PCOS: Redefining the Problem

Polycystic Ovarian Syndrome (PCOS) is the most common hormone disorder affecting women from puberty right through their fertile years and into menopause. It is thought that PCOS affects between 5-15% of all women (1). The sad thing is the majority of PCOS sufferers remain undiagnosed until later in life, with treatment only sought when trying to achieve a pregnancy.

Fertility is not just about making babies and this statement couldn’t be truer for PCOS women. The consequences of PCOS extend far beyond the symptoms of acne, hair growth and infertility. PCOS has been linked with other health issues like metabolic syndrome, obesity, elevated blood pressure and cholesterol issues (2). PCOS women also have an increased risk of developing endometrial hyperplasia, due to the lack of ovulation and constant bombardment with oestrogen while recent research indicates that 40% of PCOS women suffer from depression (3). Going through menopause doesn’t make PCOS disappear either and is why getting treatment early is so beneficial to getting PCOS under control and living a healthy vibrant life.

So how is PCOS diagnosed?

Currently there are 3 different criteria’s for diagnosing PCOS. No wonder many women get misdiagnosed and underdiagnosed.

Adapted from: http://nurse-practitioners-and-physician-assistants.advanceweb.com/

The key features for diagnosis are: androgen excess (hyperandrogenism) and irregular ovulation (oligo-ovulation)

Note: Don’t get polycystic ovarian syndrome confused with polycystic ovaries. It is possible to have cysts on the ovary without having PCOS. With PCOS you need high androgens and irregular periods too. Cysts on the ovaries without high androgens is often either an iodine deficiency and/or hormonal imbalance.

What Causes PCOS

Growing evidence suggests that PCOS develops while in the womb and there is no doubting a genetic link with PCOS. It is quite common to see mothers, daughters and sisters also affected by PCOS. It is also well known that high insulin levels (high blood sugars) result in high androgen levels which is a vicious cycle that keeps building and building. However, 30-50% of PCOS women do not have high insulin levels (4), so what causes their androgen excess?

New research emerging has shown that inflammation may be the main driver in PCOS rather than the high insulin. Don’t get me wrong if you have high insulin or are overweight then you still very much need to address the insulin factor but for women who don’t have this issue but have PCOS then inflammation looks to be the culprit. A recent study found that women with PCOS had higher levels of inflammatory markers in their blood when compared to healthy controls (5).

Another study looked at the gut health of PCOS women and found that PCOS women had lower levels of good bacteria in the gut they also had a higher presence of leaky gut when compared to healthy controls (6). There is a little food for thought – how is your gut health?

How to fix it

The great news is that PCOS is very treatable with natural medicine! I would always recommend getting treatment guidance from a natural health care practitioner to ensure your PCOS is being treated effectively and plus PCOS treatment is not one size fits all as you can see from above. Below are my top 6 treatments for PCOS to get you started.

1. Ketogenic diet

Adopting a ketogenic diet is an absolute must. A study looking at a low carbohydrate ketogenic diet in women with PCOS found that after 6 months there was a reduction in testosterone (androgen) levels by 22%, reduction in fasting insulin levels by 54% and participants in the study also lost a whopping 12% body fat on average. Two participants also become pregnant during the study despite previous infertility problems (7). The inability to digest and metabolise carbohydrates properly not only causes issues with insulin but also drives inflammation within the body.

2. Food as Medicine

With new research showing inflammation and gut health as drivers behind PCOS it’s time to pump up your diet with anti-inflammatory and gut friendly foods.

Antiinflammatory – salmon, sardines, walnuts, chia seeds ground, turmeric, ginger

Gut friendly foods – apple cider vinegar, bitter leafy greens, fermented foods like yoghurt (plain, pot set and full fat), sauerkraut, kombucha, slippery elm powder, turmeric

What to avoid – sugar, gluten, trans fats/processed fats, too much red meat

3. Antiinflammatory

With a growing body of evidence identifying inflammation as a driving force behind PCOS it is important to address inflammation when treating PCOS. My favourite natural anti-inflammatory is turmeric. The active ingredient in turmeric is curcumin which has shown time and time again to significantly reduce inflammatory markers within the body as well as reducing the expression of inflammatory markers within the ovary itself within just 14 days (8). The recommended dose of curcumin is up to 500mg/day.

4. Paeonia (Paeonia lactiflora) and Licorice (Glycyrrhiza glabra) – These two herbs in combination inhibit the production of testosterone (androgen) while paeonia also promotes aromatase activity, which stimulates the conversion of testosterone into oestrogen (a good thing for getting rid of high androgens) (9&10). A study measuring the impact of licorice on serum testosterone (androgen) levels found that after 8 weeks of supplementation with 3.5g of licorice serum testosterone had decreased by a whopping 10ng/d (9). Dose is 3g per day of each paeonia and licorice.

5. Exercise

Get moving. Whatever it is you like to do just move. Studies show that exercise improves weight loss, corrects irregular periods, reduces androgens and improves cardiovascular risk factors (11).

6. Inositol

Inositol is a natural dietary supplement that helps lower insulin resistance. In clinical studies inositol has shown to improve menstrual regularity in 85% of participants and improve ovulation in up to 70% of women with PCOS (12). It has also shown to reduce androgen levels, decrease triglyceride levels, increase good (HDL) cholesterol and lower blood pressure all very important for the management of PCOS. Dose: Use myo-inositol at 2g twice per day.

New research has changed the way we approach and treat PCOS; it’s more than just a high androgen, irregular period issue. So, if you are struggling with PCOS make sure you seek help from someone who is prepared to take a holistic approach to your health and ensure that the true cause of the problem is being treated be that inflammation, poor gut health or high insulin levels.

PCOS isn’t a diagnosis you should be scared of with the right advice, support and treatment plan you can naturally get PCOS under control! Have you successfully got your PCOS under control? I’d love to hear what worked for you or advice you have for other women struggling with PCOS.

References

1. Rosenfield, Ehrmann D. The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocr Rev. 2016. 37(5); 367-520.

2. Mobeen H, Afzal N, Kashif M. Polycystic ovary syndrome may be an autoimmune disorder. Scientifica. 2016.

3. Kerchner A, Lester W, Stuart S, Dokras A. Risk of depression and other mental health disorders in women with polycystic ovary syndrome: a longitudinal study. Fertil Steril. 2009. 91(1);207-212.

4. Gonzalez F. Nutrient-induced inflammation in polycystic ovary syndrome: role in the development of metabolic aberration and ovarian dysfunction. Semin Reprod Med. 2015. 33(4);276-286.

5. Gao L, Gu Y, Yin X. High serum tumor necrosis factor-alpha levels in women with polycystic ovary syndrome: a meta-analysis. PLoS One. 2016. 11(10);e0164021.

6. Lindheim L, Bashir M, Munzker J, Trummer C, Zachhuber V, Leber B et al. Alterations in gut microbiome composition and barrier function are associated with reproductive and metabolic defects in women with polycystic ovary syndrome (PCOS); a pilot study. PLoS One. 2017. 21(1);e0168390.

7. Mavropoulos J, Yancy W, Hepburn J, & Westman E. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab. 2005. 16(2). 35

8. Mohammadi S, Kayedpoor P, Karimzadeh-Bardei L, Nabiuni M. The effects of curcumin on TNF-α, IL-6 and CRP expression in a model of polycystic ovary syndrome as an inflammation state. Journal of Reproduction and Infertility. 2007. 18(4);352-360.

9. Armanini D et al. Licorice reduces serum testosterone in healthy women. Steroids. 2004. 69(11-12);763-766.

10. Takeuchi T et al. Effect of paeoniflorin, glycyrrhizin and glycyrrhetic acid on ovarian androgen production. Am J Chin Med. 1991. 19(1);73-8.

11. Lass N, Kleber M, Winkel K et al. Effect of lifestyle intervention on features of polycystic ovarian syndrome, metabolic syndrome and intima-media thickness in obese adolescent girls. Journal of Clinical Endocrinology and Metabolism. 2011. 96(11);3533-3540.

12. Papaleo E, Unfer V, Baillargeon J, De Santis L, Fusi F, Brigante C, Marelli G, Cino I, Redaello A, Ferrari A. Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Gynecol Endocrinol. 2007. 23(12);700-703.