PCOS & Fertility Awareness: The Theories

(A previous blog post talks about the background of PCOS and a future blog post talks about the options with PCOS.)

PCOS affects about 1 in 10 women in the US. And some would say that there are actually 5 different “types” of PCOS and therefore it’s important to have tests done to find out “where” the PCOS is starting. Is it starting in the brain? in the pancreas? in the adrenals? in the ovaries?

  1. Traditional PCOS: anovulatory, increased androgens, no insulin resistance
  2. Endocrine Syndrome X: anovulatory, increased androgens, insulin resistance or type 2 diabetes
  3. Non-traditional PCOS: anovulatory, normal androgens, obese, insulin resistant or type 2 diabetes
  4. Non-traditional PCOS: ovulatory, increased androgens, mild insulin resistance
  5. Idiopathic Hirsutism: ovulatory, increased androgens, no insulin resistance

Lara Briden, an Evolutionary Biologist and Naturopath Doctor, posits these 4 types of PCOS:

  1. Insulin-Resistant PCOS
  2. Post-Pill (or Pill-induced) PCOS
  3. Inflammatory PCOS
  4. Hidden-cause PCOS (like thyroid disease, a vegetarian diet leading to deficiencies, artificial sweeteners, and others)

And what causes PCOS? From my understanding, there are 3 main theories as to the causes of PCOS:

  1.  Genetics... thanks Mom. And each time I hear that something is “genetic,” I like to take a moment to consider if there’s a possibility that a repeating pattern is being learned and absorbed by the new generation via epigenetics... just a thought... take it or leave it.
  2.  Hormonal Imbalance... there’s miscommunication happening between the hypothalamus, pituitary gland, and ovaries (called the hypothalamic-pituitary-ovarian axis... and sometimes the miscommunication is between the hypothalamus, pituitary gland, and adrenal glands called the hypothalamic-pituitary-adrenal axis). They use hormones to talk to each other and for some reason with PCOS they're not communicating in the ideal amounts like they're supposed to do.
  3. Insulin Resistance... imbalances with insulin and androgens (like testosterone, DHEAS, etc.). One of insulin's jobs is that it can cause the liver to decrease making a molecule called sex-hormone binding globulin (SHBG). Therefore, if there’s too much insulin, it may cause too little SHBG, and too little SHBG may result in excess free testosterone.

Now there's debate about Hormonal Imbalance (#2) being the side-effect of the actual problem of Insulin Resistance (#3)... or... that Insulin Resistance (#3) being the side-effect of the actual problem of Hormonal Imbalance (#2). There are lots of experts trying to figure this one out so thankfully we don't have to! 

As a Holistic Reproductive Health Practitioner, I educate my clients to follow the best plan for them... and that might be to go down a (sometimes long) path of diagnosis with their health care provider so that the underlying problem is ultimately addressed. (There's more about holistic options here.)

When a woman with PCOS and/or irregular cycles charts them using the Fertility Awareness Method, then she has a better idea of what's going on with her body and reproductive health. She can give definitive answers to questions about how long her cycle is, how many days her periods last, what each period is like (especially if they differ), if she's ovulating or not, and if any interventions are making changes. (This is called using the menstrual cycle as a vital sign!) And if blood tests need to be done at certain points in her cycle (like 1 week after ovulation), she'll know if it should be around Day 21 like "everyone else" or (say) Day 63 if she ovulated later and will have a very long cycle.

Whether a woman with PCOS wants to avoid pregnancy, achieve pregnancy, or simply know when to expect her period, charting her cycle can give lots of really good information and make the process a little less frustrating.

“Just got my period today... day 53. *sigh* My whole life is just spent waiting for my period.”
— Gigi*, Pennsylvania, USA (*not her real name)

Don't forget to check out my posts about the background of PCOS and the options with PCOS.

Colleen Flowers Fertility Awareness Online

Colleen Flowers is a Holistic Reproductive Health Practitioner who loves teaching individuals and couples about their bodies from a natural and holistic perspective using the Fertility Awareness Method... to avoid pregnancy naturally, to increase their chances of conceiving, and to better understand their bodies! See what others have to say or contact her and subscribe to her newsletter. Like what you see? Then book an online consult with her and/or purchase a package for more in-depth coaching.

PCOS & Fertility Awareness: The Background

Many sources claim that women with irregular cycles shouldn't use a Fertility Awareness Method to chart their cycle, which is true if they’re using a statistical method like the Standard Days Method. But if a woman with irregular cycles uses an observational method like the Sympto-Thermal Method of Fertility Awareness, she’ll still be able to answer the question at the end of every day, “Am I fertile? Yes or No?” (Here’s more about statistical methods and observational methods of Fertility Awareness.)

Even as someone who has studied reproductive health quite a bit, I think trying to completely understand PCOS can be a little confusing (and that’s because the health care community still doesn’t completely understand it).

Here’s a YouTube video to help explain it. Feel free to start at 2:20 or 3:05:

This 3D medical animation describes PCOS, polycystic ovary (ovarian) syndrome. The animation begins with the normal anatomy and physiology of the ovaries, including the effects of certain hormones on the ovaries during the menstrual cycle.

Here’s Wikipedia’s explanation and here are the many terms for PCOS:

  • PCOS - polycystic ovarian (ovary) syndrome
  • PCO - polycystic ovaries
  • PCOD - polycystic ovarian disease
  • AAE - anovulatory androgen excess
  • HA - hyperandrogenic anovulation
  • Stein-Leventhal syndrome

PCOS usually refers to the “syndrome” of polycystic ovaries. Syndrome just means that this is a condition distinguished by a set of related symptoms. The most common include:

  • Irregular menstrual periods (ie, longer than 35 days, absent for 4 months, etc.)
  • Weight issues (often around the waist)
  • Excess or unwanted body or facial hair (hirsutism)
  • Thinning hair on the head
  • Skin problems (skin tags, darkening skin and acne)
  • Infertility

PCO usually means that the ovaries have multiple cysts on them but other symptoms listed above may be absent.

PCOD is the term used by Dr. Thomas Hilgers in his book The NaProTECHNOLOGY Revolution: Unleashing the Power in a Woman’s Cycle. He suggests various treatments such as using progesterone supplementation, medications, and surgery. Here is a list of NaPro providers: www.FertilityCare.org (And just so you know, the book and these providers come from a Catholic perspective.)

AAE is the term used by Dr. Jerilynn Prior who founded the Centre for Menstrual Cycle and Ovulation Research (CeMCOR). She has a lot of good information on her website about AAE (the term she uses for PCOS) and progesterone supplementation.

I've written other blog posts that talk about the theories surrounding PCOS and the options with PCOS.

Colleen Flowers PCOS Fertility Awareness Online

Colleen Flowers is a Holistic Reproductive Health Practitioner who loves teaching individuals and couples about their bodies from a natural and holistic perspective using the Fertility Awareness Method... to avoid pregnancy naturally, to increase their chances of conceiving, and to better understand their bodies! See what others have to say or contact her and subscribe to her newsletter. Like what you see? Then book an online consult with her and/or purchase a package for more in-depth coaching.