Polycystic Ovary Syndrome, also known as PCOS, is the most common endocrine disorder faced by reproductive aged women. It’s a very complex medical condition, negatively impacting a wide array of organ systems, in addition to being the number one cause of female infertility.
The cause of PCOS has been stated as unclear for many years, but it is now acknowledged to be related to chronic systemic inflammation and insulin resistance, though the cause for the inflammation and dysregulation of glucose has not been understood.
The primary reason for the chronic inflammation and insulin resistance is finally known - it is due to a deficiency of estradiol and inappropriate and reduced function of estradiol receptors throughout the body. This occurs because of both genetic factors in the production of estradiol in the ovaries and to exposure to endocrine disruptors in-utero during critical developmental times or after birth when women are most developmentally sensitive to endocrine disruptors. Most research to date has been on bisphenol A (BPA).
Secondarily, women with PCOS develop an abnormal, or dysbiotic, gut microbiome. This leads to impaired gut barrier integrity, known as “leaky gut.” This results in endotoxin formed by gut bacteria passing into the body, through the gaps in the gut lining, and stimulating the white blood cells to release their inflammatory factors, called cytokines. These inflammatory cytokines worsen insulin resistance and create total body inflammation.
They even cross the blood brain barrier and enter the central nervous system, creating Neuroinflammation. Neuroinflammation can lead to insomnia, sleep apnea, headaches, mood disorders, and an altered circadian rhythm.
Women with PCOS basically live a life of jet lag! This creates metabolic havoc, worsening all the problems and symptoms faced by women with PCOS - mood issues, insulin resistance, hypertension, arthritis, autoimmune disease, irritable bowel disease, androgen excess, acne, and more.
The path back to optimal health for women with PCOS involves a heavy dose of lifestyle medicine - a plant based diet with lots of fiber and antioxidants, exercise, sleep hygiene, stress reduction, and sleep Apnea testing and treatment. Time restricted eating, periodic fasting or fasting mimicking diets, and toxin exposure reduction are also beneficial.
And in some cases, it can be beneficial to treat women with PCOS with bioidentical progesterone and estradiol. What is sorely needed is data collected to prove what has already been shown - women with PCOS thrive when they have optimal hormones and to get their hormonal status optimized can involve treatment with bioidentical hormones.
Hopefully well done, prospective studies utilizing bioidentical and physiologic dosing of hormones will soon be started, producing data to support the observation that bioidentical hormonal supplementation in women with PCOS is a significant health benefit for those not responding well enough to lifestyle medicine.