Polycystic Ovary Syndrome (PCOS)

a woman holding her child in a field

Polycystic ovarian syndrome (PCOS) is a common (occurring in up to 4-10 percent of women of childbearing age) endocrine disorder with women in their reproductive years. PCOS is a complex health problem that is a sign of hormonal malfunction. It is strongly affected by a woman’s emotions, thoughts, diet, hormone balance, and personal history. 

Once classified as a disease, PCOS is now called a syndrome because it has a multi-facet nature and there is debate as to whether it is a single disease or a multiple associated pathologic conditions. PCOS is primarily characterized by hyperandrogenism, insulin resistance, obesity, hirsutism (excessive facial hair), amenorrhea (absence of a period), and chronic anovulation. Since the thyroid gland is directly related to many of the pathogenic conditions associated with PCOS, it has been speculated that iodine deficiency could be a leading cause.

Today, a patient usually presents clinically with concerns regarding menstrual irregularities, ovarian cysts, diabetes, acne, infertility, and hirsutism (hair growth). The syndrome is associated with higher cholesterol readings and an increased risk for heart disease. Also, hyperestrogen-related cancers such as breast and endometrial cancers are a concern. During a young woman’s reproductive years, PCOS is associated with significant infertility, abnormal uterine bleeding, miscarriage, and other complications of pregnancy. If not managed properly, PCOS can lead to increased risk for type 2 diabetes and certain cancers.

Conventional medicine cannot explain why PCOS occurs, but it seems to be strongly associated with excessive body fat. Women with high waist-to-hip ratio (apple-shaped figures) are more likely to experience ovarian dysfunction. No real genetic link has been found. The major problem associated with PCOS are that woman’s ovaries do not produce eggs, and her body produces too many hormones known as androgens (male hormones). As a result, her periods may cease or become very irregular.

The focus of PCOS treatment is on restoring regular menstrual cycles, relieving symptoms, and preventing or decreasing future complications relayed to the disorder, such as cardiovascular disease, diabetes, and cancer.

SYMPTOMS

There are a number of diagnostic criteria for PCOS. They include:

  • Hirsutism involving male hair growth patterns on the chin, upper lip, and sideburn areas. 
  • Obesity and overweight.
  • Irregular menstrual cycles, abnormal uterine bleeding, amenorrhea (no menstrual period).
  • Infertility 
  • Alopecia (hair loss) 
  • Insulin resistance (high blood insulin levels) 
  • Acne and dark patches on the neck and arms 
  • Ultrasound giving evidence of cysts on ovaries and/or enlarged ovaries 

RISKS

Since the main cause of PCOS may be caused by “estrogen dominance,” it is advisable to limit exposure to xenoestrogens in the environment (plastics, chemicals, insecticides, pollutants), and estrogen-laced milk, meat, poultry and eggs in our diet. Lack of phytoestrogen in our diet can be a risk factor, as can additional stress and anxiety on our adrenal glands. High levels of DHEA has been a risk factor in PCOS. Serum testosterone may also be elevated. 

High blood insulin levels increase circulating androgen levels, which in turn, leads to a higher risk for obesity, heart disease, hypertension, and hirsutism. Chronically high levels of androgens also prevent normal egg production: cyclic egg development in the ovaries, blocking the development and growth of the egg before it reaches maturity. Her hormonal levels remain static. This can cause small cysts from undeveloped eggs. 

On an ultrasound examination, the ovaries look enlarged, with multiple small cysts below the surface of the ovaries (hence the name polycystic ovaries.)  Other potential complications include heart disease and hypertension, hypothyroidism, endometrial hyperplasia, and high cholesterol.

INFERTILITY PROBLEMS

In normal cases, pregnancy occurs when a woman ovulates (an egg is released from one of her two ovaries). This is regulated by two hormones (FSH and LH), as directed by the pituitary gland, the body’s master control.  

In the case of PCOS, excess insulin, the hormone that regulates blood sugar, disrupts FSH and LH coordination by the pituitary gland.  When excessive insulin bombards the ovaries, they become confused. Extra insulin also stimulates excessive amounts of androgens (male hormones), normally present in a woman’s body in small amounts.  This process mimics obesity, acne, and hair growth (all male hormone problems). The increased incidence of type-2 diabetes (60 fold since the 1930s) has fueled the increase in PCOS and possibly uterine cancer.

DIET

Because of the potential side effects of many medications, weight reduction of obese patients should be a primary nutritional goal of treatment. The Standard American Diet (SAD) is high in fat and refined carbohydrates, which induces insulin resistance and lends toward obesity. Epidemiological evidence indicates a diet rich in fruits and vegetables, high in fiber complex carbohydrates, and legumes. 

Insulin sensitivity has been demonstrated to be influenced by dietary modifications. The best suggestion is to eat low-glycemic foods (i.e. white bread, donuts, pancakes, breakfast cereals, pineapples, pretzels, popcorn, ice cream, soda pop and table sugar).

Eating disorders and body image problems (especially in adolescence) is often a preliminary occurrence that may lead to PCOS. Patients should be checked for eating disorders such as fasting and binge eating.

SUPPLEMENT PROTOCOL

  1. DIETARY FIBER
    The health benefits of dietary fiber in reducing the risk of chronic disease have been well established. Benefits include the bulking effect, Increases in fecal volume, a limit on caloric intake, and slow stomach emptying. Fiber also plays a key role in the regulation of circulating insulin. A recent report by the national pharmacy association reported that women suffering from PCOS may be able to alleviate their symptoms by eating a low-refined carbohydrate diet.
  2. OMEGA 3,6 FATTY ACIDS (FLAXSEED and FISH OIL)
    The omega 3 fatty acids are very healthy for PCOS patients to consume for various reasons. Flaxseed is a significant source of plant lignans (phytoestrogens) that may reduce mammary tumor growth and positively affect endogenous sex hormone production. Fish order ingestion has been shown to decrease body fat deposition, improve thermogenesis (body’s ability to break down fat), and improve glucose clearing. Dosage: 1,000-4,000 mg daily. 
  3. CHROMIUM
    Chromium is one of the most widely studied nutritional interventions in the treatment of glucose and insulin-related irregularities. Chromium picolonate is the form most studied regarding insulin resistance, and is the form found most beneficial for women with PCOS.  Dosage: 200-1,000 mcg daily. 
  4. PROGESTERONE CREAM
    Topical application of progesterone cream appears to decrease estrogenic effects and lowers androgen/testosterone levels. Application of progesterone can also decrease symptoms and reverse xeno-estrogens (synthetic chemicals in the environment that mimic estrogen) in the body. Dosage: ¼ teaspoon externally 1-2 daily as directed by a qualified practitioner. 
  5. IODINE (POTASSIUM IODIDES)
    Iodine supplementation can effectively be used to treat hypo- or hyperthyroidism, as well as many other conditions. Supplementing iodine until the thyroid gland and all other iodine-sensitive sites in the body have reached iodine sufficiency may be a key ingredient in treating PCOS.  Dosage: See a qualified practitioner.
  6. N-Acetyl-L-Cysteine (NAC)
    One study concluded that NAC, a mucolytic agent with insulin sensitizing properties, as an adjunctive therapy in subjects with PCOS.  It was more effective than placebo and appears to be safe and well tolerated. Dosage: 100-1,000 mg daily, as directed.
  7. MULTI-VITAMIN FORMULA
    Taking a daily multi-vitamin/mineral formula is a basic foundation for nutrition and will aid in lipid (fat) metabolism.  Dosage: As directed.
  8. SAW PALMETTO (SERENOA REPENS)
    Although saw palmetto is a widely used herb for prostate hypertrophy, however, this herb has been found to be comparable to the pharmaceutical drug Proscar, and may be useful in other androgen-related conditions such as PCOS. Dosage: See a qualified practitioner.
  9. B-COMPLEX VITAMINS with EXTRA FOLIC ACID
    B complex vitamins may help with energy and the rejuvenation of cells formation. They can also help fat metabolism, which is a must for these women. Dosage: 50-100 mg daily. Folic acid 1-2 mg daily.
  10. ADRENAL GLANDULARS
    Adrenal glandulars (bovine) contain adrenal nucleoprotein , enzymes, polypeptides, which have been shown to enhance glandular function. These products (together with vital synergistic nutrients such as vitamin C, selenium, zinc, licorice and B-complex) will improve adrenal function, increase energy, and relieve stress on the thyroid gland. Dosage: See a qualified practitioner before beginning glandular therapy. 
  11. VITEX AGNUS-CASTUS
    Commonly known as chasteberry tree, the herb has traditionally been used to treat menstrual irregularities. The use of Vitex in the treatment of PCOS-related menstrual problems appears to show promise. Dosage: As directed on package. 
  12. INOSITOL
    Women with PCOS show a high incidence of ovulation failure perhaps linked to insulin resistance and related metabolic problems. In a small number of reports it has been suggested that supplementing with inositol may improve ovarian function.  Dosage: 100 mg twice a day.

Oral contraceptives (birth control pills) are often prescribed by a physician as an effective way of decreasing the luteinizing-hormone (LH) levels, thus regulating the menstrual cycle. They also assist in reducing acne and hirutism.

The diabetes drug Metformin (Glucophage) is commonly prescribed by a physician for insulin resistance associated with PCOS. 

 

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Rizk, AY, Bedaiwy, MA. NAC is a Novel Adjunct to Clomiphene Citrate-resistant Patients with PCOS. Alternative Medicine Review, June 2006. 10(2): P. 152.

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