Sarah: Doctor, My stomach hurts like hell, I’m having irregular periods, I’m gaining weight like there’s no tomorrow even though I’m barely eating a thing. Even if I nibbled a piece of bread I get seriously bloated and now my bloody hairs started thinning which I thought only happened to guys??
Doctor: Hmmmm, you may have something called PCOS.
Sarah: Oh thank God, I was freaking out. I don’t know anyone else who’s had these problems. What’s PCOS and what’s causing it?
Doctor: Actually, roughly 1 in 5 women in the UK have PCOS. The specific cause hasn’t been identified yet, but we suspect it’s genetic and as we don’t know the exact cause, we haven’t developed anything to directly treat the issue yet. But listen, I’m sure if we examined everyone’s ovaries we would all have PCOS to some degree.
Sarah: Inside voice (wow thats makes me feel so much better!! its like I don't have PCOS anymore. I'll be going then)
Countless numbers of women are left frustrated by their doctors and the lack of a permanent solution to PCOS, which is actually the leading cause of infertility in the world, and bizarrely not many people know about it. Fortunately our understanding of PCOS is slowly improving, and we do have solutions to treat the effects of PCOS quite effectively.
Obviously being told there is no cure for something can be difficult to hear as you feel like anything else you do is just masking the problem, however some of the solutions available are actually very effective so you shouldn’t feel too disheartened.
But first…what’s actually going on in the body?
With Polycystic ovarian syndrome many people will tell you its best to understand what’s actually happening in your body before you ask about what medication you need to take, because the prescriptions are not what you’d expect.
Individuals with PCOS actually have very high levels of insulin resistance, which is more commonly associated with Type 2 diabetes. When individuals who do not have PCOS eat white carbohydrates, the glucose enters their system and triggers the pancreas to release insulin so that the muscles uptake the glucose and turn it into energy.
When women with PCOS eat white carbohydrates, their blood sugar levels go up and the release of insulin is stimulated however the receptors on the cells do not respond well to the glucose causing less glucose to be taken up into the cells and converted into energy.
With less glucose being transported to the muscles, there is more glucose floating around in their blood stream, which will in turn stimulate the pancreas to release even more insulin. As they are not converting glucose into energy, they will keep eating and cause their blood sugar levels become even higher. The body soon realises it needs to do something with all the blood sugar so converts it into fat, hence the reason PCOS patients put on weight quickly.
When the excess glucose is turned into fat, the ovaries are simulated to release testosterone. Elevated testosterone levels will actually inhibit normal female brain function in regards to the ovulation process so patients will stop ovulating and therefore will not get their period, which makes it difficult to become pregnant or plan to have children because you never know when you will be ovulating.
What can PCOS patients take to help them?
Combination Birth control Pill
PCOS patients will often be prescribed a combination birth control pill. (Oestrogen and Progesterone) These birth control pills stimulate the production of a specific protein that’s purpose is to remove testosterone. When testosterone decreases, the symptoms associated with PCOS go away, such as acne, hair loss and periods become more regular.
For some patients, while the symptoms may improve, they still persist, so they often take what’s known as Spironolactone. This is more of a treatment for the cosmetic symptoms associated with PCOS and works at the level of the skin, helping to clear up acne and further prevent hair loss.
This is a blood sugar medication and it causes insulin levels to decrease, which is why Type 2 diabetics are frequently prescribed it. When the patients insulin levels drop their testosterone levels also decrease and they begin to get their periods back. A lot of patients who are trying to get pregnant will take Metformin, as obviously the birth control pill option is a no go for them here. So as weird as it sounds, PCOS patients will often be prescribed diabetic medication.
What about lifestyle changes?
Diet can play a large role in helping to treat PCOS symptoms. Patients should always try and avoid too much sugars and white carbs as a start. Its difficult to prescribe a diet that will be 100% effective because everyone is different and what works for some may not work for you. Some people will tell you to try a Mediterranean diet as it’s great for lowering inflammation, others may suggest the paleo diet, but you will need to experiment.
Could inflammation hold the Key to understanding PCOS?
Many studies are currently looking into the role that inflammation plays in PCOS. PCOS patients are known to have higher levels of four different kinds of inflammatory markers (physical indicators of inflammation). Even patients who have PCOS but don’t have problems with weight gain show the heightened levels of inflammatory markers meaning it may be the one commonality between all PCOS patients and therefore a good place to start looking at when exploring potential treatments.
Inflammation is a vital part of the immune system's response to injury and infection. It is the body's way of signaling the immune system to heal and repair damaged tissue, as well as defend itself against foreign invaders, such as viruses and bacteria.
Inflammation and weight gain
Higher levels of inflammation can lead to increased weight gain and here’s why. It can influence the activity of Leptin, a hormone involved in producing the feeling of satiety (feeling full) Leptin is produced in our fat cells and signals the brain to decrease appetite and increase our metabolism, however if you become Leptin resistant its harder to notice when you are full which can cause you to therefor consume more food and put on more weight.
Inflammation can also wreak havoc with our fat metabolism. Lowering our ability to burn the type of fatty acids known as FFA’s (Free fatty acids), the excess FFAs then ‘spill over’ into our liver, pancreas, and skeletal muscles, causing damage where they don’t belong. This is called Lipotoxicity and it further exacerbates inflammation.
As our brain cant use the fat as energy, we consume even more food and then put on even more weight.
Inflammation and insulin resistance
Studies in human obesity and insulin resistance have revealed a clear association between the chronic activation of pro-inflammatory signaling pathways and decreased insulin sensitivity. For example, elevated levels of inflammatory markers: tutor necrosis factor-α (TNF), interleukin-6 (IL-6) and interleukin (IL-8) have all been reported in various diabetic and insulin-resistant states [14–18]. In addition, the inflammatory marker C-reactive protein (CRP), a non-specific acute phase reactant, is commonly elevated in human insulin resistant states .
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