Ladies, let’s talk about PCOS aka Polycystic Ovarian Syndrome.
PCOS is a fairly common endocrine disorder that affects up to 25% of reproductive women. What are the symptoms? Irregular menstrual cycles (or anovulation), weight gain or difficulty losing weight, low libido, hair loss or excessive hair growth, infertility and – of course – acne!
Basically, these symptoms occur when there is an imbalance in androgen production (testosterone, etc) that prevents consistent ovulation (the release of an egg every month). But the how’s and why’s can be a lot more complex…
Let’s start with PCOS in relation to skin and acne. What does it mean?
Well, elevations in androgens (testosterone) directly increase the amount of sebum production in your skin. This often results in acne. If we’re getting technical, testosterone can be broken down a more “androgenic” pathway into a metabolite called 5-alpha dihydro testosterone. 5A-DHT is ten times stronger than testosterone itself. If your blood test is saying that your testosterone is within range it might actually be that your 5A-DHT is elevated and causing your symptoms!
We like to treat PCOS-related acne through a combo of skin therapy (corneotherapy) and naturopathy. These two therapies allow us to work with your testosterone levels both internally and externally.
How do we diagnose PCOS?
Many of our clients have been diagnosed early with PCOS by ultrasound alone. But several leaders in PCOS research suggest that we aren’t able to come to a true diagnosis until a woman is at least four years into their period life. This is because it takes quite a bit of time for our brain to make the connection with our ovaries to ovulate and bleed regularly each month. That’s why it’s quite common to see young women with a period cycle of 45 days!
The diagnostic criteria for PCOS is constantly changing as research evolves, but the most common thread as it stands today states that to diagnose PCOS two out of three symptoms must include: irregular menstrual cycles (anovulation); signs and symptoms of androgen excess (too much testosterone by bloods or physical signs); and/or increased amount of ovarian follicles by ultrasound.
To truly diagnose a woman with hyperandrogenism we like to test further through our General Practitioner or Functional Pathology testing services. These allow us to investigate any potential underlying drivers associated with your acne and adjust your treatment plan according to your specific cause. For example, we might investigate your glucose tolerance for insulin drivers or check out your LH/FSH ratio to determine ovulatory function.
What are the different types of PCOS?
Dietary & Metabolic – Elevated Insulin: This is the most common form of PCOS and can stem from a combo of genetic predisposition and dietary choices. Insulin carries glucose into our cells, but when we have too much glucose circulating it increases our bodies demand for insulin. This then directly affects the amount of testosterone and estrogen being produced and changes the signalling telling our ovaries to ovulate. In skin terms, the more testosterone, the more oil, the more acne.
Adrenal – Increased androgen production from adrenal glands: Testosterone is made by both the ovaries and the adrenal glands. But when we’re under a lot of stress, our poor adrenals are forced to secrete high amounts of stress hormones. Looking at your stress response is a good indicator of why your testosterone is elevated.
Inflammatory: Inflammation can stem from many places – bacterial overgrowth in the gut, food sensitivities, exposure to chemicals, and more. These sources of inflammation directly affect the enzyme that works to break down testosterone into estrogen. When this process is disrupted it causes a direct increase in sebum production within the skin.
Post-pill PCOS: This type of hyperandrogenism occurs as a result of a testosterone surge following a prolonged period of suppression (the pill). This can manifest in skin breakouts up to a year after stopping the pill. If your ultrasound shows more follicles in your ovaries, don’t stress – that’s normal. Of course you have more follicles considering you haven’t ovulated or released an egg for so long! This form of PCOS is temporary and we can help support your body as it adapts to these hormonal changes and finds its natural rhythm again.
How do I know which type of PCOS I have?
Leave that up to us! We are super skilled investigators when it comes to PCOS. We’ll get to the root cause by looking at your skin presentation, history of your acne, and appropriate blood work and functional pathology testing.
PCOS myth busting!
You can’t fall pregnant when you have PCOS. Myth! This is a common misconception, one that I’ve even personally been told by a doctor when I was 18. Many people believe that PCOS automatically means a woman isn’t ovulating and therefore can’t fall pregnant – but that’s not the case. They might just be experiencing irregular menstrual cycles.
Once I have PCOS, I’ll always have PCOS. Myth! As we already covered, many of the causes of PCOS are temporary and may only result in the syndrome for a short period of time. This is especially true for post-pill PCOS. To manage your susceptibility to PCOS it’s important to maintain a healthy diet, manage your stress and reduce your inflammatory load where possible!
I have multiple follicles on my ovaries (more than 12) so I must have PCOS. Myth! The presence of excess follicles on the ovaries without hyperandrogenism does not qualify to meet the criteria for PCOS. Women are meant to have lots of follicles, it means we’re carrying more eggs!
I’ll never be able to lose weight or get rid of my acne. Myth! Once we work through the underlying drivers, modify diet, implement a few lifestyle changes and get you on the appropriate supplement program, we can achieve amazing results!
Remember, we treat the patient in front of us – not the condition from a textbook. As you can see, there are many different drivers for hyperandrogenism that could be affecting your acne and it’s our job to identify what’s driving yours!