PCO: What are polycystic ovaries?

Having very recently been diagnosed with PCO, and having had to tolerate the entire lack of information available online regarding the condition (it's all about PCOS instead), I've decided to dedicate a post to its discussion. It is very relevant to the Primal lifestyle, particularly the lower-carb versions of it, as practiced by myself and countless others.

For this post, I will be drawing on the published pieces of information regarding PCO as written by my doctor (Dr. Graeme Edwards, Collins Place Medical Clinic), as well as one by the ultrasound specialist I consulted (at Monash Ultrasound for Women).

What are polycystic ovaries (PCO)?

PCO are ovaries which contain an excessive number of primordial follicles. (Despite the name, there are no cysts, so the condition should really be called polyfollicular ovaries). These follicles are tiny fluid-filled sacs which contain the eggs. An ultrasounds of the ovaries during the reproductive years usually shows, on average, 5-12 follicles in each ovary. When more than 12-15 follicles are present, the ovary is called 'polycystic'. This itself does not cause adverse symptoms and should not be confused with PCOS.

Normal: less than or equal to 12 follicles
Borderline: 13-15 follicles
Mild: 16-30 follicles
Moderate: 30-50 follicles
Severe: more than 50 follicles, as a general guide - these women usually have Polycystic Ovarian Syndrome (PCOS), associated with infertility, increased facial hair, and a disturbance of hormone levels.

What is the cause of polycystic ovaries?

In a normal menstrual cycle there are usually 5-10 follicles at the beginning of the cycle. Later in the cycle usually around day 14, one follicle gets bigger (leading follicle) and shortly thereafter ovulation takes place with release of the egg. The remaining eggs regress and disappear before the next cycle. These events typically occur every 4 weeks and result in the monthly menstrual bleed. With polycystic ovaries, this cyclical sequence of events does not take place. Instead, no leading egg develops and there is a build up of small immature follicles with successive cycles. Despite extensive research no single cause explains this variation from normal.

PCO is very common - it is estimated that 1 in 3 women have them. For most, this does not cause a problem and is often left undiagnosed unless they have difficulties becoming pregnant. Even in this case, many women achieve ovulation and therefore pregnancy with minimal drug involvement.

PCO is a genetic condition, and tends to develop during your 20's. PCOS usually develops much sooner, with symptoms appearing when a girl is around 16.

PCO causes a mild hormone imbalance which may cause one or more of the following:

1. Acne
2. Irregular, infrequent periods
3. Slightly reduced fertility
4. Oily skin
5. Mild hair excess on face, nipples or pubic area
6. Some degree of resistance to your body's natural insulin

Treatment:

Exercise - this burns up sugar and helps lower the strain on insulin which helps your ovaries.

Keep weight low - increased weight increases resistance to insulin in everyone.

Low carbohydrate, low GI diet - all carbs except fibre and metabolised to sugar, so low carbs lowers the strain on insulin which helps your ovaries.

Oral contraceptive pill - this treats the hormone disturbance and stops the ovaries trying to make more follicles.

If trying to become pregnant, simple agents like Metformin (which decreases your resistance to insulin) or the fertility drug Clomephene may be needed.

This image is a mock-up of what severe polycystic ovaries look like, as well as an ultrasound - much worse than mine!

But what does this mean for our beloved blogger?
Aw, you guys, I'm touched by your compassion. :)

Well, I only discovered that something was not quite right when, thanks to my rapid weight loss in January, my cycle was thrown out, resulting in multiple periods, and I stopped taking Yasmin (my BCP) to allow my system to sort itself out again. However, after five months without a period, I consulted my awesome doctor and he sent me for an ultrasound and a blood test (for my hormone levels). My blood work returns showing perfectly normal hormone levels, but the ultrasound showed 12 follicles on one ovary, and 16 on the other (borderline-mild PCO). No hairy nipples, just in case you were wondering. (See "Edit:" section below for more thoughts on this.)

I would love to know whether or not I do have a resistance to my body's natural insulin. My weight issues could easily be chalked up to this, but I am more than aware that the sheer amount of garbage I used to shove into my cake-hole (including cake) without putting on weight suggests otherwise. It took a lot of work to put on that weight, and I didn't have much trouble getting rid of it the few times I actively watched what I ate or exercised. I just never stuck with either program long term. Even eating 'healthfully', I was watching the fat intake rather than the calories/carbs, and we all know where that ends up... However, if I do in fact have mild insulin resistance, my doctor claims that I will never achieve any real sensitivity to insulin thanks to PCO (without using Metformin, but I don't believe in taking drugs unless absolutely necessary), so I'm grateful that I thoroughly enjoy living the Primal lifestyle, and that I'm not in the trap of using low-carb as a temporary fix-it bant. At the same time, I would hate for my nipples to suddenly sprout shrubbery, so I'm even less tempted to every cheat and/or return to my old eating habits. However, from talking to people who have overcome the symptoms of PCOS (one of which is PCO) through treating the hormone issue, I kind of wish my condition was that easily remedied.

As happy as I am sans period (such a relief; there's a reason it's called AMENorrhea!), I've been instructed to resume taking my BCP to control the amount of follicles I produce (i.e. none now). I was intending to do so anyway, just waiting for a period so I could just back on. Now that I know that I rarely ovulate, if ever, it's a bit of an annoyance to have to go through menstruation unnecessarily!

I hope this post helps others out there who have PCO or recognise the symptoms even if undiagnosed, and I'm glad that this condition is being thoroughly researched all over the world, including studies here in Melbourne. It seems bizarre to me that a condition which so obviously can affect fertility can be present in 1/3 of the female population. It's impossible for us to know whether this is a result of diet or lifestyle, since it has been impossible to diagnose until recently, but logic tells me it can't simply be a flaw in the human design... The claim about PCO being inherited through genetics also raises my eyebrow, since its commonness and its symptoms tend to clash with that concept. Here's hoping that the mystery is solved soon - more for those with PCOS than for folks like me who miss a few periods.

Edit: I wanted to add a current theory I have developed based on my own experiences, in case others have had a similar experience, or can disprove my theory.

I began eliminating sugars, grains and starches on the 1st of January this year, and lost weight rapidly, from Day 1. I had just finished my period, and was therefore taking my pill as usual. However, seven days into my diet (3kg down, mostly water weight) I began to menstruate, and it continued for 14 straight days. (In the meantime I lost another 2kg.) I continued to take my pill, and after a week without my period, my pill cycle was up, and another period was triggered. It was at this point that I decided to take a break from the pill to allow my hormones to sort themselves out.

So here's my theory: let's say than the hormones (estrogen & progesterone, etc) produced by my body is hX and the hormones supplied by my pill is hY. In the first week of January, I began losing weight, and as a result my hX levels were disrupted/lowered. As a result, my body thought I was no longer pregnant (as Yasmin told it I was) and shed the uterine lining. Meanwhile, hY was still doing its job, so the lining was replaced, but then shed again once hY was no longer being supplied (sugar pill week). I stopped taking hY, but hX has not 'normalised' in order to trigger a normal cycle. This may sort itself out in time, with or without the reintroduction of hY.

Here's the other theory: at some point during the last three years (taking hY), my natural levels of hX screwed up (possibly due to my diet and the eventual development of insulin resistance - though actually my diet in the past five years has been much lower in carbs and GI than it was in prior years) and my cycle was only functioning correctly thanks to hY.

My situation could well be drawing on both theories, but I'd love to hear from anyone who had strange menstrual irregularity when initially losing weight, whilst also taking a BCP. A long shot, but hey :)