Have you or someone you know been diagnosed with Poly-Cystic Ovarian Syndrome or PCOS? Perhaps what you don't know is that there can be differing causes that can be driving your condition. Getting to the root cause of your PCOS can be a game changer in being able to resolve the issues PCOS can cause such as - infertility, weight gain, insulin resistance, irregular periods, hair loss and excess hair growth.
In this article you will learn:
What is PCOS?
What are the signs and symptoms of PCOS?
Treatment options for PCOS.
Comprehensive Hormone Testing can help personalise PCOS treatment plans.
What is the DUTCH test?
How can the DUTCH test help?
Androgens and their metabolites
Oestrogens and their metabolites
Personalised treatment plans can help women with PCOS.
How to order a DUTCH test and what happens with the results?
READ THE FULL ARTICLE BELOW
AUTHOR: Tonia Willson (Naturopath & Medical Herbalist)
What is PCOS?
PCOS is a hormonal disorder that is common among women of reproductive age. PCOS affects a significant number of women in New Zealand (between 6- 12%). Because it often results in infrequent or absent ovulation, PCOS can be a real challenge to women trying to conceive, and can result in a myriad of other symptoms that can be challenging for many women.
On tests for patients with PCOS, we often see imbalances in:
Hormones (elevated androgens like DHEAS and testosterone, and low SHBG (sex hormone binding globulin))
Blood sugar (elevated fasting glucose, HbA1c, fasting insulin)
Brain-ovarian signalling (increased LH/FSH ratio)
Inflammation (elevated CRP)
Fats (imbalance of cholesterol – low HDL and elevated LDL and triglycerides)
Ovarian function (polycystic ovarian morphology (PCOM) on ultrasound, elevated Anti-Mullerian Hormones) Anti-Mullein Hormone Test
These imbalances can increase the risk for developing type 2 diabetes, cardiovascular disease, endometrial and breast cancers, and infertility. Therefore, besides improving symptoms, regulating cycles, and improving fertility, naturopathic PCOS treatment goals will also incorporate treatment strategies that are based on minimising these risks.
What are the signs & symptoms of PCOS?
PCOS can be different for everyone with the most common symptoms being:
Irregular menstrual cycles: your periods are infrequent (more common), frequent, unpredictable, or absent
Periods that are very heavy or very light
New or excess hair growth on the face and body
Hair thinning on the head
Skin issues: oily skin, acne, dark patches on the back of the neck
Weight gain, especially around the abdomen
Difficulty getting pregnant
Depression, anxiety, mood swings, irritability
Treatment options for PCOS
Conventional treatments for PCOS often include metformin to regulate blood sugar, spironolactone to decrease androgens and related symptoms, and/or birth control pills (or cyclic progestin therapy, mini-pill or progestin IUD) to reduce the risk of endometrial hyperplasia (an increase in the reproduction rate of the endometrium cells).
PCOS-related infertility can be successfully treated in many women by utilising naturopathic and functional medicine approaches. These approaches can be personalised to suit the individual, and are very effective with the help of comprehensive hormone testing.
Comprehensive hormone testing can help personalise PCOS treatment plans
With so many available treatment options, it’s difficult to know which route to take. This is where comprehensive hormone testing can make the difference between a routine therapy and a personalised treatment plan.
The Good Health Room offers hormone testing panels within the DUTCH hormone tests, that can help your naturopath to pinpoint which exact treatment will be beneficial for you, depending on what is showing up in the DUTCH Hormone test, and whether it is being driven by the adrenals or by an imbalance in hormones or both.
As a naturopath, my strategy for treating PCOS is to always treat the patient, not the PCOS!
What is the DUTCH Test?
The DUTCH test stands for Dried Urine Test for Comprehensive Hormones and involves collection of a small amount of urine on filtered paper four times a day. The DUTCH test measures hormone metabolites from the dried urine samples. The hormones measured in the test include:
This test also measures cortisol and cortisone rhythms and levels, and oestrogen metabolism pathways, to assess how well the liver is detoxifying oestrogens and your methylation capabilities.
Please click here for more detailed information on the DUTCH Test.
How can the DUTCH test help?
The DUTCH test is beneficial for those suffering with PCOS, but also for women with infertility, fibroids, PMS, irregular periods, painful periods, endometriosis, anxiety and moodiness. It provides a comprehensive picture of how adrenal and reproductive hormone imbalances may be contributing to these problems.
Specifically it will show:
ANDROGENS AND THEIR METABOLITES
The DUTCH Complete and DUTCH Plus tests offer a comprehensive view of androgen levels.
In PCOS, we will frequently see high androgens and a metabolism preference for the more androgenic, alpha pathway. When a woman prefers the alpha pathway e.g. 5a, she tends to push her androgens into more potent forms like 5a-DHT which can lead to symptoms of elevated androgens.
Your naturopath will help to regulate these underlying causes using herbs, nutrients and other minerals.
Diagram 1: Precision Analytical data showing DUTCH test results of various androgenic pathways and ratios of their alpha (a) and beta (b) metabolites.
OESTROGENS AND THEIR METABOLITES
The DUTCH Test also assesses oestrogens (E1, E2 and E3) and their downstream metabolites. We know that in some women with PCOS, aromatase (an enzyme) is genetically down regulated, resulting in less androgen-to-oestrogen conversion.
Whatever the results for oestrogen levels (high or low), your naturopath will have a range of products (herbs, vitamins or minerals) that will help to increase activity, regulate activity or clear excess oestrogen to improve long-term outcomes.
OESTROGENS / PROGESTERONE BALANCE
Your Naturopath will also see the balance between your oestrogen and progesterone levels on the DUTCH Test.
Often in women with PCOS, this will be seen as a low progesterone to oestrogen ratio. This can be associated with the fact that it is normal for women with PCOS to ovulate very infrequently or not at all, and as a result can go a long time without exposure to progesterone.
This reduced exposure to progesterone overtime can increase risk for endometrial hyperplasia and cancer and breast cancer. If a woman with PCOS is struggling to ovulate, or if her progesterone levels are low, your naturopath might consider:
Regulating blood sugars with specific herbs and nutrients
Modulating Luteinising Hormone (LH)
The DUTCH Test may also help to understand if the adrenals are contributing to the high androgen picture. Often the elevated androgens seen in PCOS are due to overproduction by the ovaries in response to insulin resistance and dysregulated brain-ovarian signalling. However, the adrenals can also overproduce androgens!
If high-free cortisol and cortisone levels (stress response hormones) are seen, these can indicate your adrenal glands are contributing to the high androgens.
Your naturopath might consider adrenal support with stress reduction, B vitamins, vitamin C, and calming herbs. However these treatment plans will be considered and personalised depending on what is going on for YOU.
Personalised treatment plans can help women with PCOS
These are just a few examples of how the DUTCH Test can aid in creating more personalised treatment plans for women with PCOS.
With the help of comprehensive hormone testing, women with PCOS can gain access to better support which can increase their chances of becoming pregnant and improve their long-term hormone and general health.
How to order the test
For new clients, an initial consultation will need to be conducted before proceeding with the DUTCH Test. The appropriate test will then be recommended for you.
AFTERPAY can be used with your DUTCH test payment.
What happens with the results?
The Good Health Room is notified once the test results are ready (which can take up to 4 weeks). You will then be emailed your results and contacted to arrange an appointment to review the results.
The DUTCH test results are incredibly detailed, consisting of 19 pages of technical data that are specific to you and you alone.
Your test results (and information collected from your initial consultation) are analysed in detail by your naturopath, who will look at any imbalances that may be highlighted to effectively determine a personalised treatment plan tailored to your specific needs. They will help you understand how the results relate to your health and what they mean for you.
Treatment may include the use of supplementation and or herbs along with nutritional recommendations, lifestyle adjustments, sleep support, and alterations to exercise and stress management.
Further recommendations for testing may also be highlighted if required.
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