What is Polycystic Ovaries

Understanding PCOS is easier if one tries to picture what goes on inside our ovaries every month.

Each month the ovaries begin to ripen a number of follicles. You may be surprised to hear that normal follicles are cysts, in that they are pockets of tissue filled with benign fluid and hormones, mostly estrogen. The number of immature follicles changes with each cycle — but during normal times, one or two follicles grow stronger than the others and produce an egg. When you ovulate, the egg in the dominant follicle pops out and is taken into the fallopian tube, where it can be fertilized, on its way to the uterus. This event is caused by and in turn triggers a host of hormonal secretions, including estrogen and progesterone, which work together to prepare the body to support a pregnancy if the egg is fertilized or a normal monthly period if it is not.

Polycystic ovaries

With PCOS, alterations in a woman’s hormonal pathways cause her ovaries to create a lot of follicles that form on the ovaries. The outer layer of the ovary (cortex) becomes thickened and the egg has difficulty breaking through.  No single follicle becomes dominant and ovulation can’t occur.

For the most part, these multiple ovarian cysts are not dangerous in themselves — unlike larger ovarian cysts, which can cause pain and rupture. But they do bring with them a range of uncomfortable side effects. Because a woman with PCOS doesn’t ovulate, her natural sequence of hormonal events gets interrupted, her levels of estrogen and androgens (testosterone and DHEA) remain high, and her body reacts with symptoms of estrogen and androgen excess as noted below.

What are the symptoms of PCOS?

The most common symptoms of PCOS are irregular or absent periods, infertility, increased hair growth and acne. Unusual weight gain, even with dieting or increased exercise, is very common, although thin women also can have PCOS. Women with PCOS will often go for months without a period and then start bleeding heavily for days. This occurs when the uterine lining has gotten too thick and the body must naturally shed it. Because PCOS disrupts ovulation it can be very difficult to become pregnant.

Other signs of PCOS include acne, high blood pressure, obesity, and abnormal facial and body hair growth (due to too much testosterone). One of the less recognizable symptoms of PCOS is depression, which can be misread as a bipolar illness. In many cases this may result from lack of progesterone, which is a natural antidepressant.  While depression stems from many factors, we think it is always a good idea to consider PCOS if patients have other symptoms. In some medical practices antidepressants are prescribed which do not alleviate the underlying issues and therefore are not very helpful. It is important to rule out other causes of these symptoms, particularly adrenal disease and thyroid disease.

PCOS and insulin resistance

Another telltale symptom of PCOS is steady, significant weight gain — even with reduced caloric intake. Some women report that they’re gaining weight no matter what they do. It’s not unusual for patients with PCOS to tell me they’ve recently gained 60 or more pounds in less than a year, despite dieting all the time and exercise. This weight usually accumulates around their middle. Why do some women with PCOS gain weight at such alarming rates? The research is showing that PCOS is strongly linked with insulin resistance.

Insulin resistance, a condition some people get by eating too many carbohydrates, leads to sustained high levels of insulin in the bloodstream. It is possible that this extra insulin hitches onto the receptors lining the ovary and stimulates cyst production. This is an issue that should be monitored because women with insulin resistance have a much higher risk of developing other serious health problems, like diabetes, heart disease, and metabolic syndrome.

Insulin resistance can be treated with a variety of modifications including diet/nutritional, nutrients that improve insulin function, Omega 3’s (EPA/DHA), proper hormone balancing especially with bioidentical progesterone (avoid synthetic, non-bioidentical pharmaceutical drugs) and iodine, if deficient.

PCOS and Iodine Deficiency

Iodine deficiency has recently been suggested as a possible factor in the development of PCOS.   In fact, the ovary has the highest concentration of iodine, second only to the thyroid.  As mentioned above, patients with PCOS may have insulin resistance.  Iodine also plays a critical role in insulin function, which may help to explain the insulin resistance often seen with PCOS.  A simply test (Iodine stimulation test) for iodine deficiency can be performed to determine if you are iodine deficient.  An iodine load is administered and the urine is collected for 24 hours.  If you are iodine deficient, you body will excrete very little iodine.  If you have plenty of iodine, you will excrete most of the iodine and we will see a large amount in the urine.