Polycystic ovary syndrome (PCOS) is a complex condition characterized by elevated androgen levels, menstrual irregularities, and/or small cysts on one or both ovaries.
According to the National Institutes of Health Office of Disease Prevention, PCOS affects approximately 5 million women of childbearing age in the U.S. Costs to the U.S. health care system for the identification and management of PCOS are approximately $4 billion per year.[1]
Research suggests that 5% to 10% of females 18 to 44 years of age are affected by PCOS, making it the most common endocrine abnormality among women of reproductive age in the U.S. [2]
What does it mean on hormonal levels
The pathophysiology of PCOS involves primary defects in the hypothalamic–pituitary axis, insulin secretion and action, and ovarian function. Although the cause of PCOS is unknown, PCOS has been linked to insulin resistance and obesity. The association with insulin function is expected; insulin helps to regulate ovarian function, and the ovaries respond to excess insulin by producing androgens, which can lead to anovulation. [3]
Clinical signs of PCOS include elevated luteinizing hormone (LH) and gonadotropin–releasing hormone (GnRH) levels, whereas follicular-stimulating hormone (FSH) levels are muted or unchanged. As a result of the increase in GnRH, stimulation of the ovarian thecal cells, in turn, produces more androgens. [4]
Clinical Symptoms
Usually PCOS patients present with enlarged ovaries with numerous small cysts, irregular menstrual cycles, pelvic pain, hirsutism, hair loss, acne, acanthosis nigricans(characterized by areas of dark, velvety discoloration in body folds and creases), skin tags.
Mainstream Treatment Approach
Treatment goals include correcting anovulation, inhibiting the action of androgens on target tissues, and reducing insulin resistance.
Drugs include Clomiphene, Metformin, Human menopausal gonadotropin (HMG), FSH and Letrozole
TCM Approach to PCOS
In a TCM research done, the sympathetic nerve function in the ovaries stemming from an alternation in the neuroendocrinological status could be regulated by therapy of repeated electroacupuncture to decrease endothelin-1 and nerve growth factor (NGF).[5] In another research, TCM combined with Western Medicine utilized in clinical practice showed encouraging outcome on the women with PCOS and anovulation, but with no obvious adverse reactions.[6] Lee, et al reported that two herbal formulae, Changbudodam Tang (Cangfu Daotan Decoction, 苍附导痰汤) and Yongdamsagan Tang (Longdan Xiegan Decoction, 龙胆泻肝汤), significantly downregulated the increased NGF staining in the ovaries without influencing the brain tissues significantly.[7]
Acupuncture and specifically low-frequency ElectroAcupuncture(EA) affect PCOS symptoms via modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine system and the neuroendocrine system.[8] In one study, 12 of 24 women with undefined ovulatory dysfunction treated with manual acupuncture (average, 30 treatments) had marked improvements in menstruation and biphasic basal body temperature for more than two cycles or became pregnant. [9]
These studies demonstrate that low-frequency EA affects endocrine, neuroendocrine and metabolic disturbances in PCOS without any negative side-effects. Indeed, EA can be a suitable alternative or complement to pharmacological induction of ovulation.
How The Green Clinic treats PCOS
Usually, patients don't know they have PCOS until they start trying to conceive(TTC). I always mention to my TTC patients, their sole objective is to CONCEIVE, not to restore FSH/LH/Testosterone/Glucose levels to optimum range. Blood serum levels fluctuate, i.e to say there will be months where you DO ovulate, the KEY is to know when you ovulate before trying. It is clinically impossible to ask patients to go for ultrasound scan every month to test for ovulation, therefore we recommend Body Basal Temperature(BBT) charting. Although it is not gold standard medically per se, it does help to map out your menstrual patterns.
After definite diagnosis, we will have to diagnose your body constitution. Not all PCOS patients are diagnosed with Kidney Deficiency or Dampness Body Constitution. Every individual is different, therefore every treatment approach is individualised.
After which, you will most likely need chinese herbal medication, acupuncture and a customised diet/exercise plan.
Contact us to make an appointment if you have been diagnosed with PCOS or have problems with ovulation.
References
[1] American Congress of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 108: Polycystic Ovary Syndrome. Obstet Gynecol. 2009;114(4):936–949.
[2] National Institutes of Health Department of Health and Human Services. Beyond Infertility: Polycystic Ovary Syndrome (PCOS) NIH Pub. No. 08-5863, April 2008.
[3] Diamanti-Kandarakis E, Kandarakis H, Legro RS. The role of genes and environment in the etiology of PCOS. Endocrine. 2006;30:19–26
[4] Urbanek M. The genetics of polycystic ovary syndrome. Natl Clin Pract Endocrinol Metab. 2007;3:103–111.
[5] Stener-Victorin E, Lundeberg T, Cajander S, Aloe L, Manni L, Waldenstrom U, et al. Steroid-induced polycystic ovaries in rats: effect of electro-acupuncture on concentrations of endothelin-1 and nerve growth factor (NGF), and expression of NGF mRNA in the ovaries, the adrenal glands, and the central nervous system. Reprod Biol Endocrinol 2003;1:33.
[6] Ansari RM. Potential use of durian fruit ( Durio zibenthinus Linn) as an adjunct to treat infertility in polycystic ovarian syndrome. J Integr Med 2016;14:22-28.
[7] Lee JC, Pak SC, Lee SH, Lim SC, Bai YH, Jin CS, et al. The effect of herbal medicine on nerve growth factor in estradiol valerate-induced polycystic ovaries in rats. Am J Chin Med 2003;31:885-895.
[8] Andersson S, Lundeberg T. Acupuncture–from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses 1995; 45: 271–281.
[9] Xiaoming MO, Ding LI, Yunxing PU, Guifang XI, Xiuzhen LE, Zhimin FU. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med 1993; 13: 115–119
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