCOS is diagnosed if a woman presents with at least two of the following:

• Irregular or absent menstrual periods (3) (cycles longer than 35 days).
• High androgens shown on blood tests or signs and symptoms of elevated androgens, including male-pattern baldness or overall thin hair, severe acne, male-pattern facial or body hair (4). 
• Polycystic ovaries that show up on an ultrasound (this is not applicable for young women within 8 years of their first period).

How can we test for it?

As a naturopath, I acknowledge the diagnosis criteria and also analyse reproductive hormones. In PCOS, high baseline levels of luteinising hormone (LH) in comparison to follicle-stimulating hormone (FSH), low SHBG and elevated fasting glucose or insulin resistance are typical.

How to reduce PCOS symptoms? 

• A lower carbohydrate diet is excellent for anyone with PCOS. Focus on making vegetables the main proportion of your plate and slowly reduce your intake of grains.
• Decrease your intake of refined sugars and fructose, as these can contribute to insulin resistance (5) in the ovaries. One or two pieces of whole fruit are great.
• Exercise is essential for managing PCOS symptoms, reducing stress and maintaining a healthy weight. 

Is it something else?

Many women are misdiagnosed with PCOS and may have another underlying condition or issue. I see this every week in my clinic where young women are incorrectly diagnosed with PCOS so be sure you are working with someone that fully understands the diagnostic criteria.

Post-Pill Syndrome

What is it? The oral contraceptive pill suppresses ovulation to stop implantation. For some women, when they stop using the oral contraceptive pill, their ovulation returns swiftly. For others, it can take months or even years for ovulation to return and the menstrual cycle to regulate (6).

How can you test for it? A blood test may indicate reduced LH which is usually the opposite of PCOS.

How can you treat it? Before diving straight into herbal remedies, give your body a few months to rest after coming off the pill. Work on the liver and gut health and consider vitex and zinc/B6 supplementation.  

Multi-Follicular Ovaries

What is it? Having multiple cysts, or small follicles, on the ovary is part of a normal ovulating ovary. Multi-follicular ovaries are characterised by many follicles developing on the ovaries that may be larger or slightly different from normal follicles. A woman can have multiple follicles found on ultrasound and not have PCOS, which can cause some confusion!

Women with multi-follicular ovaries should ovulate regularly and not experience pain, irregular periods, or other PCOS-related symptoms. This finding is often seen when women have come off the Pill and not yet started ovulating regularly.

Hypothalamic Amenorrhoea

What is it? Hypothalamic amenorrhoea (HA) (7) is the loss of periods due to undereating, carbohydrate restriction, extreme stress or intensive exercising.² It can often be masked by OCP use for many years.

While HA sounds different from PCOS, they share the following symptoms:

• Irregular or absent menstrual cycles
• Cysts on the varies
• Possible elevated androgen levels
• Mild acne
• Facial hair 

How can you test for it? Most of the reproductive and pituitary hormones will be suppressed. Low LH and oestrogen are very common.

How can you treat it? The goal is to re-establish a regular menstrual cycle, which usually requires appropriate weight gain, reduction in exercise and an increase in healthy carbohydrate foods. If HA results from an eating disorder or excessive exercise, please seek a therapist or psychologist's guidance. 

The Bottom Line 

As there can appear to be some overlap between all four conditions, it's crucial to undergo testing with a healthcare professional to receive individualised treatment.

References:

¹Boyle, J., & Teede, H. J. (2012). Polycystic ovary syndrome - an update. Australian family physician, 41(10), 752–756. 

 ² Couzinet, B., Young, J., Brailly, S., Le Bouc, Y., Chanson, P., & Schaison, G. (1999). Functional hypothalamic amenorrhoea: a partial and reversible gonadotrophin deficiency of nutritional origin. Clinical endocrinology, 50(2), 229–235. https://doi.org/10.1046/j.1365-2265.1999.00649.x