Polycystic Ovarian Syndrome, or PCOS (also known by the name Stein-Leventhal Syndrome) is an endocrine (hormonal) disorder that includes a multi system presentation. This means that it can have effects on the skin, hair, body weight, endocrine system, and reproductive system.
PCOS (Polycystic Ovary Syndrome)
PCOS is said to affect up to ten percent of women of reproductive age, and up to ninety percent of women with irregular menstrual cycles.
PCOS is the most common hormonal condition of women of reproductive age.
Many women with PCOS have irregular menstrual cycles or no menstrual periods.
PCOS affects all races and all nationalities.
Irregular ovulation and/or irregular menstrual periods, high androgen (male) hormones and weight gain are the main distinguishing features of PCOS.
Other aspects of PCOS are insulin resistance, obesity and diabetes.
A clinical sign of PCOS is to have numerous follicles show up on the ovaries in an ultrasound. It appears as a thick, shiny, white coating overlying many rows of cysts on the surface of the ovary. These multiple cysts give PCOS its name. This is also often referred to as a ‘string of pearls’.
However, my experience with patients with PCOS is that many of them do not actually have the follicles (or cysts) show up on ultrasound but they are still diagnosed with PCOS because they have the signs & symptoms.
In 1990 a National Institute of Health conference decided there are two consistent elements of PCOS:
elevated androgenic hormones
chronic lack of ovulation.
Let’s talk more about ovulation.
There may be no ovulation at all with PCOS (called amenorrhea).
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 usually don’t have a problem getting pregnant but it may take longer than usual. For women having none or very infrequent ovulations, fertility can be a struggle.
PCOS has a multitude of other symptoms as well, including obesity, acne, facial hair and increased body hair, and thinning hair on the head.
Let’s Talk About Normal Ovulation
On day 3 of your menstrual cycle (day 1 is the first day of your period) the pituitary gland in your brain secretes a hormone called FSH (follicle stimulating hormone) which sends a message to your ovaries to grow and mature an egg. As the follicles grow, they secrete estrogen. The bigger the egg, the more estrogen will be secreted.
One lucky egg will eventually get to be the largest and will secrete a lot of estrogen which then tells the pituitary gland to shut off FSH. This prevents the body from releasing more than one egg in one menstrual cycle. The smaller follicles which didn’t make the cut will die off.
At this point, another hormone called LH (Luteinizing Hormone) is secreted by the pituitary gland and this will cause the egg to be released from the follicle. This is Ovulation.
The leftover follicle is called the corpus luteum and this will produce progesterone and estrogen for the rest of your cycle.
PCOS & Abnormal Ovulation
As already stated, in a normal menstrual cycle, one follicle continues to grow and release an egg while the others undergo atresia (they die off).
In someone with PCOS, this isn’t the case because the follicles stop halfway so no follicle becomes large enough for ovulation. This is what causes the cluster of follicles as shown on ultrasound. This cluster of follicles produce enough estrogen to tell the body to shut off FSH but no ovulation has occurred. The follicles also produce some testosterone. You end up with a lot of estrogen and testosterone in the system but very little progesterone.
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.
PCOS and Insulin
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. This stimulates the activity of enzymes which help to make androgens (male hormones) in the ovary.
High insulin levels further may cause over-stimulation of androgen receptors, leading to follicular atresia (dying off) of developing eggs.
How this disease happens remains essentially unknown. Doctors and scientists have been unable to pinpoint the actual causative factor, and have been unable to treat PCOS effectively.
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?
PCOS affects 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 (uterine lining). 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 (no periods), or no ovulation with very light bleeding.
In PCOS, 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 of PCOS
Usually, the oral contraceptive pill (birth control) 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 (Clomid), 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 doesn’t address the actual quality of the eggs or the ovary’s endocrine balance over the previous three or more months of development (or 100 days to be exact).
Chinese Medicine Perspective of PCOS
In my Chinese medicine practice, I do a thorough medical assessment on the first visit to diagnose and treat the root cause of the patients’ PCOS. When I say root cause, I mean the underlying Chinese medicine pattern.
In Chinese medicine, the organ systems involved in PCOS are the liver, spleen and kidney systems.
A common manifestation of PCOS is having excessive dampness and/or phlegm in the body. Dampness and phlegm block and congest the body. It’s a sluggish heavy fluid that weighs the body down. Dampness contributes to the fluid-filled cysts. It’s also very evident in women who are overweight. Dampness typically comes from the spleen (digestion) being weak and treatment is to strengthen the spleen and get rid of dampness.
Also, when it comes to the insulin resistance part of PCOS, we look to the spleen organ system in Chinese medicine as the spleen is responsible for the metabolism of nutrients from the food we eat.
Another underlying cause of PCOS is called Kidney Yang Deficiency. Kidney yang deficiency contributes to a slower metabolism and to blockage or congestion in the body. The kidney organ system in Chinese medicine is involved with genetics and any genetic disorders.
The liver is the third organ system involved in PCOS. Stagnation of Qi (energy) and blood occurs because of the liver being congested and not doing its job of moving Qi and blood smoothly throughout the body. Blood stagnation in the channels of the body can cause the hair follicles to get over-nourished with blood causing excessive hair growth. This Qi and blood stagnation over time can also cause excessive heat which can result in acne.
Acupuncture & Chinese Herbal Medicine
My primary purpose with my PCOS patients is to induce ovulation and regulate their cycles.
In the clinic, I often combine weekly acupuncture sessions and concentrated powdered extracts of Chinese herbs.
On the first visit, I will also ask in detail regarding the patients’ diet and lifestyle and advise accordingly.
What You Can Expect
Women who don’t ovulate at all should begin to notice signs of ovulation after a few months of treatment.
Women with delayed ovulation will often notice that their ovulation comes earlier and earlier in the cycle until they ovulate normally on cycle day fourteen or so.
Having said this, women with PCOS getting Chinese medicine treatment do need to be patient. It can take time to regulate the hormones. My advice is to keep consistent, stick with the treatment protocols and you will eventually get the results you’re looking for.
If you’re overweight, PCOS responds much better when some weight is lost.
Fat cells store estrogen, and there is usually already relatively too much circulating estrogen and LH in women with PCOS. The liver metabolizes these hormones, so a healthy functioning liver is important 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. Therefore, 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 unfortunately.
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 utilizes as simple sugar.
Tips for anyone struggling with PCOS
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. Cooked warm vegetables are preferred over cold raw vegetables.
Eat 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 and move your body every day. Be consistent.
Try to reduce your stress if your stress levels are high.
Take an appropriate Chinese herbal formula prescribed by a qualified Chinese medicine practitioner
Try to wait at least 3 months before trying to conceive to regulate your cycle, restore ovulation and improve your egg quality.
If you’ve been diagnosed with PCOS and seeking treatment for PCOS naturally, I hope that the information in this article has given you hope that you can regulate your cycle, you can restore ovulation, balance your hormones and even improve your fertility.
Wishing you the best in health, Dr. Maryam
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