Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (for short PCOS) is very complex syndrome which results from many genetic alterations to some of the metabolic aspects of the female body. In fact, the syndrome is considered (by myself) so complex, that any doctor that claims that he or she has a deep knowledge or understanding of the PCOS, only one thing is certain about that doctor: he or she knows nothing about PCOS. Anyone that cannot appreciate the complexity of the interacting genes involved in this syndrome, simply cannot have even the superficial knowledge of this condition.

So lets see what we know about PCOS. First of all, this is not a disease. As I already stated PCOS is a complexion of genetic changes resulting in the metabolic changes seen, which will be described below. I am using the term "genetic changes" and not the term "genetic abnormalities"! There is nothing "abnormal" or diseased but those changes. There is mounting evidence that the genetic alterations seen in PCOS have resulted over many years. Such genetic changes had once given some survival benefit to the woman that had inherited them! More on this later on!

Metabolic abnormalities seen in PCOS

The metabolic alterations seen in women with PCOS include

Poor glucose (carbohydrate) metabolism
Inherent and unjustified tendency to gain weight
Increased formation of facial or body hair
Irregular period
In many cases irregular ovulation with a resultant difficulty in falling pregnant.

As already stated, these metabolic alterations is a result of the collection of genetic alterations. What this means is that every woman with PCOS can have different presentation and symptoms (type and magnitude of symptoms) depending on the type of genetic alteration and the number of genetic alterations.

Testosterone in PCOS, the "ancient" survival protector...

The hallmark of the syndrome is an inherent tendency to over-produce testosterone. There are two areas in the female body that could produce testosterone: the adrenals which are situated above each kidney and the ovaries. The adrenals are stimulated by the body to produce the stress hormone cortisol, and testosterone is also produced at a constant but low level as a byproduct. This means that every time a woman is stressed, she is producing slightly more testosterone. The other place that a woman is producing testosterone is the ovaries which in general contain two groups of cells: the cells that produce Oestrogen (the female hormone) and the cells that produce testosterone (the male hormone). These cells are stimulated by the brain, and as one would imagine the female brain should stimulate the Oestrogen producing cells more strongly compared to the testosterone producing cells. This is true for most women, apart to the ones with PCOS! Women with PCOS have a genetically driven reversal of the mechanism which controls the ovarian cells, and as a result those women have increased stimulation of the testosterone producing cells and increased levels of testosterone production. It has been noted that the more obese a women with PCOS is, the more the brain stimulates the testosterone producing cells. Therefore the only tool we have to correct this brain "mishandling" or poor ovarian stimulation is by loosing weight.

Lets go back to the origins of PCOS. It is my theory that the acquired over the years genes have accumulated slowly and they must have given some survival benefit. The theory of the "fittest will survive" is greatly acceptable. This is a validated theory which states that for any genetic variation, if it gives survival benefit then it will likely survive in the human genome. If it doesn't then it will probably not survive and gradually disappear. Imagine that a woman many hundred's of years ago started acquiring genes of testosterone over-production. None will argue that conditions of living were difficult and demanding, often requiring muscular strength to survive. This woman with an inherent tendency to over-produce testosterone must have probably had a clear survival benefit due to increased muscular strength. Such women were more likely to survive and have children (therefore transfer their genetic abnormality). Over the years, more and more genetic abnormalities were added to form what we call today PCOS.

The second factor that over-stimulates the ovaries to produce testosterone is insulin. There are two reasons why a woman will have high insulin levels: insulin resistance and high carbohydrate production. Unfortunately most women in Cyprus have both!

There is a genetically acquired insulin resistance and unfortunately there is high carbohydrate consumption due to cultural reasons. Insulin is independently stimulating the ovarian cells producing testosterone. So not only the woman with PCOS has an inherent mechanism or tendency to over-stimulate the testosterone cells by the brain, the high insulin levels that results will further stimulate ovaries to produce testosterone. If you imagine that a plate of pasta has carbohydrates which is equivalent to approximately 10-14 teaspoons of sugar, with an expected x80 rise of insulin to metabolise them, you can imagine that a woman that consumes pasta will convert her ovaries to a temporary "testosterone factory" for the 4 hours after she consumes pasta. Therefore if the diet of this woman is rich in carbohydrates, then the very high testosterone production will cause a massive metabolic dysharmony between her male and female hormones and the result will be increased hair growth, irregular period and/or irregular ovulation.

Therapy for PCOS

Successful restoration of menstrual cycle can be achieved by reducing carbohydrate consumption. By reducing carbohydrate ingestion, you massively reduce the insulin spikes in our body, and as a result you minimize testosterone production by the ovaries. In that way you restor the harmony between the major female hormone (oestrogen) and the male hormone (testosterone). The positive effect of a diet that has reduced refined (or simple) carbohydrates is unbelievably effective.

I have personally achieved massive improvement to the female cycle (in terms of regularity and frequency) through a specially designed diet, based on calculated Glycaemic Load of meals. The diet is based on a scientific approach, on how to reduce the inappropriate stimulation of ovaries by regulating the testosterone production by the ovaries through diet.

This appropriate diet can work more efficiently with certain vitamins and minerals (such as myoinositol. folic acid) as well as use of metformin (Glucophage).

Perhaps the most classic and notable example of positive response, is the case of a female woman with PCOS who visited myself after trying to fall pregnant unsuccessfully for 6 years with her husband, and eventually decided to undergo IVF. The reason for review was to get an opinion of thyroid control during the process of IVF. After advising regarding the thyroid, I explored the details of her PCOS management, and my conclusion was that she was unable to fall pregnant due to the fact that she didn't have ovulation due to high levels of carbohydrate consumption (even healthy carbohydrates such as boiled potatoes). We agreed to follow my very strict diet, I added vitamins and mineral to help her, as well as metformin and agreed to post-pone the IVF process for 4 months. At 3 months she had fallen pregnant naturally, since we had managed to restore ovulation.