PCOS & The Restorative Approach

Polycystic Ovary Syndrome (PCOS) is a condition of infrequent or no ovulation which causes infertility and metabolic dysfunction. It affects 5-20% of women of reproductive age with between 50 – 75% of cases being undiagnosed. Due to the infrequent ovulation, it can be associated with oligomenorrhoea (very irregular periods) or amenorrhoea (no periods), hirsutism (abnormal growth of hair on a woman’s face or body), hypertension and obesity.

It can also be associated with insulin resistance leading to type 2 diabetes. Many people with PCOS struggle to control their blood sugar as a result (leading to weight gain) and many benefit from adopting dietary measures such as a low carbohydrate diet.

It was thought for many years that only those women who had all the symptoms had the condition, however, it is now known that PCOS is more prevalent than previously believed and it can occur in women who are not obese or hypertensive.

Diagnosis

For a diagnosis of PCOS, two of the following three criteria must be fulfilled:

1. Polycystic ovaries – 12 or more cysts on one or both ovaries and/or increased size of ovaries.
2. Clinical or biochemical evidence of hyperandrogenism e.g. raised testosterone, male pattern hair loss, hirsutism and acne.
3. Irregular periods/no ovulation.

An ultrasound scan may show the presence of cysts on the ovaries. The classical sign is that of the cysts all lined up in the periphery of the ovary, which when seen by ultrasound scan gives the appearance of a “string of pearls”. However, it may just be numerous cysts that are seen and the woman has no symptoms or problems with her menstrual cycles. This is simply known as polycystic ovaries and not PCOS. For women who are charting with the Creighton Model FertilityCare™ System, it is possible to see a recognisable pattern in their cycles. Cycles tend to be long and irregular with limited cervical mucus.

Typical PCOS Treatment and its Problems

The typical management for PCOS offered to women tends to be a hormonal contraceptive (either the pill or an IUD) in an attempt to regulate the menstrual cycles. However, this does not treat the underlying problem of the polycystic ovaries or the metabolic dysfunction. In addition, this course of management does not help a couple who are trying to conceive. If a hormonal contraceptive is used, there can be a continued residual effect of the hormones on the reproductive system even after it has been stopped. This can adversely impact fertility for many months afterwards thus exacerbating any pre-existing underlying infertility.

The Restorative Reproductive Approach to PCOS - Naprotechnology

Infertility

Naprotechnology treatment of PCOS is tailored to the individual woman and will depend on whether or not she and her husband are trying to conceive. For couples with infertility, using the Creighton Model FertilityCare™ System helps to track the cycle and carefully timed treatments are given at appropriate times to stimulate ovulation.

Regulating Cycles

For women who are not trying to conceive, a concern is that the lining of the womb (endometrium) is likely to be overstimulated due to excess oestrogen. This excess growth of the endometrium increases the risk of endometrial cancer. For this reason, if the cycle is tracked carefully using the Creighton Model FertilityCare™ System, bio-identical progesterone treatment (naturally derived and chemically identical to what the body normally produces) can be given at the appropriate time and the cycles can be regulated.

Surgery

If surgical treatment is necessary, the recommendation is ovarian wedge resection – where a wedge-shaped part of the ovary is cut out. This reduces the size of the ovary and helps reduce the hyperandrogenism and metabolic dysfunction. This in turn improves symptoms and can lead to a resumption of normal ovulation. Many women who undergo ovarian wedge resection respond better to ovulation inducing medication.

In conclusion, PCOS is a multi-factorial condition which requires appropriate monitoring, diagnosis and treatment for women to restore their health and fertility.