Do You Have PCOS?
It is surprising how many women we see with polycystic ovarian disease (PCOD), but why? My guess would be that many of these women find their doctor unhelpful with hormonal conditions like PCOD and endometriosis, as many just do the standard blood tests and then recommended certain drugs or the pill and are told that little else can be done. In fact, a great deal can be done but it takes time, and a busy GP does not have the luxury of spending time with the patient these days.Very little (if any) advice is given by the conventional medical practitioner in terms of the all important diet and lifestyle changes required. Because of the complex nature of PCOD, I feel that it is important that women with PCOD be a little bit educated about and understand the health implications related to this syndrome. Let’s take a look at this all too common complaint and see what recommendations the naturopath can offer.
Polycystic ovaries or PCOD?
PCO (polycystic ovaries) literally means a condition associated with many (poly) cysts in the ovary or ovaries. There is a great deal of confusion surrounding this condition, and when I researched it I also found that even many practitioners themselves actually get confused with the terms polycystic ovaries and polycystic ovarian disease.
Since the ultrasound became quite popular, it was discovered that as many as one in five women actually have cysts on their ovaries, and many of these women have normal cycles and periods with absolutely no health problems. Many women with lumpy (fibrocystic) breasts have no health concerns either, in spite of the fact they have lumps which may be of concern to them. Women with cysts on their ovaries have polycystic ovaries, but women with cysts on their ovaries AND menstrual irregularities actually have PCOD, and this is where the confusion lies. The problem arises that making a firm diagnosis can be a problem, because the combination of the signs and symptoms of this condition can also be indicative of another hormonal disorder. A disturbed thyroid gland and even a tumour on the pituitary gland can cause signs and symptoms which may at first appear to be PCOD.
Signs and symptoms of PCOS
There are a number of typical signs and symptoms which characterise PCOS, if you have this condition or were diagnosed with it you will identify with many of the following complaints:
- A menstrual cycle which never really became regular after the period first began and continues to be erratic.
- Excess bodyweight around or before the onset of menstruation.
- A tendency to produce too much androgen (male hormones)
- Prone to acne.
- Irregular menstruation and ovulating erratically. (about 10% have regular cycles)
- Blood tests revealing an elevated LH (luteinising hormone) with a constant or a low level of FSH (follicle stimulating hormone).
- Can have a failure to ovulate and menstruate, about 50% will not menstruate.
- Hirsutism, also referred to as male pattern hair growth.
- Hair can grow on the chin, upper lip, cheeks, around the nipples and other parts of the body. (60% have excess body hair)
- Obesity (about 40% are overweight)
- Infertility (about 75% develop infertility)
PCOD is generally suspected when a female has menstrual irregularities or lack of periods (amenorrhoea) in conjunction with a male pattern hair growth (hirsutism) which may include hair on the upper lip and possibly the chin. An ultrasound is performed which then reveals multiple ovarian cysts and the person may be obese (though not always the case) and infertile. Before a firm diagnosis can be made it is important to exclude all other possible hormonal abnormalities, and the diagnosis generally involves a physical exam, blood tests in addition to the ultrasound.
There still appears to be a substantial amount of uncertainty as to what its actual cause PCOD. About 65 years have passed since PCOD was initially described, and some 90,000 articles have been published discussing medical issues regarding this increasingly common “women’s problem”. Excess weight gain seems to be able to initiate hormonal changes that can transform a symptom free polycystic ovarian woman into full blown PCOD. Some research papers I have looked at suggest that blood sugar abnormalities may be related and with other factors help to trigger the condition and others that it can be an inherited condition because a woman may well come from a background of women who had polycystic ovaries but who didn’t go on to develop the full blown problem. We also know that many women with PCOD actually have low levels of the ovarian oestrogen called oestradiol and high levels of the masculinising hormone androgen. Small cystic follicles develop instead of mature follicles because they are suppressed due to the androgens, and the lacking oestrogen helps to mature the follicle. The female then ends up with small follicles which don’t have the capacity to ovulate.
Being overweight and PCOD
Weight problems can create all sorts of health problems for the normal healthy woman, but for the woman with PCOD, excess bodyweight or obesity more in particular can seriously affect her health over time. Fatty tissue as well as muscles can convert the androgens to a form of oestrogen called oestrone by a process called “aromatisation”. When a PCOD woman has excess bodyweight to the point of being obese, her increased fat has a greatly increased capacity to enhance this process, and too much oestrone is produced which leads to chronically high levels of oestrogen. Does it therefore not make sense for a woman to lose weight if she has PCOD? I realise this is more easily said than done, but any weight loss will certainly help reduce the risks that long term high oestrogen can bring about. And because women with PCOD have an increased risk for endometrial and breast cancer due to longstanding estrogen stimulation, their menstrual function should be continually monitored well into their menopausal years.
Many PCOD women who are obese have problems associated with the hormone called insulin, and many go on to develop what is known as “insulin resistance”. The cells of the body become resistant to the effects of insulin, a hormone secreted by the pancreas designed to transport glucose (blood sugar) into the cell to help produce energy. This in turn will lead to elevated blood glucose levels and low levels of glucose inside the cells. This condition called insulin resistance is often seen in women with high abdominal fat, what we know as the “apple shaped” person. High circulating blood glucose can bring about many problems such as eye and kidney disease. Serious stuff, but most are blissfully unaware of the underlying issues just like the captain of the Titanic until disaster struck one night. It is easy to have a sense of “all is well” because no pain is experienced in the body. Have your eyes checked regularly – the retinal photograph taken by your Optometrist can be a life saver and detect problems long before your ship goes down.
Because of the link between PCOS, obesity, and decreased insulin sensitivity (blood sugar problems), glucose regulation should be monitored regularly. Studies have shown that by 30 years of age, an incredible 25-30 percent of obese PCOD women will have either an impaired glucose tolerance or Type 2 diabetes. Amazingly, a study revealed that 82 percent of women with type 2 diabetes had polycystic ovaries when they had an ultrasound performed. Of those women, over half had menstrual irregularities.
The Medical PCOD Approach
Your doctor will most likely target three main areas after PCOD diagnosis:
a) Reduce the masculinising effects of the increased level of androgens, and anti-androgen drugs, alone or in combination with oral contraceptives, are considered to be the conventional treatment of choice. Many anti-androgen treatments reduce facial hair growth and circulating levels of androgens, and the “bad” cholesterol (LDL), but they fail to restore the menstrual cycle or reduce hyperinsulinemia (high insulin levels).
b) If the woman wants to conceive, they may give her Clomiphene (Clomid) to bring on ovulation.
c) The Pill to minimise the risk of endometrial cancer, or small doses of progesterone for about 7 – 10 days of the month, leading from ovulation up to the cycle. When the progesterone stops, the period should occur
The Naturopathic Approach
The way a naturopath would go about treating PCOD is the same as the GP – protecting the endometrium, reducing the maculinising effects of excess androgens and stimulating ovulation but in this instance it would be from a holistic perspective. For example, it is important as always to treat any underlying health issues the PCOD woman may face, such as encouraging her to start a weight-loss program and maintaining a healthy diet and lifestyle conducive to maintaining a healthy BMI and weight. In addition, there are a number of natural medicines which may have potential benefit without the side effects of abnormal uterine bleeding, weight gain, and liver failure seen with some of the conventional drug approaches. I won’t make recommendations for any nutritional supplements in this article, I recommend that you visit your naturopath, herbalist or doctor who is experienced in this area. There are many choices which include fish oil (Omega3), chromium, flaxseed oil, magnesium and many more options. Get expert advice and don’t waste your money on self-prescribing!
Diet and Lifestyle are Important in PCOD
There is plenty of evidence to suggest that the typical western diet which is high in fat and refined carbohydrate and low in fiber induces insulin resistance and precedes obesity. It is common knowledge that a diet rich in fruits, vegetables, first class proteins and high fiber complex carbohydrates is associated with a lower risk of chronic disease.Studies of obese women with menstrual abnormalities have demonstrated that menstrual cycles can potentially normalise and fertility can be re-established following weight loss. I always encourage women who are overweight or obese with PCOD to lose weight, and am on the lookout for factors which may account for why a patient can’t seem to lose or maintain her weight. In some instances it will prove very difficult to lose weight, but in many other cases there will typically be a habit under pinning excess bodyweight.
Studies have shown that with weight loss of less than five percent there were not only significantly measurable biochemical improvements but very obvious clinical improvements as well. Reversal of ovarian dysfunction was striking, with 82 percent of women in the group showing marked improvement in fertility, including five pregnancies in women who actually had long standing infertility. And all that happened here was weight loss, no pills or drugs required. Convinced yet?
Eating disorders and body image problems often begin in adolescence and are carried into adulthood. Because women with PCOD are often instructed by their doctor to lose weight but then often left “high and dry”, it is important for the naturopath to encourage the healthiest of dietary practices and outline a program for the patient. Did you know that PCOD has been associated with a high incidence of eating disorders, including binge eating and fasting? One major research paper I read stated that “all women with PCOD should be evaluated for eating disorders, especially in the adolescent population”.
I recommend that the PCOD patient increase her intake of dietary fibre. Several healthy characteristics of dietary fiber have been well established, including the bulking effect that increases stool volume and fibre slows stomach emptying and makes you feel full and therefore helps to limit calorie intake. Research also suggests that dietary fiber may play a key role in the regulation of circulating insulin levels. Fiber reduces insulin secretion by slowing the rate of nutrient absorption following a meal – you eat less and gain less weight. Studies show that insulin sensitivity increases and body weight decreases in people on high fiber diets. Now here’s an interesting finding, a recent study in The Journal of the American Medical Association (JAMA) confirmed that fiber consumption could predict insulin levels, weight gain, and other cardiovascular risk factors more strongly than saturated fat consumption. So, worry more about fibre than fat. What are some healthy forms? Try ground flaxseeds and increase your vegetable and fruit intake generally, salads are a good choice and cut the red fatty and processed meats. Stick with fish, free range chicken and eggs for protein.
I am straight up when it comes to women drinking alcohol regularly with chronic hormonal health-related problems, particularly regular wine drinking with PCOD. Alcohol brings about several concerns in PCOD, it affects the liver which is the main organ to help break down excess oestrogen produced by an abundant level of circulating androgens, and it also makes you fat – increasing the risk of increasing the aromitisation process even further. The calorie value of wine if 7 calories per gram, and for fat it is 9 calories per gram, so you can see how fattening alcohol is!
I tell patients in my clinic that a large burger actually has a lower calorie value than a large glass of pinot, because nobody believes that a “drink” can be more fattening than a big burger – but it is. I have spoken in the past of the BBC club that many people belong to, that’s the “Big Bum Club”, but with PCOD you want to be careful not to belong to the BLT club. The “Big Low Tummy” club, (known as the apple shaped club) The regular consumption of one to two glasses of wine will ensure you become a “silver” member and there are plenty of gold members of this club in NZ at present, as statistics have revealed that 62% of New Zealanders are now considered overweight or obese. So how do you become a privileged gold card holder?, you drink two glasses of wine several nights a week and more on the weekends along with regular snacking on chocolate, cheese and crackers, you have a coffee for breakfast and eat too much at night, have little or no exercise, plenty of stress and lots of bread thrown in. You could go platinum, but let’s stop there; I think you get the point. It is the lifestyle and diet that needs attention with many hormonal imbalances, not just pills. The tendency to develop PCOD cannot be “cured” as such, but by keeping the bodyweight down you can certainly reduce the risks and complications such as breast and endometrial cancer as well as diabetes.
Exercise and PCOD
Physical exercise is a very important adjunct in the prevention and treatment of insulin resistance and many studies have revealed that even a single instance of exercise can markedly increase rates of whole body glucose disposal as well as increase the sensitivity of your muscles responding to insulin and glucose. Your muscles become much more efficient at how they allow insulin to move glucose (fuel) into their cells. This helps a great deal in preventing blood sugar conditions like hypo-glycemia (low blood sugar) which creates tiredness and feeling “dopey” after meals or in the afternoon as well as diabetes prevention.
Regular physical activity is required to have a lasting effect on insulin responsiveness. These positive effects on blood sugar can last for several hours after completion of exercise, and I have always noted that when a patient finally engages in a regular program of exercise that she has much less tiredness, develops better sleep patterns, can handle stress better, is more optimistic and less chance of depression and will burn fat at an increased rate. Her weight becomes more stable and her menstrual cycle improves over time. All she did was make up her mind to exercise regularly and this could mean walking daily, cycling, taking a few classes at the local gym and just looking for ways to keep active. Once you reach forty you tend to slow down, you look for all the labour saving devices and reach for the remote control as you sit on the couch with a snack and glass of wine, have you noticed? Is it any wonder we develop weight issues as we age, and all the health problems associated with it? So, let’s get moving now.
Protecting the Endometrium
It is important to understand that cellular changes will occur to the lining of the womb caused by the elevated levels of oestrogens. And for this reason it is important to try and regulate the menstrual cycle so that regular cycles occur, but this regularity will all depend on the weight and age of the woman. Obese woman are the ones most at risk of endometrial hyperplasia or cancer (too many or abnormal cell growth in the lining of the womb) and for this reason the Pill may be their best treatment to help regulate their cycle. I am certainly not against pharmaceutical medications, and when PCOD is severe, natural medicine may not be sufficient to improve the hormonal imbalance. I am against side-effects but these can be lessened and treated as appropriate. A more suitable treatment would be to combine natural medicines and drugs, particularly so when there is a serious risk of endometrial cellular change or if the patient is experiencing severe masculinising effects from androgens.
I like using herbal medicines with “women’s problems” as they have a very positive effect. Whether it is heavy bleeding, lack of periods, premenstrual syndrome or menopause, herbs are a great way to treat a woman’s imbalanced or fluctuating hormone levels. I can remember my herbal medicine teacher telling me many years ago that it was important to treat the woman’s cycle with herbs for a minimum of three to six cycles in order to get a balancing effect. You must be patient and take the herbs regularly if you want to go down this path. People don’t seem to forget the Pill every day, but many seem to “forget” their doses of supplements or herbs daily.
The main female tonic herbs for PCOD to normalise ovulation are false unicorn root (chamaelireum luteum), paeonia lactiflora, and dong quai (angelica sinensis). Unfortunately, false unicorn root is expensive and getting more difficult to get but is one of the best. These female tonic herbs generally contain levels of phyto-oestrogens amongst other factors and help to normalise ovulation by working on the underlying glandular system which regulates the menstrual cycle. (the HPA axis). I generally give a combination of these herbs or various others for specific indications at the rate of 5mls three times daily before meals. Always see a trained and preferably registered herbalist before embarking on a course of herbal treatment.
Androgen excess could literally be the topic for a whole new article, as this condition is also associated with acne for example. One herb I use with androgen excess is Chaste tree (Vitex agnus castus). The use of Vitex in the treatment of PCOD-related menstrual irregularities appears to show promise with regard to helping establish normal menstrual cycles and fertility, I have seen a positive effect in acne and excess hair growth as well. See your herbalist, you have many options you could see a Chinese herbalist or one who specialises in Western herbal medicine. I am a big fan of acupuncture in PCOD and have seen some very encouraging results when expert acupuncture was administered along with Chinese herbs.
I target the liver and most probably have the PCOD patient undergo a liver and bowel detoxification programme which would help her not only lose weight and allow her liver to function optimally, it would also start her on the road to healthier dietary and lifestyle choices. Any treatments for PCOD should not be limited to the above-mentioned natural therapies, but should be inclusive of treatments meant to detoxify the liver, specifically the cytochrome p450 pathways. We call this “Phase 1” as there are three phases of liver detoxification. Detoxification would help establish adequate hormone metabolism and enhance liver insulin clearance. Further treatment options could include optimising adrenal function, so that the body would be better able to handle both physical and mental stress, and for this reason I may recommend an adrenal treatment programme.
There is no doubt about it; natural medicine has a lot to offer the woman who has been diagnosed with PCOD. And it does make sense to combine conventional medicine in conjunction with natural medicine in severe cases. As usual, it is very important to understand that the very best results will come when you adopt a healthy diet and active lifestyle and to focus on weight-loss if this is an issue. Every single kilo you lose will be a big step towards allowing your body to regulate the menstrual cycle much more effectively, reducing your long-term risk of developing a chronic degenerative disease like diabetes or cancer.
Remember, you need to look at androgen excess, your circulating insulin levels, reducing your risks of endometrial cellular dysplasia and try your best to regulate your menstrual cycle if you want to conceive. Are you interested in getting pregnant and have been diagnosed with PCOD? Then what are you waiting for, a miracle? It isn’t going to happen – you have to MAKE it happen. Start today, stop all alcohol and start walking. Improve your bowel function and digestion and undergo a good detoxification programme with your naturopath’s guidance. Start to learn that you need to look at optimising every aspect of your health. You can feel a lot better than you have been, but results will only come from positive action.