Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal health issues in women. Caused by an imbalance of reproductive hormones that interferes with egg development and ovulation, it can lead to missed or irregular menstrual periods that results in infertility and the development of cysts in the ovaries.

Common symptoms of PCOS – 

• Irregular Menstrual Cycles: Due to irregular ovulation or lack of ovulation, periods may be infrequent, prolonged, or absent.
• Excessive hair growth (hirsutism): on the face, chest, back, or other areas where men typically grow hair.
• Thinning hair on the crown, similar to male-pattern baldness.
• Acne: Increased androgen levels can also contribute to acne, particularly along the jawline, chin, and other areas of the face.
• Weight Gain: Many with PCOS struggle with weight gain, especially around the abdomen (central obesity), and/or difficulty losing weight.
• Skin Darkening: in areas such as the neck, groin, and underneath the breasts (acanthosis nigricans).
• Fertility Challenges: PCOS is a common cause of infertility due to irregular or lack of ovulation.

PCOS can vary significantly among women. Not all women with PCOS experience high insulin levels or insulin resistance, nor do all have ovarian cysts, and not all ovarian cysts lead to hormonal imbalance. Additionally, hormonal disruption can sometimes originate from the adrenal glands, which produce steroid hormones like DHEA, especially during periods of high stress.

Investigation and Assessment

It is important to remember that although PCOS may physically manifest with ovarian cysts, it is ultimately a hormonal syndrome. In addition to presenting symptoms, ultrasound imaging and hormonal markers can also be tested.  

The following hormonal markers can provide insight into the root cause of PCOS, the likelihood of fertility, and determine the course of treatment – 

More comprehensive testing such as DUTCH test further analyzes estrogen and testosterone metabolites, as well as the activity levels of their respective enzymes. This detailed assessment provides deeper insights into hormonal imbalances, guiding more precise treatment strategies.

Management of PCOS

The treatment goals include understanding the underlying mechanisms and implementing appropriate dietary, lifestyle, and supplement routines to correct hormonal imbalances. 

Inflammation support is a fundamental component of every treatment plan. Patient-specific goals and needs also shape the treatment plan. For instance, some patients may focus on promoting healthy ovulation if they are anovulatory, while others with insulin resistance may emphasize dietary adjustments and improving cellular responsiveness to insulin and sugar to better manage weight, acne, and mood swings.

Depending on patient preferences and needs, additional adjunctive treatments may include acupuncture to optimize fertility and hormonal balance, as well as IV therapy or injection therapies to address nutritional deficiencies.