PCOS (Polycystic Ovarian Syndrome): Myths, Facts and Natural Treatment
The statistics are that PCOS (Polycystic Ovarian Syndrome) affects 5-10% of women of childbearing age, personally I think the numbers should be much higher because I think the condition often goes unrecognized and under diagnosed. I think current diets and lifestyles are making the condition more prevalent. In 60% of women with PCOS, higher than normal blood sugar and insulin levels increase androgen production and interfere with normal egg development each month. The remaining 40% who have been diagnosed with PCOS have other factors that are interfering with regular ovulation such as high prolactin, low estradiol, low body weight/anorexia etc. Improperly developed eggs can remain on the ovary as a cyst. Since ovulation is either delayed or doesn’t occur at all, the hormone progesterone is either reduced or absent in that cycle, leading to many of the symptoms of PCOS. Lack of progesterone leads to a relative imbalance between estrogen and progesterone so that estrogen’s activity isn’t balanced out properly by progesterone; this is referred to as estrogen dominance. The two hormones tend to have equal and opposite functions: estrogen causes proliferation of the lining of the uterus, while progesterone helps maintain it, estrogen causes proliferation of breast tissue while progesterone keeps it healthy, estrogen tends to provoke emotions like sadness and progesterone has anti-depressant qualities. Progesterone reduces spasm of smooth muscle, normalizes clotting and vascular strength, helps thyroid function and bone building and helps prevent endometrial cancer. Some PCOS women have more testosterone which causes problems like anovulation, infertility, acne, excess body and facial hair growth and loss of head hair. Regulation of dietary starch and sugar intake in these women can greatly improve symptoms of PCOS including infertility, hair loss, weight gain, absence of regular periods, lack of ovulation, and facial hair growth. PCOS is not an infertility sentence and can be treated naturally through diet, exercise and nutritional supplements. Aside from the fact that naturopathic medicine addresses the underlying cause of the disease, many women cannot tolerate the side effects of the conventional drug metformin and so naturopathic treatment offers a much more viable solution.
Symptoms of PCOS (Polycystic Ovarian Syndrome)
Because of the hormone imbalances associated with classic PCOS (high insulin, high androgens, low progesterone, and imbalanced ratio of estrogen to progesterone), women can suffer from the following symptoms:
- High levels of male hormones, androgens
- An irregular (short or long cycles) or no menstrual cycle (amenorrhea)
- There may or may not be many small cysts in ovaries
- Infertility or inability to get pregnant or maintain a pregnancy, recurring miscarriage
- Acne, oily skin or dandruff
- Head hair loss or hair thinning
- Excessive facial or body hair (hirsutism) – chin hairs, chest hairs, arm and abdominal hair
- Pelvic pain
- Weight gain – only 60% of PCOS women struggle with their weight, 40% are thin
- Lack of ovulation or irregular ovulation
- Heavy, painful periods
- Glucose intolerance, hypoglycemia
- Anxiety and/or depression
Tests for PCOS
There is an extensive list of tests that may be helpful to diagnose PCOS and determine why you are having problems. Download the list: PCOS and infertility tests
Naturopathic Treatment of PCOS:
- Regulating blood sugar and insulin levels
- Decreasing excess male hormones and hormonal activity and so therefore improving acne, oily skin, excessive hair growth, hair loss
- Improving progesterone production
- Ensuring regular ovulation and menstruation and improving fertility
- Weight loss and regular exercise
Myths about PCOS:
Many women (and doctors) make some wrong assumptions with regards to menstruation, fertility and PCOS:
PCOS Myth #1: I don’t plan to have children so it doesn’t matter if I don’t ovulate
Truth: it doesn’t matter if you plan on having children or not, if you don’t ovulate each month, your body is deprived of a vital hormone, progesterone, which means you may be more susceptible to estrogen dominance conditions like fibroids, breast cancer and endometriosis.
PCOS Myth #2: I get a period regularly so I must be ovulating
Truth: Having regular periods does not mean that you are ovulating. It just means that estrogen production increases and decreases each month to signal development of the uterine lining and subsequent shedding. Regular ovulation is vital to healthy hormone balance regardless of parenthood plans.
PCOS Myth #3: The ultrasound showed no cysts on my ovaries so I can’t have PCOS
Truth: The name is misleading, people with polycystic ovarian syndrome, do not have to have cysts present on the ovaries. The body breaks down and resolves cysts regularly so cysts can come and go. The syndrome is diagnosed on the basis of the presence of a collection of symptoms that can include some (but not all) of the following: head hair loss, excess facial/body hair, weight gain, insulin resistance, poor glucose tolerance, irregular menstrual cycles, anovulation, infertility, acne and oily skin.
PCOS Myth #4: The blood tests were fine so there’s nothing wrong hormonally
Truth: Hormone blood tests are notoriously poor predictors of health or disease. The reference ranges are incredibly broad and are set based on averages of [often] unhealthy people. Reference ranges for hormones should be set by health screening the people being used to set the range for any reproductive disorders such as fibroids, breast cancer, endometriosis, PCOS, irregular menses, heavy menses, painful periods, infertility, anovulation etc. Select only those who have perfectly regular periods, who ovulate every month at midcycle, have no evidence of fibroids or endometriosis, no history of reproductive organ problems etc, then use those people to set a healthy range, this is not what is done in practice.
PCOS Myth #5: If I have endometriosis, PCOS or fibroids, I can’t have children or I can only have children if I undergo aggressive fertility treatments like In Vitro Fertilization (IVF)
Truth: You can have children with any of these conditions, they do not automatically spell infertility. Depending on the severity of the condition, the best course of action may be either combination conventional therapies like drugs, surgery or IVF with naturopathic treatment or naturopathic treatment alone may be sufficient to solve the problem.
PCOS Myth #6: If there was something that could help with my problem, my specialist would know about it
Truth: Unfortunately not. Most medical doctors have quite enough on their plate to keep abreast of the latest drugs and surgical options and see a wealth of patients every day. They have neither the time nor the interest in studying naturopathic treatments for disease, that’s my specialty.
PCOS Myth #7: There is no research to support naturopathic therapies
Truth: There is plenty of research to support acupuncture, herbal medicine, vitamins and nutritional supplements. There was a time as little as 10 years ago when research was sparse. Public interest in using more natural therapies has sparked interest in researching remedies that have stood the test of time for hundreds if not thousands of years.
PCOS Myth #8: I can continue to eat like everyone else and manage my PCOS
Truth: Successfully managing PCOS naturally requires ongoing and fairly significant dietary and lifestyle changes. Those who undertake these changes, witness substantial improvement in their condition, in their overall health and prevent future problems like heart disease, inflammatory conditions and fertility problems that are associated with PCOS.
PCOS (Polycystic Ovarian Syndrome) Research
- High Intensity Interval Exercise (i.e. short bouts of intense exercise interspersed with a recovery period) more effective than Steady State Exercise (i.e. steady exercise of moderate intensity) for fat loss. Source: International Journal of Obesity 15 January 2008
- Polycystic ovaries are much more common in athletes training for the Olympics compared with the average woman – 37% of the athletes have them, compared with one in five women in the general population. Source: BBC News, Sunday April 20, 2008
- Among overweight women with low physical activity, high carbohydrate intake and high glycemic load may increase the risk of this disease.
- “Evidence is accumulating that insulin resistance and hyperinsulinemia are involved in the etiology of endometrial cancer,” Dr. Susanna C. Larsson and colleagues from Karolinska Institute, Stockholm, Sweden, write. “Obesity, physical inactivity, and type 2 diabetes mellitus are all associated with insulin resistance, hyperinsulinemia, and endometrial cancer.”
PCOS & Natural Medicine Research
Arentz S, Smith CA, Abbott J, Fahey P, Cheema BS, Bensoussan A. Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial. Phytother Res. 2017; 31(9):1330-1340.
● Lifestyle + herbal med vs. herbal med alone. Two tablets: (1) Cinnamomum verum, Glycyrrhiza glabra, Hypericum perforatum, Paeonia lactiflora, (2) Tribulus terrestris. Primary outcome was oligomenorrhea/amenorrhea
● At 3 months, combo group had significantly reduced oligomenorrhea (32.9%) vs. controls, as well as BMI, insulin, LH, BP, QoL, depression, anxiety, stress, pregnancy rates
Banaszewska B, Wrotynska-Barczynska J, Spaczynski RZ, Pawelcyzk L, Duleba AJ. Effects of resveratrol on polycystic ovary syndrome: a double-blind, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2016; 101(11): 4322-4328.
● Resveratrol supplementation was found to decrease total testosterone by 23%, induced a decrease in DHEA by 22%, decrease fasting insulin level by 31.8%, and increase Insulin Sensitivity Index by 66.3%.
Weight Loss and Fertility Treatment:
Legro RS, Dodson WC, Kunselman AR, Stetter CM, Kris-Etherton PM, Williams NI, Gnatuk CL, Estes SJ, Allison KC, Sarwer DB, Diamond MP, Schlaff WD, Casson PR, Christman GM, Barnhart KT, Bates GW, Usadi R, Lucidi S, Baker V, Zhang H, Eisenberg E, Coutifaris C, Dokras A. Benefit of delayed fertility therapy with preconception weight loss over immediate therapy in obese women with
PCOS. J Clin Endocrinol Metab. 2016; 101(7):2658-66.
● Comparison of research trials shows that delayed infertility treatment with clomiphene after lifestyle modifications and weight loss improved ovulation and live birth when compared to immediate infertility treatment.
NAC & L-arginine:
Prolonged treatment with N-acetylcysteine and L-arginine restores gonadal function in patients with PCO syndrome Source: Masha A, Martina V, et al, J Endocrinol Invest, 2009 Apr 15
Alpha Lipoic Acid:
Supplementation with a controlled-release formulation of alpha-lipoic acid (600 mg, twice/day) for a period of 16 weeks was found to be associated with a 13.5% improvement in insulin sensitivity Source: Masharani U, Gjerde C, et al, J Diabetes Sci Technol, 2010 March; 4(2): 359-364
Normalization of menstrual cycles and ovulation could occur with modest weight loss as little as 5% of the initial weight.
Source: International Journal of Womens Health, Volume 3, Pages 25-35, 2011.
Low-frequency electro-acupuncture and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS.
Source: American Journal of Physiology – Endocrinology and Metabolism, Vol 300, Issue 1, p.37-45, Jan. 2011.
Phytoestrogens in soy products appear to have a protective effect on metabolic and hormonal abnormalities in women with polycystic ovary syndrome (PCOS).
Source: Journal of Research in Medical Sciences, Volume 16, Issue 3, pages 297-302, March 2011.
Calcium and vitamin D supplementation effectively influenced symptoms of polycystic ovary syndrome showing improved weight loss, follicle maturation, and menstrual regularity.
Source: Complement Ther Clin Pract, 2012 May; 18(2):85-8.
Myo-inositol may prevent gestational diabetes in women with polycystic ovary syndrome.
Source: Gynecol Endocrinol, 2012 Jun; 28(6):440-2.
Researchers found that many women with polycystic ovary syndrome are not maintaining the healthy diet and sufficient physical exercise that optimise symptom management.
Source: Eur J Clin Nutr, 2011 June 1.
Polycystic ovarian syndrome patients ingesting a high protein diet experienced greater weight loss and body fat loss than the standard protein diet.
Source: Am J Clin Nutr, 2012 Jan; 95(1): 39-48. Epub 2011 Dec 7.
In pregnant women with polycystic ovarian syndrome, myo-inositol administration may prevent gestational diabetes.
Source: Gynecol Endocrinol. 2012 Jun;28(6):440-2. Epub 2011 Nov 28.
Vitamin D supplementation effectively influenced symptoms of polycystic ovarian syndrome showing improved weight loss and menstrual regularity.
Source: Complement Ther Clin Pract, 2012 May; 18(2):85-8.
Vitamin D & Infertility:
Low vitamin D status was found to be associated with impaired fertility, endometriosis and PCOS.
Source: International Journal of Women’s Health, Volume 3, Pages 25-35, 2011.
Acupuncture and physical exercise were found to reduce symptoms of anxiety and depression in women with PCOS.Source: BMC Complement Altern Med, 2013 June 13; 13(1): 131.
Ovulation Induction in PCOS & Black Cohosh:
The phytoestrogen Black Cohosh can be used as an alternative to clomiphene citrate for ovulation induction in women with polycystic ovarian syndrome(PCOS). Source: Kamel HH. Role of phyto-oestrogens in ovulation induction in women with polycystic ovarian syndrome. Eur J Obstet Gynecol Reprod Biol. 2013 May;168(1):60-3
The Timing of Caloric Intake:
A recent study concluded that a high-calorie breakfast and reduced-calorie dinner leads to greater insulin sensitivity and increased ovarian cytochrome P450c17α, which helps reduce the hyperandrogenism resulting from PCOS.
Source: Daniela Jakubowicz, Maayan Barnea, Julio Wainstein and Oren Froy Effects of caloric intake timing on insulin resistance and hyperandrogenism in lean women with polycystic ovary syndrome Clinical Science (2013) 125, (423–432)
Women receiving 1500 mg per day of cinnamon supplementation had significant improvement in the frequency of menstruation from baseline while women receiving placebo had no significant change.
Source: D.H. Kort, C. Sullivan, A. Kostolias, J.C. DePinho, R.A. Lobo, Cinnamon supplementation improves menstrual cyclicity in women with polycystic ovary syndrome. Fertility and Sterility Volume 100, Issue 3, Supplement, Page S349, September 2013.
Phytoestrogen supplementation significantly improved total cholesterol levels, reducing low-density lipoprotein (LDL) cholesterol and resulting in a significant decrease in the LDL-high-density lipoprotein ratio (LDL-HDL). Triglycerides showed a trend toward a decrease. Genistein treatment did not significantly affect weight, hormone imbalance, or menstrual cyclicity. No significant changes occurred in glucose and insulin metabolism.
Source: Romualdi D, Costantini B, Campagna G, Lanzone A, Guido M. Is there a role for soy isoflavones in the therapeutic approach to polycystic ovary syndrome? Results from a pilot study. Fertil Steril. 2008 Nov;90(5):1826-33.
Genistein & PCOS:
Genistein supplementation in hyperinsulinemic and dyslipidemic women with PCOS was found to significantly improve total cholesterol levels, reduce LDL cholesterol, LDL/HDL ratio and triglycerides.
Diet and Nutrients
After quantitative assessment of 54 women with PCOS, dietary modifications and recommendations were made based on data obtained in the study. According to the conclusions of the study, women with PCOS would benefit from a diet high in folic acid, vitamins D and C, cobalamin, dietary fibre and calcium. The consumption of total fats, saturated fatty acids and cholesterol should be reduced, and diet of some of the patients should be supplemented with potassium, magnesium and zinc.
Source: Quantitative assessment of nutrition in patients with polycystic ovary syndrome (PCOS). Rocz Panstw Zakl Hig. 2016;67(4):419-426.
In a case-control study, the impact of Bisphenol A (BPA) on PCOS was assessed. Researchers found that this #hormone disruptor may play a major role in PCOS and further studies are warranted on the safety of BPA products.
Source: The Association Between Bisphenol A and Polycystic Ovarian Syndrome: A Case-Control Study. Acta Med Iran. 2017 Dec;55(12):759-764.
Acupuncture and Chinese Medicine
In a randomized controlled study, 60 patients were assigned to a control (metformin and letrozole) or observational group where they were given acupuncture combined with Chinese medicine for 3 cycles. Acupuncture combined with Chinese medicine was found to improve the endocrine levels and insulin resistance of PCOS as well as increased pregnancy rates.
Source: [Acupuncture and Chinese medicine of artificial cycle therapy for insulin resistance of polycystic ovary syndrome with phlegm damp type and its mechanism]. Zhongguo Zhen Jiu. 2017 Nov 12;37(11):1163.
In a randomized control study, fasting insulin, as well as insulin resistance, were significantly decreased after 12 weeks of cinnamon administration. The cinnamon group also had decreased LDL levels compared to a placebo group. Researchers concluded that complementary cinnamon supplementation significantly reduces fasting insulin and increases insulin sensitivity in women with PCOS.
Source: Insulin resistance improvement by cinnamon powder in polycystic ovary syndrome: A randomized double-blind placebo-controlled clinical trial. Phytother Res. 2018 Feb;32(2):276-283
Source: Fertil Steril, 2008; 90(5): 1826-33.
Acupuncture and Infertility:
Acupuncture can increase menstrual frequency, decrease testosterone, and increase ovulation frequency in PCOS.
Source: Am J Physiol Endocrinol Metab. 2013 May 1;304(9):E934-43. doi: 10.1152/ajpendo.00039.2013. Epub 2013 Mar 12.
Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial.
Johansson J1, Redman L, Veldhuis PP, Sazonova A, Labrie F, Holm G, Johannsson G, Stener-Victorin E.
Acupuncture has been demonstrated to improve menstrual frequency and to decrease circulating testosterone in women with polycystic ovary syndrome (PCOS). Our aim was to investigate whether acupuncture affects ovulation frequency and to understand the underlying mechanisms of any such effect by analyzing LH and sex steroid secretion in women with PCOS. This prospective, randomized, controlled clinical trial was conducted between June 2009 and September 2010. Thirty-two women with PCOS were randomized to receive either acupuncture with manual and low-frequency electrical stimulation or to meetings with a physical therapist twice a week for 10-13 wk. Main outcome measures were changes in LH secretion patterns from baseline to after 10-13 wk of treatment and ovulation frequency during the treatment period. Secondary outcomes were changes in the secretion of sex steroids, anti-Müllerian hormone, inhibin B, and serum cortisol. Ovulation frequency during treatment was higher in the acupuncture group than in the control group. After 10-13 wk of intervention, circulating levels of estrone, estrone sulfate, estradiol, dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, testosterone, free testosterone, dihydrotestosterone, androsterone glucuronide, androstane-3α,17β-diol-3-glucuronide, and androstane-3α,17β-diol-17-glucuronide decreased within the acupuncture group and were significantly lower than in the control group for all of these except androstenedione. We conclude that repeated acupuncture treatments resulted in higher ovulation frequency in lean/overweight women with PCOS and were more effective than just meeting with the therapist. Ovarian and adrenal sex steroid serum levels were reduced with no effect on LH secretion.