What is PCOS
Polycystic ovarian syndrome, or PCOS, is a common hormonal condition affecting women in their reproductive years. . Women with PCOS can find it difficult to be pregnant and have a higher risk in developing complications during pregnancy. However, by managing and treating the symptoms, even with natural alternatives that I am going to share later on, many women with PCOS can actually become pregnant and have a healthy baby if they are diligent in changing their lifestyle and diet habits.
PCOS and polycystic ovaries
During each menstrual cycle, follicles grow on the ovaries. Eggs then develop within those follicles, one of which will reach maturity sooner than the others and be released into the fallopian tubes, ready to meet incoming sperm. This is known as "ovulation." The remaining follicles will then dissolve back into the ovary.
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) control ovulation. FSH stimulates ovary to produce a follicle and then LH triggers the ovary to release a matured egg to be fertilized.
In the case of polycystic ovaries, however, the ovaries grow larger than normal, and there are a series of undeveloped follicles that appear in clumps, something like a bunch of grapes. Polycystic ovaries are not necessarily troublesome and may not even affect your fertility; yes they can go unnoticed throughout your life.
However, when the cysts cause a hormonal imbalance, a series of symptoms may develop, known as a syndrome. These symptoms are the difference between PCOS patients and those simply having polycystic ovaries. So you can have polycystic ovaries without having PCOS. However, all women with PCOS will have polycystic ovaries.
In PCOS, many small, fluid-filled sacs grow inside the ovaries, containing an immature egg. They never mature enough to induce ovulation, which then alters estrogen, progesterone, FSH and LH levels. Estrogen and progesterone levels will be lower than optimum, while testosterone levels are higher than usual. This disrupt the menstrual cycles in women with PCOS, therefore they get fewer periods than usual.
What are the symptoms of PCOS?
Each woman with PCOS have a combination of the following symptoms:
Multiple ovarian cysts.
Polycystic ovaries 2-5 times larger than healthy ovaries.
Infertility.
Irregular or no periods
Acne.
Obesity
Excessive body or facial hair (hirsutism).
Insulin resistance and possibly diabetes.
Hyperpigmented skin folds (acanthosis nigrans).
How prevalent is PCOS?
PCOS affects as many as 10% of reproductive-age women when using the NIH criteria for diagnosis, and up to 18% of reproductive-age women are diagnosed with PCOS as per the Rotterdam criteria [1]. (basically they are just two different-yet-somehow-similar diagnosis criteria) Nevertheless, at least 70% of PCOS cases remain undiagnosed in primary care [2].
What are the risks being pregnant with PCOS?
Women with PCOS have an increased risk of insulin resistance (IR) [3], type 2 diabetes mellitus [4], obesity [3], and most importantly, miscarriage, occuring in 30 to 50% of PCOS women compared with 10 to 15% of normal women. [5]
What are the treatment options for PCOS: The Medical Method
Clomiphene
Otherwise known as Clomid, they help to induce ovulation in women who don't ovulate. However, about 20% of these pregnancies will result in spontaneous abortions[6]. Other adverse effects may include ovarian enlargement; ovarian hyperstimulation syndrome (OHSS); multiple pregnancies; hot flashes; and gastrointestinal (GI) distention, bloating, and discomfort.
Metformin
One study found that taking metformin with changes to diet and exercise improves weight loss, reduces blood sugar, and restores a normal menstrual cycle better than amendants to diet and exercise alone.[6]
Oral Contraceptives
Women with PCOS who do not wish to become pregnant may consider oral contraceptives (OCs). OCs helps to regulate menstrual periods, reduce androgen levels which in turn helps with acne and hirsutism.
What are the treatment options for PCOS: The Natural Method
1. Exercising
Losing just 5 to 10 percent of your body weight can help to normalize your menstrual cycle and improve symptoms associated with PCOS. [7] They can also help reduce cholesterol and insulin levels and heart disease risk.
Weight loss helps to reduce androgen, luteinizing hormone (LH), and insulin levels. This in turn regulates ovulation, improving pregnancy rates. [8]
2. Diet
A low glycemic index (low-GI) diet consisting of carbohydrates from fruits, vegetables, and whole grains can help regulate the menstrual cycle better than a regular weight loss diet [9].
Coupled with exercise, PCOS symptoms can improve overtime.
3. Acupuncture
Acupuncture has also shown promise in treating PCOS symptoms. [10] They can potentially improve insulin sensitivity and decrease testosterone levels in PCOS patients. [11] Acupuncture may also increase the clinical pregnancy rate and decrease the risk of ovarian hyperstimulation in women with PCOS undergoing IVF or ICSI. However, further studies are needed to determine the effectiveness and safety of acupuncture as an alternative to assisted reproductive technology.[12]
The Bottom Line
PCOS causes problems in a woman's menstrual cycles and makes it more difficult to be pregnant.
Lifestyle interventions should always be the first line of treatment for a PCOS patients, not oral contraceptives. They only make sure your period comes on time, without solving the cause of your problem.
I have complied a list of supplements with evidence-based reviews over at my 'Top 4 supplements you need for PCOS'.
Acupuncture is definitely an option if you happen to stay near one acupuncture clinic.
Alternatively, you will want to order a 60min consultation with me personally where I can personally walk you through your reports, diet and lifestyle to ensure you are back on track for your fertility journey.
[1] W. A. March, V. M. Moore, K. J. Willson, D. I. W. Phillips, R. J. Norman, and M. J. Davies, “The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria,” Human Reproduction, vol. 25, no. 2, pp. 544–551, 2010.
[2] J. A. Tomlinson, J. H. Pinkney, P. Evans, A. Millward, and E. Stenhouse, “Screening for diabetes and cardiometabolic disease in women with polycystic ovary syndrome,” British Journal of Diabetes and Vascular Disease, vol. 13, no. 3, pp. 115–123, 2013
[3] E. Diamanti-Kandarakis and A. Dunaif, “Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications,” Endocrine Reviews, vol. 33, no. 6, pp. 981–1030, 2012.
[4] L. J. Moran, M. L. Misso, R. A. Wild, and R. J. Norman, “Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis,” Human Reproduction Update, vol. 16, no. 4, pp. 347–363, 2010.
[5] Jakubowicz DJ, Iuorno MJ, Jakubowicz S, Roberts KA, Nestler JE. Effects of metformin on early pregnancy loss in the polycystic ovary syndrome. J Clin Endocrinol Metab. 2002;87:524–9
[6] Negar Naderpoor, Soulmaz Shorakae, Barbora de Courten, Marie L. Misso, Lisa J Moran, Helena J. Teede, Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis, Human Reproduction Update, Volume 21, Issue 5, September/October 2015, Pages 560–574,
[8] Guzick DS. Polycystic ovary syndrome. Obstet Gynecol. 2004;103(1):181–193.
[9] Lisa J. Moran, Henry Ko, Marie Misso, Kate Marsh, Manny Noakes, Mac Talbot, Meredith Frearson, Mala Thondan, Nigel Stepto, Helena J. Teede, Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines, Human Reproduction Update, Volume 19, Issue 5, September/October 2013, Page 432
[10] Jo, J., Lee, Y. J., & Lee, H. (). Acupuncture for polycystic ovarian syndrome: A systematic review and meta-analysis. Medicine, 96(23), e7066. doi:10.1097/MD.0000000000007066
[11] Johansson J, Redman L, Veldhuis PP, et al. Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab 2013;304:E934–43.
[12] Jo J, Lee YJ.Effectiveness of acupuncture in women with polycystic ovarian syndrome undergoing in vitro fertilisation or intracytoplasmic sperm injection: a systematic review and meta-analysis. P T. 2013 Jun; 38(6): 336-338, 348, 355.