Polycystic Ovary Syndrome (PCOS)
Better yet - here is the article
A New Epidemic that Causes Infertility, Excess Hair, Acne and More
By John Lee, MD
In the 30 years that I practiced medicine, I rarely saw a woman with polycystic ovary syndrome (PCOS). Today, estimates are that 10 to 20 percent of women have PCOS, and I would guess that among young women the number is even higher, qualifying this as an epidemic.
I have had many e-mails and letters from women in their late teens and twenties with PCOS. Their doctors tend to prescribe two treatments, both of which affect symptoms only, and neither of which is particularly successful. One treatment is temporary chemical castration, using birth control pills, androgens (male hormones), androgen blockers, synthetic estrogens, Lupron or similar drugs that block hormone production. The other is prescribing the new oral drugs for Type II diabetes, which reduce insulin resistance. I have a much safer, simpler, more effective and less expensive approach that treats the cause and not just the symptoms of PCOS.
What Is PCOS?
PCOS refers to multiple cysts on the ovaries and a host of other problems that go along with them, including anovulation (lack of ovulation) and menstrual abnormalities, hirsutism (facial hair), male pattern baldness, acne, and often obesity. Such women may also have varying degrees of insulin resistance and an increased incidence of Type II diabetes, unfavorable lipid patterns (usually high triglycerides), and a low bone density. Laboratory tests often show higher than normal circulating androgens, especially testosterone.
PCOS occurs when a woman doesn't ovulate, which causes a disruption in the normal, cyclical interrelationship among her hormones, brain and ovaries. Normally, the hypothalamus, a regulatory center in the brain, monitors the hormone output of the ovaries and synchronizes the normal menstrual cycle. When monthly bleeding ends, the hypothalamus secretes gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland in the brain to release follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones direct an ovary to start making estrogen (mostly estradiol), and stimulate the maturation of eggs in about 120 follicles.
The first follicle that ovulates, releasing its egg into the fallopian tube for a journey to the uterus, quickly changes into the corpus luteum, which is a factory for making progesterone, and raises progesterone's concentrations to 200 to 300 times higher than that of estradiol. This huge surge of progesterone simultaneously puts the uterine lining in its secretory or ripening phase, and turns off further ovulation by either ovary.
If fertilization does not occur, the ovary stops its elevated production of both estrogen and progesterone. The sudden fall in the concentrations of these hormones causes shedding of the blood-rich uterine lining and bleeding (menstruation). Then, in response to low hormone levels, there is a rise in GnRH and the cycle starts all over again.
But what happens to this cycle if, for some reason, ovulation is unsuccessful? For example, if the follicle migrates to the outside of the ovary, but does not "pop" the egg and release it, the follicle becomes a cyst, and the normal progesterone surge does not occur. The lack of progesterone is detected by the hypothalamus, which continues to try to stimulate the ovary by increasing its production of GnRH, which increases the pituitary production of FSH and LH. This stimulates the ovary to make more estrogen and androgens, which stimulates more follicles toward ovulation. If these additional follicles are also unable to produce a matured ovum or make progesterone, the menstrual cycle is dominated by increased estrogen and androgen production without progesterone. This is the fundamental abnormality that creates PCOS.
Why Eggs Won't Pop and Progesterone Isn't Made
But what causes dysfunctional follicles that won't release eggs? I am convinced, from wildlife studies and from what I have observed in my practice, this is due to the exposure of female embryos to xenobiotics, environmental pollutants that chemically act like estrogen on the developing baby's tissues.
When a female embryo develops in the womb, 500 to 800 thousand follicles are created, each enclosing an immature ovum. Studies show that the creation of ovarian follicles during this embryo stage is exquisitely sensitive to the toxicity of xenobiotics. When the mother is exposed to these chemicals, she experiences no apparent damage. But the baby she is carrying is far more susceptible, and these chemicals may damage a female embryo's ovarian follicles and make them dysfunctional; unable to complete ovulation or manufacture sufficient progesterone. This damage is not apparent until after puberty.
Lifestyle Factors that Cause Dysfunctional Follicles
There are other factors that contribute to dysfunctional follicles. These include stress (leading to the production of high cortisol levels by the adrenal glands), lack of exercise, and poor nutrition. Stress alone can cause anovulatory cycles. Birth control pills shut down normal ovary function, and sometimes it never recovers when the pills are stopped. Our diets are full of petrochemical contaminants -- also xenobiotics -- that derail normal metabolism. We take prescription drugs such as Prozac that impair the functioning of our limbic brain, including the hypothalamus, which may affect the menstrual cycle.
The Diet Connection to PCOS
By far the biggest lifestyle contributor to PCOS is poor diet. Young women with PCOS tend to eat far too much sugar and highly refined carbohydrates. These foods cause an unhealthy rise in insulin levels. According to Jerilyn Prior, M.D., insulin stimulates androgen receptors on the outside of the ovary, causing the typical PCOS symptoms of excess hair (on the face, arms, legs), thin hair (on the head), and acne. Eventually, this type of diet will cause obesity, which will cause insulin resistance (the inability of the cells to take in insulin), which will aggravate the PCOS even more. The androgens also play a role in blocking the release of the egg from the follicle.
Women, who have a high number of dysfunctional follicles to begin with, due to xenobiotic exposure in the womb, will have worse problems if their diets are high in sugary foods and low in nutrition. Since this is exactly the type of diet favored by teens and young women, it's easy to understand why there is so much PCOS in that age group. Fifty years ago, the average person age one pound of sugar a year. Today the average teenager today eats one pound a week! Potato chips, corn chips, pasta and white rice are all highly refined carbohydrates that also act on the body much the same as sugars do.
When you look at the whole picture of PCOS, you can understand why the hormone-blocking and insulin-lowering drugs don't work for very long. These approaches don't address the underlying cause of the problem. They only suppress symptoms. Improvement is only temporary and both types of drugs have terribly unpleasant side effects.
By the same token, you can't just take progesterone, and you can't just cut out the sugar. You usually need to do both. Exercise and good nutrition are also very important in maintaining hormone balance, and I have covered both at length in What Your Doctor May Not Tell You About Premenopause.
Treatment of PCOS
I recommend supplementation of normal physiologic doses of progesterone to treat PCOS. If progesterone levels rise each month during the luteal phase of the cycle, as they are supposed to do, this maintains the normal synchronal pattern each month, and PCOS rarely, if ever, occurs. Natural progesterone should be the basis of PCOS treatment, along with attention to stress, exercise, and nutrition.
If you have PCOS, you can use 15 to 20 mg of progesterone cream daily from day 14 to day 28 of your cycle. If you have a longer or a shorter cycle, adjust accordingly. The disappearance of facial hair and acne are usually obvious signs that hormones are becoming balanced, but to see these results, you'll need to give the treatment at least six months, in conjunction with proper diet and exercise. If your symptoms fade, try gradually easing off the progesterone (take half the dose, for example) and see how it goes. If your symptoms return, stay on the full dose for six more months. Ideally, as a young woman, you would use the progesterone cream only during the months you need it, and encourage your body to return to its own normal hormonal rhythms as much as possible. Some women with many damaged follicles may always need to supplement with a little bit of progesterone cream.
Why Haven't Doctors Figured This Out?
There are several reasons why doctors don't recognize the role of progesterone deficiency in PCOS. They may not be aware that the hypothalamus responds not only to the rise and fall of estrogen, but also to the rise and fall of progesterone. Since standard tests usually indicate that a woman with PCOS has plenty of estrogen, and she is still having periods, the doctor assumes she is still ovulating and producing plenty of progesterone.
The odds of a woman having estrogen dominance and progesterone deficiency rise to 50 percent in the female population by age 35, yet doctors rarely measure progesterone concentrations. They may fear giving progesterone because of all the side effects caused by synthetic progestins, and may not be aware that natural progesterone, unlike synthetic progestins, is remarkably free of side effects when given in normal physiologic doses.
Natural "Under the Tongue" Progesterone -- Ideal Hormone Balance and PMS/Menopause Relief
IMPORTANT NOTE: I briefly made the "under the tongue" progesterone recommended in this article available through this site, but while exploring supply issues, learned that the FDA will be regulating the sale of ALL progesterone -- including progesterone creams and pills -- as by prescription only. Knowing this is forthcoming, I have decided not to offer "under the tongue" progesterone for sale here, but do recommend you discuss progesterone therapy and my recommendation with your physician.
Progesterone is a naturally occurring hormone in the human body, essential for a variety of vital functions. In women, progesterone balances the estrogen hormones, and is produced mainly by the ovaries when ovulation occurs. Women approaching menopause produce lower, and often insufficient, levels of progesterone. What’s more, in our culture, even women in their childbearing years tend to be estrogen-dominant for a number of reasons. Many American women are, in other words, deficient in the progesterone hormone.
The Essential Benefits to You
The progesterone tablets I recommend and administer in my office are natural progesterone, meaning they are “bio-identical” to the progesterone your body produces. They are dissolved under the tongue, not swallowed, so they bypass the liver and kidneys where acids can dilute their potency, and instead enter the bloodstream directly. These are not the synthetic replacements known as a “progestins,” and are therefore non-toxic, rarely have any side effects at all, and are considerably less expensive than any progestin or progesterone cream or ingested pill.
With my patients, I have found that this natural "under the tongue" progesterone, which helps to balance estrogen hormones, leads to:
Relief from PMS and menopause symptoms
A normalized menstrual cycle, including relieving menstrual-related allergies
Relief from breast pain and tenderness
There is also research and medical theory indicating the appropriate balance of progesterone:
Reduces the risk of breast cancer
Protects the uterus from estrogen-induced endometrial hyperplasia (an overgrowth or thickening of the uterus lining)
Reduces the risk of osteoporosis
Helps to manage affective disorders such as depression
Progesterone, which plays a crucial role in brain function, is often called the “feel good hormone” because of its mood-enhancing and antidepressant effects.
Patients who complain about anxiety and irritability often notice that a corrected balance of progesterone vastly reduces or eliminates these feelings.
Safer, More Effective and Less Expensive than Creams and Pills
I now recommend progesterone that dissolves under the tongue over progesterone cream, because these tablets are safer, less expensive, and more effective than the cream. Progesterone is highly fat soluble, and with repeated applications of the cream to the skin, progesterone can build up in a woman’s fat tissue, especially if you are using a prescription-strength form.
I used progesterone cream for many years but ceased several years ago because, when I measured many of these women for progesterone, their levels reached up to 5,000 or even 10,000 (100-300 is normal).
Over time, this can lead to elevated levels of the hormone, contributing to disruptions in adrenal hormones such as DHEA, cortisol and testosterone. (If you continue using progesterone cream, I encourage you to be tested once a year for any build-up or imbalances it may be causing.)
I also recommend "under the tongue" progesterone over any swallowed progesterone, as women require doses of these swallowed pills or liquid that are ten times higher than their body requires for enough to bypass the digestive system and obtain effective levels.
The progesterone I recommend, meanwhile, easily dissolves under the tongue and, because it will not be destroyed by stomach acid or broken down by the liver, fully enters the bloodstream where it can be fully utilized by your organs. If taken as indicated, it's virtually impossible to overdose on "under the tongue" progesterone.
Natural progesterone is safe to use during pregnancy and may likely prevent many first trimester spontaneous abortions but should be used with caution in nursing as it may stop lactation.
IMPORTANT NOTE: I briefly made the "under the tongue" progesterone recommended in this article available through this site, but while exploring supply issues, learned that the FDA will be regulating the sale of ALL progesterone -- including progesterone creams and pills -- as by prescription only. Knowing this is forthcoming, I have decided not to offer "under the tongue" progesterone for sale here, but do recommend you discuss progesterone therapy and my recommendation with your physician.
If one has not read Dr. Lee’s books on What Your Doctor May Not Tell You About Premenopause and What Your Doctor May Not Tell You About Menopause, I would highly recommend them. These books are classics and should be in everyone’s natural medicine library. Progesterone cream has been one of the most important supplements I have ever used in my practice.
I have come to a recent realization regarding the use of these creams. Most women in our culture are estrogen dominant, so using the progesterone goes a long way towards balancing hormones which usually decreases a woman’s risk for breast cancer, improves her PMS and breast tenderness and normalizes her cycle. Like most good things in life if one uses too much of the hormone cream, complications can develop in disruption in one’s hormone balance.
Dr. Lee is fond of using the lower dose creams to avoid this. But this complication can still occur with the low-dose creams. I always attempt to provide the most cost effective solution in my practice so I use prescription strength 10% cream. Theoretically, there is no problem with this if one uses it as directed. There is a huge cost savings as this concentration is able to get the cost down to $3 per month. However, if one uses more than 1/16 of a teaspoon, complications appear to be inevitable.
The problem relates to the fact that progesterone is highly fat soluble and once applied to the skin will store itself in a woman’s fat tissue. When one first uses the cream, there is no problem here as the fat stores are very low. But as time goes on, the cream accumulates and contributes to disruptions in the adrenal hormones such as DHEA, cortisol, and testosterone. I have learned that although progesterone cream is an enormously useful tool, it needs to be used very cautiously.
I have also learned that it is FAR MORE IMPORTANT to work to normalize the adrenal hormones first. Once the adrenal hormones are balanced, the progesterone levels will frequently normalize and one will not require any cream. The wonderful thing about adrenal normalization is that it usually only takes 3-6 months to balance these hormones. Once they are balanced, one usually does not require any hormone supplements to keep them balanced.
The balancing process involves lifestyle changes first. If you haven’t already guessed it by now, the diet at Read This First on my home page www.mercola.com is the first step. Secondly, one needs to get to bed by 10 PM. This is an essential part of the process. If one is routinely going to bed after 10, then one’s biorhythms will be disrupted. Addressing emotional stress in one’s life is the other huge component. I believe that the therapy we are now offering in with Applied Psychoneurobiology, APN, (see the article section on my web site) is one of the most effective tools for this. APN clearly is not the only way to address this and there are many other wonderful approaches out there. Journaling is one of the better and least expensive ones, but there are many other approaches also.
Once the lifestyle issues are addressed, then one would ideally evaluate the adrenal and female hormones. One of the better ways to do this is though measuring salivary hormone concentrations. I had been using Aeron Labs, and they do good work. Dr. Zava used to run it and now he runs his own company, which is also a fine lab. However, I have recently been introduced to BioHealth Diagnostics (800-570-2000) and I am hugely impressed with their services. They hold regular seminars and are even having one this weekend in San Diego. I would have loved to attend, but I am still catching up from my earlier learning tour. They also hold weekly phone seminars for health care professionals, which are excellent.
I really believe they have a huge jump on the other labs as they run multiple samples to make these measurements. One can certainly perform the same test at other labs, but the bill for all the samples would literally by two to three times as expensive. The other labs also do not have an educational component. They have a wonderful clinician, Dr. Dan Bivens, who walks the health care professional through proper evaluation of the test results.
Once the results are in, the hormonal manipulation generally involves using sublingual hormones such as DHEA and pregnenolone or cortisol improving agents such as licorice root extract. The exact dosage, timing and use are determined by the results of the test. The absolutely incredible aspect of this testing and treatment strategy is that it recalibrates the brain and helps the body to start making the hormones by themselves so one is not stuck on hormone treatment for the rest of their life.
Getting back to progesterone cream, I have been finding that many of the women who were on the cream have terribly elevated levels of this hormone. This is not good. Progesterone is normally a cyclical hormone and the body really needs to see a change in the concentration to affect a proper physiological response. If the level is constantly above the concentration that it recognizes as “off” or low, this is not possible. Fortunately, this is repairable. But it may involve going off the cream for as long as two years to wash the progesterone out of the system.
I am still in an evaluation stage and learning about how common this is in my own practice as I have just started using this system for the past month. At this point, I am relatively convinced that this is a big part of the picture for hormone replacement.
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If you are a health care professional and dispensing or recommending progesterone cream, I would recommend you contact BioHealth Diagnostics for an information kit. If you are not one of my patients, you can contact them for a health care professional in your area. If you are one of my patients, there will be a huge shift in the way that we are administering the dispensing of progesterone cream in our office. We will not dispense any cream at this point without a proper evaluation of one’s adrenal and female hormones. This will be done through salivary hormone testing. This test is usually covered by one’s health insurance. This will allow me to normalize and restore the finely tuned hormone balance that one’s body is designed to have, rather than blindly slapping on progesterone cream without any appreciation of the potential complication or hormone disruptions.
Natural progesterone is the exact same hormone that is produced by a woman's ovary. It is made from naturally occurring plant steroids found in the wild yam. It is NOT the synthetic version that is commonly purchased as tablets with a prescription such as Provera. The synthetic progesterone can produce severe side effects including increased risk of cancer, abnormal menstrual flow, fluid retention, nausea, and depression. Side effects are extremely rare with natural progesterone. The only one of concern is that it might slightly alter the timing of the menstrual cycle.
Reasons Why Natural Progesterone Made by Your Body Is Good
Natural progesterone is very useful to balance excess estrogen. Natural progesterone is also different from estrogen in that your body can use it as a precursor or starting material to make other hormones such as adrenal hormones. It can even convert it into estrogen or testosterone if your body needs it. The table on the next page lists the properties of estrogen relative to progesterone. Some of the reasons that estrogen is frequently in excess in many women are:
1. Over production of estrogen. Ovarian cysts or tumors can lead to excess estrogen production. Stress also increases production, but probably the most common cause is obesity. All body fat has an enzyme which converts adrenal steroids to estrogen, so the more fat you have, the more estrogen is present.
2. Inability to breakdown estrogen. Excess estrogen is generally removed by the liver. Diseases of the liver like cirrhosis or decreased enzyme activity can lead to increased estrogen levels. Vitamin B6 and magnesium are necessary for the liver to neutralize estrogen. Increased sugar intake will also excrete magnesium and interfere with its ability to breakdown estrogen.
3. Exposure to pesticides in foods. Most of us eat foods that have pesticides on them. These and many other unnatural chemicals share a common structure with estrogen and serve as "false" estrogens which further stimulates the body's estrogen receptors.
4. Estrogen supplementation. Clearly any additional estrogen given by prescription will increase the level unless it is properly balanced with natural progesterone.
5. Decreased production of progesterone. Progesterone is necessary to counterbalance estrogen. If women do not ovulate during their cycle they will not produce any progesterone that cycle. This happens commonly and worsens the already disturbed progesterone/estrogen balance.
For More Detailed Information on Natural Progesterone: You can purchase What Your Doctor May Not Tell You About Menopause by Dr. John Lee. It is paperback book for $13 and was published in May of 1996 and the newer version What Your Doctor May Not Tell You About Pre Menopause published in 1999 with a blue cover.
Estrogen Effects Progesterone Effects
Stimulates breasts cysts Protects against breast cysts
Increases body fat storage Helps use fat for energy and keep it off hips
Salt and fluid retention Natural diuretic (water pill)
Depression and headaches Natural anti-depressant
Interferes with thyroid hormone Facilitates thyroid hormone action
Increases blood clotting and risk of stroke Normalizes blood clotting
Decreases libido (sex drive) Increases libido
Impairs blood sugar control Normalizes blood sugar levels
Loss of zinc and retention of copper Normalizes zinc and copper levels
Reduced oxygen level in all cells Restores proper cell oxygen levels
Increased risk of endometrial cancer Prevents endometrial cancer
Increased risk of breast cancer Helps prevent breast cancer
Helps decrease bone loss slightly Increases bone building
I have also learned that it is FAR MORE IMPORTANT to work to normalize the adrenal hormones first. Once the adrenal hormones are balanced, the progesterone levels will frequently normalize and one will not require any cream. The wonderful thing about adrenal normalization is that it usually only takes 3-6 months to balance these hormones. Once they are balanced, one usually does not require any hormone supplements to keep them balanced.
I've been taking a 10:1 licorice extract from Ancientway.com to strengthen the adrenals - so hopefully that will have some effect.
PCOS is a Progesterone Deficiency? 
