Hashimoto’s disease and PCOS

24 September 2021

Hashimoto’s disease and PCOS

dr Tadeusz Oleszczuk

Hashimoto’s disease and PCOS

Hashimoto’s disease loves the company of other diseases. One of them is polycystic ovary syndrome (PCOS). Do you want to find out what the symptoms of this disease are and how to deal with it? Read the article written by Dr. Tadeusz Oleszczuk – a specialist gynaecologist-obstetrician.

 

What is PCOS? 

PCOS (polycystic ovary syndrome) has its name  because in about half of the cases the ultrasound image shows more than 20 follicles with a diameter of a few millimeters. However, the most important criterion for diagnosis is not the ultrasound image, but the result of tests of hormone levels in blood serum. The term – syndrome – refers to many features and symptoms. Each follicle in its envelope has cells that produce testosterone. If, under the influence of the pituitary stimulation, the ratio of LH to FSH is disturbed, many small follicles may be formed. Consequently, the pool of testosterone increases. Testosterone exists in a form bound to proteins transporting hormones – SHBG. However, its action only starts in the free form. Therefore, when assessing its levels, it is worth checking the free form, not just the total form (bound to SHBG protein)

Often in hypothyroidism (even when there is inflammation of the thyroid gland), SHBG levels are very low. When this happens, a lot of the free form of testosterone appears . As a result, the effects of testosterone are revealed. This is often observed during puberty, but this turbulent state of fine-tuning of the endocrine system usually calms down. On it own. This lasts from one to three years. During this time from the appearance of the first period, the hormonal cycle reaches its regularity and rhythm. The only constant period, lasting two weeks, is that from ovulation to the onset of monthly bleeding. This means that if the cycle always lasts 34 days. The probability of ovulation occurs on the 20th day of the cycle. Most often, however, the cycle lasts about 28 days, so we assume that ovulation was on the 14th day of the cycle. 

What are the symptoms of PCOS?

Unfortunately, excessive and prolonged high levels of free testosterone can lead to the appearance of symptoms such as acne, hirsutism (excessive hair growth), or on the contrary – baldness. All of these symptoms can vary in severity. Much depends on individual characteristics. Half of the testosterone pool is synthesized by the ovaries, and the other half of the pool is produced by metabolism in the subcutaneous tissue. The beginning of this production takes place in the adrenal glands. Most often, however, if symptoms of excess testosterone appear, it is found to come from ovarian production. A small percentage of disorders have their origin in an adrenal nodule.

Hormone metabolism is a system of interconnected vessels. If a disorder occurs in one place, symptoms can appear in distant tissues. This is related to the metabolism of prolactin, glucose, TSH. All this is influenced by our daily activity, diet, and sleep quality. This works both ways – hormones affect daily life, and daily activity affects hormone production. It’s worth realizing that we have influence in at least one direction. 

PCOS is often combined with abnormal prolactin secretion. This situation in turn is associated with hypothyroidism. This also affects glucose turnover. Individuals complain that they have paroxysmal cravings for ‘something sweet’. Another symptom of high prolactin is a drop in blood pressure. This leads to impaired blood circulation and the sensation of ‘cold hands, legs’. Hypothyroidism, thyroiditis, hyperandrogenism (high testosterone levels), hyperprolactinemia (high prolactin levels) all can accompany PCOS. So the individual elements will determine the symptoms, which direction the metabolism will go. Thus, some women have problems with weight gain in subsequent years. Lack of any response to standard management such as dietary change, physical activity. It is only when the hormonal imbalance is compensated that a noticeable improvement is seen. 

 

Treatment of PCOS

Partial improvement can be achieved by taking hormonal contraception, but only for a period of several months. Taking certain drugs shuts down the ovaries and their hormonal production (all because synthetic hormones are already taken). So testosterone production in the ovaries decreases, and they decrease in volume and appearance. They go from being long and filled with numerous peripheral follicles to being about 3 x 2 cm with a normal follicular apparatus. Also, often (if there are no other disorders) after stopping contraception within the first few months ovulation and the possibility of pregnancy can occur. Therefore, this method is sometimes used. 

However, if PCOS is accompanied by excessive prolactin levels, ovarian blockage can occur. The follicles do not burst, there are more follicles formed, and there is no ovulation. One factor that raises prolactin levels is stress. So theoretically, everything is in the tests and seems to be normal, but pregnancy does not appear. Sometimes even though insemination (insertion of a sperm sample into the uterus), stimulation, and assisted reproduction methods are used, pregnancy does not occur. The mechanism is self-perpetuating, because the more a woman cares, the more she cannot get pregnant. In this situation, the calming of prolactin ejections that accompanies PCOS can lead to spontaneous pregnancy within a few months. 

These situations can be observed and after certain tests are performed, fertility support can be sought. 

Glucose tolerance disorders sometimes come to the fore. A vicious cycle effect can be seen here as well. Therefore, metformin (an anti-diabetic drug) is used to control glucose levels in the treatment of PCOS. Weight loss alone can restore normal hormone secretion mechanisms, improved complexion, or fertility.

dr Tadeusz Oleszczuk

Tadeusz Oleszczuk, MD, PhD - specialist in obstetrics and gynecology with over 30 years of experience. A graduate of the Medical Academy of Gdańsk. He is the author of numerous scientific publications and the books "Calm your hormones" and "What the gynecologist will not tell you". Member of the Polish Society of Lifestyle Medicine.