26 Mar PCOS: Causes, Symptoms, and Naturopathic Tips!
PCOS: Polycystic Ovarian Syndrome. It does seem to fall on the spectrum, whereby sometimes it involves insulin and other times, it is really an adrenal problem.
Here’s a typical PCOS story…
1. Menses began later in the teen years, if at all, or it began “on time” and then irregular ever since.
- put on birth control as a result
2. Cystic acne started to develop as did hair growth in places she didn’t want.
- the nipple area, top lip, chin area –> sometimes women are prescribed Spironolactone and/or Accutane
3. Started gaining weight around the middle despite trying a “good diet” and regular exercise
4. By the twenties and thirties, hair started thinning/falling out
5. When she decides to off the pill, her periods don’t return and at this point, many women seek the care of a naturopathic or integrative physician.
What is the ‘typical’ presentation of PCOS?
PCOS usually includes two out of 3 categories: androgen excess (labs and symptoms), ovulatory issues, or polycystic ovary morphology (PCOM). In other words, you do not have to have small cysts on the ovaries.
Functional hypothalamic amenorrhea (FHA) can also result in no periods or scanty/irregular periods due to low body weight contributing to diminished estrogen levels. Therefore, PCOS and FHA can have some overlap in clinical presentation. With hypothalamic amenorrhea however, increasing caloric intake and reducing frequency/intensity of exercise in itself may result in the resumption of normal menstruation. Note, all women with amenorrhea should consume 1,200mg of calcium and supplement with 1000 IU of vitamin D to protect bone density.
- Androgen excess includes hirsutism, male pattern hair loss, acne/cystic acne, anger/mood swings.
- Ovulatory issues include an inability to ovulate or irregular cycles/no cycles, fertility challenges.
- With PCOM, multiple small cysts form on the ovary. On ultrasound they look like a string of perils.
Is obesity part of the diagnosis?
It’s not always, about 30-75 % of women are obese because of insulin resistance and hence high blood sugar levels. Hyper-insulin results in high levels of testosterone which further contributes to diminished ovulation and hence low progesterone.
PCOS is not just an ovarian problem…
The ovaries produce about 25% of testosterone, 50% of androstenedione, 20% of DHEA (not DHEA-S). The adrenals produce 25% of testosterone, 50% of androstenedione, 80% of DHEA, and 100% of DHEA-S. The other 50% of testosterone is made in our fat tissue.
Therefore, you can have PCOS symptoms from either of these glands (the ovaries, adrenals) or both.
This quote nicely sums up the hormonal cause of PCOS:
“While insulin resistance and elevated insulin often drive the ovarian production of testosterone, it is the hypothalamus-pituitary-adrenal (HPA) axis that stimulates the production of DHEA/DHEA-S and androstenedione. These hormones can be converted to testosterone by peripheral tissues in the body. This process can occur independently from the ovaries and any involvement with insulin.
This means that a woman with PCOS symptoms could have normally functioning ovaries with no cysts and no insulin resistance, yet still fit the symptomatic profile of the syndrome.” – Laura Schoenfeld, MPH, RD
So if you have been diagnosed with PCOS or suspect you do but are not overweight, have no cysts on your ovaries, and do not have elevated insulin, then your PCOS may be due to the adrenal glands and the hypothalamus-pituitary-axis.
This is why comprehensive testing and a clinical history/picture is so important. Also remember, you can have both an ovarian and adrenal component to your hormonal imbalance.
Important tests to consider…
Fasting glucose/fasting insulin (with hemoglobin A1C)
Thyroid panel with antibodies and reverse T3
Anti-mullerian hormone (AMH)
Hormone testing – either blood and/or dried urine testing
Remember gut issues can affect hormone balance as well as influence mood, and therefore it’s important to always treat intestinal permeability (aka leaky gut).
Where do we start with treatment?
The health goals for PCOS treatment are: address the cause, focus on diet and lifestyle, improve cortisol (stress) levels, address blood sugar and insulin, restore ovulation, improve estrogen balance, reduce androgenic (male hormone-like) symptoms.
First: address the cause
With some women, high stress and gut inflammation are more likely to up-regulate the HPA (hypothalamus-pituitary-adrenal) axis and result in high stress hormone release (cortisol) which then can result in weight gain, irregular cycles, and elevated androgens (acne and facial hair growth).
Second: address diet/insulin/ lifestyle factors
With insulin based PCOS, some helpful herbs include: berberine, inositol, fish oils, cinnamon, N-acetyl-cysteine, zinc, green tea, gymnema, diet, weight training and resistance training as well as intermittent fasting (IMF).
Third: address the stress/cortisol connection
Addressing the cause of stress and using stress relieving techniques, including: meditation, acupuncture, journaling, counseling, finding joy/purpose, proper sleep hygiene.
Adaptogenic herbs and nutrients to regulate stress hormones, for example: phosphatidylserine, holy basil, magnolia bark, skullcap, ashwaganda, schisandra, wild yam, siberian ginseng, pantothenic acid (B5), l-theanine.
Fourth: Improve ovulation/progesterone
Useful herbs and nutrients here may include: vitamin B6 (P5P), evening primrose oil, seed cycling, cordyceps mushroom, melatonin, bio-identical progesterone during luteal phase, black cohosh during days 1-12 along with daily vitamin C may increase pregnancy rates, acupuncture. Be careful with maca in non-menopausal women because it may raise androgens. Melatonin is really important for reproductive rhythm and daily dosing with coenzyme Q10 can help with diminished ovarian reserve and increase egg cell quality and count. The herb, vitex agnus, has been researched to help lower mild elevations in prolactin and also increase pregnancy rates. Liver supportive herbs to help with phase-2 detox pathway (renders hormones water soluble) can also be considered, the major players here are: milk thistle, dandelion, globe artichoke, yellowdock and berberine.
Lastly: reduce androgen/5 alpha reductase symptoms
This is done by addressing insulin and/or high cortisol causes: spearmint tea is anti-androgenic and 5a-reductase “blockers” include: zinc, stinging nettles, pygeum bark, reishi mushroom, green tea, evening primrose oil.
If you or someone you know has PCOS, ovarian cysts, or is struggling with infertility, feel free to drop me a line on the “contact us” page on this site. I treat patients locally at my Naturopathic practice in Vancouver, B.C. and worldwide via phone or Skype.
To honoring your health potential!
Licensed Naturopathic Physician, Menopause Clinician, Acupuncturist, Author, and Health Educator