Polycystic ovarian syndrome is one of the most common endocrine disorders and can be a risk factor for infertility and pregnancy loss. The diagnosis is based on the Rotterdam Criteria, requiring the patient to have 2/3 of the following:
- Irregular or absent cycles
- Symptoms and/or blood levels indicating excess androgens
- Polycystic ovaries, observed via ultrasound
The problem is that often, the workup ends there.
PCOS is a complex, metabolic syndrome. In my opinion, the number one cause of treatment failure is a lack of proper assessment. There are a number of associated lab findings and clinical signs/symptoms that help us figure out what is going on in YOUR specific PCOS case because no two cases are the same. A “general” treatment plan for PCOS does not exist, and it’s difficult to get a resolution when that model is used.
We see a number of patterns in a PCOS picture
- Differences in brain hormones and their pattern of release
- Differences in ovarian production of testosterone, estrogen, and progesterone
- Differences in ovarian blood sugar balance and signaling- aka insulin resistance
- Differences in how cortisol (our stress hormone) is regulated
- Differences in inflammatory markers
- Differences in gut microbiome balance
- Differences in thyroid balance
- Differences in nutritional markers, such a Vitamin D or B vitamins
- Differences in other metabolic parameters such as cholesterol
That’s a lot of possible things that can be going on. Often, not all of those things are happening in every PCOS case. Proper assessment allows us to pinpoint what is going on in YOUR case. This will help figure what areas to target for YOUR treatment plan. This includes how to address nutrition, supplements, medications, how often to monitor, etc.
Why is this important?
The standard of care in the conventional system is the birth control pill to “regulate the cycle”. This can be a suitable choice for many people. My concern, however, is that PCOS is a metabolic condition. There often can be concurrent issues going on that impact other health outcomes. This includes insulin resistance, elevated cholesterol, triglycerides, and inflammatory markers. Over time, if unmanaged this can be a risk factor for a number of health concerns throughout the lifetime.
Additionally, what happens when you come off the birth control pill? I.e. for fertility, or if the pill isn’t working for you anymore? A thorough assessment can help us dig into the root cause of your PCOS picture, help support cycle regularity, and optimize parameters for a healthy pregnancy or healthy cycle.
What does a thorough assessment look like?
It starts with a complete health history. This includes a review of your family history, your experience through puberty, your contraception history, a review of clinical signs, a physical exam, and more.
This is followed by a review of your assessment to date. You may already have some blood work which is helpful for your practitioner to review. Next is follow-up testing, to narrow down what treatment strategies are going to be best for YOUR specific type of PCOS. This may include (but not limited to) one or more of the following:
- Day 3 FSH and LH
- Sex hormone-binding globulin
- Fasting insulin
- Vitamin D
- Full thyroid panel
- Cholesterol panel
- Liver enzymes
- Gut microbiome testing
If you’re looking for support for treating PCOS, the first step is a complete assessment to help zero in on areas of focus for your specific case, and get treatment success.
Questions about testing options for PCOS, or how to get started? Schedule a Discovery Call with an Acubalance practitioner to learn more!
Dr. Ashley Damm, ND
Naturopathic Doctor – Vancouver, BC