PCOS is a medical condition that affects hormone levels in women, impacting 5%–20% of women of reproductive age worldwide and characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Women with PCO end up producing a higher amount of male hormones, like testosterone, and often experiencing resistance to the metabolic hormone, insulin. These imbalances can lead to issues with acne, and missed menstrual periods (impacting fertility), amongst other symptoms. The 2003 Rotterdam criteria are currently the internationally accepted criteria by which PCOS is diagnosed.  

      However, the pathogenesis of polycystic ovary syndrome (PCOS) is poorly understood. Part of the research conducted on the origination of the disease has shown that the likelihood of PCOS development in women may be determined at birth. Research in primates suggests that excess fetal androgen exposure may predispose the infant to later development of PCOS through alternations in the epigenome (1). If there is an imbalance of hormones from PCOS during pregnancy, then there is an increased likelihood the baby may also develop PCOS if the infant is born female. Additionally, exposure to testosterone prior to pregnancy could lead to PCOS even when women have children later. 

Polycystic Ovarian Syndrome (PCOS) is one of the leading medical conditions now impacting women of reproductive age, and can also have substantial impacts on a woman’s physical and emotional well-being. We’ve already covered symptoms and diagnostic testing of PCOS here, but let's dive deeper into one key hormonal disruption that seems to be particularly troublesome for my patient population – hyperandrogenism.

​Hyperandrogenism is common in PCOS, often seen as elevated testosterone and DHEA levels on blood work. And while these two hormones are often seen as synonymous when evaluating total androgenic burden, there is a significant difference between the two. Testosterone and DHEA are both classified as androgenic hormones, however some women with PCOS may have elevated testosterone, with normal DHEA levels, and vice versa. You also don't have to have cysts on your ovaries to present with hyperandrogenism (in fact, only about 20% of women with high androgens have cystic ovaries), and cysts on your ovaries don't always mean you’ll have high androgens. Have I lost you yet?

     One of the core principles of functional medicine is to nourish the body and ensure it is getting the appropriate balance of nutrients to stay healthy. Traditionally, this was achieved in a hunter-gather diet by eating colourful whole foods and by practicing “nose-to-tail” eating of meat, which included the consumption of skin, cartilage, marrow, tendons/ligaments, and other parts of the animal that are now typically discarded. Unfortunately, much of this practice has been lost as a result of prepared meats, microwaves, and canned soups over homemade stocks. As a result, our diets have become deprived of an important protein, known as collagen.

      There is a lot of noise in the health industry lately about collagen supplementation. The concept of supplementing collagen attempts to regain what we’ve lost from our primitive diet, but the question becomes if supplementation has any benefit.
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Benefits of Collagen
I’ll admit that when I first heard about the trend of supplementing collagen, I wasn't on board. It made no sense to me. Collagen is a tissue found in our bodies made from amino acids, vitamin C, etc. So how could supplementingthe end product collagen benefit us? But as it turns out, research in mice shows that hydrolyzed collagen peptides (from gelatin) have a 95% absorption rate at 12 hours after intake, and it distributes in the body similar to that of raw amino acids, with the exception of cartilage (1). Collagen was seen to concentrate more than twice as high in cartilaginous tissue that raw amino acids (1), giving collagen some unique benefits. So, I jumped on the bandwagon.

     Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal health issues in women, affecting an estimated 1 in 10 women of reproductive age. Many women are first diagnosed when they are having difficulty trying to conceive, but PCOS presents with many other symptoms, like hair loss, acne, hirsutism, and weight gain. These symptoms can affect a woman's health even beyond trying to get pregnant. 

What Causes PCOS?
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     The exact cause of Polycystic Ovary Syndrome is unknown, though it is thought that genetics play a major role. PCOS is a complex disorder that presents itself as a group of symptoms resulting from hormonal imbalances -- usually an excess of androgens like testosterone and high levels of insulin. These symptoms include:

There is a common misperception about progesterone (naturally occurring hormone) and progestin (the synthetic version) — namely that they are essentially identical. “Progesterone” and “progestin” are used interchangeably so often that patients may inadvertently think of them as one and the same, and put themselves at risk for health issues by not being aware that they are not, in fact, synonymous. So what is the difference between progesterone and progestin? The answer may surprise you.
 
What is progesterone?
 
Progesterone is a naturally occurring hormone that functions primarily to regulate reproductive processes. It is produced by the adrenal glands and ovaries or testes, and by the placenta in pregnant women. In women, progesterone is responsible for preparing the uterus for the implantation of an egg and maintains the lining of the uterus — the endometrium — during pregnancy.

​If you’ve ever taken birth control pills and discontinued, you may have experiencedsomething known as post-birth control syndrome. It generally arises within the first 6 months of discontinuing, affects women of all ages, and has a wide array of symptoms. The severity is based on several factors, including how long you took the pill, the type of pill (dosage and hormone combination), your age, liver health, bowel regularity, and overall wellbeing.

Some of the more common symptoms one might experience after stopping the pill include acne and losing hair, and for some women it results in an absence of menses returning, known as amenorrhea. Other less common symptoms women may experience include:

Polycystic Ovarian Syndrome (PCOS) is a condition that causes significant imbalances to the hormonal system in many women today. One of the biggest concerns with PCOS is that it is widely under-diagnosed. Just in the United States alone, there are approximately 7 million women experiencing symptoms of this condition, yet around half of these women have no idea they have PCOS!

For a long time, the root cause to PCOS was believed to be a result of an overproduction of male hormones, called androgens. In more recent years, research has confirmed PCOS is in fact a condition resulting from desensitization to insulin production within the body, which in turn leads to increased production of these androgenic hormones.

In addition, studies on PCOS have revealed those with the condition are at a greater risk for heart disease and diabetes (type 2). Heart disease is the leading killer in women. Even in cases where women were young and fit, yet had PCOS, it was five times more likely they would still develop these risks if they did not seek treatment for their conditions.