Abundant Spring | Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Syndrome (PCOS) is an endocrinological condition that affects nearly 4 to 12 percent of all American women of reproductive age. It undermines the endocrine system: androgens, prolactin, lipids, and luteinizing hormone all increase, insulin sensitivity and progesterone levels decrease, and inhibits ovulation. The endometrium (uterine lining) may also be thin. When anovulation is combined with a thin endometrium, the menstrual cycle may become less frequent or worse yet, completely absent. The potential for conception plummets to near nonexistent. It is no surprise then that PCOS accounts for an estimated 30 percent of women diagnosed with infertility.

How does this happen?
The body possesses an intricate system of checks and balances ensuring homeostasis. Ideally, the hypothalamus located deep in the brain, but just above the pituitary, monitors the hormone levels. When estrogen levels dip, it signals the anterior pituitary to release follicle stimulating hormone (FSH). This in turn, triggers the ovary to prepare one of the many selected follicles for ovulation. The maturing follicle in turn releases estrogen to help plump up the uterine lining and also let the pituitary know the follicle is maturing. Heeding this signal, the pituitary slows down the release of FSH and waits for the just the right level of estrogen so it can release a large pulse of luteinizing hormone (LH) and trigger ovulation. At the same time the estrogen levels begin to fall. The egg is released from the follicle and awaits fertilization. The corpus luteum forms where the follicle was and begins to release a steady flow of progesterone to ensure the lining remains plump and plush. If there is no fertilization, the endometrium begins to break down, the progesterone falls, the estrogen, LH, and FSH are already low, and menses ensues. The hypothalamus detects the hormone drop and begins the process all over again.

In the situation of PCOS, it appears this delicate system is devilishly askew, typically manifesting in unpredictable or absent ovulation, unpredictable or absent menstrual periods, thin uterine lining and abnormal hormone lab values. PCOS can also manifest itself in curious symptoms such as excessive facial or body hair (hirsutism), male-pattern baldness (alopecia), dark skin discoloration (acanthosis nigricans), skin tags (acrochordons), cracked skin on the heels, weight gain, usually most noticeably around the abdomen, nipple discharge, acne, and obesity. Very commonly, these manifestations vary greatly from woman to woman.

In light of these grand variations, your doctor may request several additional tests such as:

Androgen levels, such as testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEA-S)
Estrogen levels, such as estradiol
Cholesterol levels, such as LDL, VLDL, HDL, and triglycerides
Glucose tolerance to determine insulin resistance and hyperinsulinemia
Prolactin (PRL)
Luteinizing hormone (LH)
Follicle Stimulation hormone (FSH)
Progesterone
Thyroid panel, such as thyroid stimulating hormone (TSH), free tri-iodothyronine (T₃)_,thyroxine (T₄₎
A transvaginal ultrasound to determine the size of the ovaries, the presence, number and location of cysts, and to assess the endometrium or uterine lining.

PCOS is not generally diagnosed unless the ovaries are enlarged, show multiple cysts around the edge of ovary, and are encased in a thick capsule. The cysts are quite simply follicles that arrested in development and began the process of atresia in the peripheral part of the ovary. Doctors describe the tissue surrounding this arrested follicle as most noteworthy. The tissue is made up of theca stromal cells, which are numerous and plump. Also noteworthy, is the starvation of the ovary as it is encapsulated. Blood flow and vital nutrients are blocked, further complicating the follicular development.

It is clear the endocrine system is working less than efficiently, but it may not be permanent. Acupuncture and Chinese herbal medicine, diet, and nutritional supplementation can help to “direct” the body back to its original state, making it able to rely on that system of checks and balances.

How Traditional Chinese medicine can help
A complex condition, PCOS is often (but not always) described in Chinese medicine as an accumulation of phlegm or dampness that results in stagnation. Phlegm-damp is best described by Jane Lyttleton as, “ a complex phenomenon (unique to TCM), which includes congealing of fluids at certain sites or in certain systems such that their function is disrupted.”⁴ Ovarian cysts, pituitary tumors are excellent examples of this congealed fluid obstructing or disrupting bodily functions.

There is often a concurrent deficit in vital Kidney energies. Kidney Essence can be thought of DNA quality, or more loosely egg quality. If the ovaries are being starved or the hormone balance is askew, then the Kidney Essence is directly affected. Additionally, Kidney Yin and Yang may also be challenged. These can loosely represent the hormones that control the menstrual cycle.^4,6

While there may also be other influences at play here, this imbalance of excess moisture in the form of phlegm or dampness and deficiency of vital essence, inhibits the ovary from fully producing and expelling eggs every month. TCM seeks to resolve this imbalance and gently nudge the body back into balance.

This balancing act begins with acupuncture and Chinese herbs. Acupuncture has been shown to be effective at circulating and increasing blood flow⁸, balancing hormones⁹, and helping to promote ovulation¹⁰. Chinese herbs are also very effective at breaking up congealed fluids and nourishing deficits, balancing hormones and promoting ovulation.

Nutritional guidelines

Eat foods that have a low glycemic load or are low on the glycemic index. Nourish your body fully via a nutrient-rich whole-foods diet that balances insulin/glucagons and eicosanoids. If you can’t see a nutritional consultant or dietition, a good resource is “The New Glucose Revolution,” by Jennie Brand-Miller.
A loss of even 10% of body weight can help improve hormone balance by increasing insulin sensitivity and normalizes insulin secretion. This helps to normalize blood sugar and reduce of excess androgens.
Supplements
- Supplement with 300 – 500 mcg of Chromium Picolinate 2g NAC or N-acetyl-cysteine daily to help normalize blood glucose. Consult your doctor for the right dose for you.
- Multivitamin. Take a high quality, high potency, multi-dose vitamin. It is best to avoid one-a-day vitamins as the quality and potency are compromised in order to compact the ingredients in one pill. You money is better spent on a higher quality product. The highest rated multivitamin is Usana Essentials.¹¹
- EFA. Supplement with essential fatty acids to equal 2000 mg of EPA and DHA daily. This will help to lower your cholesterol, augment hormone balance, decrease inflammation and quiet a hyperactive immune system. This is one of the best things you can do for yourself. Avoid cod liver oil as it often contains retinol, which in high doses can lead to birth defects. Ensure you get a high quality fish oil that has been tested for lead, mercury, PCBs and other heavy metals. It should clearly state this on the bottle.
- Probiotics. Supplement with 8 billion live cultures like lactobacillus acidophilus and bifidus twice daily with food. This will aid the intestines to eliminate excess hormones and prevent their reabsorption. High quality probiotics are often refrigerated and guaranteed to contain the number of live cultures claimed on the label. Do not exceed 8 billion live cultures at a time as this may cause mild intestinal distress.
TCM dietary suggestions:

Dampness is compounded by damp-productng foods like oily, greasy, heavy foods, dairy, and refined carbohydrates. As a result, eat a balanced whole food diet with a mix of complex carbohydrates, proteins and fats.

As outlined in most low glycemic recommendations:
- Avoid all forms of simple, refined sugar.
- Avoid all forms of refined carbohydrates like white bread, pasta, white rice, most breakfast cereals, rice cakes or any starchy, low-fiber food.
- Avoid soda, fruit juice and any drink that rapidly raises the blood sugar level.
- Yams have a high starch and sugar content which exacerbates the impaired glucose metabolism and can actually delay or prevent ovulation if you have PCOS.
Consume adequate amounts of protein, either in vegetarian form or in the form of lean meat that has not been hormonally treated.
Eat as many fresh vegetables as you wish.
Eat only complex whole grains like oatmeal, brown rice and whole wheat.
Eat fruits like berries, which are not too sweet.
Avoid milk and dairy products, which tend to exacerbate the condition of internal dampness.
Eliminate alcohol and caffeine.
increase your dietary fiber intake.
Get adequate amounts of exercise.
Drink lots of water!!

Lifestyle

Get out into the light -- natural light. It can affect the hypothalamus and pituitary gland and thus affect ovulation. Northrup suggests sleeping wtih the light on 3 days each month and consider getting full spectrum lights in your home, especially during the fall and winter months.
Get regular, moderate exercise. We suggest yoga, walking, swimming or the elliptical trainer. Avoid jarring activities like jogging, aerobics, basketball, soccer, etc.
We may suggest performing abdominal self-massage daily, as it can increase the blood flow to your ovaries, and therefore increase their productivity.

Other considerations
Studies have shown that women who do not ovulate may be tense, anxious, more dependent, and less productive mentally compared to ovulatory women. They may also have suppressed rage at their mothers. Some feel guilt and fear about their need for parental care and protection and also fear losing this protection.

Stresses have been associated with functional amenorrhea (Hypothalamus-Pituitary-Ovary axis), which a symptom of PCOS. Stresses that have been found to suppress ovarian and menstrual cycle functioning include: negative feelings about being female and also feeling subordinate or inferior.

Look for any internalized negative childhood messages about being a fertile woman. Reestablish cyclic emotional flow. (Look for menstrual patterns in relation to lunar and tide charts). Simply paying attention to these environmental cues including the light, the moon and the tides may help to regulate a woman’s menstrual cycle and fertility.

Citations:

Speroff L., Fritz, M. Clinical Gynecologic Endocrinology and Infertility. Seventh Ed. Lipponcott Williams & Wilkins. 2005.
Khan M., Klachko D., “Polycystic Ovarian Syndrome.” Emedicine.com.http://www.emedicine.com/med/topic2173.htm#section~bibliography. Jul 2006.
Lyttleton J. Treatment of Infertility with Chinese medicine. Churchill Livingston. 2004. 95, 166, 215-222.
Northrup, Christiane, MD. “Women’s Bodies, Women’s Wisdom, revised edition.” Bantam. 1998. 137.
Lewis, Randine, PhD. “The Infertility Cure.” Little, Brown and Company. 2004.
Merck Manual, 17^th Ed. Merck Research Laboratories. 1999.
Stener-Victorin E. et al. Hum Reprod 1996 Jun;11(6):1314-7
Chen BW. Intl J Acup and Electro-Therp. 1997: (22):97-108.
Cai XF. J TCM. 1997:17(2):119-121.
MacWilliam L. Comparative Guide to Nutritional Supplements. Northern Dimensions. 2003. 67, 104.

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