Polycystic Ovarian Syndrome (PCOS)

DR. Chantell Groenewald
M. Tech Hom (UJ)

 
What is PCOS?
 
Polycystic ovarian syndrome is the most common hormonal disorder affecting women of child bearing age. It is a chronic disease affecting the functioning of the ovaries causing excessive male hormones to be secreted and is characterized by:

• Increased androgens (male hormones) as mentioned,
• Insulin resistance (which further exacerbates the excess of male hormones),
• Infrequent or no menstrual cycle,
• Adult acne,
• Accumulation of multiple cysts on the ovaries,
• High cholesterol,
• Obesity and
• Infertility

 
 
What causes of PCOS?
 
The cause for PCOS is poorly understood, but genetic and environmental factors seem to play an important role. There is a hormonal dysregulation at play, which includes

• Higher than normal luthenizing hormone (LH). Produced by the anterior pituitary gland, the LH is required to stimulate the ovarian follicles to secrete oestradiol.  A surge in LH, causes the ovarian follicle to tear and release the ripe egg. Because the LH hormone is already higher than normal in patients with PCOS, there is no LH surge and ovulation does not take place.
• Decreased follicle stimulating hormone (FSH), Also released by the anterior pituitary gland, the FSH is responsible for the growth of the ovarian follicle, as well as secretion of oestrogen,
• Higher than normal levels of testosterone (hyperandrogenism). Testosterone is normally secreted in small amounts by the ovaries as well as the adrenal glands, but in patients with PCOS the ovaries secrete abnormally high levels of testosterone, and
• Elevated levels of insulin. Insulin regulates blood glucose levels, by signalling cells to absorb glucose from the blood stream to use as energy. Insulin is also involved in fat storage.

50-70% of females with PCOS suffer from insulin resistance which exacerbates excess secretion of male hormones by the ovaries. Insulin resistance contributes to obesity, which increases insulin resistance and further aggravates PCOS.
 
What are the diagnostic criteria for PCOS?
 
The current diagnostic criteria for PCOS is at least two of the three following characteristics:

• Infrequent periods (oligoanovulation)
• Increased male hormones (clinical hyperandrogenism)
• Polycystic ovaries on ultrasound (present in only 20-30% of woman with PCOS)

 
What are the signs and symptoms of PCOS?
 
The signs and symptoms of PCOS varies from one woman to the next. Here is a list of the most common symptoms:

• Infertility or difficulty conceiving
• Increased testosterone
• Oligomennorrhea (a woman who regularly goes 35+ days without having a period)
• Insulin resistance
• Gaining weight or difficulty losing weight
• Acne
• Thinning hair (male pattern balding)
• Acanthosis Nigricans (dark patches of skin)
• Hirsutism (abnormal hair growth pattern on a woman’s face or body)
• Hyperlipidemia (High cholesterol)
• Low sex drive (libido)
• Fatigue
• Obesity
• Anxiety and depression

 
What are the natural treatment protocols for PCOS?
 
1. Losing weight
This is vital in controlling insulin sensitivity, reversing insulin resistance and metabolic syndrome (triad of elevated insulin, cholesterol and blood pressure) and will aid in controlling the production of excess androgens by the ovaries. A carefully selected diet may assist in weight loss. There are various options including low carbohydrate, intermittent fasting, anti-inflammatory and anti-allergic eating programs to choose from. The correct eating plan can reduce inflammation and help control insulin levels and manage dysregulation of hormones.
 
 
2. Controlling stress
Excess cortisol produced by the adrenal glands during periods of high stress has a profound effect on our hormones. Long term expose to higher than normal levels of cortisol translate into insulin resistance, weight gain and hormonal imbalances. Getting enough sleep is also vitally important in regulating cortisol levels.
 
3. Supplements
There are various supplements that can aid in controlling blood sugar, reducing excess androgen production and balancing female hormones. A qualified practitioner can prescribe the correct supplements to help manage each individual case. Some supplements that have been suggested to benefit cases of PCOS include:
I.Chaste Tree: May be beneficial in regulating erratic ovulation, acne, oligomennorrhoea and amenorrhoea, ovarian cysts and assist in sleep maintenance.
II.Inositol: specifically, myo-inositol, is a vitamin like substance found in many plants and produced in our bodies. There are various studies that illustrates the beneficial effects of myo-inositol in the treatment of PCOS.
III.Vitamin D: Vitamin D deficiency effects an estimated 60-70% of people. The only way to test if you are vitamin D deficient is by doing a blood test (supplementing without confirmed deficiency is dangerous and should be done under the supervision of a primary health care physician). Vit D plays an important role in maturation of eggs and ovulation.
IV.Folic acid, omega 3, calcium, magnesium, zinc, n-acetylcysteine and chromium are a group of supplements that may be beneficial in the treatment of PCOS.
 
4. Homeopathy
There are various case studies that demonstrates the beneficial effects of specific homeopathic remedies to aid in the treatment of PCOS. Following a consultation, a homeopath can prescribe a remedy that suites each individual case. 
 
 
5. Exercise
Moderate exercise assists in both stress management and weight loss, which aids in controlling cortisol as well as insulin levels.

PCOS is a silent disorder with an estimated 50% of woman being not being diagnosed correctly. The potential long-term health risks of PCOS include sleep apnoea, endometrial cancer, fatty liver disease, type 2 diabetes, cardiometabolic disease and more. There are several ways to naturally balance our hormones and reverse the effects of PCOS