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Polycystic Ovarian Syndrome: PCOS

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Article by Claudette Wadsworth

Claudette Wadsworth Profile | Email | Website
Claudette Wadsworth Qualified Naturopath
Herbalist
Nutritionist

Natural Fertility Specialist
ThetaHealing Practitioner
40 Grosvenor Street
Bondi Junction
NSW
Australia 2022
(02) 9389 3689

Polycystic Ovarian Syndrome: PCOS

Polycystic Ovarian Syndrome is one of the most common hormonal problems for women and it’s a risk factor for type 2 diabetes, although it is one of the least publicised risk factors. Many women have it for 20 or 30 years before they develop diabetes and most don’t realise that their daughters and granddaughters are at high risk too. 

What is it?

PCOS is a group of conditions that affects 5-10% of women. Usually it begins in puberty and worsens with time, although it is a benign disorder. PCOS is a complex disorder because it is so affected by a woman’s emotions, thoughts, diet & personal history.

Instead of producing eggs in the ovary and releasing them once a month called ovulation, women with PCO/S produce eggs do not mature properly and develop into multiple cysts on the ovaries. The woman’s body produces too many male hormones, known as androgens.

20-25% of women will have multiple ovarian cysts of the ovaries: PCO but only half or fewer (5-10% of women) will actually have PCOS. 

What is the difference between Polycystic Ovaries and PCO Syndrome? 

PCO is a condition only affecting the ovaries while PCOS involves other body systems and organs other than the female reproductive system, such as the blood sugars and insulin.

40% of women in families with PCOS or Type 2 Diabetes have PCOS, indicating a possible inheritable tendency or underlying cause.

Between 50% and 70% of women with PCOS have high insulin levels.

Signs and Symptoms: 

•Irregular or absence of menstrual periods: usually 1st warning sign

•Infertility: 75% of women with PCOS

•Hirsutism: excess body hair 60%

•Obesity 40%

•Acne

•Irregular and profuse menstrual bleeding 30%

•Deeper voice and masculine body shape 20%

•Alopecia (hair loss/thinning on scalp & pubic hair)

•Craving sugars and starchy carbohydrates such as white flour products

•Hypoglycemia: imbalanced blood sugar levels

•Acanthosis nigricans: dark velvety patches on the skin

•Increased abdominal fat: the apple/android shape

Diagnosis

Diagnosis of PCO must include at least 2 of the following: 

1. Anovulation (no ovulation): follicles on the ovaries fail to release the eggs within. This results in irregular or infrequent occurrence of menstrual periods. Although in some women, it is possible to have periods and still not be ovulating.

2. Abnormal Hormone Blood Tests resulting in raised male hormone production:

 Lutenizing Hormone (LH) is elevated, while Follicle Stimulating Hormone (FSH) is usually low at a ratio of 2:1 or more. 

Oestrogen levels are high from conversion in the periphery of the body, such as fat stores, of androgens (male hormones) into oestrogens (female hormones) as well as an unopposed oestrogen production by the ovaries. 

Progesterone and SHBG levels are low as ovulation does not occur, while androgens which are the male hormones such as Testosterone, FAI and DHEAS are abnormally high. 

3. Internal ultrasound examination of the ovaries illustrating 10 or more cysts on the ovary. Typically the ovary contains many 2-6mm follicular cysts. 

According to Dr Warren Kidson, the leading endocrinologist on PCOS at the Prince of Wales and Sydney children’s Hospitals, all women diagnosed with PCO should be screened for insulin resistance and consequent diagnosis of PCOS by a 1 + 2 hour oral GTT: Glucose Tolerance Test with Insulin. Fasting blood sugar and fasting insulin are not sufficient.  This will determine whether it is systemic and whether the woman has already developed type 2 diabetes.

What causes it?

There are 4 primary underlying causes that all interact and contribute to varying degrees in different women and which must all be addressed. These include hormonal imbalance, insulin resistance, obesity and stress.

1. Hormones:

Our hormones are controlled by the pituitary gland in the brain where Lutenizing Hormone (LH) and Follicle Stimulating Hormone (FSH) are produced. These hormones stimulate the ovaries to produce oestrogen and progesterone. Directly above this is the brain's fertility centre or clock that regulates the production of LH and FSH. In a woman, this centre works in a cyclic fashion, once every month, while in a man it works in a continuous fashion. In PCOS, there has been a functional derangement of this centre and thus also of these hypothalamic-pituitary hormones. 

Excess LH production causes excess androgen (male hormone) production in the follicles inside the ovaries. This prevents ovulation and normal follicular development, resulting in the formation of small cystic follicles instead of mature follicles. These immature follicles are unable to release eggs for ovulation. Therefore, ovulation does not take place so progesterone is virtually nonexistent as this is only produced for the second half of a menstrual cycle after ovulation. 

These abnormally high levels of androgens, primarily testosterone and androstenedione, are responsible for the development of acne, male-pattern hair loss, excessive facial and body hair, and acanthosis nigricans (dark velvety patches on the skin). 

The lack of progesterone also stimulates the continued release of LH that remains elevated abnormally due to anovulation. 

The relatively high oestrogen levels that are unopposed by progesterone stimulate growth of the lining of the uterus, the endometrium: a concern of the long term complications of PCOS as there is very little shedding of it as there are few periods occurring.

Previous eating disorders, eg. bulimia and anorexia have been shown to upset the pituitary fertility clock and thus, hormonal regulation even years after eating is normalized.

In a few women, the fertility clock may not fully mature with periods starting later than usual, between 14-18 years of age, and the menstrual cycles irregular from the first period onwards.

2. Insulin Resistance

Insulin is a hormone secreted from the pancreas to control blood sugar levels by allowing the body’s cells to take up and use sugar (glucose) for energy. Many women with PCOS have elevated levels of insulin in their blood, causing insulin resistance where the cells no longer respond to insulin so they require bigger amounts of insulin to remove the same amount of sugar from the blood.

Excessive dietary sugars and high glycaemic carbohydrates, candida infections, mineral deficiencies, stress or excess body fat, particularly abdominal weight, all contribute to excessive insulin secretion by the pancreas in order to try and normalize blood sugar levels by getting the sugar into the body's cells and out of the bloodstream. 

Insulin inhibits Sex Hormone Binding Globulin (SHBG) that normally removes circulating androgens and oestrogens to be detoxified and broken down by the liver. The result is elevated androgens and oestogens left in the blood stream. 

Insulin also increases androgen production in the ovaries and the adrenals as well as increasing LH production by the pituitary gland.

Smoking, alcohol and caffeine exacerbate insulin resistance and PCOS.

Previous eating disorders, eg.bulimia and anorexia can programme the body into insulin resistance even years afterwards because of the extreme prior blood sugar imbalances.

3. Obesity

PCOS women have a lifelong tendency to increased abdominal weight: the android or apple shape, particularly after 30 years of age or pregnancy.  Many women with PCOS will gain weight easily and find that losing weight is difficult, despite diet and exercise.

Excess body fat activates aromatase in peripheral tissues and fat cells converting androgens into oestrogens. This has a negative feedback via the hypothalamus to increase LH, creating a vicious cycle of excess androgen production. 

Androgens are also converted in peripheral tissues into more potent forms by the enzyme 5-a-reductase: eg. Testosterone into Dihydrotestosterone. 

Enlarged fat cells also secrete TNF-alpha and a newly discovered hormone, Resistin that make the muscles more resistant to insulin. 

However, there is light at the end of the tunnel! A 5% reduction in body weight has been shown to normalize hormones. This is only approximately 5kg for most women which is realistic & achievable.

4. Stress Hormones

Stress stimulates adrenaline secretion by the adrenal glands that in turn stimulate insulin secretion to provide an immediate energy source for the body cells for "fight/flight".

Under chronic stress excess cortisol is released from the adrenals producing excessive prolactin secretion, which in turn further decreases FSH and increases LH (via decreasing GnRH). 

Also stress causes elevated androgen production from the adrenals themselves. Stress also affects your blood sugars as you have to raise your blood sugars to have something to run off, which in turn raises insulin.

These stressors may be current life stressors, emotional and psychological stress or repressed pain from the past.

Also very low body weight activates the release of adrenaline from the adrenals as the body is not provided with enough energy. This stimulates more insulin release. GnRH production that controls the pituitary gland is stopped at

 

Long Term Complications of PCOS 

Implementing prevention strategies now are crucial to any treatment of PCOS and have also been shown to be very effective at reducing the increased risks of:   

•Hirsutism (excess body and facial hair, acne, balding, deepening of voice, masculine body shape) due to high androgen levels

•Infertility: decreased fertilization due to lack of ovulation 

•Miscarriage 30-50% higher risk in 1st Trimester and a higher risk of pre-eclampsia in 3rd trimester due to high LH levels adversely affecting egg quality 

•Endometrial hyperplasia and uterine cancer: increased cell proliferation or thickening of the uterus lining is caused by the unopposed oestrogens that are a precursor to endometrial cancer. A woman must have a minimum of 5-6 menstrual periods per year or if she is over 35 years of age, a period almost monthly. (Pap smears do not detect this: cervix only) 

•Hormonal and menstrual disturbances, ovarian cancer, breast cancer

•Type 2 Diabetes mellitus & gestational diabetes due to insulin resistance and obesity. The recent Diabetes Prevention Programme has shown that a diet and exercise programme can prevent diabetes and is more effective than drug therapy (Metformin) in trials.

•Heart disease: increased risks of cardiovascular disease, hypertension, heart attack and atherosclerosis

•Osteoporosis: especially thin or adrenally exhausted women from chronic stress 

•Obesity

The best indicator for the risk of these long term complications is CRP: chronic inflammatory marker, a blood test performed by your GP. Ideally it is best less than 1 or at least less than 3.

What about simply taking the Pill?

In the past, doctors simply prescribed the oral contraceptive pill, OCP as a standard treatment for PCOS but the dangers of this is now being realised. The Pill simply masks the underlying condition and actually aggravates insulin resistance, hastening the onset of diabetes. A 1997 study of 98 590 nurses in the USA over a long period of time revealed that type 2 diabetes was 60% more prevalent in women taking oral contraceptives! According to Dr Kidson, if a woman is insulin resistant with PCOS, the Pill could be expected to increase the risk of diabetes by at least 100%, and possible by 200%.

Naturopathic Treatments for PCOS:

Self-Healing

Dietary and lifestyle changes are essential for successful treatment of PCOS and for maintenance of the condition long term to prevent long term complications.

Diet:

•Eat regularly: 3 main meals & 2 snacks daily that stimulate your metabolism. If you skip meals, it slows your metabolism down and your blood sugars drop so that you crave a sugar or stimulant to bring them back up again quickly.

•Protein in all your meals: controls your blood sugars by slowing down the absorption of sugars, stimulating your metabolism, decreasing hunger and sugar cravings as well as important for liver detoxification of the hormones: dairy, eggs, beans, legumes, nuts and seeds.

•Eliminate all sugars, sweets, chocolate, soft drinks, fruit juices (eat fruit maximum 3p/day), cordials, alcohol, dried fruit, anything with added sugar, honey, artificial sweeteners: Splenda, Nutrasweet and Aspartame.

•Decrease all refined carbohydrates: white flour products, such as white bread, white rice, noodles, pasta, packet biscuits, pastry, potatoes. Dense, seeded breads and wholemeal pasta occasionally are fine.

•Low glycaemic index foods are best, eg. whole grain breads, rolled oats, Basmati, Doongara or brown rice (not white or jasmine rice), temperate climate fruits eg apples (but not bananas).

•Avoid all junk foods, processed foods and deep fried foods: anything battered, hot chips, packet chips, dough nuts, packet cereals, packet biscuits. 

•What can I eat for breakfast? Plain rolled oat porridge or natural muesli with plain natural cultured yoghurt, fruit, nuts & seeds or eggs or baked beans with whole grain toast.

•Avoid coffee, alcohol, cigarette smoking or stimulants as they all stimulate the stress hormones of adrenaline which raises your blood sugars and insulin as well as providing numerous toxic chemicals for the body!

•Include some foods that contain phytoestrogens that help buffer against the stronger oestrogens in the body, such as 2 Tb of ground flaxseeds/linseeds daily, ¼  cup of alfalfa or sprouts, use beans and legumes instead of grains, eat sunflower seeds, non-genetically modified soy products such as tofu, tempeh and miso. However, I do not advocate other Western invented soy products such as soy sausages, soy protein powders, soy cheeses, etc

•Omega 3 oils are anti-inflammatory and should be consumed daily: avocado, walnuts, flaxseeds, cold water oily fish if you consume this.

•Herbal teas: Roasted dandelion root is a great coffee alternative or green tea, nettle leaf, red clover and calendula.

 

Lifestyle

•Regular moderate exercise: minimum 4x week 45 mins (ideally daily) with stretching or yoga is essential to control insulin levels, increase the circulation through the pelvis and for stress management. Even hip circling, pelvic thrusts and hip stretches are very beneficial if done for 10 minutes every day.

•Castor oil applied to the lower abdomen with a hot water bottle on top is very anti-inflammatory: 1 hour three times a week and pay attention to all thoughts, feelings and emotions that arise. Try to source an organic or pesticide-free castor oil.

•Adopt a lifestyle that balances work and relaxation, allowing some time to have fun, relax and have a good laugh! Consider a massage fortnightly, meditation, breathing techniques, aromatherapy, acupuncture, yoga, relaxing hot epsom salt baths with rose and lavender oils!

•Make time for some creative outlet for yourself, something you love doing or are passionate about, even if it’s only an hour on a weekend, into which you put all your stresses and emotions and start to move the energies in the body, eg. singing, dancing, gardening, art, woodwork, cooking. Our internal lives are very much reflected by our external lives & vica versa. Certainly, the female reproductive system is the utopia of creativity through fertility, whether or not it is being used for that. Therefore, it is important to look at where in my life am I being/expressing my creativity?

•Reconnect with other natural cycles such as the moon, sea, beach tides, get out in as much natural light as possible. Natural light affects the pituitary gland and affects ovulation. Even sleep with the light on for 3 days in the middle of every month.

•According to Christiane Northrup, a gynaecologist in the USA who wrote the book, Women’s Bodies, Women’s Wisdom, stresses that have been found to suppress ovarian and menstrual cycle functioning include negative feelings about being female. These women have often repressed this side of themselves so it may mean  perhaps simply allowing yourself to reconnect with your feminine, creative, nurturing, gentler side of yourself rather than the masculine, analytical, productive, goal-oriented side. 

•Northrup writes that women who do not ovulate are often tense, anxious, more dependent and may also have suppressed rage at their mothers. This indicates how important it is to deal with all of your childhood/parent dynamics and to also simply allow yourself a full range of emotional responses to events in your life. Anger is not a negative emotion but is often very appropriate for the circumstance and when expressed correctly is a very powerful force. It is interesting to note that road rage in Australia is highest amongst young female drivers. Perhaps this is because women are taught, albeit unconsciously, that anger is not an appropriate emotion for women and thus we have very little legitimate outlets for it compared to men.  Perhaps try a kick boxing or free form art class for outlets.

•It has also been noted that often women with PCOS have a need for outer or external approval and place enormous pressure on themselves trying to live up to these societal or parental expectations. So perhaps take the pressure off and starting putting your own needs and desires first every now and then.

Supplements: Nutrients & Herbs:

•There is not one single remedy that will improve PCOS and the dosages will vary according to the potency and quality of the product and the severity of the symptoms. So it is recommended to see a practitioner experienced in treating PCOS.

•Insulin Resistance and obesity: chromium, alpha-lipoic acid, gymnema, magnesium and goat’s rue are all effective.

•Acne: zinc, chromium, lots of liver support with dandelion root, calendula, burdock and Echinacea.

•Facial and body hair: requires 6-12 months’ treatment as more difficult: fennel cream 25ml in 100gm vitamin E base cream applied 3 times daily, zinc, pumpkin seeds 1-2 Tb/d, peony & licorice, saw palmetto.

•Infertility: 

This depends if the woman is currently on assisted reproductive techniques, eg. IVF as naturopathic treatment is possible concomitant with IVF treatment but the naturopathic remedies are adjusted so as not to interfere with IVF drugs but in fact, have been shown to increase the chances of successful IVF conceptions.  

Professor Robert Norman and Dr Ann Clarke in Adelaide were world pioneers when they showed that diet, regular exercise and weight reduction in women with PCOS who had failed to conceive with IVF, caused conception in 75% without IVF!! 

Peony and licorice are a common herbal combination for PCO, together with ladies mantle, chaste tree and shatavari which all help regulate the hormones.

By Claudette Wadsworth

Naturopath, Nutritionist

Bondi Junction  02 9389 3689

CBD Sydney  02 9268 9000

www.claudettewadsworth.com.au

13 Mar 2013

Last Update: 1 Sep 2013

Article/Information supplied by Claudette Wadsworth

Disclaimer - Any general advice given in any article should not be relied upon and should not be taken as a substitute for visiting a qualified medical Doctor.

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