Polycystic Ovarian Syndrome (PCOS)

According the CDC, PCOS affects an estimated 5 million women in the US and is one of the leading causes of infertility. Listen to Dr. Anna Esparham to learn about this syndrome and what conventional medicine isn't telling you. Dr. Anna will give some special insights on natural methods of helping PCOS symptoms through lifestyle and diet.

Listen below for the full podcast and keep reading for the show transcript. Don't forget to hit subscribe to the Health is PowHer podcast wherever you listen to podcasts so you don't miss a show!

PCOS - What is It?

Polycystic Ovarian Syndrome (PCOS for short) can rock a woman’s world, not only for adult women but for teens as well. PCOS may include the following signs and symptoms:

  • Ovarian cysts

  • Hormonal disruption (causing sensitivity to hormones known to be more masculinizing)

  • Extra hair in places you don’t want like mustache or belly hair

  • Acne

  • Hair loss

  • Insulin resistance or potential for diabetes

  • Poor ovulation

Typical lab findings include:

  • Elevated free and total testosterone, DHEA-sulfate, androstenedione

  • Sex hormone binding globulin can be low

  • Low progesterone in certain cases

  • Elevated pituitary hormones: luteinizing hormone (LH) to follicular stimulating hormone (FSH) ratio

You may ask, “where did the name ‘poly cystic ovarian syndrome’ come from when it sounds like a bunch of different problems?” The reason for the name is due to the presence of cysts and increased fluid volume in the ovary which may occur with this diagnosis.

How is it diagnosed?

If an endocrinologist or primary care doctor is evaluating for PCOS, usually it is a diagnosis of exclusion.This simply means they have to make sure there’s nothing else causing some of those symptoms. Conditions they may rule out include thyroid impairment, Cushing’s disease, adrenal disease, pregnancy, diabetes and prolactinoma.

For teens, it may be normal to have irregular menstrual cycles 2-3 years after their first menstrual period.  Ultrasounds are usually not a good way to diagnose PCOS because adolescents often will have multiple follicles in each ovary. This is part of their normal development until menstrual cycles become regular. So hyperandrogenism (high levels of male hormones) or sensitivity to male hormones in teens are what we rely on to diagnose PCOS in teens.

The key manifestations of PCOS in teens are:

  1. Insulin resistance/obesity

  2. Metabolic syndrome

  3. Sleep disruption

  4. Mood disorders

So what causes PCOS?

There are many factors that contribute to the development of PCOS. Here are a few of the major ones: 

  • Genetics

  • Chronic low-grade inflammation

  • Metabolism disruption (high insulin may cause high androgens

  • Food and nutrition contributors

  • Physical activity or lack thereof

  • Endocrine disruptors

  • Emotional trauma

  • Low aromatase activity - which is the enzyme that converts the more male-like hormones (androgens) to the female-inducing-hormones (estrogens)

Current Conventional Treatments for PCOS

Hormonal contraceptives*

The goal of these medications are to…

  • Reduce androgen production in ovaries

  • Regulate menstrual cycles

  • Reduce hirsutism (excess hair) and acne.

*Note: avoid contraceptives with norgestrel and levonorgestrel (progesterones) which have androgenic activity

Side effects of hormonal contraceptives

  • Nausea in first 1-2 months, if persists need to be evaluated by your physician as it can be related to elevated cholesterol/Liver function

  • Headaches, breast tenderness, candida overgrowth

  • Blood clots, hypertension

  • There is no strong evidence that it causes weight gain,  this is usually more associated with high dose estrogen contraceptives prescribed in the past

Hirsutism Treatments

Laser treatment/electrolysis

Spironolactone: a diuretic that blocks androgens in the body

Side effects of spironolactone

  • May increase potassium levels

  • Can cause irregular menses

  • Thirst, headaches, dizziness, fatigue

  • Breast tenderness

Acne Treatments through topical solutions like isotretinoin, benzoyl peroxides, retinoids or antibiotics such as clindamycin

Insulin Resistance Treatments usually via medications that increase insulin sensitivity such as Metformin.

Now let’s get into PCOS Integrative Treatments...

Certain diet and nutrition changes may help PCOS. Because it is related to inflammation oftentimes, an anti-inflammatory diet which is similar to the Mediterranean diet (with a few differences) may be beneficial. Lowering the glycemic load, aka less sugar and quick-burning carbohydrates is recommended. Other changes may include going grain-free, ketogenic, low starch or low dairy. Working with an integrative dietitian is recommended to attempt treating PCOS with diet. 

To recap…the nutrition changes for PCOS 

  1. Anti-inflammatory diet

  2. Low glycemic load

  3. Grain-free

  4. Ketogenic diet

  5. Low starch and low dairy

Another thing you can do is to supplement with healthy fats! These are powerful anti-inflammatories. Research shows that 8 week supplementation of 1-4 grams of omega-3’s improved insulin resistance, lipid profiles and decreased LH (hormone elevated in PCOS).

Side effects of Omega-3’s are:

  • burping/belching/indigestion

  • Loose stool

  • Nausea

  • Easy bruising

Decrease environmental exposures/endocrine disruptors

Substances found in everyday cleaning supplies, makeup, personal care products, building materials, plastics, etc can be toxic to our health and our hormones. Some of these substances are called “endocrine disruptors” because they have substantial effects on our hormone production. Certain ones have been linked to PCOS such as BPA, PFC’s (perfluorinated compounds) and phthalates.

Unfortunately, what is so sad about this is that it could be our grandparents’ exposures to environmental toxins that have affected our generation.  For example, a grandparent could be exposed to endocrine disrupting chemicals that change their grandchildrens’ genes, leading to affected hormonal balance!  The PCOS phenotype could have developed long before we were ever exposed to endocrine disruptors. 

Supplements and Botanicals for PCOS

Vitamin D has been in multiple studies that have shown benefit for PCOS symptoms. It upregulates insulin genes and improves insulin secretion, activates factors in the body that regulate fatty acid metabolism, and has been found to improve androgen profiles, blood pressure, menstrual regularity and glucose metabolism. Blood levels of vitamin D that are most beneficial are between 50-60 ng/mL. Women with PCOS may also consider adding magnesium, vitamin K2, and calcium supplementation as well. As far as natural sources, vitamin D is much higher in mushrooms and fish than it is in milk (contrary to popular belief).

Inositol, Myo-inositol and D-chiro-inositol (DCI): Studies have shown that the combination of myo-insoitol and contraceptives is more effective in controlling the hormone and metabolic profiles than metformin by itself. Administration of both myo-inositol and DCI (40:1 ratio) ensure better clinical results by reducing insulin resistance, androgens, cardiovascular risk, and regulating menstrual cycle with ovulation. Typical doses of myo-insoitol are 4 grams per day with D-chiro-insoitol 1200 mg per day. Side effects may include looser stools, nausea, headches, or dizziness.

Zinc 50 mg supplementation per day has shown to improve insulin sensitivity and metabolic profiles. It is important to test for low copper levels, because zinc can lower these levels even further. Many individuals start with 15-50 mg zinc daily, taken with food, but  even this can cause significant nausea due to the harshness on the stomach.

Vitex agnus-castus (chaste tree berry) can improve hormone profiles by lowering prolactin and increasing estrogen and progesterone levels. Typical doses are 30-40 mg daily, however all the way up to 1800 mg daily has been used in studies. Vitex is usually well tolerated but can cause a host of side effects including hormonal changes, headache, stomach upset, diarrhea, nausea, itching/allergies/skin rash, acne, insomnia, weight gain, and irregular menstrual bleeding. There may be interactions with dopamine antagonists/agonist medications and contraceptives.

Black cohosh and other phyto-estrogens (aka plant-derived estrogens) may have benefit in PCOS. Black cohosh may have estrogenic, serotonin and anti-inflammatory activity. A dose of black cohosh 20 mg daily for 10 days, with clomiphene daily for 5 days, during 3 menstrual cycles improved hormone ratios in PCOS.

Licorice root:There have been limited studies that 3.5-7 grams per day of licorice root reduced testosterone in women with PCOS. Typical dose can be given at 2-7 grams per day, however it may cause excessive sodium/water retention due to its mineralocorticoid effect. Licorice root may also decrease libido. Additionally it remains in the body due to its very long half-life up to 1-2 weeks. This must be taken with much caution for individuals taking antihypertensives, cisplatin (chemotherapy), steroids, and medicines that utilize certain cytochrome P450s for metabolism. 

Chromium picolinate at 200-1000 mcg daily may improve insulin levels and regulate menstrual cycles in PCOS. This is usually well tolerated though there has been some reports of cognitive and motor dysfunction, headaches, insomnia, irritability, mood changes, blood loss, stomach upset/vomiting/diarrhea. It may interact with anti-diabetic drugs and thyroid medicine.

N-acetylcystine at 600 mg twice daily may improve ovulation rates compared to placebo in women with PCOS. Potential side effects may include significant stomach upset, nausea, vomiting, abdominal pain, constipation or diarrhea. Allergic reactions may occur because sulfa groups are highly prevalent in this supplement. Also there are interactions with nitroglycerin (severe hypotension and headache).

Cinnamon at 1.5 grams per day improved menstrual cycle regularity in 17 pcos women compared to controls in one study. It is usually well tolerated but possible side effects are stomach upset, indigestion, and be careful to avoid accidental aspiration/inhalation. This must be used cautiously with antidiabetic and hepatotoxic drugs.

Last but not least...mind-body therapies for PCOS

Exercise and diet are usually the number one treatment for PCOS. Yoga practice was found to improve hormone levels, regularity, and hirsutism after 12 weeks. Mindfulness improved stress, depression, anxiety and cortisol levels in women with PCOS as well. Another ancient treatment, acupuncture unfortunately does not have sufficient evidence, however one study showed improvements in ovulation frequency after treatment.

Let’s recap, there are a whole host of natural treatment options for those with PCOS. Diet and exercise are key. 

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