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Polycystic Ovarian Syndrome

PCOS (Polycystic ovarian syndrome) is a syndrome, not a disease. This means that it is reversible. Although PCOS is a very popular diagnosis this decade, it is not yet completely understood. One thing we do know: it responds very well to natural treatment.

First off, do not be too quick to accept a diagnosis. PCOS is a hormonal condition, not a problem with the ovaries. Ultrasound is NOT enough to diagnose PCOS. You must see an endocrinologist or a Naturopath who understands hormones, and you must have blood tests.

Blood tests necessary to diagnose PCOS are:

Glucose Tolerance Test with insulin OR Fasting insulin
Free androgen index
Thyroid function
Prolactin
Vitamin D (vitamin D deficiency affects hormone balance)

Polycystic ovaries are NOT ovarian cysts
The things that you see on ultrasound are not true cysts. (Although common, ovarian cysts are another type of condition altogether.)

So-called 'polycystic ovaries' have a "pearl necklace" appearance on the ultrasound. These 'pearls' are actually multiple, undeveloped follicles. They form because ovulation is not occurring properly, and this can be due to a number of causes, but most often it is due to insulin.

Let me repeat. The problem is an underlying hormone imbalance that prevents ovulation and gives the ovaries that appearance. The ovaries look that way because something is preventing ovulation. The "something" is either insulin (in classic, type 1 PCOS), or something else (type 2 PCOS)

The ovaries themselves do not cause the weight gain. The insulin resitance that causes weight gain, also causes the ovaries to look that way. (Also causes lack of periods.)

(Many women end up thinking that all of their hormonal symptoms are caused by PCOS. Moodiness and PMT symptoms are due to ovarian hormones, but they are because of oestrogen excess, not because of PCOS. In true PCOS, there is PMT, because there are no periods.)


Type 1 PCOS: Insulin-resistant
Classic PCOS has the symptoms of weight gain, failure to ovulate, infrequent periods, infertility, facial hair, acne, hair loss and a predisposition to diabetes.

It is important to understand that the high testosterone is type 1 PCOS is actually the side effect. The real issue is insulin resistance (see Sensible News 17). It is insulin that inhibits ovulation and causes the ovaries to produce testosterone. It is insulin that is the main cause of weight gain. The symptoms of excessive testosterone, such as acne and facial hair will improve when insulin sensitivity improves.

Insulin resistance is caused by:

too many carbohydrates in the diet (about 30% of the population cannot cope with a "normal" amount of bread and sugar)
damaged vegetable oils called trans fat (see below)
environmental toxins
birth control pill
The correct treatment for Type 1 PCOS is to improve insulin sensitivity.

The birth control pill does absolutely nothing to improve insulin resistance, and can actually worsen it (1). The pill will cause a monthly bleed, but this is not a true period.

An endocrinologist will prescribe weight loss with a low GI diet and exercise, as well as a blood sugar lowering drug such as Metformin. This is approximately the correct approach, but metformin does have side effects such as nausea, diarrhoea and abdominal bloating. Fortunately, there are natural alternatives to metformin. In my experience, the natural supplements lower blood sugar as well, if not better, than Metformin.

Treatment Summary for Type 1 PCOS.
Diet - When the body is insulin resistant, it simply does not remember how to use carbohydrates for energy. It can only store them as fat. At the same time, an insulin resistant body does not have the ability to burn fat stores for energy. The solution is to restrict carbohydrates for six weeks to "remind" the body how to use them for energy. You may need to go down to 30 or 40 grams of carbohydrate per day, but you still must eat vegetables for their fibre and nutrition. Your best source of calories during this time is fat, not protein. Protein puts a stress on the kidneys, and is also converted easily into sugar, whereas fat is simply burned for energy.

Magnesium and chromium - Minerals to improve sensitivity of the insulin receptor

Gymnema, Fenugreek - Herbs to improve sensitivity of the insulin receptor

Homoeopathic Insulin & Leptin (See Sensible News 26) to improve insulin sensitivity and promote weight loss.

Homoeopathic testosterone or Paeony & Liquorice root can be used to lower testosterone, which will alleviate acne and facial hair.

Type 2 PCOS: Non-insulin-resistant
The ovaries show multiple, undeveloped follicles on ultrasound, but there is NO insulin resistance. Testosterone can be high or normal. If testosterone is normal, the acne and facial hair exist because oestrogen is too low (compared to testosteorne). Body weight can be normal.

In insulin-resistant PCOS, the ovaries were inhibited by insulin. In type 2 PCOS, the ovaries are inhibited by other things such as:

History of the birth control pill
Xenoestrogens, which are environmental chemicals that mimic oestrogen (see Sensible News 27)
Trans-fat (see below)
Adrenal stress causing low oestrogen levels
Underactive thyroid
Low fat intake
Leptin imbalance. (Leptin is a hormone secreted by fat stores, and can be deficient, especially if there is a history of an eating disorder. See see Sensible News 40 and 42.)

A special note about Trans-fat: Trans-fat is a damaged vegetable oil that is used in processed food, commercial salad dressing and margarines. Researchers from the Harvard School of Public Health found that only 4 grams of trans-fat per day is enough to interfere with ovulation.(2) This much trans-fat is found in one doughnut or one meat pie. Trans-fat has also been shown to cause abdominal obesity linked with PCOS, even when total calories are low. (2). Naturally occurring fat, even saturated fat from animals, does not appear to be a problem for PCOS.

Metformin is not a treatment for Type 2 PCOS. Nor is the Pill. The Pill will induce monthly bleed this is not actually a treatment. For those women whose PCOS has been caused by the pill, continued use will only worsen the problem.

Treatment Summary for Type 2 PCOS.
Stay off the birth control pill
Minimise exposure to xenoestrogens and use Homoeopathic drainage and detoxification to repair any damage
Rehmannia or Withania - Herbs to support the stress glands, and improve oestrogen production
Homoeopathic folliculinum to induce ovulation
Low potency homoeopathic oestrogen to improve oestrogen production
High potency homoeopathic testosterone or Paeony & Liquorice root to lower testosterone, bring on the periods, and alleviate acne and facial hair.
Homoeopathic leptin
Natural Progesterone cream
Bowen therapy to induce ovulation

MORE READING: http://www.sensible-alternative.com.au/sensnews42.pdf

Author: Lara Grinevitch BSc, ND. Sensible-Alternative Naturopathic Clinic.
www.sensible-alternative.com.au

Appointments at Sensible-Alternative
For professional advice regarding Polycystic ovarian syndrome (PCOS), please call to make an appointment...

Sensible-Alternative Hormone Clinic
Suite 1, Berry Rd Medical Centre
1A Berry Rd, St Leonards NSW.
phone: 02 9438 3448.
reception@sensible-alternative.com.au

References:
(1) Nader, S et al. The effect of desogestrel-containing oral contraceptives on the glucose tolerance and leptin concentration in hyperandrogenic women' J Clin Endocrinol Metab 1997 82: 3074-7

(2) Nader, S et al. The effect of desogestrel-containing oral contraceptives on the glucose tolerance and leptin concentration in hyperandrogenic women' J Clin Endocrinol Metab 1997 82: 3074-7

(3) Kavanagh, K. 66th Scientific Sessions of the American Diabetes Association, June 9-13, 2006, Washington; abstract 328-OR. News release, Wake Forest University Baptist Medical Center

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