Polycystic Ovarian Syndrome may be one of the most complex female
health issues of our time. It is the most common endocrine disorder in
women of reproductive age. PCOS is accompanied by a variety of different
health issues, many of which directly impact fertility. Classic PCOS
presents with obesity, polycystic ovaries (multiple ovarian cysts that
look like a strand of pearls), elevated levels of androgens and absent
or irregular menstrual cycles. Not all women who will go on to be
diagnosed with PCOS will have these issues though.
What Causes PCOS?
Doctors are unsure of what causes PCOS, but information suggests
there may be a genetic link, possible abnormal fetal development and
inflammatory response contributing to the cause. PCOS is also
negatively affected by diet, lifestyle and exposure to certain
environmental toxins. PCOS directly impacts fertility, but has serious
health implications as well, especially if left untreated.
Genetic Predisposition and Abnormal Fetal Development
Women whose mothers, sisters or grandmothers had PCOS are at a higher
risk for developing PCOS. Research suggests that exposure to excessive
amounts of male hormones (androgens) by the developing fetus may alter
proper gene expression. This means that the affected genes will not
function properly later in life, which may cause PCOS during the
reproductive years of a woman’s life.
An interesting study of 235 women with PCOS were divided into two
groups. The groups were categorized by 1. obese women with elevated
androgens, elevated LH and testosterone and 2. by thin to normal weight
women with elevated LH and normal levels of androgens. The results of
the study showed a pattern in their both mothers weight and baby’s birth
weight and fetal gestation time. Women in group 1 had above-average
birth weight and were born to obese mothers. Group 2 were born after
term (over 40 weeks gestation). The conclusion was that events
occurring during fetal development may have long-term effects on
endocrine function later in life.
Low-grade Inflammation
It has also been found that women with PCOS have low-grade inflammation,
which may be a cause for insulin resistance. White blood cells produce
substances to fight infection, this is known as inflammatory response.
In some predisposed people eating certain foods, or exposure to certain
environmental factors may trigger an inflammatory response. When
inflammatory response is triggered, white blood cells produce substances
that may contribute to insulin resistance and atherosclerosis.
Signs, Symptoms and Health Risks
Signs and Symptoms of PCOS
- Irregular menstrual cycles
- Absent period
- Anovulatory cycles
- Abnormal mid-cycle bleeding
- Excessive or heavy menstrual bleeding
- Alopecia (balding)
- Hirsutism (excessive body hair)
- Acne
- Acanthosis nigricans
- Polycystic ovaries
- History of ovarian cysts
- Mood disorders
- Obesity
- Recurrent Miscarriage
Health and Fertility Risks Associated with PCOS
- Infertility
- Menstrual cycle irregularities
- Possible increased risk for Endometrial and Breast Cancer due to unopposed estrogen
- Cardiovascular Disease
- Diabetes
- Gestational Diabetes
How is PCOS Diagnosed?
When PCOS was first discovered it was named Polycystic Ovarian
Syndrome because of the presence of polycystic ovaries seen by
ultrasound. Over time doctors began to realize that PCOS was a complex
array of health issues. This lead to certain criteria that must be
recognized to be diagnosed with PCOS, rather than just the presence of
polycystic ovaries. In fact some women with PCOS do not have polycystic
ovaries.
In order to be diagnosed with PCOS the following should be evaluated by your healthcare practitioner:
Pituitary and Ovarian Hormone serum levels
- Luteinizing Hormone (LH)
- Follicle Stimulating Hormone (FSH)
- Estradiol
- Progesterone
- Prolactin
- Free testosterone
- Free androgen index (FAI): 17-hydroxyprogesterone
- Sex hormone binding globulin (SHBG): 24 hr. urinary free cortisol
- Dehydroepiandrosterone sulfate (DHEA-S)
Endometrial Biopsy
Glucose Tolerance Test
Thyroid Panel
Blood Lipid Profile
Wondering what your test results mean? Please talk to your doctor in
detail about what your test results mean for your fertility. Some
doctors may tell you that you have mild PCOS. Women may have some or
all of the symptoms of PCOS, some may have normal menstrual cycles and
some may not. Testing is the best way to find out if you have PCOS for
sure or not.
How PCOS Affects the Menstrual Cycle
What happens in a normal menstrual cycle?
In very simple terms the hypothalamus produces GnRH
(gonadotrophin-releasing hormone) which signals to the pituitary to
produce LH (luteinising hormones and FSH (follicle stimulating hormone).
The release of GnRH is pulsatile in women with regular menstrual
cycles. This normal pulsatile release of GnRh signals some of the
follicles in the ovary to begin maturing and for the ovaries to release
estrogen and progesterone. This estrogen/progesterone signal is
recognized by the pituitary gland. As the follicles begin maturing they
release and increase the hormone estrogen over time. The rising estrogen
level signals the pituitary gland to curb release of FSH. This
communication allows for ovulation to occur. In women with PCOS the
menstrual cycle follows a different pattern of endocrine function and
communication.
What the menstrual cycle is typically like in a woman with PCOS…
In women with PCOS the cycle begins irregular, with the hypothalamus
releasing GnRH in a higher than normal pulsatile frequency. This allows
for increased LH and decreased FSH, this in turn leads to excessive
production of the androgens androstenedione and testosterone. This
causes the follicle to only mature some, but not enough to achieve full
maturity. This also allows for continued increase of estrogen,
primarily estrone. During the development of the reproductive stage and
during reproductive years for females, estrone is relatively low.
Typically we think of estrone to be associated with menopause, not women
of reproductive age. The higher levels of androgens and estrogen
creates a chronic state of low to very low progesterone.
Classic polycystic ovaries are a result of chronic anovulation.
Endocrine function is imbalanced from the very beginning of the cycle
causing mild to severe hormonal imbalance, depending on the individual.
Excessive levels of estrogen may also cause uterine hypertrophy, also
known as endometrial hyperplasia. Unopposed estrogen may cause
excessive cell proliferation of the endometrium. The endometrium is the
innermost layer of the uterus that is shed as menses during
menstruation. Endometrial hyperplasia may cause heavy menstrual
bleeding or prolonged bleeding during menstruation. The uterus may
become bulky and larger than normal.
Medical Options for PCOS
Anovulatory Cycles
Oral Contraceptive Pills (birth control)
are the number one most prescribed medication to regulate menstruation
in women with PCOS. While this may help to create a regular menstrual
cycle (which is important) it prevents pregnancy. This is not helpful
for women with PCOS who are trying to conceive. OCPs do not solve the
root of the problem.
Other hormonal medications may be commonly used as well. This is determined by case.
Clomid is commonly used for women with PCOS to
hyperstimulate the ovaries to ovulate. Once again the problem we
encounter here is that Clomid does not resolve PCOS, though it may help a woman to get pregnant.
Ovarian drilling done by laparascopic surgery. This is done with the intent to stimulate ovulation.
Insulin Resistance
Metformin
This drug is commonly prescribed for women with PCOS, even if they are
not insulin resistant or have any signs of type 2 diabetes. Metformin
helps to control the amount of glucose in the blood. Metformin is used
to treat type 2 diabetes. PCOS can often be helped by specific diet
changes, similar to a diabetic diet. Metformin comes with many risks
and side effects. Talk to your doctor in detail before choosing to use
Metformin to control PCOS. Many natural therapies may also be used with
Metformin with your doctor’s approval.
There are a variety of
other medications prescribed
depending on the symptoms of PCOS. There are medications for hirsutism
or alopecia, weight gain and more. Your doctor can provide you with
specific information on medications.
Learn to Eat a PCOS Fertility Diet
Eating a specific PCOS Fertility Diet is one of the best things you can do to improve your chances of becoming pregnant.
A big part of the problem with PCOS is the high insulin resistance.
Resistance to insulin increases the body’s insulin levels which effects
normal ovulation by preventing the body from ovulating or limiting the
maturation process of the released egg.
This directly has an affect on your fertility and ability to conceive.
Women who are insulin resistant are also 4-5 times more likely to have a
miscarriage. Imbalanced insulin levels due to PCOS make it difficult
for the embryo to attach properly to the uterus.
PCOS is also a huge red flag for the beginning of type 2 diabetes.
I do not say all this to scare you, but I do want you to know that this
is a serious matter. But there is a lot you can do to turn this all
around, naturally. The biggest step you can take is to change your diet
to a PCOS diet.
The benefits of following a PCOS Diet are:
- Increases the rate of spontaneous ovulation.
- Significantly improves the environment of the uterus, preparing it for a healthy conception.
- Decreases the potential for miscarriage
- Prevents PCOS from turning to diabetes
PCOS Diet Guidelines
1. Balance your daily protein with equal amount carbohydrates
This will help to eliminate the insulin yo-yo. When you eat equal
amounts of proteins and carbohydrates this helps to keep your insulin at
a balanced level, thus increasing your fertility.
Low-carbohydrate, high-protein diet helped insulin
resistance. High-carbohydrate, low-protein diet made insulin resistance
worse.
-Medical Journal Metabolism; no. 12: 1481-1487
A diet containing 25% carbohydrates improved insulin resistance, whereas a diet that included 45% carbohydrates did not
-International Journal of Obesity and Related metabolic Disorders 20 no. 12:1067-1072
The types of carbohydrates you choose are also an important factor.
Choose whole grain, or sprouted grain products. They contain more
protein and fiber (thus balancing insulin better) than the processed
counterparts. Avoid white processed carbohydrates which cause a spike in
your insulin levels and provide no fiber, or nutrients.
Some examples of whole grain and sprouted grain products are:
- Ezekiel breads
- Whole spelt- pastas and breads
- Quinoa – pastas, flour, grain
- Millet- breads, grains, cereal
- Brown Rice- cereals, breads, grain
The best place to find these foods are at your local health foods store or Whole Foods Market.
Make sure the proteins you are eating are complete and organic.
Organic meats and dairy contain essential fatty acids and will not
contribute to any hormonal imbalances.
2. Eat low glycemic index foods
Low glycemic index foods are carbohydrates that break down slowly in
the body, and don’t case such a dramatic spike and drop in insulin
levels.
Some examples of low glycemic index foods are:
- Any vegetables
- Whole grains
- Unprocessed foods
- Fibrous foods
Carbohydrates that break down quickly are likely to make the insulin levels jump dramatically.
Avoid foods that have a high glycemic index such as sugary and
starchy foods: pancakes, syrups, sugar, white potatoes, jams, scones,
white bread products, pasta.
3. Eat a diet high in fiber
Fiber
helps in two ways with PCOS. The first way they help is by slowing down
the digestion of sugars in the body, so there is no spike in insulin.
The second way they help is by removing excess estrogens from the body,
which may also help to reduce fibroids.
Great sources of fiber are: broccoli, celery, whole grains, Ezekiel bread, apples, and dark leafy greens.
4. Eat 5 meals a day
By eating more often, the body will not go into fasting mode. When
you look at the way most Americans eat, it is usually three big meals a
day. With such a large gap of time between meals the body goes into
fasting mode which causes the metabolism to become imbalanced.
The five meals a day should consist of three regular meals and two
healthy snacks or 5 small meals. The first snack should be eaten in the
mid-morning before lunch and the second snack to be eaten less than an
hour before bed. Between eating 5 meals a day and eating a serving of
protein (3-4 ounces), starch (1/4-1/2 cup), vegetables (1/2 cup to 1
cup) each meal, you will also experience weight loss.
Here is what the 5 meals a day could look like:
- Breakfast (right away, when you wake up): 2 eggs scrambled with spinach + 1/2 cup oatmeal
- Snack: Protein shake with organic milk, banana and spirulina
- Lunch: Organic Turkey sandwich on whole grain bread with carrot sticks and hummus on the side
- Dinner: Organic chicken with steamed broccoli and half a yam
- Snack (less than an hour before bed): organic yogurt with granola and 1/2 teaspoon spirulina
You could have your last snack between lunch and dinner, eating your
dinner right before bed. Find out what works best with your lifestyle.
5. Eat essential fatty acids daily
Eating essential fatty acids (EFA’s) helps you to lose weight,
produce balanced hormones, and creates a healthy environment for
conception.
The best source of EFA’s is Fish Oils, and Evening Primrose oil.
Omega 3 EFA supplement- Take 1-3 capsules daily with your
snack. Make sure to use an oil that contains DHA which is essential for
the baby’s healthy brain. You can take this daily and during pregnancy.
Evening Primrose Oil-
Take 1500mg of this oil from day one of your cycle (menstruation) till
ovulation. Evening Primrose Oil helps to increase cervical mucous and
metabolic function. Use in addition to the flax or cod liver oils.
6. Exercise 30 min. 5 days a week
Exercise helps PCOS by improving your insulin sensitivity, increasing
your metabolism and helping to shed any excess weight. Both aerobic and
resistance exercises are good. Researchers found that participants of
resistance exercises showed better improvement in insulin sensitivity
than with aerobic exercise alone.
You could walk and lift weights or take a Pilates class and run on the
treadmill. Discover what you enjoy doing and do this 5 days a week for
at least thirty minutes.
7. Eat Organic
You will be eating a high protein diet, so it is essential that any
animal proteins (meats and dairy) you are eating are organic. In
commercial meats there are large amounts of added hormones (estrogens)
that make the animals grow bigger, faster, and produce more milk. With
PCOS there is usually a progesterone deficiency and adding more
estrogens can make it even worse.
Studies have shown that organic foods contain more vitamins, minerals and healthier proteins.
8. Quit Coffee
Caffeine increases estrogen
levels. A study from Fertility and Sterility shows that drinking just
two cups of coffee a day boosts levels of estradiol, a natural estrogen.
Women who drink 4-5 cups of coffee a day produce 70% more estrogen in
the follicular phase of the menstrual cycle (when the body is trying to
produce a viable follicle for ovulation, which is already and issue in
women with PCOS.)
If you need help getting off the bean, check out Teccino. It is a
coffee alternative that tastes great and is alkalizing for the body.
PCOS Herbs and Supplements
In addition to eating the PCOS diet, supplements have shown to be
effective in helping those with PCOS boost there fertility and give
birth to healthy babies. The overall goal with PCOS is to balance blood
sugar levels in the body, maintain hormonal balance, promote healthy
digestion for improved estrogen metabolism, while also working to
promote regular ovulation and menses. Adaptogen herbs are also
important, this is because adaptogens increase resistance to mind-body
stress and enhance overall vitality and health through non-specific
adrenal (known as stress glands) support. Plants recognized as
adaptogens help to normalize the body’s functions, most importantly the
endocrine system, even during diseased states, are non-toxic, nutritive,
and have been deemed safe for long term use.
Herbs and supplements are not meant to be a substitute for
dietary and lifestyle changes! If important diet and lifestyles changes
specific to PCOS are not in place, herbs and supplements cannot aid the
body properly!
Supplements that are beneficial for PCOS…
Whole Food Multivitamin
A major part of decreasing the effects of PCOS and preparing the uterine
lining is to take a prenatal multivitamin. Making sure your body has
all of the nutrients necessary is a lot easier when you are taking a whole food multivitamin. Synthetic multivitamins won’t have the same effect.
Other vitamin and mineral considerations…
Chromium
This trace mineral enhances the action of insulin. Some studies have
shown supplementing with chromium may improve blood sugar control. In
one study women with PCOS were given 1,000 mcg per day of chromium for
two months. In that time results showed improved insulin sensitivity by
30% and by 38% in obese women with PCOS.Foods that are high in chromium are onions, tomatoes, brewer’s yeast,
oysters, and whole grains, bran cereals. Most foods contain little
chromium, so supplementation may be need to be considered.
Calcium and Vitamin D
Both calcium and vitamin D play significant roles in the health of many
parts of the body. Where PCOS is concerned, calcium protects
cardiovascular health. Vitamin D plays a role in glucose metabolism.
Studies have shown that people with type 2 diabetes are often deficient
in vit. D. A small study of 13 women with PCOS showed that 7 out of the
9 who had absent or irregular menstrual cycles, had a return of normal
menstrual cycles within two months of being given 50,000 IU once or
twice per week of vitamin D and 1,500 mg per day of calcium.10. This is
a marked improvement! Of those 13 women, 5 were shown to be vitamin D
deficient.
Good food sources of vitamin D are cod liver oil, eggs, salmon, mackerel, tuna and whole fat yogurt or other dairy products.
Vitamin D can also be obtained for free by sitting out in the sun for
15 to 20 minutes per day. Forget using sun block though as it will
actually block the ultraviolet light that is needed to produce Vitamin
D. The warm sun helps your skin to create Vitamin D3 that is then
transformed into the active hormone form of Vitamin D by the kidneys and
the liver. In fact, by being out in the sun for just a few minutes a
day, a woman’s body can create between 10,000 to 25,000 IU of Vitamin D.
Calcium can be found in kale, turnip, collard, and mustard greens,
kelp and wakame seaweed. Hiziki, a type of seaweed has 10 times more
calcium than a glass of milk.
Herbs and supplements that promote hormonal balance and support regular ovulation:
Omega blend
Eating essential fatty acids (EFA’s) helps you to lose weight,
produce balanced hormones, and creates a healthy environment for
conception. EFA’s have been shown to support hormonal balance and
production.
Maca (Lepidium meyenii)
Maca works to balance the estrogen and progesterone in the body, for a healthy menstrual cycle. Maca
is an adaptogen and an incredible fertility superfood. It helps to
balance the hormones, but does not contain any hormones itself. It is
able to do this by nourishing and balancing the endocrine system.
Vitex (Vitex agnus-castus)
Vitex Extract (Chaste Tree Berry) is one of the most powerful herbs
for women’s fertility and menstrual health. There are numerous studies
and testimonials of Vitex
and it’s effects on the body. One of the reasons Vitex is so effective
for women who are not ovulating due to PCOS, is because of its ability
to balance hormones while not containing hormones itself. Vitex supports
hormonal balance in the body by having an effect on the
hypothalamic-pituitary-ovarian axis (hormonal feedback loop), correcting
the problem at the source.
Tribulus (Tribulus terrestris)
May normalize ovulation in infertile women when used prior to
ovulation. This herb has been found to be wonderful in aiding women
with menstrual irregularities, improving timing of the entire menstrual
cycle. Tribulus has also been found to be a nourishing tonic for the female reproductive system as a whole, especially concerning the ovaries.
White Peony (Paeonia lactiflora) and Licorice Rt. (Glycyrrhiza glabra)
Most clinical trials have found that when White Peony
is combined with Licorice Rt., it performs better, especially for
relaxing muscles, reducing painful menstruation, as well as lowering
serum and free testosterone levels in women with PCOS.
Natural Progesterone Cream
Progesterone cream can help to oppose the estrogen dominance that occurs with PCOS. By using progesterone cream
you are able to mimic a natural cycle and help the body to establish
its own cycle, including ovulating, again. Dr. John Lee believed that
with progesterone cream, changes to the PCOS specific diet and exercise,
PCOS could become obsolete.
Healthy Estrogen Metabolism
DIM
DIM
balances the hormones and aids in the breakdown of estrogen. Estrogen
is a major culprit to many of the fertility issues women face today
including PCOS. Unopposed estrogen has been shown to cause menstrual
cycle irregularities and in more advanced cases, endometrial
hyperplasia. Removal of excess estrogen is vital to overall hormonal
balance in women with PCOS.
Insulin Resistance
Cinnamon (Cinnamomum spp.)
A pilot study published in 2007 by
Fertility and Sterility showed cinnamon to greatly reduce insulin resistance in women with PCOS. Another study suggests cinnamon
may also reduce insulin resistance by slowing the movement of food from
the stomach to the small intestine. This slows the breakdown of
carbohydrates, which is important for people with diabetes and women
with PCOS.
Gymnema (Gymnema sylvestre, G.sylvestris)
Gymnema has been used for hundreds of years to reduce high blood
sugar. This herb has a “sugar blocking” action on taste buds and the
small intestine. Gymnema blocks the typical paths that sugar molecules take during digestion, delaying the absorption of sugar.
It works by stimulating the regeneration of pancreatic cells that
produce insulin, which aids in more insulin production; in turn
stimulating production of enzymes that help with the uptake of glucose
into cells; and then prevents stimulation of the liver to produce more
glucose. Gymnema also appears to have a lipid-lowering effect, which
aids in weight loss
.
Saw Palmetto (Serenoa repens)
Saw Palmetto
has been found to inhibit DHT production by reducing 5 alpha-reductase
production, which may help prevent hirsutism in women with PCOS. This
herb also helps to reduce endometrial hyperplasia and hormonal acne
symptoms.
Inflammatory response
Because women with PCOS usually have low-grade inflammation constantly
present in the body, it is important to support the body by promoting
healthy inflammation response. Some foods are known to trigger
inflammation in the body. If you have food allergies, avoid foods which
you are sensitive to, they trigger inflammatory response.
Omegas
Omega
essential fatty acids decrease the risk of inflammation, especially
omega 3 and 6. Getting enough essential fatty acids in the diet may
help, whether through foods you eat or through supplementation.
Fertility Enzyme Therapy
Fertility Enzyme Therapy
using systemic enzymes are another option. Systemic enzyme blends work
as a biological response modifier; working with the bodies own immune
defense system to moderate inflammatory response. They also break down
the proteins in the blood that cause inflammation.
Royal Jelly and Bee Propolis
Royal jelly
and bee propolis have been shown to reduce inflammation and naturally
boost the body’s immune system. They may also aid in hormonal balance
through endocrine system support.
Summary
PCOS is a complex female health issue. It consists of many different
health issues and risks. If permanent diet and lifestyle changes are
implemented, these risks and health issues may become obsolete. There
are many ways to support the proper health of a woman’s body that is
dealing with PCOS. Important key tips…
1. Make sure your doctor performs the correct tests and you get a proper diagnosis.
2. Follow a PCOS specific diet to help decrease insulin resistance, balance weight, promote estrogen metabolism.
3. Promote hormonal balance and support regular ovulation. Consider supportive herbs and supplements.
4. Support proper inflammatory response.
5. Stick to your plan, believe in yourself, you have the ability to change your circumstances!
Red Raspberry (Rubus idaeus, spp)
is one of the most well known and most loved fruits in the world, but
in the herbal and midwifery world it’s leaves are also a dearly
treasured herbal remedy for women of childbearing age. Raspberry Leaf
is most popular as a tonic for pregnancy and labor, but is it also
excellent as a nutritive and tonic in preparation for pregnancy. It is
also one of the main herbs that is considered safe in most cases to use
during pregnancy in preparation for labor. But, why wait until you are
pregnant to reap the benefits of this wonderful leaf?
This
herb is best taken as an infusion (herbal tea). Drink 1 cup, 1-3 times
a day. Pour ¼ cup of dried red raspberry leaf into a quart mason jar,
fill with freshly boiled water, cover and let steep for at least 15-30
minutes. For a stronger infusion, steep for 3-4 hours.
