PCOS polycystic ovarian syndrome cysts on the ovaries
Polycystic Ovarian Syndrome

PCOS (Polycystic Ovarian Syndrome)

Polycystic Ovarian Syndrome, or PCOS, is a condition where ovulation is either irregular or absent.  There are a number of reasons why this can occur, the most common, but not the only reason, is androgen (male hormone) excess.  This type of PCOS, or what I would call “classic PCOS”, occurs in about 60% of all women with PCOS.  The remaining 40% (non-classic PCOS) will have a variety of hormone imbalances that are influencing ovulation.

What Causes PCOS?

It depends on which type of PCOS you mean.  In “classic PCOS” where androgens are high, insulin is often triggering excessive androgen production from the ovaries or adrenal glands.  In “non-classic” PCOS, there can be undiagnosed hypothyroidism or Hashimoto’s, high or low estrogen or high prolactin or high stress or low body fat. Thorough blood testing is essential to understand which factors are contributing to lack of ovulation.

Signs and symptoms of PCOS

In Classic PCOS – some, many or all of these may be present:

  • high DHEAs, testosterone, DHT and/or androstenedione
  • acne
  • head hair loss
  • excessive facial or body hair (hirsutism)
  • irregular or absent periods
  • heavy, painful periods
  • anxiety, depression, irritability
  • insulin resistance
  • weight gain or difficulty losing weight (although some women with insulin resistance are thin)
  • dysglycemia
  • cysts on the ovaries on ultrasound (these do NOT have to be present to have PCOS)
  • often a family history of cardiovascular disease and/or diabetes
  • infertility

Because there is a variety of factors that can cause non-Classic PCOS, the symptoms are more variable:

  • irregular or absent periods
  • cysts on the ovaries on ultrasound (may or may not be present)
  • acne
  • anxiety, depression, irritability
  • there may be an absence of androgen induced symptoms such as head hair loss, excessive body hair and acne
  • may be of any weight/size
  • infertility

What is the conventional treatment for PCOS?

For women who are not trying to conceive, doctors will prescribe birth control pills to provide an artificial menstrual cycle and manage some of the symptoms. Spironolactone may also be prescribed as an anti-androgen.  Metformin may be prescribed for women who are trying to conceive and may help those women who are the classic PCOS-type because it helps lower insulin levels.  Clomid is one of the first line medications for women with PCOS who are trying to conceive and if that fails, then injectables and IVF may be recommended, but in my experience, shouldn’t be necessary.

What is the naturopathic treatment for PCOS?

Naturopathic treatment for PCOS is tailored to the individual and to the type of PCOS.

Classic PCOS Treatment

  1. Reduce insulin requirements to reduce high androgens – diet, stress reduction and exercise are all important aspects of this.
  2. Improve insulin sensitivity – cinnamon, zinc, inositol, exercise and n-acetyl cysteine can all improve insulin response.
  3. Help with weight loss – losing even 10% of your body weight can help improve fertility and reduce PCOS symptoms. Regulating blood sugar levels and reducing insulin, in turn, helps with weight loss and burning body fat.
  4. Block the male hormones with anti-androgen herbs – herbs like spearmint, saw palmetto, pygeum, nettle root, and green tea have anti-androgen properties.
  5. Help stabilize blood sugar – minerals like chromium and vanadium, and herbs like banaba leaf, holy basil, and fenugreek can help create a more stable blood sugar, which helps curb carb and sugar cravings.
  6. Help balance female hormones – support normal estrogen production with vitamins, minerals and herbs like peony, support normal progesterone production with herbs like vitex.
  7. Enhance fertility through lowering androgens and balancing estrogen and progesterone.
  8. Optional acupuncture to enhance fertility.

Non-Classic PCOS Treatment

  1. Treat the underlying hormone imbalance – support normal  estrogen levels, lower high prolactin
  2. Help with stress reduction
  3. Help with adopting an appropriate diet to maintain a healthy body weight.
  4. Support the normal functioning of the entire endocrine system – ovaries, adrenal glands, parathyroid, thyroid, hypothalamus, pituitary, pineal, pancreas, thymus gland.
  5. Optional acupuncture to normalize the function of the endocrine system and enhance fertility.

PCOS Research

BMI and Fertility

A study looking at the connection between body mass index (BMI) and fertility found that a higher than normal BMI was an independent negative factor for many aspects of fertility. These negative effects were more profound in those with severe obesity and with PCOS.   Source: The effect of female body mass index on in vitro fertilization cycle outcomes: a multi-centre analysis. 2018.  Journal of Assisted Reproduction and Genetics, 1-11.

Acupuncture, TCM and PCOS

In a randomized controlled study, 60 patients were assigned to a control or observational group where they were given acupuncture combined with Chinese medicine for 3 cycles. Acupuncture combined with Chinese medicine was found to improve the endocrine levels and insulin resistance of PCOS as well as increased pregnancy rates.  Source: [Acupuncture and Chinese medicine of artificial cycle therapy for insulin resistance of polycystic ovary syndrome with phlegm damp type and its mechanism]. Zhongguo Zhen Jiu. 2017 Nov 12;37(11):1163.