PCOS is now recognised to be a metabolic syndrome which may include hyperinsulinaemia, hyperlipidaemia, diabetes mellitus, and possibly cardiac disease, as well as the more conventionally recognised increase in androgen levels, cosmetic problems such as acne and excess hair, anovulation, infertility, endometrial cancer and obesity.

Symptoms
Menstrual irregularities – cycles shorter than 21 days or longer than 35 days
Hyperandrogenism – hirsutism, acne, male pattern baldness
Overweight – mainly central weight gain around stomach
Infertility – anovulation and/or dysfunctional uterine bleeding
Lack of a regular cycle – no period evident at all

Diagnostic Criteria
Polycystic ovary syndrome is diagnosed if there are any two of the following:
• Presence of polycystic ovaries on ultrasound examination
• Clinical or biochemical hyperandrogenism
• Menstrual dysfunction with anovulation
(European Society of Human Reproduction and Embryology and American Society for Reproductive Medicine)
It is important to remember that women of normal weight can also have PCOS. Up to 20% of women have polycystic ovaries on ultrasound but lack any other criteria for PCOS. PCOS is generally under diagnosed and menstrual abnormalities, such as cycles shorter than 21 days or longer than 35 days, are often associated with the condition. Many young women with these abnormalities are prescribed the oral contraceptive pill, which masks the condition until they try to achieve pregnancy. Statistics show a prevalence of 5-10% of women in reproductive age have PCOS. Actual figures are presumed to be higher.

Cause
There are three main contributing factors:
1. Insulin resistance – women with PCOS show insulin resistance in tissues such as muscles and liver while the adrenal glands, ovaries and pituitary show no insulin resistance. This results on an over stimulation of the ovaries which leads to the cells around the follicles producing too many androgens.
2. Genetic disposition - causes the ovaries to become more sensitive to the effects of insulin and this blocks follicular development. This genetic disposition can be seen in men as premature balding.
3. Hypothalamus imbalance – leads to elevated luteinizing hormone (LH) and reduced follicle stimulating hormone (FSH). This also results in excess ovarian androgen production
These causative factors lead to a combination of raised levels of androgens, oestrogen, insulin and LH and explain the classic PCOS presentation of hirsutism, anovulation or dysfunctional bleeding as well as dysfunction of glucose metabolism.
Features of the metabolic syndrome, including obesity (central), insulin resistance and dyslipidaemia, are common in women with PCOS.

Investigations
History and general examination, pelvic ultrasound, hormone levels (FSH, LH, FAI, SHBG, DHEA, free testosterone), glucose levels, cholesterol levels, thyroid function test, prolactin levels or laparoscopy.

Naturopathic Treatment
This always focuses on the individual so it is best to consult with your naturopath before self prescribing over the counter medicines. Many herbal medicines have been clinically proven to help with PCOS and your naturopath will choose the most relevant herbs for you.
Therapeutic goals of treatment centre on:
1. reducing insulin resistance & stabilizing blood sugar levels
2. encouraging weight loss
3. modifying hormonal imbalances
4. managing cholesterol levels
Diet is a major focus of any naturopathic treatment and this is imperative in PCOS. Dietary recommendations may include the following:
● reduce saturated animal fats and increase omega 3 and omega 6 fatty acids – 3 meals of deep sea fish per week (if vegetarian 10ml flaxseed oil/day), daily nuts and seeds
●increase intake of fibre rich phytoestrogens – LSA mix, legumes and soy foods (see handout on phytoestrogens)
● increase intake of bitter foods – dandelion root tea, bitter salad greens, artichokes and grapefruit
● following a low GI style diet (see handout on Glycemic Index)
Various supplements and homeopathic medicines will also be utilized depending upon your individual case.