PCOS: Maybe She’s Born With It

      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. 

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      Gestational diabetes and insulin resistance could also be a potential risk factor for PCOS pregnancies. Not only are mothers with PCOS more likely to develop gestational diabetes (2) (some resources suggest getting tested even earlier than 24-28 wks because of this), pregnancy-induced hypertension, pre-eclampsia, preterm labor, and cesarean sections rates are higher in mothers with polycystic ovaries (3).
From an environmental standpoint, we also must consider external influences on fetal epigenetics. PCE (perchloroethylene, commonly found in adhesives, household cleaners and dry cleaned clothing) and bisphenol A (plastics) are two chemicals that when exposed to can lead to PCOS not just for a single infant, but for future generations (4). 

Can PCOS Come from Fathers?
      Research studies on whether PCOS could be passed from fathers to their babies have been conducted, and have found that there may be a connection through genetics, but not in the in-utero environment. 
The studies have found that male pattern baldness, metabolic issues, and obesity in fathers can influence if their offspring develop PCOS (5). The studies also found that even though male infants do not develop PCOS, they could essentially be affected by the exposure to the excess androgen while in the in-utero environment. Essentially, a male baby could be a future contributor to PCOS when they have children.

Testing AMH as a predictor for PCOS 
      AMH (Anti-Mullerian-Hormone) is a hormone found in women that seems to be a reliable predictor of certain hormonal problems, like PCOS. PCOS research has found that AMH levels in affected women tended to be higher throughout their pregnancy. However, for women with a higher BMI (body mass index), AMH was not always a good indicator of PCOS. Your naturopath many chose to order your AMH when assessing fertility status, in cases of multiple miscarriages, or if classic markers for PCOS diagnosis seem unclear. It may also be used as a helpful indicator of egg quality in patients without PCOS.

Reducing Risks of PCOS
      While women cannot control the genetic factors contributing to their in-utero environment, there are some simple strategies they can try to reduce risks of higher androgens/insulin during pregnancy and resultant impacts on their children. 

• Exercise and Eat a Healthy Diet: It is important to be active and eat a healthy diet. Doing so will help control blood sugar levels, prevent insulin resistance, and reduce risks of developing gestational diabetes during pregnancy. It’s also important to not over-exercise, as excessive exercise may increase over androgen production.
• Maintain Your Weight: Maintaining a healthy BMI helps control androgen and insulin levels. 
• Reduce Carbohydrates: Insulin levels are increased in people with a high-carbohydrate diet. 

      For further information about PCOS, reducing risks, and what you can do to support a healthy pregnancy, please feel free to schedule an appointment with Toronto Naturopathic Doctor, Dr. Courtney Holmberg by calling 647-351-7282 today! 


References: 

1. Xu, N., Kwon, S., Abbott, D. H., Geller, D. H., Dumesic, D. A., Azziz, R., … Goodarzi, M. O. (2011). Epigenetic Mechanism Underlying the Development of Polycystic Ovary Syndrome (PCOS)-Like Phenotypes in Prenatally Androgenized Rhesus Monkeys. PLoS ONE, 6(11), e27286.
2. Joan C. Lo, Seth L. Feigenbaum, Gabriel J. Escobar, Jingrong Yang, Yvonne M. Crites, Assiamira Ferrara. Increased Prevalence of Gestational Diabetes Mellitus Among Women with Diagnosed Polycystic Ovary Syndrome. Diabetes Care Aug 2006, 29 (8) 1915-1917; DOI: 10.2337/dc06-0877
3. Rose McDonnell, Roger J Hart. Pregnancy-related outcomes for women with polycystic ovary syndrome. Womens Health (Lond). 2017 Dec;13(3):89-97. doi: 10.1177/1745505717731971
4. Chaoba Kshetrimayum, Anupama Sharma, Vineet Vashistha Mishra, and Sunil Kumar. Polycystic ovarian syndrome: Environmental/occupational, lifestyle factors; an overview. J Turk Ger Gynecol Assoc. 2019 Dec; 20(4): 255–263. doi: 10.4274/jtgga.galenos.2019.2018.0142
5. Berg, T., Silveira, M. A., & Moenter, S. M. (2018). Prepubertal Development of GABAergic Transmission to Gonadotropin-Releasing Hormone (GnRH) Neurons and Postsynaptic Response Are Altered by Prenatal Androgenization. The Journal of Neuroscience, 38(9), 2283–2293.