In the late 1960’s researchers discovered a naturally produced “factor” that would relax the blood vessels. They named it endothelium derived relaxing factor (EDRF). After considerable research, it was later discovered that EDRF was a simple molecule containing one atom of nitrogen and one atom of oxygen produced locally by the blood vessels, and was more correctly called nitric oxide (NO). This discovery eventually culminated in three researchers winning the Nobel Prize for medicine in 1998; sadly one of the key researchers, Salvador Moncada, was overlooked by the Nobel Committee. Who says there are no politics in science? Cardiovascular Disease
Polycystic Ovarian Syndrome is a hormone disorder affecting 5-10% of childbearing women and is the most significant cause of infertility amongst women of all nationalities. Symptoms vary greatly between women: typical and atypical type making it difficult to correctly diagnose.
The diagnostic criteria for PCOS include at least two of the following:
1) light or no menses which may result in infertility or multiple miscarriages.
2) clinical or biochemical signs of hyperandrogenism (including excess coarse hair growth, male pattern baldness, and/or acne.)
3) polycystic ovaries.
Further, there is a strong link with insulin resistance and PCOS. Other symptoms include: weight gain – particularly an increase in abdominal fat, the development of dark skin patches, elevated lipid levels, difficulty breathing, depression, and pelvic pain from abnormal ovary size and shape. The psychological effects of PCOS are also significant, including depression, anxiety, and body dysmorphia.
Common Signs and Symptoms
- Dandruff: due to excessive oil production individuals are susceptible to an increased number of fungal infections causing dandruff
- Hair loss (alopecia): particularly male pattern baldness may cause thinning of the hair on the crown of the head
- Depression: The constellation of symptoms can have a significant impact on quality of life for many women and takes its toll on mental health
- Hirstruism is excessive hair growth on face, chest, back, stomach, fingers and toes
- Texture of hair may become coarser
- Androgenization is the masculinization of features due to increased testosterone
- Signs and Symptoms
- Acanthosis nigricans: This dark pigmentation of the skin is linked to insulin resistance common in PCOS
- Acne: Increased oil production and testosterone results in cystic acne commonly found along the jaw-line, back and chest
- Weight gain- particularly increase in central obesity
- Endometrial hyperplasia: Thickening of the uterine walls
- Polycystic ovaries: Multiple cysts can be seen on ultrasound of ovaries, may cause pelvic pain if large enough
- Reduced or no menses, with lack of ovulation
- With reduced or no ovulation results in infertility
The exact cause of PCOS is still unclear; however, some key risk factors and related conditions have been identified. The first major risk factor is genetics; there is a strong (up to 50%) risk of developing PCOS with a first degree association with a family member who also has PCOS. A number of genes have been linked to PCOS though there is no consensus yet on which mutations will result in the hormonal dysregulation seen in this condition. Obesity is another risk factor for PCOS, while weight gain is a common symptom of PCOS. Stress can also increase the risk for atypical PCOS, since it can disturb the hypothalamic pituitary axis (HPA) lowering most sex hormones. Further, insulin resistance creates a vicious cycle where more insulin in the bloodstream promotes androgen production, which then exacerbates insulin resistance. This upsets the delicate hormone balance in the body having widespread systemic effects.
Two theories exist to explain the excess androgens present in women:
- The rhythm of reproductive hormones from the hypothalamus and anterior pituitary are disturbed.
- GnRH secretion from the hypothalamus is increased
- Luteinizing hormone (LH) and follicle stimulating hormone (FSH) ( LH:FSH ratio is increased) are increased resulting in immature follicles which are not released (anovulation), and abnormal or no menstruation
- Without ovulation of follicles, estrogen levels rise because they are unopposed
- This promotes androgen production in the ovaries as well as in fat tissue where excess estrogen is converted to testosterone
- Women with PCOS seem to have high levels of insulin in their blood indicating an insulin resistance.
- High insulin levels contribute to this hormone dysregulation independently to the HPA axis though it may be simultaneous
- Insulin can stimulate the ovaries and adrenal glands to increase production of androgens, and can also have an effect on the hypothalamus
- Insulin also reduces the amount of sex hormone binding globulin (SHBG,) this means more sex hormones exhibit longer effects
Conventional treatments for PCOS include:
- oral retinoid for skin concerns
- oral contraceptives
- anti-adrenergic therapies
- Insulin management medications such as metformin may also be prescribed
That being said many dietary and lifestyle factors can have a significant impact on the syndrome. Dr. O’Brien outlined many of these treatments in a previous blog post, that you can view here. To review some lifestyle modifications include:
- Fat loss through high intensity interval exercise
- Blood sugar management through consumption of high fibre, low glycemic index foods, avoiding saturated and trans-fats, simple sugars
Dr. O’Brien also discussed the benefits of inositol supplementation, which acts as a key signalling molecule between cells. In recent years, research has uncovered the powerful effects of high doses of this nutrient on regulating the menstrual cycle, supporting the healthy functioning of the ovaries, balancing mood and regulating metabolic factors. In regards to PCOS treatment, researchers have found that 1-4g/day of inositol has been correlated with a statistically significant reduction in blood sugar levels. There are two forms of inositol, myo-inositol and d-chiro-inositol, it is the combination of these two forms in a 40:1 ratio respectively, that was shown to significantly improve insulin sensitivity by cells. This also had an impact on a regulating number of sex hormone levels, and improved egg quality leading to improved fertility. AOR’s Advanced PCOS Relief contains this ratio of the two forms as well as inositol. Since inositol improves fertility, folic acid was added to ensure that women have healthy folic acid levels preconception which is known to prevent neural tube defects during fetal development. It is also the first of its kind to be delivered in a vegetarian softgel.