During the menstrual cycle, two hormones, estrogen and progesterone, are made by the ovaries. Each month, these hormones cause the endometrium (lining of the womb) to grow in preparation for a possible pregnancy.
About 12–14 days before the start of the period, an egg is released from one of the ovaries. This is called ovulation. The egg then moves into one of the fallopian tubes. There it can be fertilized by a sperm. If it is not, pregnancy does not occur. The levels of hormones decrease. This decrease is a signal for the uterus to shed its lining. This shedding is the menstrual period.
What is a normal
What is an irregular period?
The cycle begins with the first day of bleeding of one period and ends with the first day of the next. In most women, this cycle lasts about 28 days. Cycles that are shorter or longer by up to 7 days are normal. For most women, the period lasts for 4-7 days.
The average cycle length is about 28 days. Menstrual cycles that are longer than 35 days or shorter than 21 days are abnormal. The lack of periods for 3-6 months (amenorrhea) is not normal. Either of these patterns should be evaluated by your doctor.
PCOS is a hereditary condition causing hormonal imbalance and is found in 8-13% of women. It is most commonly known for causing irregular periods. This is due to irregular or the absence of ovulation, which in turn can impair a woman's ability to get pregnant.
PCOS is typically related to insulin resistance. As insulin levels rise, so do rates of obesity, irregular menstrual cycles and blood testosterone levels. The link with obesity suggests that excessive insulin may play a role in the development of PCOS
what is polycystic ovarian syndrome (PCOS)?
what are the criteria used to diagnose PCOS?
The current diagnostic criteria (known as the Rotterdam criteria) require at least two of the following 3 findings:
Anovulation = irregular or absent ovulation
typically less than 9 periods over the past 12 months
Hyperadrogenism = excess testosterone
clinical signs such as facial hair or acne OR
biochemical signs = elevated blood levels of testosterone
Polycystic-appearing ovaries on pelvic ultrasound
polycystic ovaries alone are insufficient to make the diagnosis of PCOS
Four main types of PCOS
In the past, irregular periods was considered the defining symptom of PCOS. In fact, many women were advised they could not possibly have PCOS if they indeed had normal ovulatory cycles. This has been shown NOT to be the case.
PCOS has been linked to infertilty due to lack of ovulation. For those who successfully achieve pregnancy, they are at an increased risk of miscarriage, pre-term delivery, pre-eclampsia and gestational diabetes.
Insulin resitance leads to obesity and metabolic syndrome which raises the risk of cardiovascular disease, type 2 diabetes, sleep apnea and non-alcholic fatty liver disease as well as a greater risk of endometrial cancer.
what are the contributory factors for PCOS?
family history of diabetes
diet & lifestyle
high carb, high inflammatory diet
lack of exercise
overgrowth of pathologic flora in the gut
rule out other hormonal disorders
congenital adrenal hyperplasia
androgens (male hormones)
testosterone, free and total
sex hormone binding globulin
menstrual cycle hormones
LH (luteinizing hormone)
FSH (follicle stimulating homrone)
AMH (anti-Mullerian hormone)
hsCRP (high-sensitivity C-reactive protein)
management of PCOS
Therapy for PCOS should be tailored to your concerns and goals. It should encompass all the metabolic issues that have been identified, seeking to improve your symptoms as well as adress the potential long-term consequences of metabolic imbalance.
diet & lifestyle
diet & lifestyle
The value of lifestyle modifications in the mangement of PCOS cannot be overemphasized. Diet & lifestyle changes that improve insulin sensitivity can be as effective as medication WITHOUT the side effects.
The following diet & lifestyle modifications are well known to be INSULIN SENSITIZING
low-glycemic index, low carb diet high in vegetables, fiber and Omega-3 fatty acids
remove sugar, gluten and dairy as these foods are highly inflammatory
7-8 hours of restorative sleep each night
birth control pills
traditionally, first-line therapy is oral contraceptives. OCPs will help the hormonal aspects of PCOS by regulating the period and decreasing testosterone.
OCPs do not help the metabolic aspects of PCOS. Thus, metformin can be added as it is known to lower insulin and thus androgen production. Doses range from 500-2,000 mg daily. The most common side effect is stomach upset so start low and increase the dose slowly
blocks the ability of testosterone to bind to receptors in the skin. It can specifically decrease acne as well as hirsutism (facial hair and male pattern baldness)
Surgical management of PCOS is no longer mainstay but has been included here for completeness. Although these procedures can be approach laparoscopically, they still include surgical risks and have mostly been abandoned.
using laser or cautery parts of the ovary are destroyed. Ovarian drilling works by breaking through the thick outer surface and lowering the amount of testosterone made by the ovaries. This has been shown to trigger ovulation.
ovarian wedge resection
An ovarian wedge resection is the surgical removal of part of the ovary, which is thought to help regulate periods and promote normal ovulation. Most physicians strongly recommend against having wedge resection due to the risk of scarring on the ovary.