PCOS

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 6–20% of women of reproductive age, depending on diagnostic criteria. It is defined by excessive androgen levels, insulin resistance, and ovulatory dysfunction. The condition results from a combination of genetic predisposition and environmental factors, including epigenetic changes and influences during fetal development.

PCOS is a heterogeneous disorder, meaning patients may present with different symptoms and underlying drivers. Both conventional and natural medicine recognize several PCOS subtypes, but the main features include:

• Hyperandrogenism: Elevated total or free testosterone or free androgen index (FAI)

• Menstrual Irregularities: Oligomenorrhoea (cycles >35 days) or amenorrhoea (<8 periods per year)

• Polycystic Ovarian Morphology: ≥20 follicles per ovary or ovarian volume ≥10 cm³, confirmed by ultrasound.

Underlying mechanisms involve increased GnRH pulsatility, which raises LH secretion and stimulates ovarian androgen production. Insulin acts as a co-gonadotropin, further boosting androgen synthesis, while hypersensitivity of ovarian thecal cells amplifies these effects. Adrenal and fat cell-derived androgens also contribute to excess levels. High androgens promote abdominal fat, which worsens insulin resistance and perpetuates the cycle of hormonal imbalance. This process also reduces progesterone’s anti-androgen benefits.

Clinical Signs and Symptoms

• Hyperandrogenism: Acne, excessive hair growth, ovulatory dysfunction

• Insulin Resistance: Increased risk of type 2 diabetes and cardiovascular disease

• Ovarian Dysfunction: Multiple immature follicles, low progesterone, irregular cycles or amenorrhea

• Neuroendocrine Dysregulation: Elevated GnRH and LH, causing hormonal imbalance

• Chronic Inflammation: Low-grade inflammation complicates metabolic and reproductive health.

A typical pathology finding is LH dominance (LH at least three times higher than FSH on cycle days 2–3), low progesterone (due to infrequent ovulation), and high AMH.

PCOS Phenotypes

Naturopathic practice recognizes four main PCOS phenotypes, each with distinct drivers and treatment approaches:

1. Insulin Resistant PCOS: High androgens with insulin resistance

2. Inflammatory PCOS: High androgens with inflammation (no insulin resistance, no recent hormonal contraception)

3. Post Pill PCOS: High androgens after stopping hormonal contraception (no insulin resistance)

4. Adrenal PCOS: High DHEAS (no insulin resistance or inflammation).

Long-Term Health Risks

PCOS is now understood as both a reproductive and metabolic condition, associated with:

• Infertility

• Metabolic syndrome

• Obesity

• Impaired glucose tolerance

• Type 2 diabetes

• Cardiovascular risk

• Mental health issues (depression, anxiety, disordered eating)

• Sleep apnoea

• Endometrial hyperplasia/cancer

• Fatty liver disease

• Hypothyroidism.

Common Medications

• Type 2 diabetes medications

• Combined oral contraceptive pill (OCP)

• Progestins (oral, implant, IUD)

• Insulin sensitizers

• Anti-obesity and anti-androgen drugs

• Ovulation induction agents

Diagnostic Assessments

Primary Tests:

• Anti-Mullerian hormone (AMH) – Day 2–3

• Follicular phase hormones: oestradiol, progesterone, LH, FSH, prolactin, SHBG, testosterone, free testosterone, DHEA-S, androstenedione

• Mid-luteal phase ovulation check: progesterone, oestradiol

• Fasting insulin and glucose

• Lipid profile

• Liver and kidney function tests

• Ovarian ultrasound (GP referral required)

Secondary Tests:

• HbA1c

• Continuous glucose monitoring

• CRP/high-sensitivity CRP

• Vitamin D

• Thyroid function tests (TSH, T3, T4, reverse T3, TPOAb, TGAb)

• Zinc

Diet & Lifestyle Recommendations

• Support SHBG production (binds testosterone) by reversing insulin resistance

• Diet and exercise are key for blood glucose regulation and insulin sensitivity

• Prioritize protein at each meal

• Increase vegetables and fibre

• Pair complex carbohydrates with protein or healthy fats

• Use apple cider vinegar or bitters before meals

• Take a quick walk or do squats after meals to blunt glucose spikes

• Aim for a daily 30-minute walk and strength training

• Reduce exposure to endocrine-disrupting chemicals

Common TCM Differential Diagnosis Patterns for PCOS

Traditional Chinese Medicine does not diagnose PCOS as a single disease entity. Instead, it identifies underlying patterns of disharmony that manifest as PCOS symptoms. The most common TCM patterns associated with PCOS include:

1. Kidney Deficiency

• Considered the foundational pattern in PCOS.

• TCM believes the Kidneys govern reproduction and hormonal balance. Nourishing Kidney energy is central to restoring hormonal harmony.

2. Phlegm-Dampness Accumulation

• Common in patients with weight gain, insulin resistance, and metabolic disturbances.

• Phlegm-Dampness stagnates and obstructs the Qi and Blood circulation, impeding reproductive health

3. Liver Qi Stagnation

• Often linked to emotional stress and hormonal imbalance.

• Liver Qi stagnation can disrupt the smooth flow of Qi and Blood, affecting menstrual regularity and ovulation.

4. Spleen Qi Deficiency with Dampness

• Associated with digestive weakness and metabolic issues.

• Spleen Qi deficiency leads to dampness accumulation, which can contribute to cyst formation and hormonal imbalance.

5. Blood Stasis

• Related to poor circulation and chronic stagnation.

• Blood stasis can cause ovarian cysts and menstrual irregularities

  The DCNMC Acupuncturist combine their Traditional Chinese medicine expertise, to create a wholistic approach. Our Acupuncturists offer free 15 minute discovery calls if you are interested in learning more or having a chat before booking in.