Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders among women of reproductive age. An estimated 10%-20% of reproductive-aged women suffer from this condition (4, 5, 8), which causes enlarged ovaries with small cysts on the outer edges (1, 2). Symptoms can include menstrual irregularity, infertility, acne, excess hair growth, insulin resistance, and obesity.
There is no specific cure for this very complex condition (5). It’s one of the most common causes of infertility and treatment is available to reverse infertility in most cases. Other treatments are available to help control symptoms and potentially slow the disease process to keep it from worsening.
However, standard therapies can cause side effects and may not work for every woman. Research continues to look for alternative and complementary treatments to give women who have not been helped by standard treatments additional options (1, 3).
What causes PCOS?
A specific cause of PCOS is not clear, but a combination of genetic, endocrine, and environmental factors is the most likely cause. Several factors play a causal role in PCOS, including excessive insulin, inflammation, heredity, and excess androgen hormones (6).
Insulin resistance is common for women with PCOS, and some experts believe elevated insulin is the underlying imbalance causing PCOS (11). If the body doesn’t use insulin well, glucose levels increase. As insulin resistance increases, it can lead to type 2 diabetes, and an abnormally high level of androgens, which can prevent ovulation (1, 2).
Low-grade inflammation, common in women with PCOS, can cause an overproduction of androgens. Polycystic ovaries produce too much androgen, causing infertility and leading to cardiovascular problems (6).
Obesity, a problem for about 80% of women with PCOS, also increases insulin levels, and usually makes PCOS symptoms worse, including irregular menstrual cycles (1, 2, 6).
PCOS may have a hereditary connection. It’s common for several women in a family to have PCOS (1).
Metabolic syndrome, cardiovascular disease, and high blood pressure are associated with PCOS (2). Metabolic syndrome, a combination of high blood pressure, high glucose levels, excess body fat around the waist, and abnormal cholesterol levels, increases your risk of heart disease, stroke, and diabetes.
What are the symptoms of PCOS?
PCOS symptoms can develop when a woman has her first menstrual periods during puberty. It can also develop later, possibly cause by substantial weight gain (6). Symptoms may include (1, 9, 10):
Infertility
Missed periods, irregular periods, or very light or heavy periods
Enlarged ovaries with many small, fluid-filled cysts on the edges of the ovaries
Fatigue
Excess body hair on the face, chest, stomach, upper thighs, and back – about 70% of women have this symptom
Weight gain, especially around the abdomen – 80% of PCOS patients are overweight
Carbohydrate cravings and binges
Food sensitivities and constipation
Acne or oily skin that doesn’t respond to standard treatments
Thinning hair or male-pattern baldness
Skin tags (small pieces of excess skin) on the neck or armpits
Patches of thick, velvety, darkened skin on the back of the neck, armpits, and under the breasts (acanthosis nigricans)
Endometrial hyperplasia along with PCOS can cause the uterine lining to thicken, increasing the risk of endometrial cancer (2).
Women with PCOS have an increased risk of sleep disorders, sleep apnea, depression, anxiety, low self-esteem, and eating disorders (2, 6).
Because PCOS can affect many other systems in the body (2), it can cause a higher risk of type 2 diabetes, high blood pressure, heart problems, sleep apnea, endometrial or uterine cancer, a greater risk of miscarriage and premature birth, and depression and anxiety (1, 5, 6, 8).
How is PCOS diagnosed?
Diagnosis includes a physical and pelvic exam. The pelvic exam can check for any abnormalities such as an internal mass or growth. Because some PCOS symptoms can also be caused by other health problems, your doctor will likely order additional tests, including an ultrasound and blood tests. Ultrasound can assess the size of the ovaries, check for cysts, and assess the thickness of the uterine lining (1, 2). Blood tests can check androgen and other hormone levels, as well as blood glucose and cholesterol levels.
A diagnosis of PCOS can be confirmed if you have at least two of these symptoms: irregular periods, excess androgen hormones, or ovaries with multiple cysts (6).
What are the standard treatments for PCOS?
Treatment will depend on your age, overall health, how severe your symptoms are, and if you are planning a pregnancy. Standard treatments focus on managing your symptoms and may include hormone therapy, surgery, procedures to remove excess hair, medications such as metformin (to prevent prediabetes from progressing to type 2 diabetes), or statin medications to control high cholesterol (1).
Birth control pills can regulate periods and help reduce premenstrual pain. However, they do not lower the risks associated with PCOS because they mask or hide PCOS symptoms rather than addressing the condition’s underlying cause. While hormones cannot cure PCOS, they usually reduce symptoms (1). Birth control pills may contain both estrogen and progestin, or progestin alone. Side effects associated with these medications include a higher risk of a multiple birth, and ovarian hyperstimulation, which causes the ovaries to release too many hormones. Excess hormones can cause stomach bloating and pelvic pain (1, 2).
Other hormone therapies will be prescribed to increase fertility by causing ovulation if you are planning a pregnancy (6, 9).
These therapies include:
Clomiphene, an oral anti-estrogen medication, is taken in the first part of your menstrual cycle (6).
Letrozole (Femara), a medication for breast cancer, will also stimulate the ovaries to ovulate.
Metformin is taken for type 2 diabetes to lower insulin levels, improve insulin resistance, and reduce androgen levels. It may also slow the growth of body hair and induce more regular periods. It can be used with Clomiphene to increase the chance of pregnancy. Patients with prediabetes can potentially prevent, or at least slow, their progression to type 2 diabetes. It also helps with weight loss (6).
Gonadotropins are hormones given by injection (6).
Standard treatments only address one symptom, can cause side effects, have low compliance, and may not be effective for some women (3). PCOS specialists are increasingly using a multidisciplinary approach that is supported by evidence-based medicine.
Modifications in diet and exercise may be recommended. Improving your diet and increasing physical activity can help control weight, use insulin more effectively, lower glucose levels, and may improve ovulation (2). Some patients are helped by a low-carbohydrate diet, ketogenic, or low glycemic diet, or a blood-sugar balancing diet that also reduces caffeine, alcohol, and sugar (10).
Weight loss is important because it alone may be enough to regulate the menstrual cycle and improve fertility. Weight loss through a better diet and increased activity can also improve cholesterol and insulin levels, reduce acne, and help reduce excess hair growth. Women who are overweight may see improvements in symptoms with even a small loss of weight.
Reducing stress can help reduce your cortisol levels, which can also reduce blood glucose levels, and may help with weight reduction (9).
Are there Functional Medicine treatments for PCOS?
Functional medicine, which relies on an individual analysis of the root causes of a disease or condition, can help determine if these potential causes are factors in your PCOS issues. By healing the root causes of your PCOS, the syndrome can be truly healed.
Functional Medicine and complementary and alternative medicine (CAM) have a role in treating PCOS. Therapies may range from incorporating lifestyle changes such as modifications in diet and exercise and reducing stress, to reducing environmental toxins, to acupuncture, herbal medicine, and mind-body therapy, including Tai Chi, yoga, Qigong, and meditation (3,4,5).
Certain herbs, called adaptogens, can help balance hormones and protect against the effects of chronic stress. These include ashwagandha, holy basil, robiola, maca root, and licorice (9). Inositol is a supplement that can improve PCOS symptoms. Omega-3 supplements can affect how the body uses insulin and lipids (9).
Other important supplements for PCOS patients are magnesium and zinc. It’s hard to get enough magnesium through diet alone. Magnesium glycinate supplementation is important for any woman with menstrual irregularities. Magnesium can also improve the function of insulin, leptin, and thyroid hormones, and the production of estrogens and progesterone. Zinc helps support a normal menstrual cycle and ovarian follicle development (egg production), which is a primary issue with PCOS. Oral contraception can deplete zinc so supplementation can often help women who are taking birth control pills.
Reducing oxidative stress can also help with PCOS. Increasing antioxidants with a plant-rich diet and phytonutrient supplements, as well as adding fish oil, herbs, and spices (curcumin, quercetin, bromelain) to the diet is an important functional medicine treatment of PCOS (11).
Toxins in the environment are endocrine or hormone disrupters. Discovering what toxins are disrupting an individual patient and eliminating them can help PCOS treatment.
If insulin resistance is a factor, insulin can be controlled with a low-glycemic, Mediterranean, or ketogenic diet, intermittent fasting, maintaining a healthy body weight, and supplements like cinnamon, chromium, vanadium, alpha-lipoic acid, fiber, and rho-iso acids (11).
An analysis of research on Oriental herbal medicine (OHM) herbal extracts vitex (Vitex agnus-castus), black cohosh (Cimicifuga racemosa), bindii (Tribulus terrestris), licorice (Glycyrrhiza), Chinese peony (Paeonia lactiflora), and Chinese cinnamon (Cinnamomum cassia), in the treatment of oligo/amenorrhea, hyperandrogenism and PCOS, showed positive results. The luteinizing hormone (LH) was reduced, along with prolactin, fasting insulin, and testosterone (3). The highest-quality evidence of regulation of ovulation, improved fertility, and a better metabolic hormone profile was attributed to vitex and black cohosh. The evidence was not as strong for the combination of spironolactone and licorice (3). The other herbs: bindii, and licorice alone and in combination with Chinese peony and in combination with Chinese cinnamon, produced changes in the number of ovarian cysts, lowered androgen hormones, and improved insulin sensitivity. No adverse side effects were reported (3).
Another analysis of Oriental herbal medicine showed that, compared to the Western medicine (WM) control group, OHM combined with moxibustion produced a significantly higher pregnancy rate. When OHM and moxibustion were used together as adjunctive therapy to WM (clomiphene citrate, birth control pills, and/or metformin), the pregnancy rate was significantly higher than the WM-only control group (4). Additionally, there were no reports of side effects, or abnormal blood, urine, liver, and kidney function tests (4).
Moxibustion is a Chinese therapy that’s been used for more than 2,500 years. Stimulation of the body’s acupoints by the burning moxa is believed to work by affecting the autonomic nervous system (controls internal organs), causing an adjustment of the nerve-endocrine-immune network and circulatory system (7).
A third analysis examined the efficacy of using OHM, acupuncture, dietary supplements (vitamins), and mind-body techniques (Tai Chi, yoga, and meditation). Acupuncture was shown to improve insulin resistance, regulate metabolism, and promote ovulation. While there was no improvement with vitamin use or mind-body techniques, the incidence of cardiovascular disease, diabetes, anxiety, and depression were reduced with these techniques, and quality of life was improved (5).
Luckily for women diagnosed with PCOS, there are both standard and alternative therapies and treatments that can help your PCOS. Please contact us at the Temecula Center for Integrative Medicine to learn more about the full range of therapies we offer that have the potential to alleviate your symptoms and/or the pathology of PCOS and improve your quality of life.
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
info@tcimedicine.com
951-383-4333
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