PCOS (Polycystic Ovarian Syndrome)

PCOS (Polycystic Ovarian Syndrome): Myths, Facts and Natural Treatment

What is PCOS?

PCOS or polycystic ovarian syndrome is a collection of symptoms that indicate a hormonal imbalance.  The one common symptom experienced by women with PCOS is a lack of regular ovulation.  Statistics say 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.

What Causes PCOS?

Current diets and lifestyles are making the condition more common. In 60% of women with PCOS, high blood sugar levels and high insulin levels increase male hormone production.   These high male hormones 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. For example, other factors that affect ovulation include high prolactin, low estrogen, low body weight, anorexia, hypothyroidism, etc.

Either way, poorly developed egg follicles remain in the ovary as a cyst.

Estrogen Dominance in PCOS

Since ovulation is either delayed or doesn’t occur at all, the hormone progesterone is either reduced or absent. Low progesterone leads to many of the symptoms of PCOS. When 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 thickening of the uterine lining, while progesterone helps maintain it.  Estradiol causes increased breast tissue while progesterone keeps it healthy.  Estrogen provokes emotions like sadness and progesterone has anti-depressant qualities. Progesterone reduces muscle spasms, normalizes clotting and vascular strength.  It helps thyroid function and bone building.

High Testosterone in PCOS

Some PCOS women have high testosterone which causes problems like irregular menstrual periods, lack of ovulation, infertility, acne, excess body and facial hair growth, and loss of head hair. Regulation of dietary starch and sugar intake can greatly improve symptoms of PCOS.

Women with PCOS are at higher risk of cardiovascular diseases like high blood pressure and heart attacks and also diabetes.

Can I Have Children with PCOS?

PCOS is not an infertility sentence.  It can be treated naturally through diet, herbs, exercise, and nutritional supplements.  Most women with PCOS can conceive naturally with the right advice.

Symptoms of PCOS (Polycystic Ovarian Syndrome)

Because of the hormone imbalances associated with classic PCOS (high androgens, low progesterone), women can suffer from:

• 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
• Excess 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.  It helps me to determine why you are having problems. I can then prescribe the appropriate treatment.  Download the free list: PCOS and infertility tests

Natural Treatment of PCOS

As a naturopath, my PCOS treatment goals include:

• Regulating blood sugar and insulin levels
• Decreasing excess male hormones and hormonal activity. Therefore, we can improve acne, oily skin, excessive hair growth, hair loss
• Improving progesterone production
• Ensuring regular ovulation and menstruation and improving fertility
• Weight loss and regular exercise

Why Choose Naturopathic Treatment?

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.  So, naturopathic treatment offers a much more viable solution.

For help with this or any other health problem, book an appointment here or call the office for more information at 416-481-0222. I can give you tailored advice in person or virtually if you are anywhere in Ontario. If you are elsewhere, I can’t provide personalized treatment, but you can get general information about natural approaches for PCOS in my ebook here.

Authored by Dr. Pamela Frank, BSc(Hons), ND

8 Myths about PCOS:

Many women (and doctors) make some wrong assumptions with regards to menstruation, fertility, and PCOS.

Myth #1: I don’t plan to have children so it doesn’t matter if I don’t ovulate.

False. Whether you plan on having children or not, if you don’t ovulate each month, your body is deprived of a vital hormone, progesterone.  That means you may be more susceptible to estrogen dominance conditions like polyps, fibroids, anxiety, depression, and endometriosis.

Myth #2: I get a period regularly so I must be ovulating

This is false. Having regular periods does not mean that you are ovulating. It just means that estrogen rises and falls enough each month to build a uterine lining and then shed it. Regular ovulation is vital to healthy hormone balance and overall well-being.

Myth #3: The ultrasound showed no cysts on my ovaries so I can’t have PCOS

Not true. The name is misleading.  People with polycystic ovarian syndrome, do not have to have cysts present on their ovaries. The body breaks down and resolves cysts regularly so cysts can come and go. Diagnosing this condition is based on the presence of a collection of symptoms.

These symptoms can include some (but not necessarily all) of the following:

• head hair loss
• excess facial/body hair
• weight gain
• insulin resistance
• poor glucose tolerance
• irregular menstrual cycles
• anovulation
• infertility
• acne
• oily skin

Myth #4: The blood tests were fine so there’s nothing wrong hormonally

Nope. Hormone blood tests are notoriously poor predictors of health or disease. The lab ranges are incredibly broad and are set based on averages of [often] unhealthy people. People in optimal health are NOT what is used to set lab ranges.

In a perfect world, reference ranges for hormones should be set by screening the people being used to set the range for perfect health.  This would eliminate women with conditions such as fibroids, endometriosis, PCOS, irregular menses, heavy menses, painful periods, infertility, anovulation, etc.

The lab would select only those who have perfectly regular periods, who ovulate every month at midcycle, have no evidence of fibroids or endometriosis, have no history of reproductive organ problems, etc.  Then those people would have their hormones measured to set a healthy range.  This is not what is done in practice.

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).

This is false. 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 a combination of conventional therapies with naturopathic treatment or naturopathic treatment alone may be enough.

Myth #6: If there was something that could help with my problem, my specialist would know about it.

No. Unfortunately not. Most medical doctors have quite enough on their plate to keep abreast of the latest drugs and surgical options.  They also see numerous patients every day. MDs have neither the time nor necessarily the interest in studying naturopathic treatments for the disease.  That’s my specialty.

Myth #7: There is no research to support naturopathic therapies

This is false.  There is plenty of research to support acupuncture, herbal medicine, vitamins, and nutritional supplements. There was a time about 20 years ago when the research was sparse. Public interest in natural therapies has sparked interest in researching herbal remedies. These natural treatments have stood the test of time for hundreds, if not thousands, of years.

Myth #8: I can continue to eat like everyone else and manage my PCOS

This is not true. Successfully managing PCOS naturally usually requires diet and lifestyle changes.  Those who make these changes, witness substantial improvement in their condition.  They also see benefits for their overall health.  And, they prevent future problems like heart disease, inflammatory conditions, diabetes, and fertility problems.

PCOS (Polycystic Ovarian Syndrome) Research

High-Intensity Interval Exercise (i.e. short bouts of intense exercise interspersed with a recovery period) is more effective than Steady-State Exercise (that is, steady, moderate-intensity exercise) 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.

Natural Treatment for PCOS: A Sample of the Research

Chromium

Systemic review: The articles reviewed demonstrated that chromium supplementation has limited effects on weight reduction, glucose control, lipid profile, and hormonal disturbance of women with PCOS

Source: Maleki V, et al. Chromium supplementation does not improve weight loss or metabolic and hormonal variables in patients with polycystic ovary syndrome: A systematic review. Nutrition Research (New York, NY). 2018;56:1-10. doi:10.1016/j.nutres.2018.04.003.

Herbal Medicine:

Arentz S, et al. Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial. Phytother Res. 2017; 31(9):1330-1340.

This study examined lifestyle + herbal medicine vs. herbal medicine alone. There were two types of herbal tablets: (1) Cinnamomum Verum, Glycyrrhiza glabra, Hypericum perforatum, Paeonia lactiflora, and (2) Tribulus Terrestris. The primary outcome was menstrual regularity.

At 3 months, the combo group had more regular periods (32.9%) vs. controls.  As well, there was an improved body mass index, insulin, LH, blood pressure, quality of life, depression, anxiety, stress, and pregnancy rates.

Resveratrol:

Banaszewska B, et al. 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 decreased total testosterone by 23%, decreased DHEA by 22%, decreased fasting insulin level by 31.8%, and increased Insulin Sensitivity Index by 66.3%.

Weight Loss and Fertility Treatment:

Legro RS, et al. 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.

A comparison of trials shows that delayed infertility treatment after lifestyle modifications and weight loss improved ovulation and live birth compared to immediate infertility treatment.

NAC & L-arginine:

Prolonged treatment with N-acetylcysteine and L-arginine restores ovarian 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 produced a 13.5% improvement in insulin sensitivity Source: Masharani U, Gjerde C, et al, J Diabetes Sci Technol, 2010 March; 4(2): 359-364

Weight Loss:

Normalization of menstrual cycles and ovulation could occur with modest weight loss as little as 5% of the initial weight.
Source: International Journal of Women’s Health, Volume 3, Pages 25-35, 2011.

Electro-acupuncture:

Low-frequency electro-acupuncture and physical exercise improved male hormone excess and menstrual frequency more effectively than no intervention.
Source: American Journal of Physiology-Endocrinology and Metabolism, Vol 300, Issue 1, p.37-45, Jan. 2011.

Soy:

Phytoestrogens in soy products appear to have a protective effect in women with polycystic ovary syndrome (PCOS).
Source: Journal of Research in Medical Sciences, Volume 16, Issue 3, pages 297-302, March 2011.

Calcium:

Calcium and vitamin D supplementation improved weight loss, follicle maturation, and menstrual regularity in PCOS.
Source: Complement Ther Clin Pract, 2012 May; 18(2):85-8.

Myo-inositol:

Myo-inositol may prevent gestational diabetes in women with polycystic ovary syndrome.
Source: Gynecol Endocrinol, 2012 Jun; 28(6):440-2.

Diet:

Researchers found that many women with polycystic ovary syndrome are not maintaining a healthy diet and sufficient physical exercise to manage their symptoms.
Source: Eur J Clin Nutr, 2011 June 1.

A low GI index pulse-based diet with aerobic exercise 5x/week improved insulin response, diastolic BP, TG, LDL, TC, HDL significantly when compared to the Therapeutic Lifestyle Changes (TLC) diet.

Source: Kazemi M, et al. Nutrients. 2018;10(10). doi:10.3390/nu10101387.

Protein:

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.

Vitamin D:

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.

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:

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.

In this study, 60 patients were assigned to a control (metformin and letrozole) or a group where they were given acupuncture combined with Chinese medicine for 3 cycles. Acupuncture combined with Chinese medicine was found to improve the hormone levels and insulin resistance of PCOS as well as increase pregnancy rates.

Source: Acupuncture and Chinese medicine of artificial cycle therapy for polycystic ovary syndrome Zhongguo Zhen Jiu. 2017 Nov 12;37(11):1163.

Acupuncture can increase menstrual frequency, decrease testosterone, and increase ovulation frequency in PCOS.

Source: Johansson J, et al Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial.  Am J Physiol Endocrinol Metab. 2013 May 1;304(9): E934-43. doi: 10.1152/ajpendo.00039.2013.

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 phytoestrogens in ovulation induction in women with polycystic ovarian syndrome. Eur J Obstet Gynecol Reprod Biol. 2013 May;168(1):60-3

The Timing of Calorie Intake:

This study concluded that a high-calorie breakfast and reduced-calorie dinner leads to greater insulin sensitivity. This then helps to reduce the high male hormones in PCOS.

Source: Daniela Jakubowicz, et al. Effects of caloric intake timing on insulin resistance and hyperandrogenism in lean women with polycystic ovary syndrome Clinical Science (2013) 125, (423–432)

Cinnamon:

Women taking 1500 mg per day of cinnamon had significant improvement in the frequency of menstrual periods.

Source: D.H. Kort, et al. Cinnamon supplementation improves menstrual cyclicity in women with polycystic ovary syndrome. Fertility and Sterility Volume 100, Issue 3, Supplement, Page S349, September 2013.

In this study, fasting insulin, as well as insulin resistance, significantly decreased after 12 weeks of cinnamon administration.

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

Soy Isoflavones:

Genistein supplementation in women with PCOS was found to significantly improve total cholesterol levels, reduce LDL cholesterol, LDL/HDL ratio, and triglycerides.

Source: Romualdi D, et al. 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.

Diet and Nutrients

According to this study, women with PCOS would benefit from a diet high in folic acid, vitamins D and C, B12, dietary fiber, and calcium. The consumption of total fats, saturated fatty acids, and cholesterol should be reduced.  The 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.

Bisphenol A

Researchers found that this hormone disruptor may play a major role in PCOS.  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.

Dr. Pamela has practiced as a naturopathic doctor in Toronto since 1999. She has received numerous “Best Naturopath in Toronto” awards. She is registered with the College of Naturopaths of Ontario.

Dr. Pamela Frank uses a natural treatment approach that may include acupuncture, herbal medicine, nutrition, diet, vitamins, supplements, and other natural remedies to restore balance and provide long-term resolution to almost any health problem.