Polycystic ovarian syndrome (PCOS) affects about 10% of women and is the most common anovulatory disorder. Anovulatory disorders, where an issue in the endocrine system results in lack of ovulation, are responsible for about 15% of infertility cases.
What is PCOS?
PCOS is a syndrome in which menstrual cycles are long or irregular, ovulation is infrequent or absent, ovaries appear to be covered in small cysts and there are signs of excess androgens such as increased body hair and acne. PCOS often presents challenges for those trying to conceive and is also linked to increased incidence of metabolic disorders such as diabetes. PCOS tends to run in families.
In the case of PCOS the ovaries are not able to produce fully mature eggs due to hormonal dysfunction. The follicles begin development but do not get far enough along to release an egg. Mature follicles produce progesterone so when follicles can’t fully develop there is often not enough progesterone for regular menstruation and periods can become irregular or stop all together. The partially developed follicles can also build up fluid and sometimes those fluid follicles turn into cysts. Cysts produce androgens, hormones that are present in males and females but often thought of as more male hormones. These androgens can also prevent ovulation further complicating the picture.
Androgens from the cysts can also send a false message to the body that results in a rise in estrogen. The increased estrogen causes a rise in lutenizing hormone (LH) which is what is tested with an ovulation predictor kit (OPK). A positive OPK leads many people to believe they are ovulating when in fact no egg has been released. Sometimes folks with PCOS can get positive OPKs for many days in a row due to the increased LH.
What are the symptoms?
People with PCOS can experience a wide range of severity of symptoms from never having periods to just a slightly irregular cycle where they still ovulate. Sometimes ovulation may be late enough in the cycle that the egg quality will be impacted increasing risk of miscarriage either due to egg quality or low progesterone. Other
times fertility drugs will be used to force ovulation though it should be noted that this does not increase egg quality.
Another common symptom of PCOS is hirsutism, the growth of dark, coarse hairs in androgen dependent areas such as the face, chest, or lower abdomen. Acne and skin tags are also common. Lab work many show high lipid levels and cholesterol. 35-56% of women with PCOS are obese with weight accumulation around the middle section due to high androgen levels.
Oftentimes weight issues with PCOS come from insulin resistance, a problem in how the body processes sugars. The body uses the hormone insulin to process sugar into energy and when insulin resistance is an issue the body no longer responds to insulin. Blood sugar increases even though the pancreas keeps producing insulin. Insulin resistance can disrupt hormonal balance and throw off the menstrual cycle.
Are there associated risks?
Beyond infrequent or absent ovulation making it difficult to conceive, PCOS has other longer term effects on health. Increased risk of high blood pressure, diabetes and heart disease are all real concerns. Getting your PCOS under control and sustaining that through the childbearing years and beyond will not only help you get pregnant but also improve your overall health.
What does testing look like?
Lab work for PCOS includes testosterone and DHEAs, insulin levels and fasting glucose (blood sugar). Women may test high in testosterone and DHEA and normal in insulin and glucose or vice versa. Another common test is a sonogram of the ovaries which could show “a string of pearls” of small follicles around the ovary. History of ovulation and menstrual cycles should also be considered. Cycles longer than 35 days or less than 9 periods a year could fit the PCOS picture. Doctors will also look for presence of symptoms such as hair growth, male pattern hair loss, and acne. Based on all of these findings a doctor may diagnose PCOS and could recommend drugs such as clomiphene or letrozole to stimulate ovulation or a different path of treating insulin resistance with metformin.
Acupuncture and PCOS
Acupuncture helps to soothe the sympathetic nervous system which is what is engaged when the body is in fight of flight. In modern times our sympathetic nervous system is no longer just reserved for fleeing the predator who is after us. Many of us run around in fight or flight all day most days with the constant stressors and demands of the today’s world. When stress hormones are flooding the body this can destabilize other hormones leading to all kinds of issues. Acupuncture helps to put things back into balance, calming stress hormones and relaxing the neuroendocrine system. With regular treatment hormones stabilize and ovulation can return. Herbal formulas can also be incredibly helpful. Studies in China have shown that some Chinese herbs surpass metformin in inducing ovulation for folks with PCOS. Herbal formulas are highly customizable to the person and exactly where they are in their cycle. Both acupuncture and herbal medicine seek to treat the symptoms of PCOS while also addressing and correcting the root cause.
Diet and lifestyle recommendations
Managing weight by eating well and regular exercise can be of tremendous help if you have PCOS and are trying to get pregnant. Studies have shown that losing as little as 5-7% of body weight can improve insulin resistance, reduce hyperandrogenism and restore healthy ovulation in roughly 75% of women with PCOS.
A low carb diet focused on vegetables, lean proteins, healthy fats, fruits and whole grains can help normalize blood sugar, improve insulin’s ability to process sugar and improve hormonal balance. Eliminating processed foods and junk foods as well as food with added sugar is recommended.
Here are some basic diet and lifestyle guidelines:
- Reduce animal fats, increase essential fatty acids
- Focus on veggies, fruits and low fat proteins like beans, chicken and fish
- Limit carbohydrate intake to balance blood sugar (some carbs are necessary to maintain serotonin levels and mood)
- Eat foods high in antioxidants to fight inflammation (inflammation can exacerbate PCOS)
- Talk to your provider about supplements like N-acetyl cysteine (NAC) and Inositol. NAC is a supplement which can help reduce circulating testosterone, insulin, cholesterol, plasma triglycerides, and low-density lipoproteins. Inositol is a nutrient that can improve insulin sensitivity, reduce androgen levels and may help regulate cycles and improve ovulation.
- Exercise, at least walking briskly, for a half hour daily to help increase metabolism
- Reduce and manage stress by practicing meditation, yoga and other self care
I think I have PCOS, what should I do now?
– Have you tracked your cycle? Start now so you have some concrete information to reference. Start by marking day 1 of your full flow period as cycle day 1 (CD1). Proceed through the month making note slippery cervical mucous, breast tenderness lower abdominal pain, PMS, results of OPKs if you are doing them and anything else out of the ordinary.
– Make the diet and lifestyle changes discussed above. Reduce stress and practice kindness to yourself as your body adjusts.
– Consult an acupuncturist who specializes in women’s health, fertility and pregnancy. Regular acupuncture and herbal formulas specifically tailored to you and your cycle can help restore ovulation and improve overall health.
– Make an appointment with your OBGYN or midwife. Tell them about your symptoms and concerns and do some lab work to see what that shows. You can consider this step as part of gathering information to inform healthy diet and lifestyle changes before rushing into doing medications.
– Take a three month break from trying to conceive. It takes about three months to improve egg quality and the follicles that have been exposed to excessive androgens may be poor quality which can increase risk of miscarriage.
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