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Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic condition. Although global prevalence rates vary due to factors such as differing diagnostic criteria and substantial geographic differences in medical care access and health education, this disorder has been estimated to affect 4 to 20% of reproductive-age women worldwide.¹ In the United States, prevalence is estimated up to 12%,² and recent reporting indicates the economic burden of PCOS is approximately $8 billion annually in 2020 USD when combining costs for both  immediate and long-term health complications.³

Despite being a common hormone disorder in women of reproductive age, the variation in PCOS phenotypes and symptomatology often leads to a delayed or underdiagnosis.^4,5 Reports also indicate that the clinical phenotype of PCOS shows a wide variation depending on a patient’s race and ethnicity.^1,6 In addition, some patients who receive a PCOS diagnosis report a high level of dissatisfaction with their health care.⁷ And unfortunately, not all patients experiencing PCOS symptoms seek care, potentially unaware that treatments, including lifestyle approaches, may provide some symptom relief.^5,8,9

PCOS Health Risks

PCOS has been associated with chronic inflammation,^10,11 insulin resistance,¹² and an overall increase in health risks. Common comorbidities include subfertility and infertility, hypertension, type 2 diabetes, depression, anxiety, sleep apnea, menstrual irregularities, and more.^5,12 A 2020 systematic review of 23 cohort studies found that in addition to an increased risk of hypertension and type 2 diabetes, women with PCOS also showed higher serum concentrations of total cholesterol, lower serum concentrations of high-density lipoprotein-C, and increased risks of non-fatal cerebrovascular disease events compared to women without PCOS.¹³ Women with PCOS are also more likely to have anxiety or depression.¹⁴ Additional studies even suggest an association between PCOS and metabolic syndrome in adolescents, with those adolescents with PCOS showing three times greater odds of having metabolic syndrome compared to controls.¹⁵

Diagnosis & Treatment Approaches

Recognizing certain health patterns such as insulin resistance, chronic inflammation, and metabolic disorders as well as PCOS risk factors¹⁶ such as obesity, environmental pollutants,¹⁷ and gut dysbiosis^18,19 may help with early PCOS diagnosis. Functional medicine offers effective tools to help organize a patient’s complete health story and implement personalized interventions.

Recent clinical trials continue to show that lifestyle modifications, including healthy diets, appropriate nutraceuticals, exercise, and mind-body therapies help patients with PCOS alleviate some symptoms and may help reduce ongoing health risks by improving metabolic profiles.^5,8,9,20-24 A recent Cochrane review also concluded that lifestyle interventions may improve androgen levels and reduce weight and BMI in women with PCOS.²⁵ A 2021 systematic review that included 11 clinical trials found that both aerobic and resistance training interventions for women with PCOS demonstrated significant improvements in depression and anxiety symptoms in addition to positive improvements in their health-related quality of life.²⁶

Other interventions and approaches such as traditional Chinese medicine and acupuncture continue to show promise as adjunctive treatments for PCOS.²⁷ While further large-scale trials are still needed, a 2020 meta-analysis of 10 randomized controlled trials (n=737 patients with PCOS) showed significant decreases in BMI and waist to hip ratio in the acupuncture treatment groups compared to controls, in addition to significant improvements in fasting plasma glucose, insulin sensitivity, and triglyceride measurements.²⁸

Conclusion

Accurate diagnosis followed by multimodal interventions may not only help the immediate concerns of patients with PCOS but may also help improve their overall health in the long-term. Learn more about the complexities of hormonal balance and creating effective and personalized treatment approaches for your patients at IFM’s Hormone Advanced Practice Module (APM).

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References

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2. PCOS (polycystic ovary syndrome) and diabetes. Centers for Disease Control and Prevention. Reviewed December 30, 2022. Accessed April 1, 2024. https://www.cdc.gov/diabetes/basics/pcos.html#:~:text=PCOS%20is%20one%20of%20the,US%20women%20of%20reproductive%20age
3. Riestenberg C, Jagasia A, Markovic D, Buyalos RP, Azziz R. Health care-related economic burden of polycystic ovary syndrome in the United States: pregnancy-related and long-term health consequences. J Clin Endocrinol Metab. 2022;107(2):575-585. doi:1210/clinem/dgab613
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