What exactly is PCOS?
One of the most common endocrine disorders in young women and leading cause of infertility in American women of childbearing age is the condition known as PCOS (polycystic ovary syndrome). Like other syndromes, PCOS is actually a cluster of symptoms, most notable of which is an unusually high level of androgen hormones (male sex hormones) in women. The name originates from the presence of ovarian “cysts”, which are actually immature egg follicles that never descend into the uterus, remaining in the ovary and thus appearing as cysts. Ovulation does not occur in women with PCOS, so these follicles that normally turn into a corpus luteum (egg ready for fertilization) remain undeveloped and consequently, infertility results.
What role do androgens play in this unique syndrome?
The key diagnostic criteria for PCOS is high androgen levels, although the role of androgens in women is commonly misunderstood. The most potent androgen hormone is testosterone, and thus androgen hormones are typically thought of as male hormones, although androgens (including but not limited to, testosterone) exist and serve an important role in women as well. But in PCOS patients, the androgen levels have become too high relative to other hormones. DHEA and androstenedione (important precursor hormones to estrogen) are also androgens, existing in both male and females.
How does PCOS present clinically?
Clinical manifestations of PCOS include acne, oily skin, unusual facial hair in women from the high testosterone (also known as hirsutism), infertility, insulin resistance and obesity. From a hormone perspective, women with PCOS will have high testosterone levels. In addition, they tend to be obese. Since fat cells contain the hormone aromatase which converts testosterone to estrogen (this occurs in adipose tissue of both men and women and is called aromatization), PCOS women can have high testosterone and high estrogen. Another hallmark of PCOS is insulin resistance (precursor to diabetes) which contributes markedly to weight gain and obesity. Since insulin resistance is indicative to poor glycemic control, reversing the blood sugar regulation dysfunction that occurs in PCOS is paramount to treatment.
Other hormone indications in PCOS patients is high luteinizing hormone (LH) and low follicle stimulating hormone (FSH). Hyperandrogenic women (high testosterone) with PCOS tend to have low serum SHBG concentrations as well.
What role do micronutrients play in treating PCOS?
PCOS is first and foremost a hormone-linked syndrome. Micronutrients profoundly affect hormones, including insulin – the hormone responsible for shuttling blood glucose into cells. When insulin is chronically high, it becomes the key contributor to weight gain and metabolic dysregulation that is associated with PCOS.
Inositol is a B-complex associated nutrient that plays a very important role in cell to cell communications, which work hand-in-hand with hormone signaling. Studies indicate that exogenously administered inositol improves insulin activity (dosages of 1200 mg D-chiro-inositol were assessed).1 Evidence even goes to far as to suggest that insulin resistance in PCOS is due to inositol deficiency and that repletion of this key nutrient can significantly improve circulating hormone levels and ovulation rate.
Lipoic acid is another key nutrient in the treatment of PCOS. It enhances glucose uptake into muscles, improves insulin sensitivity and lowers triglycerides. Similarly, vitamin D deficiency is common in PCOS. This vitamin, which is actually considered a pro-hormone helps normalize the menstrual cycle. Chromium has been shown to benefit clinical manifestations of PCOS as well by facilitating the binding of insulin to receptors in the body, thus improving insulin sensitivity.
In reality, any nutrient that affects hormone production, weight management, fertility or glycemic control will potentially impact PCOS as well.
How to address the problem
Having a complete hormone panel run, along with a micronutrient analysis would be a good starting point in understanding what imbalances need to be addressed and how to correct them. Order your tests today!
Interested in learning more about PCOS? Register for our upcoming webinar on The PCOS Environmental Roadmap: How to Reverse PCOS and Begin Recovery.
1. Nestler JE, Jakubowicz DJ, Reamer P, et al. Ovulatory and metabolic effects of D-chiroinositol in the polycystic ovary syndrome. N Engl J Med 1999;340:1314-1320.
2. Masharani U, Gjerde C, Evans J et al. Effects of controlled-release alpha lipoic acid in lean, nondiabetic patients with polycystic ovary syndrome. J Diabetes Sci Technol 2010;4:359-364.
3. Fang F, Ni K, Cai Y et al. Effect of vitamin D supplementation on polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Clin Pract 2017;26:53-60.
4. Lydic M, McNurlan M, Bembo S et al. Chromium pioclinate improves insulin sensitivity in obese subjects with polycystic ovary syndrome. Fertil Steril 2006;86:243-246.