Forty years ago, polycystic ovary syndrome was a rare condition. Today, one woman in 10 has it. Naturopath Lara Grinevitch reports.

Firstly, don’t accept a diagnosis too quickly. Twenty-five percent of women will display polycystic ovaries at some time in their lives. A subsequent ultrasound will often show a normal appearance. I have seen patients slapped with a PCOS diagnosis after one ultrasound or one elevated luteinising hormone (LH) reading. A diagnosis must include at least two of these: no periods or irregular periods, elevated testosterone on blood test, and polycystic ovaries on ultrasound.

Secondly, PCOS is often reversible. The “cysts” are just immature follicles or eggs, which are reabsorbed as the ovary attempts to ovulate. Causes of polycystic-looking ovaries include thyroid disease, stress, and low body weight. However, true PCOS involves hormonal irregularities only picked up with a blood test. Treatment depends on the cause, most commonly insulin-resistance. This type of PCOS responds well to weight loss and blood sugar medication. Other types require different treatments.

Type 1 Classic insulin-resistant PCOS

This is the most common type of PCOS. An abnormal response to insulin (insulin-resistance) interferes with normal production of oestrogen and ovulation. Type 1 PCOS is confirmed by abnormal glucose tolerance test. Weight loss, diabetic drugs, magnesium and chromium improve insulin sensitivity. The Pill is not recommended because it worsens insulin sensitivity. Type 1 PCOS can arise from an imbalance of leptin, a metabolic hormone. Leptin problems occur frequently in women with a history of eating disorder or extreme sport. Diagnosis is by blood test.

Type 2 Non-insulin resistant PCOS

Type 2 PCOS sufferers are often thin, with normal insulin and leptin, so something else is causing irregular ovulation and elevated testosterone. Type 2 PCOS does not respond to weight loss or diabetic medication. Underlying obstacles include:

The Pill It interferes with normal hormone feedback and elevates the pituitary hormone LH. For most women, LH drops when the Pill is stopped, but some find it stays high. Chronically elevated LH interferes with ovulation, stimulates testosterone, and leads to a PCOS diagnosis. Herbal medicines - peony and licorice - can inhibit LH, restore ovulation, and reverse PCOS.
Under-active thyroid Causes period irregularity, which is technically not PCOS, but may cause an incorrect diagnosis. To complicate things, there is an association between true PCOS and autoimmune thyroid disease.
Vitamin D deficiency Ovaries require vitamin D to function. If a deficiency is confirmed, supplements are effective.
Prolactin This pituitary hormone suppresses ovulation and causes irregular periods. This is not PCOS, but it is surprising how often this blood test is not done.
Hormone-disrupting chemicals Exposure to bisphenol-A and phthalates is linked with PCOS.
Intestinal bacteria The wrong gut bacteria can suppress sex hormone-binding globulin (SHBG), which controls testosterone.

Symptom checklist

* acne
* facial hair
* hair loss
* irregular periods
* excessive testosterone
* weight gain
* infertility

Is there an upside?

“As PCOS patients get older, their chance of getting pregnant are actually higher," says researcher Miriam Hudecova. The thrifty metabolism that predisposes women to insulin-resistance may have a conserving effect on ovarian reserve. Research shows that by age 35, women with PCOS have as many successful pregnancies as women without PCOS, even without fertility treatment.

Naturopath Lara Grinevitch BSc ND is dismayed by the current over-diagnosis and mismanagement of PCOS.