Hope you're having a good week! Here's a quick overview of Polycystic ovary syndrome (PCOS) - I know everyone presents differently and we treat every one differently. There are evidence based modalities to treat PCOS. Book a consult if you think you or someone you know needs care in that area. Functional medicine and TCM have great solutions! Thanks to all those who left Google Reviews!
What is PCOS?
Polycystic ovary syndrome (PCOS) is a hormonal condition in women that often manifests in adolescence. During the menstrual cycle of a healthy woman, one follicle, produced by the ovaries, will release an egg. In women with PCOS, the ovaries over-produce testosterone, yielding many smaller follicles. The immature follicles can accumulate in the ovaries and do not mature to release eggs. PCOS affects about 10% of women in their childbearing years.
The diagnosis of the condition in adolescents requires evidence of hyperandrogenism (high levels of androgen hormones in females) and abnormal menstrual patterns. In adults, four different types of PCOS have been identified (I know, there are other classifications!):
- Classic PCOS: characterized by hyperandrogenism (high androgens), oligo-ovulation (irregular ovulation), and a polycystic ovary.
- Hyperandrogenic PCOS: characterized by hyperandrogenism and irregular ovulation.
- Ovulatory PCOS: characterized by hyperandrogenism and one or more polycystic ovaries.
- Non-hyperandrogenic PCOS: characterized by irregular ovulation and one or more polycystic ovaries.
Causes & Risk Factors
While the cause of PCOS remains unknown, several risk factors have been identified, including:
- The basic abnormality is with the hypothalamic-pituary axis with lutenizing hormone (LH) overproduction
- Excess ovarian production of androgens is the primary event
- Insulin resistance
- Heritable traits such as maternal PCOS
- Functional ovarian hyperandrogenism (FOH) as an adolescent
Signs, Symptoms, and Complications
- Hirsutism (male-pattern hair growth in women including growing extra facial hair or hair loss
- Treatment-resistance acne
- Menstrual irregularity
- Acanthosis nigricans (skin discoloration in body folds and creases)
- Increased endometrial cancer risk
- Pelvic pain
- Increased risk of insulin resistance, type 2 diabetes, cardiovascular disease and infertility
Diet & PCOS
Women with PCOS often struggle to maintain a healthy weight. Research shows that a low starch/low dairy diet may benefit overweight and obese women with PCOS, improving weight, insulin sensitivity, and testosterone levels.
- Substitute non-hydrogenated unsaturated fats for saturated and trans-fats
- Increase omega-3 fatty acids from fish, fish oil supplements, or plant sources
- Increase fruits, vegetables, nuts, and whole grains
- Decrease refined grain products
- Avoiding carbohydrates by themselves and instead combining them with proteins and fats
- Spacing out carbohydrates during the day which reduces the rise in blood glucose level that causes a sharp rise in insulin.
- Consuming carbohydrates with a low glycemic index (glycemic index is a measure of how fast the body converts carbohydrates into glucose; the lower the glycemic index, the slower the conversion to glucose and the slower the increase in insulin)
Lifestyle & PCOS
Healthy lifestyle or behavioral strategies like goal-setting, self-monitoring, and utilizing social support can help women with PCOS achieve weight loss. Research has demonstrated several benefits from losing 5% of body mass, including increased ovulation frequency, increased chances of pregnancy, and improved hormonal balance.
The International Guideline for the Assessment and Management of PCOS provides recommendations for weight management:
- Adolescents: at least 60 minutes of moderate to vigorous physical activity per day, including muscle strengthening 3 days per week
- Adults 18-64: at least 150 minutes per week of moderate physical activity, or 75 minutes per week of vigorous activity, including muscle strengthening 2 days per week
PCOS & TCM
There are a number of TCM patterns associated with PCOS:
- Kidney Yang Deficiency: delayed periods, scanty periods, amenorhea, infertility, tinnitus, weak low back and knees, fatigue, cold extremities frequent urination, loose stool, low libido, excess body hair
- Phlegm Dampness: delayed periods, scanty periods, or amenorrhea, obesity, excess vaginal discharge, nausea, oppression in the chest, fatigue, sleepiness
- Liver Qi Stagnation Leading to Fire: irregular menstruation, scanty periods, or amenorrhea, infertility, excess body hair, acne on the face, PMS, breast tenderness, thirsty, constipation
- Qi and Blood Stagnation: delayed periods, scanty periods, blood clots, or amenorrhea, infertility, distention in the abdomen and breast, depression, or angry easily, irritability
- Mixed Patterns (combinations of the above and most likely the case)
At the present, the common western treatments are birth control pills, progesterone preparations, anti-androgen agents, insulin sensitizing agents and ovulation induction treatment. Western medicine treatments have side effects and the condition is easy to relapse after stopping the treatment. With gradually in-depth study in the traditional Chinese medicine for this disease, In recent years, a large number of clinical studies have shown Chinese medicine can improve local microcirculation, improve the ovarian endocrine function, improve the response of ovarian HCG, increased mucus secretion in cervix, benefit sperm absorption, and improve endometrial receptivity as well help embryo implantation and development.
Our treatments are always personalized with acupuncture, modified classical formulas and supplements, so we can't recommend one-size-fits all here! And need to remind readers that this newsletter in no way consists of medical advice! Always work with a board certified medical provider!
Special thanks to my friend and colleague Dr Suzuki for proof reading these newsletters!