PCOS Guide

Polycystic ovarian syndrome (PCOS) is a common metabolic/endocrine condition affecting 10% of women, which is estimated at over 116 million women worldwide. 

Clinically it’s common to see PCOS being both overdiagnosed and underdiagnosed. How? 

Many women are told they have PCOS after having a pelvic ultrasound that showed they have polycystic appearing ovaries. Often this term can get lost in translation, or their Doctor is unclear on how PCOS is accurately diagnosed, and the woman is led to believe they have PCOS when they *just have polycystic appearing ovaries* and no other factors that lead to a PCOS diagnosis. 

Let’s make it clear today – just having polycystic (poly – many, cystic – follicles) appearing ovaries does NOT necessarily mean you have PCOS, which is a complex and potentially lifelong syndrome. 

In order to be accurately diagnosed with PCOS, the Rotterdam Criteria is used, which is the current gold standard of PCOS diagnosis.
Two of the three following criteria needs to be met: 

  1. Long menstrual cycles/delayed ovulation. With menstrual cycles lasting 35 days or more. 
  2. High levels of androgens: eg. testosterone OR clinical signs of high androgens like hirsutism, cystic acne and hair loss. 
  3. Polycystic ovaries seen on an ultrasound: 12 or more follicles seen on each ovary 

Despite there being clear diagnostic criteria for PCOS, many women slip between the cracks for getting an accurate diagnosis, with estimates of the amount of women experiencing PCOS being much higher. 

What are the signs & symptoms of PCOS? 

The signs and symptoms of PCOS can be varied and very individual to the person. Someone else’s experience of PCOS may be quite different to yours and present in different ways. And remember, you don’t need to have all of the symptoms below to fall into the PCOS category. 

Some common signs and symptoms of PCOS can include: 

  • Long menstrual cycles (35 days and over) 
  • Facial hair growth, or excess hair seen below the belly button and nipples
  • Cystic acne, particularly around chin and jawline 
  • Abdominal weight gain 
  • Hair loss/thinning 
  • Subfertility 
  • History of miscarriage
  • Skin tags 
  • Darkened skin areas or hyperpigmentation (underarms, back of neck, face)
  • Anxiety & depression 

What blood tests should you get for PCOS? 

  • FSH, LH and estradiol (done on day 2 or 3 of a period, if there is severe anovulation/no period, choose anytime to get a baseline reading) 
  • Progesterone (tested 7 days post ovulation, again if there is severe anovulation/amenorrhea, test anytime to get a baseline reading) 
  • AMH 
  • Free testosterone 
  • Total testosterone 
  • DHEA-s 
  • Thyroid panel: TSH, fT3, fT4, thyroid antibodies 
  • Glucose 
  • HbA1C 
  • Fasting insulin 
  • CRP 
  • Homocysteine 
  • Cortisol (can be done by both a serum cortisol and a 4 point salivary cortisol) 

Additional markers can be useful to get a rounded picture such as: 

  • Full iron panel 
  • B12 
  • Folate 
  • Zinc 
  • Copper 

What causes PCOS? 

The causes of PCOS can also vary from person to person. With research expanding in this area all the time, we learn more and more about the origins and pathogenesis of PCOS and the steps to take to help support the body back into balance. 

Some causes of PCOS include: 

  • Insulin resistance 
  • High androgens 
  • Inflammation 
  • Genetic/epigenetic factors: a predisposition for PCOS can be laid down whilst in utero depending on the mothers environmental exposures, stress and inflammation. 

Where to start with treating PCOS? 
The first step is to ensure you have been properly diagnosed, this can sometimes take second, or third opinions!

Once you have been accurately diagnosed with PCOS, the next step is for you to understand how PCOS is actually presenting for you. Do you have insulin resistance? Do you have elevated androgens? Or both? Do you have polycystic ovaries? Are your cycles regular, or long? 

If you don’t have insulin resistance, then the common recommendations for PCOS (such as “losing weight”) are likely not going to be of any use for you. To really get a handle on PCOS, it is not the time for implementing general advice, but for understanding specifically what is going on for you and creating a treatment plan that is individualised – and actually relevant – for you! 

All the same pillars for foundational menstrual health still apply with PCOS:

  1. Eating a nutrient dense, blood sugar stabilising diet. 
  2. Optimising sleep & the circadian rhythm 
  3. Supporting nervous system regulation 
  4. Movement & exercise: weight training in particular is especially useful/essential for those with insulin resistant PCOS 
  5. Reducing exposures to endocrine disrupting chemicals (EDCs) 

These are the foundations to get a handle on when trying to address most menstrual health concerns. Prioritise this and then add in the additional, specific treatments/therapies for your PCOS. 

Other areas you may wish to explore for support you in managing PCOS are: 

  • Chinese medicine (acupuncture & Chinese herbal medicine) 
  • Naturopathy 
  • Nutritional medicine 
  • Functional medicine 
  • Herbal medicine 
  • Personal trainer and/or exercise physiology 
  • Reproductive abdominal massage 

To end on an important question you might have… 

You may be wondering, can you use the Femtek BBRing if you have PCOS? The answer is a resounding YES! In fact, if you have PCOS, you can input this information into the Femtek cycle tracking app and receive a user experience that is specifically designed for you and your needs. 

Many women are hesitant to start tracking their basal body temperature (BBT) if they have irregular/long menstrual cycles, thinking that it won’t work for them. However this is not the case! Whether you have 12 periods a year, or just 1, you can still track your basal body temperature, still confirm ovulation when it happens, still get insight into your fertile window and still use this information to better understand your body and your health.

At Femtek we love championing women with PCOS to gain deeper insight into your health, your menstrual cycles and how to support your body better.

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