Polycystic Ovary Syndrome (PCOS) is often confused with having polycystic ovaries. The distinction is crucial:

– Polycystic Ovaries: This term means there are many cysts on the ovaries. Up to 20% of women may have cysts visible on an ultrasound, yet many of these women have regular cycles and no health issues.

– Polycystic Ovary Syndrome (PCOS): This is a more complex condition characterized by polycystic ovaries combined with additional symptoms such as menstrual irregularities, excess androgen levels, and possibly other hormonal imbalances.

Diagnosing PCOS can be challenging because its symptoms overlap with other conditions like thyroid disorders or pituitary tumors. Studies suggest that about 10% of women have ovarian cysts, which are typically benign and don’t require treatment unless they cause symptoms.

Women with ovarian cysts alone might not have PCOS or any related health problems. Similarly, fibrocystic breasts, which have lumps, often do not pose significant health risks despite being a concern for some women.

Ovarian Cyst Symptoms (Polycystic Ovary)

Women with ovarian cysts might experience a range of symptoms, but some might not notice any. Common symptoms include:

– Pain or pressure in the lower abdomen on the side of the cyst. This discomfort can vary from subtle to intense and may be continuous or intermittent.
– Sharp, intense pain if the cyst ruptures.
– Pain, nausea, and possibly vomiting if the ovary twists (torsion).

Ovarian cysts are not typically linked to cramping or irregular periods, and they rarely cause vaginal bleeding.

Here are some typical signs and symptoms of PCOS that you might recognize if you have the condition:

– Menstrual cycles that are irregular or never became regular after they first started.
– Excess body weight, particularly around or before menstruation.
– Elevated levels of androgens (male hormones).
– Prone to acne.
– Irregular menstruation and erratic ovulation; about 10% have regular cycles.
– Blood tests showing high LH (luteinizing hormone) and constant or low FSH (follicle-stimulating hormone).
– Failure to ovulate and menstruate; about 50% may not menstruate.
– Hirsutism, or male-pattern hair growth on the chin, upper lip, cheeks, around the nipples, and other areas; about 60% experience excess body hair.
– Obesity; approximately 40% are overweight.
– Infertility; about 75% may experience infertility.

PCOS Diagnosis

PCOS is typically suspected in females with menstrual irregularities or a lack of periods (amenorrhea), along with male-pattern hair growth (hirsutism), which may include hair on the upper lip and chin. An ultrasound can reveal multiple ovarian cysts. The individual may also be obese (though not always) and experience infertility. Before confirming a diagnosis, it is crucial to rule out other hormonal abnormalities. The diagnostic process usually involves a physical exam, blood tests, and an ultrasound.

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The exact cause of PCOD (Polycystic Ovarian Disease) remains uncertain, even after 65 years of research and around 90,000 published articles on the topic. Excess weight gain is known to trigger hormonal changes that can escalate a symptom-free woman with polycystic ovaries into full-blown PCOD. Research suggests that blood sugar abnormalities might play a role in triggering the condition, while genetic factors could also be involved, as some women with a family history of polycystic ovaries may never develop the full-blown syndrome.

Additionally, many women with PCOD have low levels of the ovarian estrogen estradiol and high levels of androgens, the masculinizing hormones. This imbalance leads to the development of small cystic follicles rather than mature ones. The elevated androgens suppress the maturation of follicles, and the low estrogen levels fail to support follicle development, resulting in small follicles that cannot ovulate.

Excess weight can create numerous health issues for anyone, but for women with PCOS, it can have particularly serious consequences. In PCOS, fatty tissue and muscles can convert androgens into a form of estrogen called estrone through a process known as aromatization. For women with obesity, this conversion process is greatly amplified, leading to elevated levels of estrone and, consequently, chronically high estrogen levels.

Losing weight can significantly benefit women with PCOS. Although shedding pounds can be challenging, even modest weight loss can help mitigate the risks associated with high estrogen levels. This is especially important because women with PCOS face an increased risk of endometrial and breast cancer due to prolonged estrogen exposure. Therefore, it’s crucial to monitor menstrual function and overall health well into the menopausal years.

Many women with PCOS who are obese struggle with insulin-related issues, often developing insulin resistance. This condition occurs when the body’s cells become less responsive to insulin, a hormone that helps transport glucose (blood sugar) into cells for energy. As a result, blood glucose levels rise while glucose inside the cells drops. Insulin resistance is commonly seen in individuals with high abdominal fat, often referred to as “apple-shaped.”

Monitor Blood Glucose

High blood glucose can lead to serious complications, including eye and kidney disease. It’s important to monitor your health regularly, even if you don’t feel any symptoms. Regular eye exams, including retinal photography, can help detect problems early, potentially saving your vision.

Given the strong link between PCOS, obesity, and insulin sensitivity issues, monitoring glucose regulation is essential. Research indicates that by age 30, 25-30% of obese women with PCOS may have impaired glucose tolerance or Type 2 diabetes. In fact, a study found that 82% of women with Type 2 diabetes had polycystic ovaries on ultrasound, and over half of these women experienced menstrual irregularities.

PCOS Treatment

After a PCOS diagnosis, your doctor will likely focus on three main areas:

1. Reducing Masculinizing Effects: To address the increased level of androgens, your doctor may prescribe anti-androgen drugs, either alone or in combination with oral contraceptives. These treatments often help reduce facial hair growth, lower circulating androgens, and decrease “bad” cholesterol (LDL). However, they may not restore the menstrual cycle or reduce high insulin levels (hyperinsulinemia).

2. Inducing Ovulation: If you want to conceive, your doctor might prescribe Clomiphene (Clomid) to stimulate ovulation.

3. Minimizing Cancer Risk: To lower the risk of endometrial cancer, your doctor may recommend the Pill or small doses of progesterone for about 7-10 days each month, starting from ovulation until the next cycle. When the progesterone is stopped, your period should occur.

A naturopath’s approach to treating PCOS aligns with that of a GP in key areas: protecting the endometrium, reducing the male effects of excess androgens, and stimulating ovulation. However, this is done from a holistic perspective. For instance, it’s crucial to address any underlying health issues, such as encouraging a PCOS patient to start a weight-loss program and maintain a healthy diet and lifestyle to support a healthy BMI.

In addition, natural medicines may offer benefits without the side effects associated with conventional drugs, such as abnormal uterine bleeding, weight gain, and liver issues. While I won’t recommend specific supplements here, I strongly advise consulting a naturopath, herbalist, or doctor experienced in this area.

There are many options available, including fish oil (Omega-3), chromium, flaxseed oil, and magnesium. Expert advice is key to ensuring that you choose the right supplements for your needs without wasting money on self-prescribing.

There’s strong evidence to suggest that the typical Western diet—high in fat and refined carbohydrates and low in fiber—induces insulin resistance, often leading to obesity. It’s well-known that a diet rich in fruits, vegetables, high-quality proteins, and high-fiber complex carbohydrates is associated with a lower risk of chronic disease. Studies involving obese women with menstrual irregularities have shown that losing weight can potentially normalize menstrual cycles and restore fertility.

I always encourage women who are overweight or obese with PCOS to focus on weight loss and to identify any underlying habits that might be contributing to excess weight. While it can be challenging for some to lose weight, many others have habits that can be addressed to help shed those extra pounds.

Research has demonstrated that even a weight loss of less than five percent can lead to significant biochemical and clinical improvements. In fact, one study found that reversing ovarian dysfunction was strikingly effective, with 82 percent of women in the group experiencing marked improvements in fertility, including five pregnancies in women who had long-standing infertility. And all this was achieved through weight loss alone—no pills or drugs required.

Are you convinced yet?

Healthy Dietary Practices are Essential

It’s also important to note that eating disorders and body image issues often begin in adolescence and can persist into adulthood. Women with PCOS are frequently advised by their doctors to lose weight but are often left without proper guidance. This is where a naturopath can play a crucial role in encouraging healthy dietary practices and outlining a comprehensive program for the patient.

Did you know that PCOS is associated with a high incidence of eating disorders, including binge eating and fasting? One major research paper even stated that “all women with PCOS should be evaluated for eating disorders, especially in the adolescent population.” Addressing these concerns early on is key to managing PCOS effectively.

Fibre

For PCOS patients, increasing dietary fiber intake is essential. Dietary fiber offers several well-established health benefits, such as increasing stool volume and slowing stomach emptying, which helps you feel full longer and limits calorie intake. Research also indicates that fiber plays a crucial role in regulating circulating insulin levels. By slowing the rate of nutrient absorption after a meal, fiber reduces insulin secretion, leading to less eating and less weight gain.

Studies show that people on high-fiber diets experience increased insulin sensitivity and decreased body weight. Interestingly, a recent study published in The Journal of the American Medical Association (JAMA) found that fiber consumption is a stronger predictor of insulin levels, weight gain, and other cardiovascular risk factors than saturated fat consumption. So, focus more on fiber than fat.

To boost your fiber intake, try adding ground flaxseeds to your meals and increasing your consumption of vegetables and fruits—salads are an excellent choice. Reduce your intake of red, fatty, and processed meats, and opt for fish, free-range chicken, and eggs as your primary protein sources.

I want to be clear about the impact of regular alcohol consumption, especially wine, for women dealing with chronic hormonal issues like PCOS. Alcohol can pose several challenges for those with PCOS. It affects the liver, which plays a key role in breaking down excess estrogen produced by elevated androgens. Additionally, alcohol contributes to weight gain, which can increase the risk of further hormonal imbalances. To put things in perspective, wine has 7 calories per gram, while fat has 9 calories per gram, so it’s easy to see how alcohol can contribute to weight gain.

I often explain to patients that a large glass of wine can have more calories than a large burger, which can be surprising for many. Regular consumption of one or two glasses of wine, especially combined with other factors like unhealthy snacking, lack of exercise, and stress, can lead to weight gain. This can worsen PCOS symptoms and increase the risk of complications like breast and endometrial cancer, as well as diabetes.

It’s important to focus on lifestyle and diet when managing hormonal imbalances. While PCOS can’t be “cured,” maintaining a healthy weight and making mindful choices can significantly reduce the risks and complications associated with the condition.

Physical exercise is crucial in preventing and treating insulin resistance. Many studies show that even a single session of exercise can significantly improve whole-body glucose disposal and increase your muscles’ sensitivity to insulin and glucose. Essentially, your muscles become more efficient at moving glucose (fuel) into their cells with the help of insulin. This process is vital for preventing blood sugar issues like hypoglycemia, which can cause tiredness and feeling “dopey” after meals or in the afternoon, as well as helping to prevent diabetes.

To maintain these benefits, regular physical activity is essential. The positive effects on blood sugar can last for several hours after exercise. I’ve observed that when patients commit to a regular exercise routine, they experience less fatigue, better sleep, improved stress management, a more optimistic outlook, and a reduced risk of depression. They also burn fat more effectively, achieve more stable weight, and see improvements in their menstrual cycle over time. All it takes is deciding to stay active—whether it’s walking daily, cycling, taking gym classes, or simply finding ways to move more.

As we age, especially after forty, it’s easy to slow down and rely on labor-saving devices, reaching for the remote while snacking with a glass of wine. But this leads to weight gain and the health problems that come with it. So, let’s get moving now and make physical activity a part of our daily routine.

It’s important to understand that elevated estrogen levels can cause cellular changes in the lining of the womb. This is why regulating the menstrual cycle is crucial, aiming for regular cycles. However, achieving this regularity depends on factors like the woman’s weight and age. Obese women are at a higher risk of developing endometrial hyperplasia or cancer, where abnormal cell growth occurs in the womb lining. In such cases, the Pill may be the most effective treatment to help regulate the cycle.

I’m not against pharmaceutical medications; in fact, when Polycystic Ovary Syndrome is severe, natural medicine alone may not be enough to address hormonal imbalances. While I am cautious about side effects, they can often be managed with the right approach. A more balanced treatment plan might involve combining natural medicines with conventional drugs, especially when there is a serious risk of endometrial cellular changes or if the patient is experiencing severe masculinizing effects from androgens.

I like using herbal medicines for women’s health issues because they have a very positive effect. Whether it’s heavy bleeding, missed periods, PMS, or menopause, herbs can be an excellent way to treat imbalanced or fluctuating hormone levels. I remember my herbal medicine teacher telling me that it’s important to treat a woman’s cycle with herbs for at least three to six cycles to achieve a balancing effect. Patience and consistency are key if you choose this path. People rarely forget their daily Pill, but many tend to “forget” their doses of supplements or herbs.

For PCOD, the main female tonic herbs to normalize ovulation are false unicorn root (Chamaelirium luteum), Paeonia lactiflora, and dong quai (Angelica sinensis). Unfortunately, false unicorn root is expensive and becoming harder to find, but it’s one of the best. These herbs contain phytoestrogens and other compounds that help regulate the menstrual cycle by working on the underlying glandular system (the HPA axis). I usually recommend a combination of these herbs, or others depending on the specific needs, taken at a dose of 5 ml three times daily before meals. Always consult a trained and preferably registered herbalist before starting a course of herbal treatment.

Here’s a more concise version:

Androgen excess could fill an entire article, as it is linked to conditions like acne. Chaste tree (Vitex agnus-castus) is one herb I use for androgen excess. Vitex shows promise in regulating menstrual cycles and improving fertility in PCOS, and it can also help with acne and excess hair growth. Consult your herbalist for options, whether a Chinese herbalist or one specializing in Western herbs. I also recommend acupuncture, which, combined with Chinese herbs, has shown encouraging results for PCOS.

I target the liver and typically have PCOS patients undergo a liver and bowel detoxification program. This helps with weight loss and optimal liver function while promoting healthier dietary and lifestyle choices. Treatments for PCOS should include more than just natural therapies. They should also focus on liver detoxification, specifically the cytochrome P450 pathways, known as “Phase 1” of detoxification. This approach aids in hormone metabolism and enhances liver insulin clearance. Further treatment options might include optimizing adrenal function. This helps the body handle both physical and mental stress, so I may recommend an adrenal treatment program.

Natural medicine offers a lot to women diagnosed with PCOD. It makes sense to combine it with conventional medicine in severe cases. But remember, the best results come when you adopt a healthy diet and active lifestyle. If weight loss is needed, focus on that. Every kilo lost helps your body regulate your menstrual cycle more effectively. This reduces your risk of chronic diseases like diabetes or cancer.

If you’re dealing with androgen excess, high insulin levels, or endometrial issues, it’s crucial to take action. Want to conceive and have PCOS? Don’t wait for a miracle—you have to make it happen.

Start today. Cut out alcohol and start walking. Improve your digestion and bowel function. Work with your naturopath on a good detox program. Focus on optimizing every aspect of your health. You can feel better, but only if you take positive action.

Read our article on Breast Cysts here