So, you’ve been diagnosed with PCOS, now what?
This is a picture I often see in my clinic: A young women who has stopped getting her period comes in with a diagnosis of PCOS. But does she really have PCOS? Or is it something else?
What is PCOS?
PCOS or polycystic ovarian syndrome is a collection of hormonal symptoms that present in a number of different ways such as reduced fertility, acne, excessive hair and obesity. Women with missing or irregular periods are often diagnosed with PCOS. If this is you, then it’s worth doing some investigation to make sure your diagnosis, and treatment, is right. There are a number of reasons why your period may have disappeared. And all is not lost. With the right approach and a clear diagnosis you can get your period back.
To be diagnosed with PCOS GPs in Australia need to follow strict guidelines from The Rotterdam Criteria. This means a number of different tests need to be carried out for the diagnosis to be 100% certain. And too commonly these are not being done.
To be diagnosed as having PCOS in Australia women need to have two of the following symptoms from the Rotterdam criteria:
- Oligo-ovulation or anovulation which means lack of, or infrequent ovulation
- Clinical or biochemical hyperandrogegism, this means the woman must present with clear sign androgen excess in blood tests or physical signs such as excessive body hair, acne or hair loss.
- The presence of polycystic ovaries on an ultrasound
I commonly see women at my clinic who have been diagnosed with PCOS from ultrasound alone – and this just is not right.
So here is my checklist of what you should do once you get your PCOS diagnosis.
STEP ONE: Check Your Pathology
The first thing you need to do to get a clear diagnosis of PCOS is ask your doctor for some blood tests. This would include screening for fasting insulin, androgens including testosterone, and other hormones such as sex hormone binding globulin (SHBG), luteinising hormone (LH), follicle stimulating hormone (FSH), oestrogen and progesterone.
These tests should give us a clear picture of whether you have classic insulin resistance polycystic ovarian syndrome.
On these tests we will commonly seen low SHBG, and raised testosterone and androgens. Depending on where you are in your cycle the oestrogen and progesterone, LH and FSH will provide answers around what is happening to your ovulation as well.
STEP TWO: Ask yourself these questions
As well as getting pathology it is important to ask the following questions because there are number of other causes to be ruled out for women with amenorrhea ( lack of periods) or oligomenorrhea (in infrequent periods).
1. Have you been on Hormonal birth control?
You cannot diagnose PCOS for someone who is on hormonal birth control.
What’s more it can take a while for women who have stopped birth control to regulate their cycle.
Sometimes I work with women for over a year to get a regular period to return. In this case. Blood tests commonly show an inverse of the pathology for PCOS. So you may have high SHBG, low testosterone but your insulin may still be high depending on your diet and the impact that the pill has had on you.
I advise waiting until a few months after you have stopped the pill before going through a thorough investigation for PCOS. In the meantime working with a naturopath to help balance your hormones naturally will see the return of your period sooner rather than later.
2. Are you eating enough?
This is also a really important question to ask yourself if your periods are irregular, or if they have disappeared all together. We call this hypothalamic amenorrhea (HA), And it is very common, particularly with women who are exercising a lot, counting calories and dieting – and especially those avoiding carbohydrates all together. The ovaries of these women will look polycystic. The danger with these women being diagnosed with PCOS, is that the advice from the GP will be to lose weight and diet – potentially causing more damage to their ovaries and their ability to ovulate.
STEP THREE: Patience
Doctors commonly prescribe the pill to regulate menstrual cycles. It is important to realise that the Pill will not regulate your cycle as the Pill commonly stops women from ovulating which is the very thing we need your body to do naturally.
STEP FOUR: Eat Happy
Eat happy and follow the guidelines of your nutritionist or naturopath. Different causes of amenorrhea deserve different treatment plans, so there isn’t necessarily a one-size-fits-all approach to diet for women with no periods. However we know that avoiding lots of processed sugar, processed foods, junk food, excessive alcohol and sometimes dairy really does improve treatment outcomes.
So if you are confused by your diagnosis of PCOS and you’re still waiting for your period return please speak to New Leaf – we are here to help and listen to your story.
I am a huge advocate of the woman’s right to choose how their body is treated, and to improve your quality of life and promote Women’s Health. We need a our hormones and sometimes they are elusive.
Hannah Boyd is a nutritionist and herbal medicine practitioner in Sydney’s Inner West. She specialises in wholefood eating, mental health, plant-based diets and hormone balancing. Book an appointment with her today to gain the tools you need to develop a healthy, balanced approach to health.