PCOS (Polycystic ovarian syndrome) is a common condition that affects fertility. PCOS is a syndrome, not a disease. This means that it is reversible. Although PCOS is a very popular diagnosis this decade, it is not yet completely understood. One thing we do know: it responds very well to natural treatment. (For an appointment with our Naturopathic Doctor, click here.)
First off, do not be too quick to accept a diagnosis. PCOS is a hormonal condition, not a problem with the ovaries. Ultrasound is NOT enough to diagnose PCOS. 25% of perfectly normal women display polycystic ovaries at one time or other (1). A subsequent ultrasound will show it to be normal again. True PCOS involves hormone irregularities that must be picked up with blood test.
Do you actually have PCOS? Which Type? Take our PCOS Quiz or consult with one of our Naturopaths to find out.
Many cases of PCOS are temporary. More specifically, many cases of so-called PCOS that we see in our clinic can more accurately be described as post-Pill syndrome. Your doctor will not tell you this, but it is a medically recognised fact that it can take up to 2 years for normal ovulation to resume after stopping the Pill. (6)(7)(8)
Blood tests necessary to diagnose PCOS are:
- Fasting blood glucose
- Fasting insulin
- Fasting leptin
- Testosterone
- SHBG
- Thyroid function
- Prolactin
- Vitamin D (vitamin D deficiency affects hormone balance)
- Urinary iodine
Blood tests are available at Sensible-Alternative Hormone Clinic.
Polycystic ovaries are NOT ovarian cysts
The things that you see on ultrasound are not cysts in the truest sense. It is important to understand a normal ovary produces fluid-filled follicles that contain the eggs. In a way of thinking, these follicles are 'cysts', but they are cysts that the ovary is supposed to have. Ovarian 'cysts' form and are reabsorbed every month, in every woman. Follicles of different number and different size will be visible in every ovary. It is when the follicles do not form properly, that the concept of cyst has some meaning. Follicles can be too large (a type of 'ovarian cyst' that can cause pain or rupture), or too small (as seen is polycystic ovaries). The 'cysts' seen in PCOS are actually small, underdeveloped follicles. They look like that because ovulation is not occurring properly, and this can be due to a number of causes, but in true PCOS, it is due to a problem with insulin.
Let me repeat. The polycystic appearance may mean nothing - may be normal. Or the the ovaries may look that way because something is preventing ovulation from progressing normally. The "something" is either insulin (in classic, type 1 PCOS), or something else (type 2 PCOS)
The ovaries themselves do not cause the weight gain. It is the underlying insulin resistance that causes weight gain, also causes the ovaries to look that way. (Insulin prevents ovulation and causes a lack of periods.)
(Many women end up thinking that all of their hormonal symptoms are caused by PCOS. Moodiness and PMT symptoms are caused by too much oestrogen compared to progesterone. This can occur with PCOS in some cases, but it is more commonly associated with oestrogen-dominance leading up to the period.)
PCOS linked with thyroid disease
A recent German study has found that PCOS sufferers have an increased risk for autoimmune thyroid disease. (2)
The researchers believe that the progesterone deficiency associated with PCOS makes women more susceptible to the autoimmune condition. It may also be that women with thyroid conditions are more like to develop PCOS. Healthy thyroid function is necessary for healthy ovulation.
Autoimmune thyroid disease, also called Hashimoto's, is common. Read more about it here.
PCOS may improve with age
"As [PCOS patients] get older, their chance of getting pregnant may actually be higher," according to Swedish researcher Miriam Hudecova. Her research shows that by the age of 35, women with PCOS have had as many successful pregnancies as women without PCOS, even without the assistance of fertility treatment. (3)
The number of follicles in the ovaries gradually reduce as women age. Normally, this is a bad thing, but it appears to be a good thing for PCOS sufferers. Other studies have shown something similar in that the periods of PCOS patients become more regular over time.
Plastic chemical BPA linked to PCOS
Two new studies have been released this week linking the plastic chemical Bisphenol A to a increased risk for Polycystic Ovarian Syndrome. (4)(5)
The chemical referred to has BPA, was originally developed as an oestrogen drug, but is now widely used in the manufacture of plastics. It is found in much food packaging, baby bottles and baby toys. It has also been linked with obesity, diabetes, cancer and heart disease.
Trans-fat linked with PCOS
Trans-fat is a damaged vegetable oil that is used in processed food, commercial salad dressing and margarines. Researchers from the Harvard School of Public Health found that only 4 grams of trans-fat per day is enough to interfere with ovulation. This much trans-fat is found in one doughnut or one meat pie. Trans-fat has also been shown to cause abdominal obesity linked with PCOS, even when total calories are low.(10). Naturally occurring fat, even saturated fat from animals, does not appear to be a problem for PCOS.
Does the Pill cause PCOS?
The Pill is not a solution for PCOS. It does absolutely nothing to improve the underlying insulin resistance, and can actually worsen it (8). In 2003, the Journal of Clinical Endocrinology & Metabolism published an article called 'A Modern Medical Quandary: Polycystic Ovary Syndrome, Insulin Resistance, and Oral Contraceptive Pills'.(9) The Pill has been standard treatment for PCOS, and yet, perversely, it appears to worsen the metabolic problem that is at the root of the condition. The authors say: '...what has been lacking is a critical examination of whether oral contraceptives might...exert adverse metabolic effects with long-term consequences..'.
The Pill may have made further contributions to the epidemic of PCOS. The Pill is known to cause permanent hormone changes, even once it is stopped.(6,7). As stated above, it is medically known that it can take a long time to get ovulation going after stopping the Pill. (Some women are lucky to have periods start again easily, but that is not the case for everyone.)
The pill will cause a monthly bleed, but this is not a true period.
Read Lara's article Problem with the Pill for more information.
Two Types of PCOS.
One of the reasons that there is so much confusion about PCOS is that it is not one condition. PCOS can be divided into 2 main types. This is important, because each requires a different treatment. What type are you?
Type 1 PCOS: Insulin-resistant
Classic PCOS has the symptoms of weight gain, failure to ovulate, infrequent periods, infertility, facial hair, acne, hair loss and a predisposition to diabetes. They key feature is high testosterone on blood test.
The high testosterone is actually the side effect, rather than the cause. In type 1 PCOS, The real underlying issue is insulin resistance and leptin resistance. Improper signalling from these metabolic hormones inhibit ovulation and cause the ovaries to produce testosterone. It is a problem with the metabolic hormones that is the main cause of weight gain. The symptoms of excessive testosterone, such as acne and facial hair will improve when insulin and leptin sensitivity improve.
Insulin resistance is caused by:
- leptin resistance
- too many refined carbohydrates in the diet, especially flour and sugar
- damaged vegetable oils called trans fat (see below)
- smoking
- environmental toxins such as BPA (see above)
- birth control pill
The correct treatment for Type 1 PCOS is to improve insulin sensitivity.
An endocrinologist will prescribe weight loss with a low GI diet and exercise, as well as a blood sugar lowering drug such as Metformin. This is approximately the correct approach, but metformin does have side effects such as nausea, diarrhoea and abdominal bloating. Fortunately, there are natural alternatives to metformin. In my experience, the natural supplements lower blood sugar as well, if not better, than Metformin.
Treatment Summary for Type 1 PCOS.
Diet - When the body is insulin resistant, it simply does not remember how to use carbohydrates for energy. It can only store them as fat. At the same time, an insulin resistant body does not have the ability to burn fat stores for energy. The solution is to restrict carbohydrates for six weeks to "remind" the body how to use them for energy. You may need to go down to 30 or 40 grams of carbohydrate per day, but you still must eat vegetables for their fibre and nutrition. Your best source of calories during this time is fat, not protein. Protein puts a stress on the kidneys, and is also converted easily into sugar, whereas fat is simply burned for energy.
- Eliminate refined sugar from the diet
- Magnesium and chromium - Minerals to improve sensitivity of the insulin receptor
- Resveratrol - improves sensitivity to insulin and leptin
- Homoeopathic Insulin & Leptin (See Insulin article and Leptin article)
- Peony & Licorice herbal formula to lower testosterone, which will alleviate acne and facial hair.
- Indole-3-carbinol to assist with oestrogen metabolism and clearance
- Detoxify environmental toxins such as BPA that may be interfering with the insulin receptor
- The Pill is absolutely not an appropriate treatment (see above).
Type 2 PCOS: Non-insulin-resistant
What if you have confirmed PCOS, but your insulin and blood sugar are normal?
The ultrasound may show multiple, undeveloped follicles. LH may be elevated, and periods do not occur regularly. Testosterone may be high or normal. If testosterone is normal, the acne and facial hair exist because oestrogen is too low (compared to testosteorne). Body weight can be normal.
In insulin-resistant Type 1 PCOS, the ovaries were prevented from ovulating because of insulin. In type 2 PCOS, the ovaries are prevented from ovulating because of something else. But what?
Here are some possibilities:
- History of the birth control pill (see above)
- Vitamin D deficiency
- Hormone disruptors are environmental chemicals that mimic oestrogen (see Sensible News 27)
- Trans-fat (see below)
- Adrenal stress which disrupts ovulation (see Stress article, Low Blood Pressure article, and Sleep article)
- Thyroid disease
- Low fat intake
- Leptin deficiency. (Leptin is a hormone secreted by fat stores, and can be deficient, especially if there is a history of an eating disorder.)
Metformin is not a treatment for Type 2 PCOS. Nor is the Pill. The Pill will induce monthly bleed this is not actually a treatment. For those women whose PCOS has been caused by the pill, continued use will only worsen the problem.
Treatment Summary for Type 2 PCOS.
- Do not take the birth control pill
- Correct vitamin D deficiency
- Reduce exposure to hormone disrupting chemicals.
- Detoxify to repair any hormone damage
- Avoid cow's milk to reduce inflammation and clear acne
- Herbal medicine to normalise adrenal hormones
- Homoeopathic folliculinum to induce ovulation
- Peony & Licorice herbal formula to lower testosterone, bring on the periods, and alleviate acne and facial hair.
- The herbal medine Vitex (Chaste tree) can be used with caution. It can aggravate PCOS symptoms in some patients.
- Indole-3-carbinol to assist with oestrogen metabolism and clearance
- Homoeopathic leptin
- Natural Progesterone to suppress LH secretion (from the pituitary) and allow ovulation to occur. For this purpose, a low dose progesterone cream (1%) should be used intermittently. Consult with one of our Naturopaths for more information.
- Bowen therapy or acupuncture to induce ovulation
Author: Lara Grinevitch BSc, ND. Sensible-Alternative Naturopathic Clinic.
Appointments at Sensible-Alternative
For professional advice regarding Polycystic ovarian syndrome (PCOS), please make an appointment with one of our Naturopaths.
Locations in Crowsnest Pass, Canada and Sydney, Australia.
1) Dr Lara Grinevitch - Crowsnest Pass, Canada
Lara sees patients on Mondays.
Phone Crowsnest Clinic: 1 403 563 3334. (Clinic phone is attended Tuesday-Friday)
Text message or leave a voicemail on Lara's cell: 1 587 880 4436
2) Biljana Koga or Deborah Gibson - Sydney, Australia
Two Sydney locations: Chatswood - Cronulla
Sydney phone number: 02 8011 1994
To email our Sydney head office: click here.
References:
(1) Polson DW et al. Lancet. Polycystic ovaries--a common finding in normal women.1988 Apr 16;1(8590):870-2.
(2) Janssen OE. High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrin 150(3): 363-369
(3) Hudecova, M et al. Long-term follow-up of patients with polycystic ovary syndrome: reproductive outcome and ovarian reserve. Human Reproduction, doi:10.1093/humrep/den482
(5) Diamanti-Kandarakis E. P2-395. Presented at: The Endocrine Society 92nd Annual Meeting and Expo; June 19-22, 2010; San Diego.
(6) Gnoth, C et al. Cycle characteristics after discontinuation of oral contraceptives. Gynecol Endocrinol 2002:16(4): 307-17.
(7) Vessey, M et al. Return of Fertility after discontinuation of oral contraceptives: influence of age and parity. The British Journal of Family Planning. 1986: 11: 120-124.
(8) Nader, S et al. The effect of desogestrel-containing oral contraceptives on the glucose tolerance and leptin concentration in hyperandrogenic women' J Clin Endocrinol Metab 1997 82: 3074-7
(9) Diamanti-Kandarakis, E et al. A modern medical quandary: Polycystic Ovary Syndrome, Insulin Resistance, and Oral Contraceptive Pills. J Clin End Met 2003.88(5): 1927-1932
(10) Panzer et al. Impact of Oral Contraceptives on Sex Hormone-Binding Globulin and Androgen Levels: A Retrospective Study in Women with Sexual Dysfunction. The Journal of Sexual Medicine. 2006. 3:p.104-113
(11) Kavanagh, K. 66th Scientific Sessions of the American Diabetes Association, June 9-13, 2006, Washington; abstract 328-OR. News release, Wake Forest University Baptist Medical Center
