Polycystic Ovary Syndrome (PCOS)

Originally Posted 3/1/2018

A client came to me because her birth control pills are not working. Did I just get your attention? Birth control pills (BCPs) are generally used to prevent pregnancy. They are also used for other hormonal conditions. This client was using BCPs for Polycystic Ovary Syndrome (PCOS).

I’ve had a lot of questions on this lately, Please note this is not meant as medical advise. This is for information only. For treatment specific for you, discuss your condition with your physician or qualified health care professional.

PCOS is a common endocrine disorder in women of reproductive age. In the US, PCOS affects nearly 10% of the female pop……………..

PCOS is a common endocrine disorder in women of reproductive age. In the US, PCOS affects nearly 10% of the female population. 85% of the women with androgen excess and hirsutism have PCOS.  For diagnosis, the patient must have 2 of the 3 symptoms below:

  1. Irregular periods – infrequent, irregular, or prolonged menstrual cycles.
  2. Clinical or biochemical signs of excess androgen activity
  3. Polycystic ovaries on ultrasound

Patients with PCOS have different menstrual cycle physiology vs. what is considered normal. For example, there may be increased circulation luteinizing hormone (LH), and decreased follicle stimulating hormone (FSH) leading to excessive production of androstenedione and testosterone (androgens). With low FSH, the follicles grow but do not mature, leading to degeneration of developing follicles. Patients often have low progesterone or even absent, leading to increased secretion of gonadotropin-releasing hormone (GnRH). This further contributes to high LH and low FSH in a vicious cycle.

Many researchers believe that PCOS has a hereditary component. It is suggested that women with PCOS are born with a gene that triggers higher than normal levels of androgen and/or insulin. Genetics aside, other factors may play a role in the development of PCOS include: Excess insulin (increase androgen production by decreasing sex hormone binding globulin (SHBG) levels; low grade inflammation (stimulates polycystic ovaries to produce androgens); Excess Androgen (ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne).

Environmental toxins may potentiate the development of PCOS. Phthalates, Bisphenol-A (BPA), cadmium and mercury toxicities have been shown to be related to PCOS. These toxins alter the hormones to cause anovulation, develop insulin resistance, and increase level of androgens.

Stress may be a contributing factor to PCOS. Many women with PCOS cannot process cortisol effectively, leading to elevated cortisol levels in the body. Further, when women are under stress, prolactin is released. If too much, this may impede the ovaries from producing the right balance of hormones.

Hypothyroidism may also be a cause of PCOS. Studies have found that 27% of women with PCOS had elevated thyroid antibodies. Another study was conducted on teenage girls with PCOS who were treated for hypothyroidism. The study demonstrated that the ovarian cysts resolved once hypothyroidism was reversed. Our body truly is a hormonal symphony!

Some symptoms of PCOS often develop around the time of the first menstrual period during puberty. Signs and symptoms of PCOS vary greatly from patient to patient. Aside from those used for diagnosis, patients may also experience the following:

  • obesity or inability to lose weight with weight gain usually being around the waist as opposed to overall weight gain.
  • infertility/recurrent miscarriage
  • Hirsutism
  • Oily skin/acne
  • Hair loss (male-pattern baldness)
  • Skin tags
  • Depression/irritability/tension
  • Sleep apnea
  • Pelvic pain
  • Elevated insulin level or insulin resistance
  • Decreased SHBG
  • Abnormal lipid profile
  • Hypertension

Back to the BCP client. What are some other options for her?

  1. Fiber-Yes, fiber! Soluble fiber lowers blood sugar, blood pressure and cholesterol.
  2. Low Glycemic Index diet and exercise-study with 18 women with PCOS on a 6 month program showed 11% reduction in central fat, 71% improvement in insulin sensitivity, 33% decrease in fasting insulin level, 39% decrease in LH levels, and 50% of the women started ovulating. There are studies showing that exercise alone improved the condition without other interventions.
  3. Stress reduction – To reduce cortisol level
  4. Essential fatty acids – Decreases inflammation, and slows down the absorption of carbohydrates into the blood.
  5. Nutrient supplementation – Vitamin D deficiency is common in women with PCOS. d-chiro-inositol lowered insulin and testosterone levels in study subjects. N-acetyl-cysteine, when used in conjunction with clomiphene increased ovulation and pregnancy rates vs. clomiphene alone.
  6. Herbal therapies – Use of adaptogens for stress improves stress response. Adaptogens include Ashwagandha, ginseng, Rhodiola, Schizandra. Black cohosh binds to estrogen receptors and lowers LH. Chasteberry reduces prolactin secretion. Saw Palmetto inhibits the conversion of testosterone to DHT and decreased androgen effects. Nettle root binds and increases SHBG, decreasing the amount of free testosterone.  Green Tea increases SHBG, and decreases testosterone. Licorice root can decrease testosterone synthesis, but can also increase blood pressure. Spearmint Tea – lowers testosterone level. White Peony increases progesterone, reduces testosterone, modulates estrogen and prolactin.
  7. Detoxification – Test for toxic metals and detoxify if needed.
  8. Medications
  9. Anti-androgen medications such as spironolactone
  10. Testosterone metabolism blockers (finasteride)
  11. GNRH antagonists (leuprolide)
  12. Insulin Resistance regulator (metformin)
  13. Progesterone
  14. Surgery: Ovarian wedge resection or laparoscopic ovarian drilling.

My client and I had a long, detailed discussion about her history, adn we agreed that diet and exercise modification may be the logical approach as she comes off her BCP.  Interestingly, lifestyle modification was not discussed with her when she was first diagnosed a year ago.  Yet, lifestyle modification is the one thing that you have control over, and could really help you no matter what disease.  As much as you’d like to think so, there is no magic bullet.  Even with prescription medicines, you can have a better outcome if you have a healthy lifestyle. For the best options, speak with a health care professional who can help you to understand your condition and work with you to address them at the root cause.

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