PCOS: Treatment and Fertility Support
Poly Cystic Ovarian Syndrome (PCOS) is a complex metabolic imbalance in the communication between the hypothalamus, pituitary, ovaries(HPO Axis), pancreas, adrenals and thyroid. It can present with a varying number of symptoms and labs values.
Symptoms most commonly include:
Poly Cystic Ovarian Syndrome (PCOS) is a complex metabolic imbalance in the communication between the hypothalamus, pituitary, ovaries(HPO Axis), pancreas, adrenals and thyroid. It can present with a varying number of symptoms and labs values.
Symptoms most commonly include:
- Irregular menstrual cycles
- Infrequent or lack of ovulation
- Weight gain
- Hair loss
- Acne
- Hirsutism
Many women may not even know they have PCOS since they present with atypical symptoms or no outward symptoms at all. Lab work will often reveal elevated androgens from the ovaries and adrenals, abnormal FSH:LH ratios, insulin resistance, elevated lipids and blood sugar levels. I often investigate PCOS in relation to fertility optimization in women having trouble getting pregnant. Women with PCOS are also at risk for cardiovascular disease, Type 2 diabetes and uterine cancer.
My experience with PCOS usually begins with women and couples coming to see me because they are having trouble getting pregnant or report “always” having irregular periods. Naturopathic medicine works incredibly well to regulate ovulation, lower androgens eliminating acne and hair changes and balance blood sugar/insulin resistance affecting weight. Diet and exercise changes are essential to this approach but first and foremost I promote hormone balance. Estrogen and Progesterone ratios need to be in balance and testosterone within normal.
My goal as a doctor is to properly evaluate and assess imbalances, atypical or otherwise, and reduce associated risk factors(Cardiovascualr and “Diabesity”), regulate menses and restore ovulation to support fertility.
Physiology:
The hallmark of PCOS is an elevated LH/FSH ratio. Elevated estrogen(E1) and deficient progesterone secretion is thought by negative feedback to further accentuate the aberrations.
The dysfunction in the HPO axis causes an increase in LH secretion and deficient secretion of FSH by the anterior pituitary. Without a synchronized midcycle surge of FSH and LH triggering normal luteinization of the ovarian follicles, the follicles become cystic and secrete androgens instead of progesterone(p119). This multiple hormone imbalance in PCOS results in acyclic perpetuation of the menstrual cycle dysfunction.
Other hypothesis include a central nervous system deficiency of dopamine causing a hyperprolactinemia and or a hypersecretion of insulin and insulin receptor sites.(119) The cause of PCOS is unknown but may have a genetic component as 50% of women will have a sister or mother with PCOS. A genetic chromosomal mutation can lead to insulin resistance and glucose dysregulation. I believe some main contributors are that we live in a stress driven society keeping us in “fight or flight “ mode upsetting cortisol balance, and we have elevated daily exposure to exogenous androgens, toxins and pesticides.
Labs:
- FSH/LH
- DHEA
- SHBG
- FAI
- Free Testosterone
- Estrogen
- Progesterone
- Prolactin
- Fasting Insulin, Glucose, HemoglobiA1c
- Thyroid Function Test
- Adrenal Stress Index
- Lipid Evaluation
- Ultrasound
- Micronutrient Testing
Treatment:
Supplemental Ideas and Lifestyle Support to Consider:
- Saw Palmetto to reduce conversion of testosterone to the more potent form dihydrotestosterone(DHT).
- Berberine to manage blood sugar and insulin.
- NAC to manage total cholesterol, LDLs, lower BMI and hirsutism.
- Glycyrrhiza to lower testosterone and improve blood sugar and cortisol levels. Not advised with high blood pressure.
- Calcium/Vit D for menses and blood sugar regulation
- Myo-Inositol/Chromium for insulin and blood sugar support
- Green Tea, Nettles, Flax seeds and Soy can help reduce estrogens and increase SHBG.
- Vitex know to improve abnormally high E/P ratios and support progesterone
- B6, Magnesium, EFAs
- Progesterone
- Breakfast EVERY DAY
- Add to DIET: Fennel, Fenugreek , Maitake, Spearmint, Fiber, Legumes, Cinnamon. Mediterranean Type Diet, high protein, low carb. Green Greens Greens! Water half of your body weight in ounces per day. AVOID all sugar, alcohol and coffee caffeine.
- Good Sleep Hygeine
- Exercise aerobic 5-6 days a week for 30 minutes minimum and weight training.
Resources:
Powell, Dirk, ND. Endocrinology & Naturopathic Therapies,(p.119), 7th edition, 2005.
PCOS www.PCOS nutrition.com PCOS Nutrition Center
PCOS COPE website and workbook
Meridian Valley Lab fotos
