Cracking the PCOS Code: Types, Genetics & Solutions

In today’s fast-paced world, where women strive to excel personally and professionally, their health often takes a backseat. PCOS is one of the most prevalent hormonal disorders affecting women. 

Approximately 15% of women of reproductive age suffer from polycystic ovary syndrome, depending on the diagnosis. It has been recognized for decades, but its prevalence has surged recently, affecting millions of women worldwide.

A variety of factors contribute to the development and progression of PCOS. It affects multiple body systems despite being classified as a reproductive disorder. It can profoundly affect reproductive health, metabolic function, and overall health. Exploring the underlying factors contributing to its development is crucial to comprehend this enigmatic condition better.

In this article, we will delve into the intricacies of PCOS, explore its various types, understand the genetic links associated with the condition, and highlight effective solutions for managing and improving the quality of life for those affected.

What is the PCOS?

Polycystic ovary syndrome is a multifaceted disorder characterized by irregular or absent menstrual cycles, excessive androgen production, and the formation of small cysts in the ovaries. Complications include infertility, metabolic disturbances, and an increased risk of cardiovascular disease in women of reproductive age. The condition is characterized by at least two of the following:

• Irregular menstrual periods
• Hyperandrogenism (excess production of male hormones)
• Polycystic ovaries (ovaries that contain multiple small cysts)

Types of the PCOS

PCOS is not a one-size-fits-all condition. It presents itself in different ways, with varying symptoms and underlying causes. There are different types of PCOS, so it is important to know what kind of PCOS you have. The most common types of PCOS include:

1. Insulin-resistant

PCOS of this type is the most common. Smoking, sugar, pollution, and trans fat cause this PCOS. High insulin levels prevent ovulation and trigger the ovaries to create testosterone.

If you are borderline diabetic, have an abnormal glucose tolerance test, have high insulin levels, and are overweight, you might have insulin resistance PCOS.

2. Pill-induced 

Among PCOS types, this is the second most common. It results from the suppression of ovulation by birth control pills. The pill’s effects usually last a short time, and most women resume ovulating afterward. Some women, however, cannot ovulate again for months or years after the effects of pills have worn off. Women should consult their doctors during that time.

If your periods were regular before you started taking pills, you might have Pill-induced PCOS. It may also be a sign if your levels of LH are elevated in the blood test.

3. Inflammatory

Due to inflammation, PCOS prevents ovulation, imbalances hormones, and produces androgens. Stress, environmental toxins, and inflammatory diets like gluten cause inflammation.

The symptoms of inflammatory PCOS include headaches, infections, and skin allergies, and blood tests show you are deficient in vitamin D, your blood count is not normal, or your thyroid is overactive.

4. Adrenal

Most women with PCOS have elevated androgens.  But if you only have elevated DHEAs you may have adrenal PCOS. 

Usually, PCOS has several causes, including thyroid disease, iodine deficiency (ovaries need iodine), a vegetarian diet (which makes you zinc deficient, and the ovaries need zinc), and artificial sweeteners.

Symptoms

The symptoms of PCOS usually begin around the time of your first period. Symptoms can develop after you have had periods for a while.

If you have at least two of these symptoms, you are diagnosed with PCOS:

Irregular periods. 

Women with PCOS often have irregular periods or fewer menstrual periods. Periods that last more than normal are also problematic. It is possible to have less than nine periods each year, which may occur more than 35 days apart. Additionally, you may not be able to get pregnant.

Too much androgen. 

Excessive facial and body hair may result from high androgen levels. The condition is called hirsutism. It is also possible to have severe acne and male-pattern baldness.

Polycystic ovaries. 

You may have larger ovaries with many immature eggs developing around the edges of your ovary. There is a possibility that the ovaries do not function properly.

Obese people tend to experience more severe PCOS symptoms.

Complications of PCOS

Polycystic ovary syndrome can cause the following complications:

• Infertility
• Pregnancy-induced hypertension or gestational diabetes
• Premature birth or miscarriage
• Steatohepatitis – an inflammation caused by fat buildup in the liver that is often nonalcoholic
• The metabolic syndrome combines high blood pressure, high sugar levels, and unhealthy cholesterol and triglycerides, placing you at greater risk for heart disease and stroke.
• Pre-diabetes or type 2 diabetes
• Sleep apnea
• Anxiety, depression, and eating disorders
• Endometrial cancer (cancer of the uterine lining)

Causes of the PCOS

There’s no exact cause of PCOS. However, there is some evidence that genetics may play a role. Several other factors, most notably obesity, contribute to PCOS:

• Insulin resistance. 

Insulin allows cells to use sugar, your body’s primary energy supply. Blood sugar levels can rise if cells become resistant to insulin. As a result, your body may make more insulin to lower blood sugar levels.

A high insulin level can cause the body to overproduce androgen, a male hormone. Consequently, your ovary may not release eggs during the ovulation process.

Dark, velvety patches of skin under the breasts, armpits, groins, and on the lower part of the neck are signs of insulin resistance. Other symptoms include an increase in appetite and weight gain.

• Low-grade inflammation. 

In response to infection or injury, white blood cells produce substances. This response is called low-grade inflammation. Studies have shown that long-term, low-grade inflammation leads to androgen production in polycystic ovaries in people with PCOS. It can lead to problems with the heart and blood vessels.

• Heredity or Genetic Factors:  

According to research, PCOS may be caused by certain genes. A family history of PCOS may contribute to its development.

Studies have shown that PCOS has a strong genetic component. Many genes are involved in hormonal regulation, insulin signaling, and ovarian function, which may contribute to Polycystic ovary syndrome. Identifying specific genetic variants associated with Polycystic ovary syndrome may provide valuable insights into the disease’s etiology and lead to more targeted treatment options.

While the exact genetic mechanisms and their contributions to PCOS are still being researched, here is an overview of some genes that have been implicated:

• Insulin Signaling Genes: 

PCOS has been associated with genes related to insulin signaling and glucose metabolism. For example, variations in the INSR gene (insulin receptor gene) and IRS-1 gene (insulin receptor substrate one gene) have been linked to insulin resistance, commonly observed in women with PCOS.

• Steroid Biosynthesis Genes: 

The genes responsible for producing and metabolizing steroid hormones, including androgens and estrogen, have also been implicated in PCOS. Also, PCOS has been associated with variations in the CYP17A1 gene (cytochrome P450 17A1), which encodes an enzyme responsible for androgen synthesis.

• Gonadotropin Signaling Genes: 

Several gonadotropin-related genes may also contribute to PCOS development, such as those involved in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The follicle-stimulating hormone receptor gene FSHR and the luteinizing hormone/choriogonadotropin receptor gene LHCGR have been found to alter gonadotropin signaling and disrupt follicular development in PCOS patients.

• Obesity-Related Genes: 

Several genes that regulate body weight and fat metabolism may interact with genetic factors in PCOS. Genetic variations in fat mass and obesity-associated genes like FTO (fat mass and obesity-associated gene) and PPARG (peroxisome proliferator-activated receptor gamma gene) have been linked to obesity and PCOS.

• Hormonal Imbalances: 

PCOS is characterize by an imbalance in sex hormones, particularly elevated levels of androgens such as testosterone. PCOS is associate with high levels of androgen produce by the ovaries. As a result of excess androgen, irregular egg development, hirsutism, and acne may occur.

• The Obesity Connection

PCOS and obesity have a complex relationship. While PCOS can predispose individuals to weight gain, obesity can exacerbate PCOS symptoms and complicate management. Insulin sensitivity and hormone balance can be further disrupt by adipose tissue’s production of hormones and inflammatory molecules. Dietary changes and exercise are crucial to managing PCOS and improving fertility.

• Gut Microbiome Involvement 

There is emerging research that suggests Polycystic ovary syndrome is associate with alterations in the gut microbiome. Researchers have found that women with Polycystic ovary syndrome may have a different gut microbiota, which influences metabolic function and hormone regulation. Dietary interventions and probiotic supplementation may effectively treat Polycystic ovary syndrome symptoms and improve overall health by targeting the gut microbiome.

• Environmental Factors: 

Environmental factors, such as exposure to endocrine-disrupting chemicals (EDCs), have been suggest as potential contributors to PCOS development. EDCs can interfere with hormonal regulation and disrupt reproductive function.

Solutions for treating the PCOS

You’ll get the right treatment based on your symptoms, medical history, and other conditions. Various treatments are available, including medications, lifestyle changes, or a combination of both. In order to treat Polycystic Ovarian Syndrome, the following are some solutions may be consider:

• Lifestyle Modifications: 

Change your lifestyle to support PCOS management and take charge of your health. Regular exercise, such as aerobic activities and strength training, can help improve insulin sensitivity, promote weight loss, and regulate hormonal balance. Make sure your diet is healthy and includes whole foods, fiber, lean proteins, and healthy fats. There can be a significant impact on your health and well-being if you make even a few small changes.

According to a 2022 study published in BMC Endocrine Disorders, lifestyle interventions effectively treat polycystic ovary syndrome (PCOS). Researchers found that lifestyle interventions, such as diet and exercise, could improve PCOS symptoms, such as irregular menstrual cycles and excess hair growth.

The study included 120 PCOS women randomly assigned to either a lifestyle intervention or a control group. Diet, exercise, and weight loss counseling were provided to the lifestyle intervention group. The control group received no intervention.

After 12 months, the lifestyle intervention group significantly improved menstrual cycles, decreased excess hair growth, and improved insulin resistance compared with the control group. Hence, researchers concluded that lifestyle interventions may effectively treat PCOS.

• Medications and Hormonal Therapy: 

According to your symptoms and needs, your healthcare provider may prescribe medications for PCOS. The use of oral contraceptives can dramatically reduce androgen levels, alleviate acne-related symptoms, and reduce excessive hair growth. Hirsutism and hair loss can also be treat with anti-androgen medications. Your healthcare provider will guide you in determining the most suitable medications for your situation.

• Low-Glycemic/Low-Carb Diet/Ketogenic Diet

Dietary interventions are crucial to Polycystic ovary syndrome management. 

Women with Polycystic ovary syndrome can reduce insulin resistance and hormonal imbalance by following a low-glycemic index (GI), low-carbohydrate, or ketogenic diet. 

According to a study, a low-GI diet reduced PCOS women’s insulin resistance and androgen levels. These diets focus on minimizing the consumption of high-sugar and high-carbohydrate foods, promoting stable blood sugar levels, and supporting overall metabolic health.

• Insulin-Sensitizing Medications for the PCOS: 

Metformin, an insulin-sensitizing medication, may be helpful for women with insulin resistance. As a result, these medications improve insulin function, regulate blood sugar levels, and reduce androgen production, addressing both metabolic and hormonal issues.

• Nutritional Support: 

Also several supplements and nutritional interventions are effective in managing PCOS symptoms. It has been discovered that inositol, a naturally occurring compound produced by our body, regulates menstrual cycles, restores ovulation, and improves insulin sensitivity. 

Additionally, studies have investigated the benefits of omega-3 fatty acids and vitamin D supplementation in PCOS management, positively affecting hormonal balance and metabolic health.

Furthermore, some herbal remedies such as Aloe vera, Vitex agnus-castus,  chamomile, and octane have also proven effective in treating PCOS and improving fertility.

• Weight Management: 

Weight management is crucial for managing PCOS. Losing excess weight, even a modest amount, can help improve insulin sensitivity, regulate menstrual cycles, and reduce androgen levels. 

Also, a registered dietitian can assist you in finding the appropriate supplements and weight management plan that will work for you.

• Fertility Treatments: 

If fertility is a concern, various fertility treatments can assist in achieving pregnancy. Ovulation induction, where medications stimulate ovulation, can increase the chances of conception. Depending on individual circumstances, in vitro fertilization (IVF) may also be consider an assisted reproductive technology.

• Manage gut microbiota

There is evidence that gut microbiota may contribute to Polycystic ovary syndrome development, and managing gut microbiota might be a solution.

Research suggests that managing gut microbiota can help treat PCOS. Also, a study published in Nature Reviews Endocrinology in 2019 found that probiotics improve menstrual cycles, lower testosterone levels, and improve insulin sensitivity in women with Polycystic ovary syndrome.

Similarly, a study published in 2020 found that women with Polycystic ovary syndrome who followed a low-glycemic diet for 12 weeks had improved gut microbiota and better insulin sensitivity.

These studies suggest that managing gut microbiota may be a promising approach for treating Polycystic ovary syndrome. However, the long-term effects of gut microbiota management on PCOS warrant further investigation.

Remember, PCOS management cannot be standardized. Working closely with a knowledgeable healthcare provider who tailor a treatment plan specifically for you is important. Also, taking these steps and seeking professional guidance can help you manage PCOS, improve your quality of life, and embrace a healthier, brighter future.

Conclusion

The management of Polycystic ovary syndrome is complex and requires a holistic approach. Several factors contribute to Polycystic ovary syndrome development, including insulin resistance, genetics, obesity, and emerging research on the gut microbiome. But, supplementing inositol, modifying diet, exercising regularly, reducing stress, and sleeping enough can help women control and find balance. Continued research and a collaborative effort between healthcare providers and patients are vital in unlocking the secrets of Polycystic ovary syndrome and paving the way for a brighter, healthier future for women everywhere.