It is one of the commonest hormonal disorders in women commonly associated with infertility and affects 6-21% of females of childbearing age with many not being correctly diagnosed (less than 50%) (6) and unaware of the causes of their underlying symptoms (1, 2).

GOOD NEWS is that there are effective protocols for managing the symptoms naturally and possibly rebalancing the hormones.

There are three main features of PCOS – cysts on ovaries, excess male hormone, absent or irregular periods (3,4).

This under diagnosed condition is becoming more widely recognised, which is very important as PCOS has also been associated with a higher risk of type II diabetes, mood disorders, fatty liver disease, high blood pressure, heart disease, metabolic syndrome, insulin resistance (5), and a higher incidence of/susceptibility to bacterial vaginitis.

The endocrine system is complex and still not well understood and there are many reasons why PCOS can develop but hormone imbalances do have a role to play along with insulin resistance (3, 6). It is these levels of excess of insulin that can lead to the conditions mentioned above.

In PCOS women have slightly higher androgen levels leading to excessive body and facial hair and it appears that the higher levels of androgens are caused by the increased levels of insulin (5). These androgens may cause an increase in lack of ovulation and absent periods and increased luteinising hormone potentially leading to infertility (5).

Some women can also develop cysts on the ovary which are in fact not true cysts but immature underdeveloped fluid filled follicles which create hormone imbalances and irregular ovulation (7).

There can be a genetic element to PCOS (8) but there are also other possible causes/risk factors such as sedentary lifestyle, smoking, excessive alcohol consumption, epilepsy, metabolic syndrome, type 1 or 2 diabetes, premature puberty, altered action of luteinising hormone, insulin resistance, and genetic predisposition to hyperandrogenism (9).

Diagnosis is usually on a case-by-case basis as the illness is complex, but blood tests may show increased androgens, luteinising hormone, prolactin and oestrogen and reduced sex hormone binding globulin (10). Insulin resistance and blood glucose levels may also be assessed as part of the diagnosis due to the association of insulin resistance, female sex hormones and complications that may develop (5, 6).

Symptoms can be varied but can include – cysts on ovaries, painful ovulation, excess hair growth and hair loss, lack of ovulation, irregular appetite, constipation, disordered gonadotropin production, insulin resistance/high fasting blood insulin levels, increased ovarian androgen production, low libido, fatigue, mood swings, lack of regular cycles, obesity/weight gain/ problems losing weight, fertility problems, acne and oily skin (symptom of hyperandrogenism), absent or irregular periods, increased luteinising hormone that can lead to infertility (9), anovulatory cycles and high levels of androgen and luteinising hormone which are normal in puberty but alongside weight gain is now seen as an indicator of PCPS (3)

Treatment

Herbal solutions are very individual and for a complex condition such as PCOS need to be prescribed by a qualified medical herbalist as part of a multi-herb formula but may include berberine containing herbs (10), Panax ginseng (10), Trigonella foenicum (12), Gymnema sylvestre (10,13), Vitex agnus castus (14), Actaea racemosa, Glycyrrhiza glabra, Withania somifera (16), Plantago ovatum, Asparagus racemesa (15), Paeonia lactiflora. The combination of herbs depends upon the person, symptoms experienced hence why a qualified medical herbalist who will take a thorough medical history as some herbs will not for a variety of reasons be appropriate and could be dangerous and/or contraindicated.

Diet can also help with evidence indicating that the ketogenic diet can be beneficial for PCOS with benefits such as improving mental health, brain fog, help with weight loss and help insulin resistance (17). Chemicals such as pesticides, phytoestrogens (yarrow red clover, soya), DBP, DEHP, BPA, bisphenol A, phthalates, dioxins etc that disrupt hormones (endocrine disruptors) should be avoided as far as possible and certainly minimised (18, 19). Research has also found that acupuncture can be of benefit (20, 21) along with stress reduction, good quality sleep (21, 22) and exercise (23). Vitamin D deficiency has also been shown to potentially exacerbate the symptoms of PCOS (24).
So, in conclusion this is a summary of a very individual and complex condition.

If you would like to discuss this further, think that you may have PCOS and/or would like to book a consultation please do not hesitate to reach out.

References
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Sirmans S, Pate K. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical Epidemiology. 2013;6(6):1-13. https://doi.org/10.2147/clep.s37559  2
Rasquin L, Mayrin JV. Polycystic Ovarian Disease. Nih.gov. Published 2022. https://www.ncbi.nlm.nih.gov/books/NBK459251/ 3
Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier; 2013. 4
Purwar A, Nagpure S. Insulin resistance in polycystic ovarian syndrome. Cureus. 2022;14(10). :https://doi.org/10.7759/cureus.30351 5
Ovalle F. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertility and Sterility. 2002;77(6):1095-1105. https://doi.org/10.1016/s0015-0282(02)03111-4 6 London Women’s Centre. The Difference between PCOS & Ovarian Cysts explained. London Women’s Centre. Published November 14, 2017. Accessed May 30, 2019. https://www.londonwomenscentre.co.uk/info/news/difference-ovarian-cysts-pcos 7Singh S, Pal N, Shubham S, et al. Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. Journal of Clinical Medicine. 2023;12(4):1454. https://doi.org/10.3390/jcm12041454  8
PCOS is a systematic endocrine and metabolic disorder, Herbal Reality article, www.herbalreality.com/contions/polycystuc-ovarian-sydrome-pcos/
Huffman AM, Samar Rezq, Jelina Basnet, Romero DG. Biomarkers in polycystic ovary syndrome. Current Opinion in Physiology. 2023;36:100717-100717. https://doi.org/10.1016/j.cophys.2023.100717 Kong WJ, Zhang H, Song DQ, et al. Berberine reduces insulin resistance through protein kinase C–dependent up-regulation of insulin receptor expression. Metabolism – Clinical and Experimental. 2009;58(1):109-119. https://doi.org/10.1016/j.metabol.2008.08.013
Sharma RD. Effect of fenugreek seeds and leaves on blood glucose and serum insulin responses in human subjects. Nutrition Research. 1986;6(12):1353-1364. https://doi.org/10.1016/s0271-5317(86)80020-3 Baskaran K, Ahamath BKizar, Shanmugasundaram KRadha, Shanmugasundaram ERB. Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin-dependent diabetes mellitus patients. Journal of Ethnopharmacology. 1990;30(3):295-305. doi:https://doi.org/10.1016/0378-8741(90)90108-6 Abbaspoor Z. Effect of Vitex agnus-castus on Menopausal Early Symptoms in Postmenopausal Women: A Randomized, Double Blind, Placebo –Controlled Study. British Journal of Medicine and Medical Research. 2011;1(3):132-140. https://doi.org/10.9734/bjmmr/2011/163
Pandey AK, Gupta A, Tiwari M, et al. Impact of stress on female reproductive health disorders: Possible beneficial effects of shatavari (Asparagus racemosus). Biomedicine & Pharmacotherapy. 2018;103:46-49. https://doi.org/10.1016/j.biopha.2018.04.003 Lopresti AL, Smith SJ. Ashwagandha (Withania somnifera) for the treatment and enhancement of mental and physical conditions: A systematic review of human trials. Journal of Herbal Medicine. 2021;28(1):100434. :https://doi.org/10.1016/j.hermed.2021.100434
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