Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) affects 6–10 per cent of reproductive-aged women and is the most common cause of anovulatory infertility (1).

What is PCOS

PCOS is a complex hormonal condition that involves two or all of the following:

• Oligo-anovulation (irregular, infrequent or absent ovulation)
• Hyperandrogenism (excessive secretion and activity of androgen hormones)
• Polycystic ovaries (multiple partially formed follicles on the ovaries)

This means there is excess secretion and activity of the androgen hormone which causes abnormalities in ovarian function (1). Failure of the ovaries to regularly ovulate causes disruption to a host of hormones including lowered progesterone and oestradiol as well as elevated testosterone (2). These abnormal hormone levels, among others, cause a number of the symptoms associated with PCOS (2).

PCOS is also associated with various metabolic syndromes such as obesity, abnormal insulin activity, type 2 diabetes mellitus and cardiovascular disease (3, 4). Alongside these associated conditions is the prevalence of psychological issues including mood disorders and eating disorders (3). Another huge contributing factor for PCOS patients is high stress and cortisol production.

Symptoms

• Menstrual abnormalities (irregular, infrequent, heavy or absent menstruation)
• Acne
• Hirsutism (excess body and facial hair)
• Acanthosis nigricans (dark colouring on the back of the neck and underarms)
• Alopecia (hair loss on the scalp)
• Polycystic appearing ovaries (numerous cysts on the ovaries and enlarged ovaries)
• Obesity, particularly central adiposity
• Infertility
• Abnormal hormone levels

Key nutrients that can help with PCOS

Nutritional supplementation can aid many aspects of this syndrome including stabilisation of female hormones, reducing the formation of ovarian cysts, regulating the timing of ovulation, supporting and preventing associated metabolic syndrome, improving and managing weight balance, stabilising blood sugar levels, reducing insulin resistance and supporting adrenal function (4). Below are just a few of the many nutrients that can assist with the management of PCOS. Please be aware that correct dosages and time frames are essential when treating PCOS. Discussing your health with a qualified naturopath is vital to achieving improvements.

B vitamins

Due to their important role as cofactors in metabolising carbohydrates and fats, B vitamins may be beneficial to improving insulin sensitivity in women with metabolic syndrome associated with PCOS. They may also be helpful in decreasing risk factors of cardiovascular disease for women with PCOS who take some forms of diabetic medication (4).

Omega-3 fatty acids

Omega-3 fatty acids are beneficial in a number of ways for women with PCOS. Not only do they have anti-inflammatory properties, important in reducing cardiovascular disease risk, they also improve insulin sensitivity and have been shown to have a positive effect on liver fat content and other cardiovascular risk factors in women with PCOS (4).

Zinc

A randomised, double-blind, placebo-controlled trial evaluating the effects of zinc supplementation on a number of endocrine outcomes in women with PCOS over an eight week time period, showed a number of significant results. Zinc supplementation on this group of women demonstrated beneficial effects on symptoms associated with PCOS such as decreasing alopecia, hirsutism and plasma Malondialdehyde—a biomarker of oxidative stress (5). Alongside these benefits, zinc also plays a key role in modulating insulin and may also help with acne associated with PCOS (4).

Iodine

Adequate iodine concentration in the ovaries promotes healthy ovulation, reduces ovulation pain and prevents ovarian cysts (6). Iodine affects the reproductive hormones oestrogen and progesterone through promoting oestrogen detoxification and desensitising oestrogen receptor cells, as well as elevating progesterone through ovulation (6).

Inositol

Inositol has had beneficial results for women with PCOS in increasing fertility rates and improving embryo quality (7, 8). These benefits were demonstrated in two studies: a randomised control trial with PCOS patients who underwent IVF-ET and were treated with a combination of different forms of inositol (7), and a randomised placebo control group study with PCOS patients undergoing IVF treatments and using a combination of inositol and folic acid (8). Both studies resulted in improved oocyte and embryo quality as well as improved rates of fertilisation (7, 8). Alongside this, a further study on the presence of ovulation in women with PCOS with inositol supplementation in comparison to a placebo group demonstrated successful ovulation in 19 out of 22 women as compared with 6 out of 22 women in the placebo group (9).

Key herbal medicine that can help with PCOS

There are a range of herbal medicines that can be used to help women who have PCOS. Two of the main herbs which are commonly used in combination are Glycyrrhiza glabra and Paeonia lactiflora. Trials have demonstrated that these herbs in combination can reduce follicle stimulating hormone and luteinizing hormone (FSH:LH) ratio and ovarian testosterone production, and improve ovulation. Glycyrrhiza glabra can also play a significant role in PCOS patients who are highly stressed with elevated cortisol production. This is due to the cortisol lowering actions this herb also exerts. Naturopaths will also assess the individual and create herbal mixtures with additional herbs based on their symptoms and contributing factors.

How diet can assist with the management of PCOS

As women with PCOS are at a higher risk of metabolic syndrome and cardiovascular disease, diet has a massive impact on prevention of these associated conditions (4). There are a number of dietary changes that aid in the management of PCOS. These are targeted around improving weight balance, healthy weight management, reducing insulin resistance, stabilising blood sugar levels and supporting and preventing metabolic syndrome associated with PCOS (4).

If you would like to discuss how we can help in the management of PCOS or if you would like to know more about the condition, click here to make an appointment with Karly.

References

(1) http://www.nejm.org.ez.library.latrobe.edu.au/doi/pdf/10.1056/NEJMcp1514916

(2) Briden, L ‘Treatment for 4 types of PCOS’

(3) http://www.nejm.org/doi/full/10.1056/NEJMcp1514916

(4) Hechtman, L Clinical Naturopathic medicine

(5) http://link.springer.com/chapter/10.1007/978-3-540-69375-8_76#page-1

(6) Briden, L ‘Why I prescribe iodine for breast pain, ovarian cysts and PMS’

(7) http://link.springer.com/article/10.1007/s00404-013-2855-3

(8) https://www.hindawi.com/journals/ije/2016/4378507/abs/

(9) http://www.europeanreview.org/wp/wp-content/uploads/1896-1903.pdf