May 1, 2017

PCOS

Polycystic Ovarian Syndrome, or PCOS (also known by the name Stein-Leventhal Syndrome), includes a multi system presentation, having its effects on the skin, hair, body weight, endocrine system, and reproductive system. It’s said to affect up to ten percent of women of reproductive age, and up to ninety percent of woman with irregular menstrual cycles.


PCOS: The Western Medical Perspective

PCOS was first recognized as a medical disease or syndrome in the West in 1845 in France. Its most distinctive sign is the abnormal appearance of sclerocystic changes on the larger than average ovaries. They appear to have a thick, shiny, white coating overlying many rows of cysts on the surface of the ovary. These multiple cysts give PCOS its name.

In 1990 a National Institute of Health conference decided there are two consistent elements of PCOS:

-elevated androgenic hormones

-chronic lack of ovulation.

Ovulation

There may be no ovulations at all with PCOS (amenorrhea or erratic anovulatory bleeding). There may also be occasional ovulations (oligomenorrhea). Some women are mildly polycystic. They don’t notice any symptoms other than slightly irregular menstrual cycles. These women don’t have a problem getting pregnant but it may take longer than usual. For women having none or very infrequent ovulations, fertility is unlikely.

PCOS has a multitude of other symptoms as well, including obesity, acne, facial hair and increased body hair, and thinning hair on the head.

In a normal cycle, one follicle continues to grow and release an egg while the others undergo atresia. In PCOS, the follicles stop halfway. These follicles produce estrogen and some testosterone. Reading the estrogen levels, the pituitary gland cuts back its supply of FSH (follicle stimulating hormone) and produces more LH (luteinizing hormone) in readiness for ovulation. However, since none of the follicles have matured, the estrogen and LH keep being produced and hormone production is not turned off.

The capsule of the ovary is thickened and waxy. Multiple small cysts exist inside the ovary which are not the same as active follicles, but have been arrested in their development. These cysts and the connective tissue surrounding them, the stroma, produce male hormones called androgens. Testosterone is very similar in chemical composition to estrogen, but it causes the male type effects so often seen in PCOS. The brain detects circulating levels of sex hormone, and therefore inhibits ovulation.

Luteinizing hormone is often elevated higher than FSH in a woman with PCOS, and remains elevated throughout the cycle. LH stimulates the cells of the ovary to produce androgens, which block follicular development, causing the follicles to degenerate. This process makes ovulation unlikely.

Impaired glucose tolerance and insulin abnormalities are also a factor in many cases of PCOS, and have to do with the pancreas. Insulin resistance affects ovulation by producing higher amounts of circulating insulin, which stimulates the activity of enzymes which help to manufacture androgens in the ovary. High insulin levels further may cause over stimulation of androgen receptors, leading to follicular atresia of developing eggs.

How this disease happens remains unknown. Doctors and scientists have been unable to pinpoint the actual causative factor, and thus have been unable to treat it effectively.

Women with PCOS are at risk for other health hazards like disorders in lipid metabolism, obesity and its health concerns, vascular disease and cancer.

There is a strong genetic component to PCOS. It is common in women with a family history of PCOS.


So, how does PCOS affect fertility?

By affecting the ability to ovulate. Less estrogen is produced, but more LH and testosterone. This affects not only the quality of the follicle, but also the state of the endometrium. As a result, menstrual cycles become more erratic and unpredictable. Women with PCOS will often have very long cycles and very heavy bleeding; or amenorrhea, or anovulation with scanty bleeding. When an egg is released, it is often released later in the cycle, and it is of poorer quality because of the surroundings in which it has been developing. Follicular development is a process that takes approximately one hundred days within the ovary. Eggs are meant to develop in an estrogen and progesterone (female hormones) rich environment, not in an androgenic (male hormone) setting.


Western medical treatment

Usually, the oral contraceptive pill is given to women with PCOS who don’t wish to get pregnant. Women with PCOS who do wish to get pregnant are given metformin (diaformin), a drug which normalizes the body’s use of insulin and lowers blood sugar levels, helps weight loss, and increases ovulation frequency.

Clomiphene, hCG, and gonadotropin are some drugs prescribed for women with PCOS whose fertility is affected. If these drugs fail, IVF (in vitro fertilization) and other ART (assisted reproductive technology) are recommended. The problem with hormonal manipulation is that it does not address the actual quality of the eggs or the ovary’s endocrine balance over the previous three or more months of development (follicular development within the ovary is a process that takes about 100 days).


Polycystic Ovarian Syndrome – Chinese Medicine Perspective

In Chinese Medicine, Polycystic Ovarian Syndrome is broken down into two main sub-categories:

Deficiency
-Kidney yang deficiency
-Kidney yin deficiency
-Spleen qi deficiency

Excess
-Phlegm dampness
-Liver stagnation with heat
-Blood stasis

The most common manifestation of PCOS is dampness and/or phlegm in the body. However, PCOS is often complicated with patterns of deficiency and excess. Most women with PCOS will ovulate later in the cycle if at all. The BBT graph for dampness/phlegm is not bi-phasic but rather more erratic and flat-lined across the graph. It may also reveal a long follicular phase (indicated by lower temperatures) with a shortened luteal phase (indicated by high temperatures). Yang Qi deficiency may produce phlegm because it doesn’t get the fluids to move but rather to condense into dampness.

I ask many questions about the patient’s medical history on the first visit. From that, I will differentiate your pattern and treat the root cause of the PCOS.
Anovulatory women should begin to notice signs of ovulation after a couple months of treatment. Women with belated ovulation will often notice that their ovulation comes earlier and earlier in the cycle until they ovulate normally on cycle day fourteen.


Acupuncture & Chinese Herbal Medicine

In the clinic, I often combine weekly acupuncture sessions and concentrated powdered extracts of Chinese herbs for my patients with PCOS. On the first visit, I will also ask in detail regarding the patients’ diet and advise accordingly.


Dietary Therapy
If you are overweight, this condition responds much better to weight loss. Fat cells store estrogen, and there is usually relatively too much circulating estrogen and LH in women with PCOS. The liver metabolizes these hormones, so a healthy functioning liver is mandatory for proper therapeutic effect. Include dietary sources of the B vitamins, which keep the liver healthy.

Because of the insulin resistance and impaired glucose metabolism found in PCOS, it is very important to modify dietary intake if you have this condition. Insulin is a hormone secreted by the beta cells of the pancreas and is designed to maintain the blood glucose level within a certain range. Insulin stores glucose in the form of fat. Insulin resistance means that the body’s response to insulin in various tissues is impaired. Hence, the pancreas secretes more insulin. When the body fails to respond to insulin, glucose intolerance and diabetes and its many complications may become the eventual result.

The best natural management for insulin resistance and impaired glucose metabolism is to lower the level of sugar intake from the diet, and eliminate the ingestion of any food substance that the body can utilizes as simple sugar. Here are some tips:

  • Limit intake of all forms of refined sugar
  • Limit intake of refined carbohydrates. The body immediately turns these into sugar. This includes white bread, pasta, potatoes, white rice, most breakfast cereals, rice cakes, popcorn, or any starchy, low fiber food.
  • Do not adhere to the fertility diets that advocate massive yam consumption. This can actually delay or prevent ovulation if you have PCOS.
  • Avoid soda, fruit juice, and any drink which rapidly raises the blood sugar level.
  • Consume adequate amounts of protein, either in vegetarian form or in the form of lean meat which has not been treated hormonally.
  • Eat as many fresh vegetables as you wish.
  • Eat only complex, whole grains.
  • Eat fruits like berries.
  • Avoid milk and dairy products which tend to exacerbate the condition of internal dampness.
  • Limit alcohol and caffeine.
  • Increase your dietary fiber intake.
  • Exercise.

Research Study of Effectiveness of Acupuncture on Poly Cystic Ovarian Syndrome (PCOS):

A Swedish/Italian controlled study from the Biology of Reproduction Journal, (date): involved inducing a state of poly cystic ovaries in rats, with injections of estradiol valerate. Increased activity of the sympathetic nervous system resulted, followed by increased concentrations of nerve growth factor in ovaries, and the adrenal glands. Within 60 days the rats developed polycystic ovaries. The control group received no therapy and maintained features of PCOS. Those treated with acupuncture showed a reduction in the hyperactivity of the ovarian peripheral sympathetic nerve fibers, reduction of the increased nerve growth factor concentrations within the ovaries to normal and reduced the weight of the poly cystic ovaries. This group of doctors then set out with the aim of reproducing similar results in women with PCOS. The study concluded, “We have shown that repeated electroacupuncture treatments restore regular ovulations in the anovulatory women with PCOS. In addition, acupuncture influenced neuroendocrine and endocrine parameters indicative of PCOS, such as LH/FSH ratios, mean testosterone concentrations, and beta-endorphin concentrations, which reduced significantly.”

This study illustrates the hormonal origin of this disease process, and the fact that it can be induced artificially. The induction of this hormonal trauma produces a physiologic state of stress which raises the activity of the sympathetic nervous system, producing a disease syndrome. Acupuncture treatments were effective at resolving this pathologic process because it reduces the level of hypersympathetic nervous system response, relaxing the whole neuroendocrine system.

 

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