POLYCYSTIC OVARIAN SYNDROME (PCOS)

DESCRIPTION

Polycystic Ovarian Syndrome, or PCOS, is an ovulatory disorder that impacts almost all other aspects of the endocrine system, including the pancreas, hypothalamus, pituitary gland and adrenal glands in various ways. The condition is still sometimes called Stein-Levanthal Syndrome. Women with PCOS may also have insulin resistance, glucose intolerance, lack of ovulation and excess androgens like testosterone. A 1990 National Institutes of Health conference stated that the two most consistent elements of PCOS include elevated androgenic hormones and chronic lack of ovulation. Women with PCOS are also at risk for other health hazards like vascular disease and cancer.

SYMPTOMS

Symptoms of PCOS include irregular or absent periods, obesity, increased fat stores and an inability to lose weight, acne, excess facial and body hair, loss of head hair, thick skin, high lipid levels in the blood and disturbances of sugar metabolism.

Many women with PCOS think that they're ovulating because each time they use an ovulation predictor test, it turns positive. That's because the urine test detects LH, which in some women with PCOS remains elevated. Diagnostically, the most distinctive signs of PCOS are changes in the ovaries, which are larger than average and appear to have a thick, shiny, white coating overlying the many rows of cysts on their surface. Hormone levels are also high in women with PCOS.

WESTERN MEDICAL TREATMENT

Western doctors often prescribe drugs like Clomiphene (Clomid), which is designed to induce ovulation, for women with PCOS. If they don't respond to Clomid, hCG may be added to release the eggs, and if that is not successful, the treatment may proceed to gonadotropin injections. If these drugs fail, IVF and other assisted reproductive techniques usually are recommended.

However, most women with PCOS don't respond well to Clomid or other hormonal manipulation because it does not address the health of the egg and the state of the ovary's endocrine balance over the previous three months or more of development. Follicle development within the ovary is a process that takes many months, and eggs are meant to develop in an estrogen- and progesterone-rich environment, not in an androgenic setting. Thus, even if a woman's body is forced to ovulate using ovulation-stimulating drugs, the quality of her eggs may be poor and pretty much ensure that the outcome of the procedure will not be successful.

Other treatments for PCOS focus on eliminating follicular cysts surgically and balancing hormone levels using drugs and/or supplements. If a woman with PCOS has elevated DHEA levels, her doctor may recommend Dexamethasone, an oral steroid. However, long-term use of this drug can cause bone changes in the hip joints. Drugs like Glucophage or Actose are often prescribed to control insulin and blood sugar levels.

DISCUSSION AND ROOT CAUSES

In PCOS, multiple small cysts, which are actually tiny follicles, develop inside the ovary. The cysts are not the same as active follicles, but instead have been arrested in their development, never growing to full size and releasing healthy eggs. The cysts and the connective tissue surrounding them (the stroma) produce male hormones called androgens. Androgens block follicular development and cause the follicles to degenerate, preventing the release of mature eggs. In addition, androgen produced by the cysts enters the bloodstream and alters the feedback mechanism within the hypothalamic-pituitary-ovarian (HPO) axis. The amount of estrogen circulating in the bloodstream increases relative to other hormones like progesterone, causing increased production of LH and testosterone. Because of this hormonal cascade, ovulation is prevented.

PCOS affects a woman's ability to ovulate by compromising not only the quality of the follicle, but also the maturity of the endometrium. The endometrial tissue will usually thicken in response to estrogen; in fact, it may continue to thicken unchecked. But, without the presence of the right hormones like progesterone, the lining won't exhibit the changes necessary for implantation. As a result, menstrual cycles become more erratic and less predictable. In some cases, women with PCOS can have very long cycles and very heavy bleeding; in other cases, they can demonstrate anovulation (lack of ovulation) with scanty bleeding or amenorrhea (complete absence of menstruation).

With PCOS, if an egg is released, it is often later in a woman's cycle, and it is of poorer quality because of the unhealthy surroundings in which it has been developing. The actual causative factor of PCOS has not been identified, and thus not treated effectively.

One contributing or linked factor to PCOS appears to be abnormal insulin and glucose (sugar) interaction. Insulin is secreted by the pancreas and maintains blood glucose levels within a certain range. Insulin also helps convert excess glucose to fat. Insulin resistance means that the body's response to insulin in various tissues is impaired; however, the pancreas continues to pump out insulin at an accelerated rate. Excess insulin circulating in the bloodstream stimulates enzymes that help manufacture androgens in the ovary. High insulin levels may also cause over-stimulation of androgen receptors, leading to follicular atresia, basically "starving" the follicle of the correct hormonal food for the developing eggs. Improper insulin production or insulin resistance can contribute to obesity, which is one of the reasons many women with PCOS are overweight. Glucose intolerance and diabetes also are associated with insulin resistance.

NATURAL TREATMENT

The natural view of treating PCOS is that the health of the ovary depends on the health of the whole body-thus, the entire state of the body must be addressed before the ovary can respond in a healthy way. After a couple months of treatment using a combination of diet, acupuncture and herbs, anovulatory women should begin to notice signs of ovulation like increased fertile vaginal discharge followed by an elevation in their basal body temperature. Women with belated ovulation will often notice that their ovulation comes earlier and earlier in the cycle until they ovulate normally on cycle day 14.

DIETARY THERAPY TO MANAGE INSULIN:

Most women with PCOS have endocrine abnormalities that are affected by diet. If you are overweight, you can help treat your PCOS by losing weight. Fat cells store estrogen, and usually women with PCOS have too much circulating estrogen and LH. The liver metabolizes these hormones, so a healthy functioning liver is also mandatory for proper insulin balance. To keep the liver healthy, include dietary sources of the B vitamins like meats and organ meats, leafy green vegetables and whole grains. Also because of the insulin resistance and impaired glucose metabolism that often occurs with PCOS, the best natural treatment is to lower your level of sugar intake and eliminate the ingestion of any food that the body metabolizes as a simple sugar.

Dietary Guidelines:

Cut out all forms of refined sugar.
Cut out all forms of refined carbohydrates as the body immediately turns them into sugar. Refined carbohydrates include white bread, pasta, potatoes, white rice, most breakfast cereals, rice cakes, popcorn and any other starchy, low-fiber food.
Do not follow fertility diets that advocate massive yam consumption. The high starch and sugar content in yams exacerbates the impaired glucose metabolism and can actually delay or prevent ovulation if you have PCOS.
Avoid soda, fruit juice and any other drink that rapidly raises your blood sugar level.
Consume adequate amounts of protein, either vegetarian or in the form of lean meat that has not been treated hormonally.
Eat a variety of fresh vegetables.
Eat only complex, whole grains.
Choose fruits like berries, which are not too sweet.
Avoid milk and dairy products, which tend to exacerbate the condition of internal dampness.
Eliminate alcohol and caffeine.
Increase your dietary fiber intake.
Get adequate amounts of exercise.
o Do the exercises listed in Chapter 6 of The Infertility Cure to increase blood flow to the ovaries.

Adhering to a low-carbohydrate diet and eliminating sugar and starches may make you prone to hypoglycemia, or low blood sugar, until your body gets used to its new metabolic regimen. Supplementing your diet with chlorophyll helps reduce the symptoms of hypoglycemia without raising your blood glucose level. Chromium supplementation also increases the sensitivity of insulin receptors within the cell to fluctuations in blood sugar levels. The recommended chromium dosage is approximately 300 micrograms per day. Other supplements that improve insulin resistance include the B vitamins, magnesium, alpha lipoic acid and conjugated linoleic acid.

One novel treatment for insulin imbalance is the antioxidant N-acetyl-cysteine, or NAC. In a study (source:_______) done at the Universita Cattolica del Sacro Cuore in Rome, Italy, women with impaired glucose tolerance and hyperinsulinemia were given between 1.8 and 3 grams of NAC per day. As a result of treatment, they exhibited statistically significant decreases in total circulating testosterone levels and free androgen index, as well as total cholesterol, plasma triglycerides, low-density lipoproteins, insulin, pancreatic C-peptide and insulin sensitivity. In Chinese medicine, NAC would be categorized as a liver-clearing substance.

USING HERBS TO TREAT PCOS

If you choose to use herbal supplementation to treat PCOS, include Gleditsia during the first half of your menstrual cycle up through ovulation. Gleditsia is categorized as a phlegm-resolving medicinal in TCM, and is known to dissolve the waxy capsule that forms around the ovaries in PCOS. Gleditsia also promotes ovulation.

Leonurus Fruit is a blood-quickening medicinal which has the effect of encouraging ovulation in those who have any element of Blood stasis or ovulatory pain. Other herbs are given to address additional concurrent patterns of imbalance.

USING ACUPUNCTURE TO TREAT PCOS

Acupuncture works to restore the entire sympathetic nervous system to health and balance. The result is a normalization of the hormonal system directly tied to ovulation and reproduction. Then, the entire hormonal cascade that allows an egg to develop and be released can occur right on schedule.

The Fertile Soul's acupuncture treatment of PCOS often includes points that normalize the hormonal environment, like Yintang, ear Intratragic notch, Sp 6, Zigong, Ren 3, Ren 4, Ren 6 and St 40 to resolve phlegm. Then, we use electro-acupuncture treatment to the low back (UB 23, UB32, UB52) along with Sp 6 and ear Triangular fossa to reduce the sympathetic activity to the ovaries. Finally, our treatments also seek to identify and address the underlying pattern.

With PCOS, as with all treatments, it is important to remember the 90-day timeline for the production of a healthy egg. To ensure your follicles are healthy and capable of nurturing healthy eggs, we recommend that you wait until the end of your third cycle before you start trying to conceive in order to give your body and your future child the chance for the healthiest conception and pregnancy possible.

ASSISTED REPRODUCTION CASE STUDIES CLINICAL STUDIES

Studies done in Europe in the 1990s on anovulatory women with PCOS showed that electro-acupuncture restored ovulation in one-third of the test subjects. Acupuncture also reduced the endocrine indicators of PCOS, including LH/FSH ratios, mean testosterone concentrations and beta-endorphin concentrations. Researchers theorized that this improvement was due to an inhibition of hyperactivity in the sympathetic nervous system. For more information, see Chapter 11 of The Infertility Cure.

A Swedish/Italian study in 2000 described in the Biology of Reproduction Journal validated this theory. This study involved using injections of estradiol valerate, a kind of estrogen, to induce a state of polycystic ovaries in rats. Increased activity of the sympathetic nervous system resulted, followed by increased concentrations of nerve growth factor in the rats' ovaries and the adrenal glands. Within sixty days, the rats developed polycystic ovaries. The rodent subjects were separated into two groups. The control group received no therapy and maintained features of PCOS. In contrast, those treated with acupuncture showed a reduction in the hyperactivity of the ovarian sympathetic nerve fibers, reduction of the increased nerve growth factor concentrations within the ovaries to normal and reduction the weight of the polycystic ovaries. These are all indicators of a reduction in the "stress" reaction within the nerve and blood supply of polycystic ovaries. Acupuncture treatments were effective at resolving this condition because they reduced the level of hypersympathetic nervous system response, relaxing the whole neuroendocrine system.