Polycystic Ovary Syndrome

In honor of Women’s Health Month, I felt it important to discuss a syndrome that, like women, is elusive, complex, and foolish to ignore. The syndrome is Polycystic Ovary Syndrome.

PCOS appears in between 4 and 12% of women seen in American clinics (1. 2) and in 20% of obese women (3). These numbers may be inaccurate, though, because of the variety and inconsistency of criteria for diagnosis in the past, and the myriad of subtle symptoms that go unreported or overlooked. Symptoms such as acne, mild facial hair or nipple hair, irregular periods, heavy periods, difficulty conceiving, or intermittent pelvic pain may seem unremarkable or easily treatable by themselves, but collectively, they point to a very important diagnosis.

This is disturbing because not only are we at risk for missing the mark on its prevalence, but we may also be missing the diagnosis of PCOS all together.

The possibility of misdiagnosing or ignoring PCOS has significant implications.  There is increased risk for Type 2 diabetes, increased thickening of the endometrial lining and hyper-estrogen related cancers, and cardiovascular disease. Treatments typically include pharmaceutical hormone regulators such as oral contraceptives and metformin, as well as a recommendation for weight loss in the overweight or obese PCOS patient. While medications have been beneficial for some, many women are opposed to the use of prescription medications unless absolutely necessary.  And women often do not like the side effects associated with these treatments.

More and more, women are asking the question, “Are there any alternative therapies?” The good news is that for many women the answer is yes.

With the use of lifestyle changes, nutritional therapy, herbs, Chinese medicine, hydrotherapy, and homeopathy, many patients are seeing results. In some instances, patients choose to integrate both natural and conventional therapies to get the best possible outcome. Regardless of the approach, the goals for treatment are; decreasing circulating insulin and androgens, restoring ovulation and menstrual regularity, weight loss, improving cardiovascular profiles, supporting liver function, and improving the hypothalamic-pituitary-adrenal (HPA) axis.

Diagnostic criteria have indeed varied, however, several professional groups now agree that ovulatory dysfunction, hyperandrogenism, polycystic ovaries, and exclusion of other disorders in varying combinations are what defines PCOS (4). Only two of the above criteria need be present to be diagnosed with PCOS. Under the care of a physician well versed in the recognition and treatment of PCOS, a woman should expect:

• To report a thorough medical history
• She may be asked to have a pelvic ultrasound to rule out a classic ovarian morphology
• A blood draw to test for certain hormones, such as thyroid function tests, testosterone, LH and FSH, insulin and blood sugar levels, lipid panel, prolactin levels

Some of these tests are for a PCOS diagnosis while others are intended to rule out other possible diagnoses.

As frightening as it might first seem, it can be empowering for a woman to learn that she has PCOS.

Discovered sooner than later, there are many health benefits.  A woman will be able to increase her chances for conception, regulate her cycles (whether painful, infrequent, extremely light, or excessively heavy), decrease acne and hair growth, and lose weight. And most importantly, she’ll improve her longevity and quality of life in regards to successful aging (a term that refers to entering one’s 60s and 70s without cardiovascular disease, diabetes, or cancer, among other things).

While there are many medications and even natural remedies, lifestyle changes will likely have the most profound impact, and for many, can reverse the presentation of PCOS.

In fact, for overweight and obese women with PCOS, weight loss alone can be the biggest catalyst for change.  Weight loss is associated with a reduction in serum testosterone concentration, resumption of ovulation, and ability to achieve pregnancy (5, 6. 7). By reducing calories, increasing both cardiovascular and weight bearing exercise and choosing whole foods rich in fruits and veggies, as well as whole grains over processed foods high in fat, sugar, and chemicals, a woman can not only lose weight, but may also improve hormone regulation and longevity.

Exercise is key. Increasing muscle mass improves glucose regulation, stimulating ovulation.  Exercise can also improve cardiovascular function by lowering high LDL and triglycerides and raising protective HDL.  In fact, any treatment focused on reducing insulin levels in both lean and obese women with PCOS may be beneficial. Women may see a fall in ovarian androgen secretion and an improvement in cyclic pituitary-ovarian function, which may reduce hair growth and restore menstrual regularity, and presumably fertility (4).

A comprehensive treatment plan will aim to regulate menses, reduce pelvic pain, improve fertility, and reduce male pattern hair growth or loss.  The plan will also aim for weight loss as well as require that the patient incorporate exercise and nutrition to prevent heart disease, diabetes and cancer.

Naturopathic medicines may include but are not limited to:

• Fiber for improved elimination of wastes, including hormonal metabolites and reduction in chronic disease
• Flax seed for its lignans, which may reduce hyperestrogen states
• Fish oils, specifically EPA and DHA, to improve glucose uptake by the cell, improve insulin sensitivity, and more specifically, to increase thermogenesis, decrease body fat deposition, and improve glucose clearance (8)
• Chromium for blood sugar regulation
• D chiro – inositol to increase ovulation, lower insulin, improve triglycerides and blood pressure
• Vitex, for its long time use among midwives and herbalists, for cycle regulation
• Nettles, which may increase SHBG which is elevated in response to the high insulin and high androgen states seen in some women.

Most of these remedies have some research to draw on, are relatively inexpensive, easy to take, are safe and have no side effects.

Finally, very important to a holistic protocol, is the use of acupuncture and Chinese herbs.  With acupuncture as part of their treatment plans, many women report normalization of menses, improved weight loss and improved quality of life. An acupuncturist may aim to support kidney deficiency, which is related to adrenal function, spleen deficiency to support blood sugar regulation, and liver dysfunction to improve blood flow and address hormone imbalances.

When dealing with PCOS, a condition that is often addressed by treating a symptom rather than the whole person, possibly under-diagnosed and reported, and often misdiagnosed, it is critical that women speak up and seek out an understanding of what is going with their bodies.

I find it tragic that most treatment plans for PCOS are based entirely on pharmaceuticals, when there are many known benefits in lifestyle counseling, increased activity, improved nutrition, and the implementation of even one of the many naturopathic and Traditional Chinese remedies.

Chuckling, I realize that both of those statements are actually incredibly true for so many conditions that Americans are experiencing today.

The lesson…that nature cures. 

In peace and health,

Rose Paisley, ND

References available upon request

If you’d like to discuss treatment and diagnosis of PCOS, you can contact Dr. Paisley, or call the clinic at (503) 287-4970 to set up a consultation.

Tags: alternative PCOS treatment, Diet, Exercise, Infertility, irregular periods, natural PCOS treatment, naturopathic PCOS treatment, Nutrition, Obesity, PCOS, polycystic ovarian syndrome, polycystic ovary syndrome, Type 2 diabetes, Weight loss

This entry was posted on Tuesday, March 16th, 2010 at 4:30 pm and is filed under Articles by our Doctors, Dr. Rose Paisley. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.