Whether recently diagnosed or suffering for years, there is a particular four letter word that has come to plague many of us: PCOS. Polycystic Ovarian Syndrome, or PCOS, affects 6-10 percent of reproductive-age women; it is one of the most common causes of irregular menses and infertility. Along with an unpredictable menstrual cycle, women with PCOS often experience significant weight gain, acne and unwanted hair growth (hirsuitism). Much of this is due to the stimulation of androgens (male hormones), including testosterone. So how does all this start? To answer this question, let’s take a look at the physiology.
The Role of Insulin in PCOS Pathogenesis
Insulin is a hormone secreted by the pancreas; its role is to sequester glucose from food and drive it into the cells of the body where it is used for energy. If glucose overconsumption occurs, insulin is secreted quicker than it can be used, and excess glucose builds up in the blood, resulting in hyperglycemia. Long term, the pancreas overcompensates by producing more insulin. This insulin builds up in the blood (hyperinsulinemia); but for reasons not completely understood, the body no longer responds to this insulin, a condition known as insulin resistance. If blood sugar remains uncontrolled, the risk for diabetes increases to four times more than the general population.
Insulin resistance appears to be the main driver in the development of PCOS. Excess insulin can overstimulate androgen production from insulin receptors in the ovaries. Other proposed mechanisms that merit further research include exposure to external androgens sometime before puberty, increased nervous system stimulation to the ovaries, and/or a possible genetic predisposition to increased androgen production caused by a defect in the ovarian theca cells. The prototypical woman with PCOS has symptoms that probably started as early as her teen years. She indulged in sweet carbonated drinks, salty carbs and saturated fats from her favorite fast food locale. At first she noticed the weight gain, then the missed periods. She decides to get on birth control to “regulate” her periods, never thinking about the problem again until she is in her 20s or 30s, and intends on having a child. She gets off birth control only to learn that her periods are still irregular, but, to her surprise, they were never regulated. For many women, what is equally frustrating is the length of time it takes to get diagnosed. A survey from the Journal of Endocrinology & Metabolismrevealed that it generally takes two years and up to three different healthcare providers to receive a diagnosis. As a result, the time it takes to receive treatment is further prolonged.
PCOS Treatment Options
Allopathic or Naturopathic?
Conventional treatment for PCOS often includes Metformin, a pharmaceutical drug designed to lower blood sugar and improve insulin sensitivity in the body. Many women are prescribed hormonal contraceptives to address irregular menses by lowering androgens like testosterone, the culprit behind acne and hirsuitism. For infertility, clomiphene and letrozole are often used to induce ovulation. These medications are aimed at treating the symptoms, and not without side effects, so results vary in terms of efficacy.
Naturopathic treatment of PCOS is comprehensive, including dietary counseling, physical activity recommendations, nutritional/herbal supplementation and often times acupuncture. Some allopathic physicians are needlessly apprehensive about naturopathic medicine because they are not familiar with the various treatments. Naturopathic doctors (NDs) are trained in both pharmaceutical interventions and herbal medicine, so they are able to present a holistic view of how naturopathic and conventional treatments may or may not work together. The good news is that we can explore multiple avenues to healing. Because PCOS is multifactorial, it is often advantageous to consult with multiple health care practitioners to figure out a treatment that works best for you.
Ditch the Sugar
If nothing else, focus on sugar intake. This is something we alone can control. Consume a diet rich in fiber, leafy greens, healthy fats and lean protein. In particular, cruciferous vegetables like broccoli, cauliflower and kale contain sulforaphanes, substances that encourage the breakdown of excess hormones in the liver. Beans contain fiber, protein and are a source of inositol, a nutrient which has yielded positive effects on blood sugar. Avoid saturated fats, dairy and red meat. If we must have dairy, choose organic and make sure the meat comes from grass-fed animals to avoid additional hormone disruption. Even some presumably healthy foods can raise insulin levels, so be sure to avoid high glycemic foods until hormone levels are under control. In conjunction with exercise, there has been promising information concerning time-restricted diets such as intermittent fasting (IF). Studies show that IF can be effective in addressing obesity and reducing blood sugars. Speak to an ND or nutritionist about whether this may be right.
Move on It!
Moderate levels of physical activity have shown to be successful in the reduction of insulin resistance. This is favorable information not only for those with PCOS, but also diabetics. An added benefit of exercise is combating obesity. Weight loss can be a challenge with PCOS, but it is not impossible. A study in the International Journal of Obesityfound high-intensity interval training workouts three times a week to be effective in reducing body fat percentage, particularly in the abdominal region. Lastly, serious consideration should also be given to yoga; numerous studies have demonstrated increased circulation, blood sugar reduction and mood elevation.
Look to the East Side of Medicine
Traditional Chinese Medicine (TCM) has been used for thousands of years to treat various conditions. The aim is to find the underlying disease pattern and bring the body into balance. Chinese herbal medicine can be combined with conventional medications to improve efficacy. In regards to PCOS symptom management, the main focus in TCM is to induce ovulation. A TCM practitioner may use a combination of acupuncture and Chinese herbal therapy to achieve this goal. A commonly used TCM herbal formula is white peony and licorice, which has been effective in lowering androgen levels and promoting ovulation. Dong quaiis another popular herb used in Chinese medicine used to strengthen and balance the uterus and improve fertility. Research studies show that acupuncture can help increase uterine and ovarian blood flow, lower testosterone and alter the release of hormones from the pituitary gland. In addition, acupuncture can assist with the symptoms of anxiety and depression often seen in PCOS patients. A licensed acupuncturist or ND trained in the use of TCM can assist in utilizing these ancient healing methods.
Hope Lies Ahead
While there is no established “cure” for PCOS, treatment and guidance from a ND can lead us to balanced hormonal levels and a visible decline of symptoms. Using many of the aforementioned protocols, many NDs can attest to substantial reductions of immature ovarian follicles “cysts,” regular menstrual cycles and improved fertility in their patients. Lifestyle changes are often lifelong, starting with initial rigidity, and graduating to a maintenance protocol as the condition improves. There is no easy solution, but with dedication and the proper guidance, we can improve our reproductive and overall health.
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