PCOS (Polycystic ovarian syndrome)
Polycystic ovarian syndrome is a widely prevalent endocrine disorder. The multifaceted clinical presentation of PCOS requires a comprehensive approach, addressing not only the biological aspects but also holistic dimensions, encompassing psychological, emotional, social and spiritual factors for optimal clinical outcomes.
The predisposing risk factors for PCOS includes a combination of biological, psychological and lifestyle factors.
Pathophysiologically, PCOS is characterized by insulin resistance, hyperinsulinemia, hyperandrogenism, low- grade inflammation and adiposity.
WHAT IS PCOS?
Polycystic Ovarian Syndrome refers to a hormonal condition that is characterised by dysregulated menstrual cycles, infertility, and insulin resistance.
It includes a wide range of impacts to our metabolic and hormonal health.
WHAT CAUSES PCOS?
One of the primary causes of PCOS is hormonal imbalance, specifically involving insulin and androgens. Insulin resistance, a condition in which the body fails to respond effectively to insulin, disrupts normal hormone regulation and triggers the ovaries to produce excessive amounts of androgens. These male hormones interfere with the ovulation process and results in the formation of cysts in the ovaries. The elevated levels of androgens also lead to the characteristic symptoms of PCOS, such as acne and excessive hair growth.
Genetic also plays a vital role as they contribute to the risk of developing the condition. These genes are involved in hormone regulation, insulin action and the production of androgen receptors.
Having a close family member with PCOS increases the likelihood of developing the condition, suggesting a hereditary component.
Environmental and lifestyle factors also contribute to the development and severity of PCOS. Obesity, sedentary lifestyle, and poor diet can exacerbate insulin resistance and hormonal imbalance.
Additionally, high stress level, inadequate sleep and exposure to endocrine-disrupting chemicals can further disrupt hormone regulation, and increases the risk of PCOS.
PCOS SYMPTOMS
According to Rotterdam Consensus PCOS can be diagnosed with presence of at least two of the following criteria –
- Chronic ovulatory dysfunction
It can be confirmed by oligomenorrhea (irregular menstrual cycle), amenorrhea (absence of menstruation), and anovulation (absence of ovulation).
- Hyperandrogenism
It can be diagnosed clinically by presence of excessive acne, androgenic alopecia or hirsutism (male pattern excessive hair growth) or chemically by elevated serum levels of total bioavailable or free testosterone or dehydroepiandrosterone sulphate.
- Metabolic symptoms
These are common in PCOS patients because of the insulin resistance associated with the condition, including high blood sugar, high cholesterol and triglycerides, high blood pressure and excessive body weight.
FUNCTIONAL MEDICINE LAB TESTS FOR ROOT CAUSE ANALYSIS OF PCOS
- DUTCH TEST
It requires several urine and salivary collection over one day to measure oestrogen, progesterone, androgens, cortisol, organic acids and their respective breakdown products. These tests analyse how the body makes and metabolize reproductive hormones and can provide insight into underlying causes of dysfunctional stress responses and sleep patterns.
- SERUM HORMONAL LEVEL TESTING
Oestrogen, progesterone, testosterone, and DHEA can also be measured in the serum. Some providers prefer assessing hormones via the serum; however, single blood tests cannot provide insight into how hormones fluctuate throughout the menstrual cycle, nor do these results help evaluate hormonal metabolism. Measuring sex hormone binding globulin (SHBG) with testosterone helps identify how much testosterone is bound in circulation, rendering it inactive. In PCOS, SHBG levels are often lower than optimal.
Additional hormones are often ordered for patients with suspected PCOS because specific hormonal patterns are commonly seen in these patients. Although these hormones are not required for diagnosis, they can help to confirm a PCOS diagnosis clinically. Prolactin is often elevated in patients with PCOS. In healthy women, the ratio between LH and FSH usually lies between 1 and 2; in women with PCOS, this ratio becomes reversed and might reach as high as 2 or 3.
Follicular cells of the ovaries produce anti-Mullerian hormone (AMH), which can correspond to a woman’s ovarian reserve. Given the polycystic nature of PCOS, the level of AMH is two- to three-fold higher in women with PCOS compared to that in healthy women of childbearing age.
- THYROID PANEL
Thyroid dysfunction can interfere with the healthy cycling of reproductive hormones. Women with PCOS are more likely to develop subclinical hypothyroidism and autoimmune thyroiditis. A thyroid panel, including TSH, total and free levels of T4 and T3, and thyroid antibodies, should be ordered at least annually to screen for thyroid conditions.
- CARDIOMETABOLIC PANEL
Given the increased risk, a comprehensive cardiometabolic panel should include a lipid panel, diabetes panel, hs-CRP, vitamin D, and CMP to screen for dyslipidaemia, hyperglycaemia and insulin resistance, and kidney and liver disease.
- COMPREHENSIVE STOOL ANALYSIS
Dysbiosis has been associated with insulin resistance and ovarian dysfunction. Therefore, gut function testing and microbiome assessment should be considered with a comprehensive stool analysis as part of a root-cause diagnostic evaluation of PCOS.
FUNCTIONAL MEDICINE TREATMENT PROTOCOL FOR PCOS
Functional medicine aims to decrease inflammation, correct insulin resistance and balance hormones to restore regular ovulation and glucose metabolism.
OUR TREATMENT PROTOCOL FOR PCOS IS …
- BHRT (bioidentical hormone replacement therapy)
Bioidentical hormone therapy involves the use of hormones that are chemically identical to those produced by the human body. Unlike synthetic hormones, bioidentical hormones are derived from natural sources, such as Yams & Soy, and have same molecular structure of endogenous hormones. This similarity allows for better absorption and utilization by the body, resulting in fewer side effects and improved efficacy.
- IV Detox therapies
- Dietary modifications
- IV Omega-3 therapy
- FIR Detox Therapy
- Peptide therapy