New Diagnostics and Treatment Plans for Polycystic Ovarian Syndrome - Naturopathic Medicine Ottawa
Updated: Feb 3, 2020
Polycystic Ovarian Syndrome (PCOS) is a common hormonal (endocrine) condition that affects the majority of organ systems in some way. It usually presents with some symptoms in adolescence, but can worsen with time and manifest in new symptoms down the road.
How Common is Polycystic Ovarian Syndrome?
Polycystic ovarian syndrome is a very important topic when it comes to fertility for two reasons: it is present in up to 18% of Women of reproductive age (up to 1/5 Women!) and because it is incredibly difficult to diagnose. In fact, it may take years for you to receive a diagnosis of PCOS from the first time you present to a healthcare provider with some symptoms to when it is actually diagnosed.
What Causes Polycystic Ovarian Syndrome?
Polycystic ovarian syndrome can develop from a variety of factors, but largely the cause is still unknown! Some of the most important things we know about PCOS are: it has a genetic component (most likely related to the X-chromosome) so if you have a 1st degree relative with PCOS you are more likely to have it, presence of pregnancy hormones in high levels can stimulate PCOS in the baby (largely AMH and androgen hormone levels), presence of obesity during adolescence can increase production of specific hormones and contribute to the development of PCOS, and that PCOS can present very differently in its symptoms between Women.
Updates in the Diagnosis and Treatment of PCOS
37 International Organizations present in 71 countries contributed to newer research to help improve our ability to diagnose and update our treatment approach to infertility when it comes to Polycystic Ovarian Syndrome.
Updates for Diagnosis:
1. Screen for congenital adrenal hyperplasia before diagnosing PCOS by doing a blood test for 17-hydroxyprogesterone in the follicular phase (prior to ovulation)
2. When checking for increased testosterone always use free-testosterone (not attached to albumin or SHBG proteins), bioavailable testosterone (free testosterone + testosterone attached to albumin), or free-androgen index only
3. If the Patient is using a birth control pill, this will increase sex-hormone binding globulin and therefore decrease testosterone available for blood tests. Ask Patient to discontinue birth control pill for at least 3 months (!!!) before testing for the above mentioned testosterone blood tests
4. For adolescent women (<18 years of age) who have irregular menstrual cycles for more than 2 years since onset of menarche (irregular cycles defined as longer than 35 days or shorter than 21 days) consider diagnosing PCOS with appropriate tests and screening
5. Ultrasounds that show polycystic ovaries have not been shown as specific tests to accurately diagnose PCOS, therefore ultrasounds are not recommended for adolescent women, rather the use of above mentioned tests and symptom screening should be used to diagnose PCOS
Updated Treatment Guidelines for PCOS
*Below recommendations are to help support weight loss in Women with a BMI > 25kg/m2 and prevent weight gain in Women with BMI < 25kg/m2*
Reduce caloric intake and choose healthy foods (regardless of with macronutrients compromise the diet)
Monitor caloric intake and keep target total caloric intake in a day below average daily expenditure
It is the joint responsibility of all healthcare providers seeing patient to support healthy weight loss, a referral to a dietician should be considered if needed
150 minutes of exercise should be done every week as this helps to support metabolic function in Women with PCOS
For best clinical outcomes: 90/150 minutes of weekly exercise should be high-intensity or moderate-intensity (60-90% of maximum heart rate)
2. Second line treatment: Clomiphene citrate (clomid) Or Aromatase Inhibitors (with caution - i.e. letrozole (femara)
3. Clomid + Metformin or
4. Metformin (if BMI < 30kg/m2)
5. Gonadotropins (medications commonly used in IVF or IUI)
6. Surgical Intervention (i.e. bariatric)
This article is in no way a replacement for medical advice or medical care, it is advised that anyone concerned about their Health should speak with their Naturopathic Doctor.