Polycystic ovarian syndrome (PCOS) is a complex female reproductive-endocrine disorder characterised by ovarian dysfunction and hyperandrogenism (excessive androgen production produced by the ovaries).

The aetiology of PCOS remains elusive, however it’s known to be influenced by hereditary susceptibility (estimated at 70%) and environmental factors including diet and lifestyle which play a role in the expression of genes and could lead to obesity and insulin resistance (IR) which are main contributing factors involved in the onset and progression of PCOS.

From a pathophysiological perspective, PCOS involves a dysfunction of the HPO-axis (hypothalamus-pituitary-ovaries) often presenting with abnormal hormonal ratios (specifically related to gonadotropin, luteinising hormone (LH) and follicle-stimulating hormone (FSH), as well as altered insulin activity impacting metabolic functions, and increased presence of pro-inflammatory cytokines promoting inflammation.

Signs/Symptoms

The clinical presentation of PCOS differs individually, especially dependent on the lifestage a woman is at (puberty, reproductive, prenatal, postmenopausal, etc.), however the most common signs and symptoms include:
- Anovulation
- Infertility
- Menstrual irregularities
- Pregnancy complications - miscarriage, gestational diabetes
- Elevated androgens including testosterone and DHEA-S
- Elevated LH and low FSH (LH:FSH 2:1 to 3:1)
- Low progesterone and SHBG
- Elevated prolactin
- Skin conditions due to hyperandrogenism (i.e. hirsutism, acne, alopecia (male baldness patterns)
- Weight gain / Obesity
- Metabolic syndrome
- Insulin resistance
- Anxiety
- Depression
- Eating disorders
- Reduced quality of life
- Breast, endometrial and/or ovarian cancer

Investigations

Diagnosis is established through thorough case taking and pathology testing. Referrals are often required, and general pathology tests may include:
- Thyroid function tests
- Prolactin
- Total and free testosterone levels
- Sex hormone binding globulin (SHBG)
- Free androgen index
- FSH and LH
- Glucose
- Insulin
- Lipid profile
- Ovarian ultrasonography (trans-vaginal)
- Pelvic CT scan or MRI
And so many more.

Naturopathic Aims*
*Note: these would be case-by-case dependent

- Restore hormonal balance specifically LH:FSH ratio
- Reduce androgen (testosterone) levels
- Rebalance menstrual irregularities
- Rebalance ovarian dysfunction and promote ovulation
- Regulate HPO axis
- Improve ovulation and support natural fertility
- Support glucose metabolism / Correct Insulin Resistance / improve insulin sensitivity
- Reduce sympathetic nervous system overactivity and support HPA axis
- Reduce inflammation and improve antioxidant status

Herbal Support

Cinnamon: manages insulin resistance with PCOS, improves menstrual cyclicality, improves antioxidant status

Licorice: anti-androgenic (reduce androgens and improve hirsutism)

St Mary’s Thistle: antioxidant and anti-inflammatory support to optimise liver metabolism/detoxification. Liver support is required in PCOS to aid clearance of excess sex hormones from the body

Paeonia: reduce androgens and improve hirsutism

Tribulus: hormone-modulator/regulator

Chaste tree: reduces androgens, modulates progesterone/hormones/prolactin, modulates HPO-axis, improve cycle regularity

Withania: thyroid support, adaptogen/HPA-axis and mood support

Nutritional Support

Omega 3 fatty acids: anti-inflammatory to reduce inflammation and oxidative stress, improves insulin sensitivity

Chromium: improves PCOS symptoms, improves insulin sensitivity,
Inositol: improves insulin sensitivity, metabolic and hormonal profiles, regulate menstrual cycles, improve ovulation

Zinc: inhibits the enzyme 5 alpha-reductase and therefore reduces the conversion of testosterone to dihydrotestosterone (DHT), and is useful to treat acne and hirsutism

Vitamin D: Vitamin D deficiency is common with PCOS and is associated with insulin resistance, weight gain and excess androgens. Vitamin D is essential for metabolic and reproductive health and has been shown to reduce inflammation and oxidative stress, improve glycaemic control and insulin sensitivity, as well as being beneficial for follicular development and cycle regulation

B-Vitamins: essential for nervous system function/regulation, and psychological symptoms

Probiotics: Pre- and probiotic support improves digestive function, reduce intestinal permeability and formation of endotoxins.

NAC: antioxidant

Anti-inflammatory nutrients/style of eating

Limit caffeine consumption (>500mg/day) to avoid disrupting ovulation

Consume regular meals with sufficient protein intake

Opt for foods with a lower glycaemic index (GI), low saturated fats and high fibre foods (wholegrain, fruits, vegetables, nuts, seeds)

Lifestyle Support

Mindful movement that feels good for you: aim for at least 150 minutes per week with a variety of types of movement and intensity (20-30 minutes daily)

Meditation/mindfulness for emotional well-being: meditation, yoga, social interaction, breathing techniques, movement, nature walks, music, dancing, creativity

Aim for at least 10 to 20 minutes of safe sunshine exposure to improve Vitamin D status

Avoid endocrine disrupting chemicals (EDCs). These are often found in plastics, canned food, soaps, non-stick cookware, make-up, and other personal care products. Swap for natural/organic products, glass Tupperware, reusable coffee cups, stainless steel cookware

If you’re looking for further support with PCOS or menstrual irregularities/reproductive complaints, please contact Tayla via email hello@curawellness.co, Instagram @curawellness.co or book in for a naturopathic consultation (Australia-wide only).