Why You’re Treating PCOS Wrong & How To Make It Right

by Krista Russ

As you likely know, Polycystic Ovarian Syndrome (PCOS) is a female disorder often characterized by irregular or heavy menses, infertility, physical secondary symptoms like acne, and great difficulty losing weight. It is also the most common reproductive disorder and leading cause of infertility in females [1].     

If you’re a physician and someone asks you “how do you treat PCOS?”, you might give a variety of answers. Based on what you learned in medical school or your training, you might reply with birth control pills, progestins (progestin-only mini pill),

that PCOS doesn’t need to be “treated” at all unless the patient is trying to conceive. But what if you found out that none of these approaches effectively treat PCOS, or may even make it worse? You would be stumped, perhaps even angered. 

Sadly, many practitioners, from family physicians to highly trained OB/GYNs, for reasons rooted in prevailing misconceptions about the disorder, including who gets it, what it looks like, how it should be diagnosed, and most importantly, how to treat it. Our content is focused on PCOS aims to clear the air, giving you valuable tools to treat PCOS, so you can help patients who have been underserved or even unfairly blamed by medical professionals and have lost all hope.  

But before we can explore how to effectively treat PCOS, we have to expose misconceptions and myths about the disorder, so buckle up and get ready to be thoroughly surprised.  

PCOS is Not an Ovarian Problem - It’s Endocrine

Polycystic Ovarian Syndrome needs a new name because the term implies the problem lies in the ovaries. If you have ever done an ultrasound on a patient with PCOS, you’d note that many don’t even have cystic ovaries, although their labs are disturbed and/or they have physical symptoms that are clearly reflective of PCOS.  

While the ovaries are affected by PCOS, the root cause of PCOS goes beyond the ovary. As you know, the ovaries and menstrual cycle on a whole are controlled by the brain. Much of the metabolic disruption starts there, with problems like chronically elevated Luteinizing Hormone (LH)–a problem that lies in the pituitary gland–not the ovary. Also, most women with PCOS have some degree of insulin resistance and this is widely accepted to explain much of the etiology of PCOS. Other issues include chronically low progesterone levels.  

These are all endocrine problems that include multiple organ systems outside the ovary. So, while ovarian dysfunction is a result of PCOS, it is not the cause of it. At its core, PCOS is a metabolic disorder–affecting the whole body–not just a reproductive one. 

PCOS is (partly) autoimmune

We know this due to the presence of inflammation and auto-antibodies commonly seen in PCOS, such as anti-ovarian, anti-spermatic, anti-TPO, anti-nuclear, and anti-islet cell antibodies–some of the same antibodies observed in Hashimoto Thyroiditis and Systemic Lupus Erythematosus [1].    

PCOS is Inflammatory

Women with PCOS often have higher levels of chronic low-grade inflammation and elevated CRP levels [2]. This is a problem because chronic inflammation of the uterine lining can interfere with implantation, preventing successful pregnancy or may even lead to endometrial and other cancers down the line. Elevated CRP is also a potent predictor of future heart disease.  

PCOS is Genetic

PCOS is likely genetic in origin. We know this because PCOS often runs in families. For example, if your mother has PCOS, you are up to 70 percent more likely to have it yourself as her daughter [3]. Also, if PCOS were caused by weight gain alone, it doesn’t explain why lean, fit women can and often do have PCOS.   

Genes that play a role in fat cell function, energy metabolism, and glucose regulation are suspected to have polymorphisms that could be responsible for some of the traits seen in PCOS, such as those found on the PPAR-y gene and genes that play a role in chronic inflammation such as the TNF-alpha gene which is thought to modify some phenotypic traits of PCOS [4].  

In fact, there is evidence that PCOS is likely present in infancy–but doesn’t “activate” until menarche [5].

The Bottom Line

There are many misconceptions about PCOS. A clearer understanding of what PCOS is and what it is not paves the way for more efficacious treatments for managing it–treatments we’ll explore in more detail in our other blog posts and in our EBook: Your Ultimate PCOS Toolkit, where we will dive into exciting topics such as helpful biometrics and labs for diagnosing PCOS as well as case studies that will aid in real life, practical application–an indispensable addition to your comprehensive understanding of PCOS and how to treat it.

References

Mobeen H, Afzal N, Kashif M. Polycystic Ovary Syndrome May Be an Autoimmune Disorder. Scientifica (Cairo). 2016;2016:4071735. doi: 10.1155/2016/4071735. Epub 2016 May 5. PMID: 27274883; PMCID: PMC4871972. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871972/   

Watson K. Basina M. PCOS and Chronic Low Grade Inflammation: Should You Worry? Healthline. April 21, 2022. Accessed August 2, 2023. https://www.healthline.com/health/womens-health/inflammatory-pcos 

Crisosto N, Ladrón de Guevara A, Echiburú B, Maliqueo M, Cavada G, Codner E, Paez F, Sir-Petermann T. Higher luteinizing hormone levels associated with antimüllerian hormone in postmenarchal daughters of women with polycystic ovary syndrome. Fertil Steril. 2019 Feb;111(2):381-388. doi: 10.1016/j.fertnstert.2018.10.011. Epub 2018 Dec 7. PMID: 30527840. https://pubmed.ncbi.nlm.nih.gov/30527840/  

Unluturk U, Harmanci A, Kocaefe C, Yildiz BO. The Genetic Basis of the Polycystic Ovary Syndrome: A Literature Review Including Discussion of PPAR-gamma. PPAR Res. 2007;2007:49109. doi: 10.1155/2007/49109. PMID: 17389770; PMCID: PMC1820621. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1820621/ 

Welt CK, Carmina E. Clinical review: Lifecycle of polycystic ovary syndrome (PCOS): from in utero to menopause. J Clin Endocrinol Metab. 2013 Dec;98(12):4629-38. doi: 10.1210/jc.2013-2375. Epub 2013 Sep 24. PMID: 24064685; PMCID: PMC3849665. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849665/#:~:text=However%2C%20there%20is%20evidence%20that,based%20on%20predisposing%20environmental%20influences 

Weiss P. Gurevich R. What Is Lean PCOS? Delayed diagnosis and other unique challenges. VeryWell Health. Updated on November 11, 2022. Accessed August 2, 2023.  https://www.verywellhealth.com/unique-challenges-of-lean-women-with-pcos-4155138#:~:text=Lean%20PCOS%20is%20polycystic%20ovary,condition%20fall%20into%20this%20group 

Welt CK, Carmina E. Clinical review: Lifecycle of polycystic ovary syndrome (PCOS): from in utero to menopause. J Clin Endocrinol Metab. 2013 Dec;98(12):4629-38. doi: 10.1210/jc.2013-2375. Epub 2013 Sep 24. PMID: 24064685; PMCID: PMC3849665. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849665/#:~:text=However%2C%20there%20is%20evidence%20that,based%20on%20predisposing%20environmental%20influences