Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women. It affects up to 10% of women in their reproductive years. It has implications for day-to-day life, fertility and long term health. The most widely accepted guide to diagnosing PCOS is the 2003 Rotterdam Consensus. To be diagnosed using these criteria, there must be two of the following present:

  • reduced number of ovulations (often causing irregular periods)
  • elevated androgens- observed in the patient’s symptoms or found with blood tests
  • ovaries with multiple cysts shown by ultrasound

Additionally, some diseases that could cause similar symptoms must be ruled out: congenital adrenal hyperplasia, androgen secreting tumours, Cushing syndrome, thyroid dysfunction and hyperprolactinemia.

Symptoms of elevated androgens include male-pattern hair loss, and/or a condition called ‘hirsutism’, in which underarm, pubic, facial and chest hair become darker and coarser. The blood tests are the free androgen index and free testosterone.

Women suffering from PCOS skip ovulations and in extreme cases, don’t ovulate at all. Without ovulation, conception cannot happen. So many women are affected by PCOS that it is the most common cause of infertility. Treatments offered by medical doctors include hormonal birth control (obviously not compatible with trying to conceive), metformin (for which the safety in pregnancy has not been sufficiently confirmed) and a surgery called ovarian drilling, which has fallen out of favour because it did not result in longterm improvement.

Finding an effective treatment for PCOS is important not only for fertility, but for long term health as well. Women affected by PCOS are more likely to develop low bone mineral density, mood disorders, diabetes and heart disease.

In my opinion, first line treatment for PCOS should be with a naturopathic doctor, combining diet advice, supplements and herbs. When I treat, PCOS, I have the following objectives:

  • increase progesterone: induce ovulation using supplements and/or herbs or give progesterone as a prescription 
  • reduce insulin levels: using diet, supplements and herbs
  • reduce/block androgens: using herbs and supplements
  • assess for and treat causes of chronic inflammation: overweight, low vitamin D, food sensitivities, chronic infections

Over time research has found a strong association between PCOS and sleep apnea. Sleep apnea is when a person periodically stops breathing while asleep. Sufferers may wake up in the night short of breath, snore, feel very drowsy during the day, be forgetful, have a sore/dry throat or wake frequently during the night. Sleep apnea should diagnosed using a sleep study, for which you have to go to a special centre and stay overnight. Medical doctors can provide a referral.

Despite having a genetic component, PCOS has a very positive prognosis. Seeing improvement in the frequency of ovulation takes time and consistent application of the treatment recommendations, but it is worth it- for fertility, for reducing the symptoms of high androgens, and for long term health.

Dr. Andrea Hilborn is a naturopathic doctor in Kingston, Ontario

Ann Endocrinol (Paris). 2017 Jul;78(3):176-185. doi: 10.1016/j.ando.2017.04.024. Epub 2017 Jun 9. Which origin for polycystic ovaries syndrome: Genetic, environmental or both? Fenichel P1, Rougier C2, Hieronimus S2, Chevalier N3.

Fertil Steril. 2004 Jan;81(1):19-25. Revised 2003 consensus on diagnostic criteria and long-term health risks relatedto polycystic ovary syndrome. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group.
Centre for Menstrual Cylce and Ovulation Research. Anovulatory Androgen Excess (PCOS). http://cemcor.org/resources/topics/anovulatory-androgen-excess-aae. Accessed August 11 2017.

Med Hypotheses. 2017 Mar;100:54-58. doi: 10.1016/j.mehy.2017.01.012. Epub 2017 Jan 23.
Should metformin be included in fertility treatment of PCOS patients? Haas J1, Bentov Y2.
Endocr Connect. 2017 Jul 24. pii: EC-17-0129. doi: 10.1530/EC-17-0129. [Epub ahead of print]
Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature. Helvaci N1, Karabulut E2, Demir AU3, Yildiz B4.