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The Effects of PCOS on your Long-Term Health

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April 15, 2020
PCOS long-term health naturopathic doctor toronto

While I’m at home practicing social/physical distancing, I thought it would be an opportune time to catch up on the literal stack of studies I’ve printed out over the last year or two – many of them being about PCOS (polycystic ovary syndrome).

Today I’m going to summarize an article that came out in 2018, which discusses the effects of PCOS on your long-term health.

A quick recap: PCOS is the most common hormonal disorder in reproductive-aged women. To be diagnosed, you need at least 2 of the 3 following criteria:

  1. Delayed ovulation or irregular menstrual cycles (oligomenorrhea)
  2. High androgenic hormones like testosterone
  3. Polycystic ovaries on ultrasound

If you’re in the perimenopausal and menopausal time period, you can still be diagnosed with PCOS if you’ve experienced a history of irregular periods and high male hormone levels (which may have resulted in male-pattern hair growth or hair loss) in your reproductive years.

Because PCOS is associated with many other conditions like diabetes and metabolic syndrome, the study suggests that we should also be spending time decreasing the risk of future symptoms in addition to treating the symptoms you may be currently experiencing.

Type 2 Diabetes and PCOS

Women with PCOS often have a higher risk of developing impaired glucose tolerance – which essentially means that your body isn’t able to process glucose (aka. sugar) as effectively as it should, thereby leading to higher blood sugar levels.

This finding was seen in women who’s PCOS was diagnosed based on total testosterone levels and a history of irregular menstrual cycles.

In women over the age of 40, those with a ‘normal’ weight still had increased odds of developing diabetes, compared to ‘normal’ weight women without PCOS.

Overall during the reproductive years, the risk of impaired glucose tolerance is increased. Whereas the risk of diabetes is increased during perimenopause and menopause. This means that if you’ve been diagnosed with PCOS, you should be monitoring your fasting blood glucose and fasting insulin every 1-3 years to assess your risk of eventually developing diabetes.

Dyslipidemia and PCOS

Dyslipidemia is a fancy word for abnormal amount of lipids (fats) in your blood. In people with PCOS, this is seen in those who are overweight/obese, and may happen when they’re younger and can persist past menopause. So, this would likely also result in screening every couple of years to assess risk.

Overweight, Obesity and PCOS

Obesity is super common in women with PCOS, and they often express their difficulties in losing weight. Most evidence demonstrates that women with PCOS continue to be overweight/obese as they age compared to women without PCOS. Specifically, obesity is higher in white women compared to Asian women.

Metabolic Syndrome and PCOS

Metabolic syndrome is a collection of five health conditions:

  • Insulin resistance
  • High blood pressure
  • High fatty acids in your blood
  • Low HDL cholesterol (aka. the ‘good’ cholesterol)
  • Visceral obesity (aka. a waist circumference of more than 35 inches in women)

Because PCOS can encompass many of these conditions, it’s worth it for us to pay attention to these conditions from a preventative mindset and screen frequently.

Pregnancy Complications and PCOS

Check out a post I wrote about how PCOS can affect your pregnancy. I cover miscarriage, gestational diabetes, pregnancy-induced hypertension, and more.

Depression, Anxiety, and PCOS

Although there isn’t any great research looking at depression and anxiety in PCOS women over 40 years old, there is an increased incidence of depression and anxiety in younger women with PCOS.

Final Thoughts

If you have PCOS, it’s important to address your condition now, but to also think of things preventatively. Because insulin resistance and diabetes is so prominent – you may want to discuss the benefit of annual blood work to assess your risk. These two conditions can also lead to obesity and metabolic syndrome, making it exceptionally important to be aware of.

If you’re pregnant, please check out my pregnancy and PCOS blog post to get an idea of what you should be aware of as you approach the second and third trimester.

Blood tests you should *also* be looking at yearly:

  • Fasting insulin
  • Fasting glucose
  • Fasting lipids

Although these aren’t blood tests, consider getting your blood pressure checked often as well as measuring your waist circumference. If you’re pregnant, your waist circumference will change – so keep that in mind.

References

Cooney, L., & Dokras, A. (2018). Beyond fertility: polycystic ovary syndrome and long-term health. Fertility And Sterility110(5), 794-809. doi: 10.1016/j.fertnstert.2018.08.021

Can Fibre Improve PCOS Parameters?

March 27, 2020
pcos fibre diet naturopathic doctor toronto

I’ve written many posts about PCOS, and today I want to explore the relationship between PCOS and dietary fibre.

To recap, polycystic ovary syndrome (PCOS) is the most common hormonal disorder in reproductive-aged women. Whenever I mention PCOS to my clients, many of them say that they don’t have cysts on their ovaries. Here’s the thing, you can be diagnosed with PCOS without having cysts.

To be diagnosed, you need at least 2 of the 3 following criteria:

  1. Delayed ovulation or irregular menstrual cycles (oligomenorrhea)
  2. High androgenic hormones like testosterone
  3. Polycystic ovaries on ultrasound

Whenever I’m suspecting PCOS, I like to run blood work to determine androgen levels. In addition, because insulin resistance is common with PCOS, it’s important to also assess those parameters.

Some of the tests I like to run:

  • Free testosterone
  • Total testosterone
  • DHEA-S
  • Sex Hormone Binding Globulin (SHBG)
  • Fasting insulin
  • Fasting glucose

A 2019 study looked at the relationship between fibre, insulin resistance and PCOS. It demonstrated that a low fibre intake in people with PCOS is a significant factor in insulin resistance, and people with PCOS consumed less fibre than those without PCOS.

Fibre is a complex carbohydrate that isn’t digestible. There are 2 types – soluble and insoluble. Soluble helps to lower things like blood glucose and cholesterol. While insoluble helps to bulk up stool, improve motility, and it can also increase insulin sensitivity.

However, many of us don’t eat nearly as much fibre as we should. A low-fibre diet is associated with many health problems including type 2 diabetes and metabolic syndrome (which is essentially a cluster of syndromes including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels).

Fibre can help regulate blood glucose by slowing it’s absorption in the blood, which then improves glucose tolerance. The 2019 study also showed that in people with PCOS who did not eat much fibre, they tended to have increased testosterone and DHEAS levels. Moreover, insulin resistance may actually worsen high androgens.

This means that including more fibre-rich foods in your diet may lower insulin resistance and manage high androgen levels and improve those PCOS parameters.

Foods that are rich in fibre include fruits, vegetables, beans and legumes, as well as grains. Some fibre-rich foods include:

  • Raspberries – 4g of fibre for 1/2 cup
  • Pear – 5.2g of fibre for 1 medium pear
  • Apple – 3.3g of fibre for 1 medium apple
  • Brussel sprouts (cooked) – 3.2g of fibre for 1/2 cup
  • Carrots – 3g of fibre for 1 large carrot
  • Lentils (cooked) – 10.4g for 2/3 cup
  • Black beans (cooked) – 7.5g for 1/2 cup
  • Peanut butter (chunky) – 2.6g for 2 tbsp
  • Brown rice (cooked) – 1.8g for 1/2 cup
  • Rolled oats (cooked) – 4.2g for 3/4 cup

Ideally people with PCOS should be aiming for 30-35g of fibre per day. As you increase your fibre intake, be sure to make sure you’re also increasing the amount of water you’re drinking per day (this is because fibre can bind water).

Reference

Cutler, D., Pride, S., & Cheung, A. (2019). Low intakes of dietary fiber and magnesium are associated with insulin resistance and hyperandrogenism in polycystic ovary syndrome: A cohort study. Food Science & Nutrition7(4), 1426-1437. doi: 10.1002/fsn3.977

PCOS in Pregnancy

March 20, 2020

When people with PCOS become pregnant, this may lead to some pregnancy complications. Complications are dependent on which PCOS criteria the pregnant person fulfilled prior to pregnancy.

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in reproductive-aged women. To be diagnosed with PCOS, you need at least 2 of the 3 following criteria:

  1. Delayed ovulation or irregular menstrual cycles (oligomenorrhea)
  2. High androgenic hormones like testosterone
  3. Polycystic ovaries on ultrasound

Although not a criteria of PCOS, insulin resistance is also a hallmark of PCOS. High insulin (known as hyperinsulinemia) is more prevalent when features of high androgens (like testosterone) are present.

PCOS and Pregnancy Complications

Miscarriage

During pregnancy, miscarriage is more frequent in those with PCOS. It’s specifically influenced by BMI. High androgens as well as high insulin levels cause inflammation within the body that may lead to difficulties in embryo implantation, miscarriage and adverse pregnancy outcomes, some of which are outlined below.

Gestational Diabetes

Gestational diabetes is pregnancy-induced diabetes, that usually resolves in the postpartum. Studies show that women with PCOS have a 3x higher chance of gestational diabetes, from high androgen levels.

Risk Factors for developing gestational diabetes are:

  • Over 35 years old
  • Pre-pregnancy BMI is over 30 kg/m2
  • Ethnicity (Aboriginal, African, Asian, Hispanic, South Asian)
  • Family history of diabetes
  • Polycystic ovary syndrome, and acanthosis nigricans (a skin condition causing hyperpigmentation of skin, especially in the folds)
  • Corticosteroid use
  • Previous diagnosis of gestational diabetes
  • Previous ‘big’ baby

Around 24-28 weeks, pregnant people are offered screening for gestational diabetes. However, if there’s a high risk of gestational diabetes based on the above risk factors, screening or testing may be offered earlier and then repeated at 24-28 weeks if it was normal.

Pre-eclampsia

Pre-eclampsia is pregnancy-induced high blood pressure (formally known as hypertension) and protein in the urine, or other adverse symptoms; at or after 20 weeks gestation. Studies show that women with PCOS have a 3x higher chance of pre-eclampsia due to high androgen levels.

Symptoms of pre-eclampsia include:

  • Persistent headache
  • Visual disturbances
  • Abdominal pain at the upper right quadrant
  • Nausea and/or vomiting
  • Chest pain/shortness of breath

Risk factors in developing preeclampsia are:

  • Antiphospholipid antibodies
  • Previous pre-eclampsia
  • Pre-existing diabetes
  • Family history of pre-eclampsia
  • Raised pre-pregnancy BMI

Blood Work to Consider

If you’re planning on becoming pregnant or are in the early stages of pregnancy, it may be worthwhile to do some blood work to assess your risk and possibly decrease it.

  • Complete blood count
  • Blood lipids
  • Fasting insulin and fasting glucose
  • Free testosterone, total testosterone, Sex hormone binding globulin (SHBG)

Final Thoughts

Unfortunately there isn’t much treatment for people who have PCOS during pregnancy, although adopting a healthy diet and physical activity is recommended – check with your health care provider to see what’s right for you.

References

Christ, J., Gunning, M., Meun, C., Eijkemans, M., van Rijn, B., & Bonsel, G. et al. (2018). Pre-Conception Characteristics Predict Obstetrical and Neonatal Outcomes in Women With Polycystic Ovary Syndrome. The Journal Of Clinical Endocrinology & Metabolism104(3), 809-818. doi: 10.1210/jc.2018-01787

GESTATIONAL DIABETES MELLITUS: A review for midwives. Retrieved 20 March 2020, from https://www.ontariomidwives.ca/sites/default/files/Gestational-diabetes-mellitus-backgrounder-PUB_0.pdf

Hart, R. (2019). Generational Health Impact of PCOS on Women and their Children. Medical Sciences7(3), 49. doi: 10.3390/medsci7030049

Hypertensive Disorders of Pregnancy. Retrieved 19 March 2020, from https://www.ontariomidwives.ca/sites/default/files/CPG%20supplemental%20resources/HDP%20Summary.pdf

Palomba, S., de Wilde, M., Falbo, A., Koster, M., La Sala, G., & Fauser, B. (2015). Pregnancy complications in women with polycystic ovary syndrome. Human Reproduction Update21(5), 575-592. doi: 10.1093/humupd/dmv029