Polycystic Ovarian Syndrome (PCOS)

Natural Treatment of PCOS  – Perth & Australia wide

PCOS is an increasingly common hormone condition that causes ovarian cysts to form on a woman’s ovaries.   It is caused by an imbalance of female hormones. At our Perth clinic we specialise in the treatment of PCOS and treat the underlying causes of PCOS.

It affects from 12-20% of women that are in the reproductive age group and can cause a range of symptoms including irregular periods, excess hair growth, hair loss, mental health issues, obesity and acne.  It is associated with insulin resistance and androgen dominance.

Diagnosis of PCOS is made if two out of the following three criteria are met: irregular ovulation and/or lack of ovulation; excess androgen activity; and polycystic ovaries. The presence of ovarian cysts alone is not diagnostic of PCOS.

Ovarian cysts are fluid-filled sacs that form in or on one or both of the ovaries. An ovarian cyst occurs when the follicle containing the egg matures but fails to break open and release the egg into the fallopian tube.  This may be caused by estrogen dominance.

PCOS is the most common cause of infrequent periods and amenorrhoea (absense of a period).

Causes of PCOS

• Functional ovarian cysts form due to slight changes in the way the follicle releases the egg. May be due to relative oestrogen excess.

• Caused by excessive production of androgens, especially testosterone, by the ovaries, either due to the release of excessive LH by the pituitary or through high insulin levels in women whose ovaries are sensitive to this stimulus.
  • Insulin resistance is thought to be a primary cause in the development of PCOS.  Nearly all women with PCOS have insulin resistance in both normal weight and overweight patients. High insulin levels contributes to HPA axis abnormalities such as increased gonadotropin-releasing hormone (GnRH), increased lutenizing hormone (LH), increased ovarian androgens, decreased follicular maturation and decreased sex hormone binding globulin (SHBG).
  • Estrogen dominance is also commonly present in women with PCOS as excess androgens are converted to estrogen in fatty tissues (ovarian estrogen production is usually chronically low).

Risk factors – PCOS

• Family history of PCOS
• Insulin resistance – occurs in the majority of patients with PCOS (even if not overweight). Elevated insulin levels contribute to or cause the abnormalities that lead to PCOS. Specifically, high insulin increases GnRH, LH and ovarian androgen production, and decreases follicular maturation and SHBG
• High glycemic load diet – causes high insulin levels
• Obesity – occurs in the majority, but not all, PCOS patients
• Stress
• Nutritional deficiency
• Bacterial and fungal overgrowth of the gut
• SIBO
• Methylation imbalances
• Sedentary lifestyle
• Thyroid disorders – women with PCOS have a high incidence of autoimmune thyroiditis. Thyroid function should be checked in women with PCOS
• Poor liver function – approximately 30% of women with PCOS have raised liver enzymes. High insulin levels also inhibits the production of SHBG in the liver.

Signs & symptoms of PCOS

• Functional cysts: usually asymptomatic but may cause late or painful periods. If very large, may also cause abdominal bloating and discomfort, and painful defecation or intercourse.

• Irregular menstrual cycle, especially irregular menstruation, amenorrhoea, breakthrough bleeding
  • Infertility – due to lack of ovulation
  • Hairloss
  • Acne
  • Obesity: occurs in 50%
  • Prolonged periods of PMS-like symptoms
  • Chronic pelvic pain
  • Hypoglycemic episodes / diabetes
  • Hypothyroidism

TREATMENT STRATEGY – PCOS

• Improve insulin sensitivity
• Balance hormone profile:
  • Reduce androgens
  • Reduce excess estrogen (caused by conversion of androgens to estrogen)
  • Reduce LH (will decline once androgens slow down)
  • Reduce prolactin (if indicated)
  • Increase SHBG (to reduce bioavailable androgens)
• Stimulate ovulation
• Reduce inflammation (increases insulin resistance)
• Support thyroid (if indicated)
• Decrease weight (if indicated)
• Support nervous system

TREATMENT OPTIONS

Diet plan 

• High-protein, low-carbohydrate or ketogenic diet: typically associated with excellent weight loss and improved insulin sensitivity in women with PCOS. Sugars, refined and starchy carbohydrates should be eliminated, and diet should emphasise healthy proteins and fats and non-starchy vegetables
• Mediterranean-style or Paleo style diet: also associated with weight loss, improved insulin parameters and reduced inflammation
• Fasting is shown to improve PCOS symptoms, fasting increases SHBG and assists with insulin sensitivity
• Emphasise anti-inflammatory foods: in cold-water oily fish, berries, nuts and seeds, turmeric, ginger, green tea, olive oil.
• Reduce pro-inflammatory foods such as commercially produced meats, sugar, refined grains, alcohol and caffeine
• Increase dietary fibre intake: stabilises blood sugar levels, increases SHBG and clears excess estrogens. In particular, soluble fibre will help slow glucose and fat absorption
• Include bitter foods, cruciferous vegetables (cabbage, kale, broccoli, Brussels sprouts), turmeric and rosemary to improve liver clearance of estrogen
• Include phyto-estrogens: blocks effect of xeno-estrogens
• Include foods that inhibit aromatase activity – white button mushrooms (Chen et al, 2006), cruciferous vegetables, onions and garlic, citrus fruits, many culinary herbs (parsley, dill, oregano, rosemary, sage, coriander), celery, oysters, grapes, berries, red wine and green tea
• Cinnamon – 1-2 tsp daily can improve insulin sensitivity
• Reduce exposure to xeno-estrogens – non-organic animal fats, unfiltered water, plastic-wrapped food, microwaving foods in plastic containers, tinned foods, etc.

Supplements 

• Omega-3 EFA‘s – controls cell membrane flexibility to allow binding of insulin to receptors; also reduces inflammation
• Chromium –  improves metabolism of glucose and insulin sensitivity
• Magnesium –  improves insulin sensitivity and reduces sympathetic nervous response
• B-complex –  supports healthy blood glucose metabolism
• Myo-inositol –  reduces testosterone, promotes ovulation and improves insulin resistance
• Alpha-lipoic acid – increases insulin sensitivity
• Zinc – reduces androgenic activity in the skin
• B6 –  supports progesterone production
• B6, methyl folate, B12: improves metabolism of estrogen through improving methylation

Herbal Medicine 

• Blood sugar balancers – fenugreek, goat‘s rue, gymnema, cinnamon
• Improve insulin resistance – Korean ginseng, cinnamon
• Anti-androgenic – saw palmetto, peony & licorice
• Reduce LH – black cohosh, hops, peony & licorice
• Increase FSH – tribulus
• Reduce prolactin – chaste tree
• Ovarian tonic – shatavari, false unicorn root, peony, blue cohosh, dong quai, chaste tree
• Liver clearance of excess estrogen – turmeric, rosemary, St Mary‘s thistle

Lifestyle / Physical Measures

• Regular exercise and stress management are essential

FUNCTIONAL MEDICINE TREATMENT OF PCOS – PERTH CLINIC

Polycystic ovarian syndrome is a complex hormonal imbalance condition that is contributed to by a number of underlying dysfunctions in the body.  

Insulin resistance, gut dysbiosis, SIBO, methylation imbalances, poor clearance of estrogen and poor diet and lifestyle are key areas that we regularly see in our PCOS patients.  Supporting the body to process hormones efficiently and through the correct pathways require the body to be somewhat in balance.

At our Perth clinic of Advanced Functional Medicine we have experience with women with PCOS and other female health problems.  

If you or a family member are suffering from PCOS or another hormonal related condition we would love to hear from you.  Have you recovered from PCOS, what measures did you take?  What have been the best remedies you have used to improve the condition?  Have you investigated your gut health and methylation?  Please leave a comment below.

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