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Article from www.sensible-alternative.com.au Polycystic Ovarian Syndrome(For more information about PCOS, please see Sensible News: The PCOS update issue.)
PCOS (Polycystic ovarian syndrome) 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. 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 can only be seen with blood test. Blood tests necessary to diagnose PCOS are:
Blood tests are available at Sensible-Alternative Hormone Clinic. Polycystic ovaries are NOT ovarian cystsThe 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 form because ovulation is not occurring properly, and this can be due to a number of causes, but in true PCOS, it is due to 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.) Type 1 PCOS: Insulin-resistantClassic 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 (see Sensible News 17). It is insulin that inhibits ovulation and causes the ovaries to produce testosterone. It is insulin that is the main cause of weight gain. The symptoms of excessive testosterone, such as acne and facial hair will improve when insulin sensitivity improves. Insulin resistance is caused by:
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. Magnesium and chromium - Minerals to improve sensitivity of the insulin receptor Gymnema, Fenugreek - Herbs to improve sensitivity of the insulin receptor Homoeopathic Insulin & Leptin (See Sensible News 26) to improve insulin sensitivity and promote weight loss. Homoeopathic testosterone or Paeony & Liquorice root can be used to lower testosterone, which will alleviate acne and facial hair. The Birth Control Pill is NOT the AnswerThe birth control pill does absolutely nothing to improve insulin resistance, and can actually worsen it (2). 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'.(3) 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..'. I propose that the Pill has made additional contributions to the epidemic of PCOS. The Pill is known to cause permanent hormone changes, even once it is stopped.(4). Most doctors agree that it can take 1 to 2 years for normal menstrual cycles to resume after stopping the pill (5,6,7). 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. Type 2 PCOS: Non-insulin-resistantThe ovaries show multiple, undeveloped follicles on ultrasound, but there is NO insulin resistance. Testosterone can 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 PCOS, the ovaries were inhibited by insulin. In type 2 PCOS, the ovaries are inhibited by other things such as:
A special note about Trans-fat: 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.(8). Naturally occurring fat, even saturated fat from animals, does not appear to be a problem for PCOS. 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.
Author: Lara Grinevitch BSc, ND. Sensible-Alternative Naturopathic Clinic.
Appointments at Sensible-AlternativeFor professional advice regarding Polycystic ovarian syndrome (PCOS), please call to make an appointment... Sensible-Alternative Hormone Clinic References:(1) Polson DW et al. Lancet. Polycystic ovaries--a common finding in normal women.1988 Apr 16;1(8590):870-2. (2) 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 (3) 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 (4) 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 (5) Farrow, A et al. Prolonged use of oral contraception before a planned pregnancy is associated with a decreased risk of delayed conception. Hum Reprod. 2002. 17(10): 2754-61 (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) 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 Return to Main Menu |
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