Polycystic Ovary Syndrome (PCOS) is one of the most common hormone disorders affecting women, yet it remains widely misunderstood. Despite affecting up to 10% of women, PCOS is often misdiagnosed or overlooked due to its complex symptoms and varying diagnostic criteria.
True PCOS is an ovulation disorder caused by androgen excess, but not all women with polycystic ovaries have PCOS, and not all PCOS cases are the same.
The Challenges of Diagnosing PCOS
One of the biggest hurdles in diagnosing PCOS is the inconsistency in diagnostic criteria. The Rotterdam criteria, the most commonly used tool, require two out of three of the following:
- Irregular or absent ovulation
- High androgens (elevated in blood tests or presenting as acne, hair loss, or hirsutism)
- Polycystic ovaries on ultrasound
However, relying solely on these criteria can lead to over-diagnosis. Many women with polycystic ovaries on an ultrasound do not actually have PCOS, and high androgen levels can sometimes be linked to other conditions.
A more refined approach suggests that:
- Irregular cycles and high androgens should be the primary indicators of PCOS.
- Ultrasound findings alone are not enough for an accurate diagnosis.
- Identifying the root cause of PCOS is essential for effective treatment.
The Different Types of PCOS
Not all PCOS is the same, and identifying the root cause is key to effective management. Below are the four main types of PCOS:
Androgen-Dominant PCOS (True PCOS)
This type is characterised by consistently high levels of androgens, leading to symptoms such as acne, hair loss, and hirsutism. Androgen-dominant PCOS is often linked to insulin resistance but can also be driven by inflammation or genetic predisposition.
Insulin-Resistant PCOS
This is the most common type and is driven by excess insulin, which stimulates the ovaries to produce more androgens. It is often associated with weight gain, sugar cravings, and metabolic issues such as prediabetes.
Post-Pill PCOS
Some women experience a temporary surge in androgens after stopping the oral contraceptive pill, leading to PCOS-like symptoms. This is particularly common after stopping pills containing drospirenone or cyproterone acetate, which suppress androgens strongly while in use.
Inflammatory PCOS
This type is driven by chronic inflammation rather than insulin resistance. Women with inflammatory PCOS often experience digestive issues, skin conditions like eczema, and elevated inflammatory markers.
Getting the Right Diagnosis and Treatment
Because PCOS is not a one-size-fits-all condition, a proper assessment is crucial.
Testing should include:
- Blood tests for androgens (including free testosterone and DHEA-S)
- Fasting insulin and glucose levels to assess metabolic health
- Inflammatory markers like CRP if inflammatory PCOS is suspected
- Thyroid function tests to rule out hypothyroidism
Managing PCOS Naturally
Once the underlying driver of PCOS is identified, an individualised treatment plan can be developed, focusing on lifestyle, diet, targeted supplementation and of course herbal medicine.
PCOS is often confusing, but with a more precise understanding of its different forms, women can take charge of their health and find solutions that work for them. Instead of a one-size-fits-all approach, addressing the root cause—whether it be insulin resistance, inflammation, or post-pill hormone disruption—can restore hormonal balance, improve ovulation, and achieve long-term health and well-being.
If you suspect you have PCOS, reach out for a consultation. Naturopathic treatment strategies may include dietary modifications to balance blood sugar and support ovulation, lifestyle changes to manage stress and inflammation, and evidence-based supplements and herbal medicine such as inositol, zinc, magnesium, and adaptogenic herbs. By addressing the root cause of PCOS, naturopathic care aims to restore hormonal balance, improve cycle regularity, and enhance overall well-being.
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