About Women's Health

Polycystic Ovarian Syndrome
by Bethany Stricker, Charis Midwifery Student
 

Bethany Stricker lives in Northern Virginia.  Working on her goal of becoming a midwife has been rewarding!  She's excelling in her Charis midwifery course studies and is blessing her community as a doula.  Bethany also has the pleasure of assisting a CPM in solo practice at home and birth center births.  In her spare time, she enjoys friends, family, being mentored, sewing, gardening, real food cooking, knitting, building her library and permaculture.   She wrote this feature specifically for the Charis newsletter.  If this sobering and educational topic interests you, enjoy her full research paper which goes into more extensive detail of what is outlined here.

Current routine protocol for the treatment of Polycystic Ovarian Syndrome in women of childbearing age does not cure the syndrome but simply treats and covers up symptoms.  Lifestyle changes and alternative medicine offers cheaper, gentler and more effective options for women with polycystic ovarian syndrome who desire the eradication of disease and optimal fertility.

Polycystic ovarian Syndrome (PCOS) is a common syndrome with potential causes that are not very well understood.  We know the risks and long term health consequences that are associated with PCOS, although the idea of preventing those consequences, restoring health and fertility in the short term and dissipating symptoms of the disease entirely is not touted to be an option in a large part of the medical world.  Ongoing study and research will reveal what PCOS is on the chemical level in the body, potential causes of PCOS, risks of having PCOS in the long term, how it is diagnosed and how it is treated using allopathic medicine and alternative medicine.

PCOS is defined as sex hormone imbalance and hyperandrogenism, the presence of enlarged ovaries from ovarian cysts, and obesity from insulin resistance. These pathologies in the body lead to infrequent or irregular menstrual cycles, anovulation, infertility, miscarriage, hirsutism, acne or dandruff, cravings, weight gain, male-pattern baldness or thinning hair, pelvic pain, anxiety, depression and fatigue. (“Polycystic topic Overview”) (“Publications”) (Pick) PCOS is the most common reproductive disorder in women of reproductive age as it affects between 1 in 10 and 1 in 20 women or statistically five million women in the United States. (“Publications”) (Hywood and Romm, 176)

Pathologically, 80% of women with PCOS have hyperinsulinemia where they overproduce insulin. This leads to insulin resistance over time, which in turn stimulates the production of androgens, like testosterone, in the ovaries. It is not known why the ovaries produce more androgens when more insulin is present, but it is known that the ovaries function better when the presence of insulin is reduced.

Excess androgens disrupt the cyclical hormone balance in women resulting in male pattern hair growth, like hirsutism and hair loss. In addition, excess androgens are converted to estrogen, but excess estrogen suppresses the surge of follicle-stimulating hormone (FSH) that the body needs to ovulate.

When ovulation does not occur, called anovulation, unreleased ova are present in the ovaries which then form small cysts. Without ovulation, luteinizing hormone (LH) remains high and produces even more androgens. Normally, LH peaks with ovulation and then falls for progesterone to rise and maintain a pregnancy, or when the ovum is not fertilized, progesterone then falls again to trigger menstruation. LH does not fall at its cyclical time for women with PCOS, resulting in low progesterone levels and consequently, irregular or absent menstruation. If the ovum is fertilized and if low progesterone levels continue, miscarriage results.

Potential causes for this hormone imbalance resulting in PCOS and the associated symptoms are multiple. Scientific research and ongoing studies have found PCOS to be linked to genetic predisposition, insulin resistance and obesity, and environmental factors like diet and pollution. It is common for medical authorities to say that “the cause for PCOS is unknown” yet, at this time we have many theories. What should be said is that the exact cause for all cases of PCOS is unknown. Because PCOS is a syndrome, not a disease, it is possible and logical that causative factors are different in every woman just as PCOS symptoms and their severity are different in every woman but still resulting in PCOS in some form.

PCOS is associated with a three-fold higher risk of subsequent incident diabetes and dyslipidemia, independent of BMI, age and race, (Legro, et al) (Ehrmann, et al) compared to women without PCOS. Since women with PCOS often develop diabetes, hypertension, dyslipidemia and hypertension, they are automatically at an increased risk for cardiovascular disease also. (Christian, et al) Studies show that women with PCOS have an increased risk of cardiovascular disease because of the presence of oligomenorrhea and/or hirsutism, but especially in the presence of both, also. (Taponen, et al) Young PCOS women have an increased diastolic dysfunction and left ventrical mass (LVM) which are not dependent on weight, making PCOS women early candidates for cardiovascular disease. (Orio, et al)

Because of the obesity, hyperinsulinemia and dyslipidemia associated with PCOS, women with PCOS also have a higher risk of hypertension. (Elting, et al) (Velasquez)

Women with PCOS have a much higher rate of infertility from oligo/anovulation and amenorrhea.  When conception does occur, they also have a much higher rate of miscarriage.  There are several factors that can contribute to miscarriage in women with PCOS including abnormal luteinizing hormone (LH) levels, luteal phase defects, insulin resistance, cystic ovaries and endometrial dysfunction.

For PCOS women who conceive and carry a baby to term, there are several factors that may make exclusive breastfeeding a challenge.  The doctors who discovered and gave PCOS its name noted breastfeeding issues with their PCOS patients.  Anecdotally, mothers report more breastfeeding trouble when they themselves have PCOS compared to their non-PCOS counterparts. (Marasco) In a casual survey of 39 mothers in PCOS support groups online, 67% reported sufficient milk supply while 33% reported an inadequate milk supply.  1 out of 5 mothers with sufficient milk supply reported problematic overproduction. (Childers)  There are several reasons inadequate milk supply may occur including hypoplasia of the mammary glands, low progesterone, abnormal prolactin and androgen levels, and insulin resistance. (Marasco)

Women with PCOS have a higher risk of endometrial cancer. (Gerber, et al) (Dahlgren, et al) (Kaaks, et al) Greater than 40% of the incidence of endometrial cancer was contributed to excess body weight and another large percentage to physical inactivity. (Kaaks, et al) Cigarette smoking reduced the risk of endometrial cancer because it had an anti-estrogenic effect on the unopposed estrogen associated with the endometrial cancer risk factors listed. (Dahlgren, et al)

Women with PCOS are at a higher risk of non-alcoholic fatty liver disease (NAFLD) because PCOS and NAFLD share causative factors such as insulin resistance-related disorders like Type 2 diabetes, weight gain, poor diet or associated illnesses like tuberculosis. (“PCOS and non-alcoholic”) (Schwimmer, et al)

Polycystic ovarian syndrome is diagnosed when patients report symptoms to a medical professional who then performs testing to confirm that PCOS is the present pathological condition.  Symptoms from PCOS include menstrual cycle irregularity, lack of ovulation, breakthrough ovulation pain, infertility, hirsutism, male pattern hair growth and hair loss, obesity or inability to lose weight, predominance toward abdominal adiposity, sleep apnea and fatigue, depression, acne, dandruff, oily skin, and skin tags. All of these symptoms show cause to hyperinsulinemia and hyperandrogenism.

Specifically, insulin resistance provokes depression, sleep apnea, fatigue tendency towards abdominal adiposity, and inability to lose weight. Hyperandrogenism is responsible for menstrual cycle irregularity, lack of ovulation, infertility, hirsutism, male pattern hair growth and loss, depression, acne, dandruff, oily skin and skin tags. Ovarian cysts from hyperandrogenism cause breakthrough ovulation pain. With insulin resistance encouraging the ovaries to produce more androgens, hyperandrogenism and hyperinsulinemia are a cycle that feed each other and the symptoms of PCOS. (Strowitzki, et al) (Evans, et al) (Vgontzas, et al) (Rasgon, et al) (Timonen, et al) (“Acne and PCOS”)

Testing for PCOS is important, because even if some of the above symptoms are present, other medical conditions like pituitary tumors, (A.D.A.M.) endometriosis, and adrenal thyroid problems may be present and be causing the same or similar symptoms. Obviously, menopause and pregnancy can disrupt menstruation also.  Ultrasound is used to test for ovarian cysts.  Blood tests check hormone levels and glucose levels.  Saliva testing can also check hormone levels. (American)

Common pharmaceuticals used to address the symptoms and etiology of PCOS including oral contraceptives and insulin sensitizers.  Clomid or a similar drug is prescribed to increase the rate of conception due to anovulatory cycles. When PCOS symptoms become worse or infertility becomes a larger issue, surgery like ovarian drilling, cyst aspiration, cystectomy, oophorectomy, intrauterine insemination and in vitro fertilization are allopathic medicine’s next options.

Oral contraceptives are prescribed to women with PCOS who are not trying to conceive because of the symptoms that PCOS women have.  One of the most common symptoms of PCOS, irregular menstruation, is managed through oral contraceptives.  Acne and hirsutism may be managed with the long term use of oral contraceptives also. (Galan)

Biologically, the normal menstrual cycle is maintained by a feedback system of LH and FSH in response to varying levels of progesterone and estrogen. With oral contraceptives, the action of the hypothalamus and anterior pituitary is suppressed when sex hormones progesterone and estrogen are in excess, leading to insufficient FSH and LH for follicle maturation and ovulation.  The hormone levels produced by oral contraceptives are similar to a state of early pregnancy, telling a woman’s body to not ovulate. (Bennett and Pope)  The estrogen in oral contraceptives also has an antifertility effect by altering the endometrium, making it less favorable for implantation. Progestins also create cervical mucus that is thick and virtually penetrable by sperm decreasing sperm penetration, transport and survival. These changes in the cervical fluid also renders sperm with an impaired ability to penetrate ovum. (Lowdermilk and Perry, 219) (Varney, et al, 513)

Progesterone-only pills are often called the mini pill and may or may not inhibit ovulation depending on the dose of progesterone.  These pills work primarily by thickening the cervical mucus and secondarily, by effecting the endometrium and impairing implantation. (Bennett and Pope) In all cases, when a woman is on contraceptive pills, it produces a pharmacologic rather than a physiologic state with menstruation being a pseudomenstruation produced by the withdrawal of the pharmacologic drugs.  This is better called withdrawal bleeding where the hormonal withdrawal causes the endometrium to break down and accounts for the shorter duration and scantier flow often noticed by women taking the combination oral contraceptive pills.  The combined estrogen-progestin pill produces stromal edema, predeciduation and some degree of glandular involution.  After a few cycles, the endometrium yields a thick, hypoplastic appearance. For this reason, women may experience cessation of menstrual flow. (Varney, et al. 513-514)

Since polycystic ovarian syndrome occurs in the body on a biochemical level because of excess androgens, estrogen, and insulin, taking oral contraceptives to regulate menstruation and potentially manage hirsutism and acne will not address the present biochemical excess.  Instead, it introduces more hormones in hopes of cycle regulation, when in fact it does not reach that goal for all women, does not solve the woman’s fertility problems and introduces more side effects and risk factors that are not present until oral contraceptives are introduced to manage, not cure, the biochemical etiology.  Prescribing oral contraceptives to young women as a way to manage symptoms with the thought of addressing fertility later on in life does not put the best interest of the woman or her fertility first.

Side effects common with oral contraceptives include headaches, migraines, mental depression (even to the point of suicide and/or suicidal tendencies), a decrease or loss of sexual drive, abdominal cramps, bloating, weight gain or loss, and water retention; nausea and vomiting (in about 10% of users); symptoms of PMS, vaginitis and vaginal infections, changes in vision (temporary or permanent blindness, and an intolerance to contact lenses); gall bladder disease and either temporary or permanent infertility, when discontinuing the Pill, in users with previous menstrual irregularities or who began the drug before full maturity.  For some women, the pill is contraindicated because of some symptoms, like migraines, as they may be pathology for another life-threatening complication. (Weckenbrock) Oral contraceptives have shown to affect the uptake and physiologic use of key vitamins and minerals in the body. (Tyrer) (Thorp) (Prasad, et al) (Sutterlin, et al)

Pharmaceutical drugs, like oral contraceptives, also increase the risk of gut dysbiosis and affect the gut flora in humans directly.  This is a direct cause of PCOS and for this reason alone, other treatment options for PCOS symptoms should be considered. (Campbell-McBride, Gut, 36) (“How the Pill”) The risk of blood clots and heart attacks with oral contraceptive use increases substantially.  Women with PCOS are already at risk for cardiovascular disease and taking oral contraceptives increases this risk. (Weckenbrock) (Thorogood and Vessey)  In addition, oral contraceptives increase the risk of breast cancer several fold depending on the age of the user and length of time it is used. (Singer, “Rethinking”) (Romieu, et al) (Brind) Interestingly, new research is showing that oral contraceptive use does not protect women against endometrial cancer either. (Diamanti-Kandarakis, et al) For PCOS women in particular, studies have also shown that insulin resistance induced by oral contraceptive use is substantial, a major problem as PCOS symptoms and infertility will become worse with oral contraceptive use because of this fact. (Diamanti-Kandarakis, et al)

Because the logic of using oral contraceptives as a treatment PCOS is flawed from the beginning and side effects are serious, and sometimes fatal, the routine protocol of oral contraceptive use for PCOS must be questioned and other options considered.

After oral contraceptives, insulin sensitizers are the most commonly prescribed pharmaceutical for PCOS women.  Prescription insulin sensitizers are aimed at the root cause of PCOS, elevated insulin levels and seek to effectively regulate and process insulin to combat PCOS symptoms.  Originally prescribed to people with type II diabetes, PCOS women are now treated with insulin sensitizers also.  These medications work for PCOS women who are insulin resistant by increasing the sensitivity of muscle cells to insulin.  Thus, insulin sensitizers reduces insulin resistance, reduces the level of insulin needed to control blood sugar levels, and reduces the production of testosterone from the ovaries because high levels of insulin tell the ovaries to produce more testosterone.  In this way, lower, i.e. normal, testosterone levels for PCOS women manages hirsutism, irregular periods, anovulation and infertility. (Canvin)   This is definitely a benefit for PCOS women and a good way to manage symptoms, if they so choose.

Benefits of insulin sensitizers include the possibility of reducing endometrial cancer because of the increased frequency of ovulation compared to the reduced risk of endometrial cancer with oral contraceptive use, (Diamanti-Kandarakis, et al) reduced risk of breastfeeding issues from hormonal imbalance (Danielsson), reduced risk of gestational diabetes in pregnancy for women who are insulin resistant (Richardson), reduced risk of miscarriage due to the etiology of miscarriage from PCOS (Boyles), and the reduced risk of developing diabetes, especially when partnered with diet and lifestyle changes. (Diamanti-Kandarakis, et al)

Side effects from Metformin include gastrointestinal distress like diarrhea, flatulence, abdominal discomfort and indigestion, although the extended release version does not usually have gastrointestinal side effects of the same proportion.  Some people report general malaise or a feeling of being unwell while on Metformin.  Other side effects include nerve damage, vitamin B12 deficiency, hypoglycemia, hyperglycemia, and lactic acidosis, a rare condition where there is too much lactic acid in the bloodstream causing feeling tired or weak, difficulty in breathing, dizziness or lightheadedness, irregular heartbeat or tachycardia, shortness of breath, frequent nausea, abdominal pain, an enlarged or tender liver, and feeling cold, blue or cold hands and feet. The fact that metformin has also caused liver damage in some individuals is a point of controversy and should be considered for all that are considering taking it.  Because PCOS women are more at risk for liver damage and disease, metformin may be adding more risk in this area. (“Metformin”) (“Metformin Warnings”) (“Metformin Side”)

When women with polycystic ovarian syndrome have trouble conceiving due to anovulatory cycles, ovulatory stimulants, most often Clomid, is prescribed.  See referenced papers for more information on this drug and why it is unsafe.

When pharmaceutical drugs do not help women reach their goals, surgical procedures are the next step and include cyst aspiration, oophorectomy, hysterectomy, artificial insemination and in vitro fertilization.  The risks of these procedures fill up pages.  Please see the other papers for more information on these areas.

Pharmaceutical drug use and surgical options fall short for PCOS women who wish to eradicate symptoms and achieve pregnancy as safely and effectively as possible.  Other natural options which have proven to be gentler, safer and more effective in healing PCOS include lifestyle changes like stress reduction, weight loss, exercise, diet changes and supplementation.  Natural curative options with scientific evidence of healing efficacy for PCOS women include botanical medicine, homeopathy, phototherapy, and acupuncture.

The ability for stress to affect the body in such a way that hormonal dysregulation, cortisol and blood sugar regulation and adrenal function are all affected, is well established.  One animal study showed that increased sympathetic nervous system activity from stress preceded the induction of polycystic ovaries and played a role in the maintenance of ovarian cysts. Stress management strategies are an important part of the holistic treatment of women with PCOS that is not often addressed with a medical model of care. (Romm, 178, 185)

Weight loss in obese women with PCOS should be a “first response”, curative goal in the protocol of these women.  It has been proven for decades that obesity is linked to hormonal imbalance in women, specifically abnormal ovulation, menstrual irregularities and excess hair growth. (Hartz, et al) In 2003, a study indicated that obesity is the factor determining the insulin sensitivity, hyperinsulinemia, and ovarian hyperandrogenism, in obese women with PCOS. (Dravecka, et al)  Because of these findings, weight loss is considered to be an effective step in treating PCOS.  A study on PCOS women who underwent gastric bypass surgery showed that weight loss made a significant improvement in the clinical manifestations of PCOS including hirsutism, menstrual irregularities and infertility. (Eid, et al)  Besides being a trigger for the current clinical manifestations of PCOS, obesity also has shown to be the trigger for long term consequences of PCOS including hyperinsulinemia, hypertension and cardiovascular disease with menstrual irregularities.  Studies have shown that obesity produces the pathology of PCOS where the age and size of the follicle cohort and ovarian cysts do not have the same pathological impact. (Sukalich and Guzik) (Elting, et al)

The key to meeting the goal of weight loss is successful long term weight reduction and then maintenance.  Dietary modification that is a lifestyle change, meaning long term and practical to continue, with exercise, is the safest way to lose weight.  Drastic weight loss from extreme dieting worsens PCOS symptoms and if it cannot be maintained, it often results in more extreme weight gain. (Norman, et al) (Richardson)

Exercise is an important part of healing from PCOS because of its effects on weight loss, which is vital to obese women with PCOS and because it lowers hypertension risk, (Mayo clinic, “High blood”) relieves stress, and plays an essential role in the treatment and prevention of insulin resistance (Borghouts and Keizer).  From the studies by Duncan et al, it is concluded that exercise even without weight loss is beneficial because it improves insulin sensitivity, independent of changes in cardiorespiratory fitness or body composition.  Brisk walking as many days of the week as possible for 30-60 minutes has shown to reduce the morbidity and mortality associated with cardiovascular disease and diabetes. (Ross, “Does Exercise”)

Since many of the potential causes of PCOS can be traced back to daily food consumption, it is only logical that the food PCOS women do and do not eat will impact their health, their ability to manage PCOS symptoms and their likelihood of curing the disease.  The foods that women eat must be one of the highest priorities, and developing a plan to consistently consume the healthiest, healing foods must be part of PCOS women’s protocols if improving fertility and wellness is the ultimate goal.

Determining the best diet for any woman with PCOS is personal to her, although several things apply to all women with PCOS.  Processed foods must be avoided, probiotic foods that build the gut flora must be added, and foods with cholesterol and saturated fat need to be part of the daily diet.

For women with Polycystic Ovarian Syndrome, not eating processed foods is their best medicine.  Insulin resistance is the first step in the cascade that becomes PCOS.  Not eating processed foods with sugar, artificial sweeteners, and processed flours is the only way to stop insulin resistance in its tracks.  Since metabolic syndrome is the leading cause of heart disease today, avoiding processed food is the key to halting symptoms and avoiding long term diseases. (Campbell-McBride, Put 49-53)

There are many names for sugar in processed foods including evaporated cane juice, corn syrup, corn sweeteners, high-fructose corn syrup, crystalline fructose, sucrose, malt, malt syrup, barley malt syrup, maltose, maltodextrin, dextrose, maple syrup, brown rice syrup, beet juice, muscovato, succanat, turbinado sugar, and invert sugar.  All of these are molecules of glucose, fructose, maltose, or dextrose monosaccharides and all are converted to glucose or glycerine when consumed. (Shanahan, 225)  Agave nectar is also a processed sweetener with ratios not found in nature because of the processing it goes through.  Studies have shown that it contains more concentrated fructose than high fructose corn syrup and causes an increase in visceral fat and insulin resistance associated with heart disease, just like high fructose corn syrup. (“Agave”)

It should also be added that studies have shown that fructose can only be metabolized by the liver, and large amounts from our present diet cause harm the same as seen in alcohol-induced liver disease.  Fructose also does not engage the receptors in the brain that produce leptin, the chemical that controls satiety, the way that glucose does.  This causes people to eat more even when they may be full.  That high-fructose corn syrup laced fizzy drink is going to make you eat the entire burger, instead of half, and have you go back for more, drink and fries.  PCOS women are already at risk for liver disease.  High fructose corn syrup must be avoided. (Lustig)

For women with PCOS, there are some concerns with consuming soy.  Toxicity, one of the potential causes of PCOS, is a little known side effect with soy.  Soy foods are high in fluoride content, because soybeans pull fluoride from the soil and fertilizers, like most plants.  Hydrogen fluoride gas, a pesticide, can also be taken in by the beans.  It has also been reported that soybean plants are wonderful at taking industrial fluorides in the air and converting them into toxic organic forms.  With any food item that is not organic, contamination from toxins is a concern for PCOS women.  Soy foods are high in toxins in general because of the food processing factories where tap water is used.  Tap water is used in soy milk, soy ice cream, and most parents reconstitute soy formula with tap water.  To make the issue even more pertinent, fluoride synergizes and potentiates the actions of other toxins including lead, mercury, aluminum, manganese and other neurotoxins. (Daniel, 259-264)  Aluminum toxicity is a concern with soy products because the more high-tech, industrial processes used, the more aluminum appears in the final soy product. (Daniel, 266)

Because soy is the leading plant phytoestrogen, soy in large amounts can have a big impact on the hormone system.  Phytoestrogens are similar enough structurally to act like hormones and bind with estrogen-receptor sites throughout the body. (Daniel, 295)  While there are more than 300 plants with estrogenic activity, including clover, only one commonly appears in our food supply--soy.  Fertility problems from phytoestrogen exposure has been reported in birds and cows, mice and cats, dogs and sheep, as well as humans.  In sheep, the phytoestrogens in clover caused endometrial damage and cervical mucus changes associated with the inability to conceive.  In cheetahs, the soy protein feed consumed in captivity disrupted the hormonal activity along the hypothalamic-pituitary-gonadal axis, and damaged the endometrium making implantation difficult, just like with sheep.  In studies on women of childbearing age, menstrual cycles lengthened, mid-cycle levels of luteinizing hormone reduced, follicle stimulating hormone reduced by 53% and the effects of the soy isoflavones or protein continued for three months after ceasing soy consumption. With PCOS, swollen ovaries is a condition similar to goiter when the thyroid swells leading to hypothyroidism and hormone imbalance. (Cowan)  Soy foods have been shown to be a large factor and precursor to goiter, hypothyroidism, and related hormone imbalance. (Daniel, 311-330)  It has been proven that soy consumption not in step with traditional soy preparation and consumption, can adversely affect fertility.  Childbearing women with PCOS should know the side effects of excessive phytoestrogens on their bodies and on their babies in utero. (Daniel, 357-377)  Processed foods rarely do not contain soy lecithin and other processed soy products.

Women with polycystic ovarian syndrome, and anyone really, should not consume processed vegetable oils because of their risk and tendency for obesity, heart disease, hormone imbalance and infertility and the effect that vegetable oils, trans fats, and high ratio of omega-6 have on these diseases.  Good olive oil and flaxseed oil can be used as salad dressings and otherwise cold in small amounts, but all other vegetable oils including safflower, sunflower, canola, soy, rice seed, cottonseed, grapeseed, and foods containing them, should be avoided for optimizing healing, balance and fertility.  These processed vegetable oils are so processed and denatured that they are no longer healthy to consume. (Alvheim, et al) (IACM) (“How Vegetable”)(Shanahan, 171-199)(Esmaillzadeh and Azadbakht) (Kresser) (Hutchins)

Probiotic foods are required for optimal wellness and include all fermented foods and drinks like yogurt, kefir, sauerkraut, and kombucha.  Daily consumption of probiotic foods will allow PCOS women to reap the benefits.

Nearly every diet recommended for women with PCOS highly recommends abstaining from all foods with saturated fat and cholesterol from the assumption that these foods lead to heart disease.  Since PCOS women are already at risk for heart disease, consuming these foods over a lifetime would compound the problem and increase risk.  Unfortunately, so-called experts leave out the fact that cholesterol and saturated fat are required for hormone synthesis and bodily function.  Without these foods, it is impossible for PCOS women to manage symptoms and heal disease.  Additionally, many studies have disproved the lipid hypothesis and shown that other factors cause heart disease, especially toxins and chemical laden processed foods, not naturally occurring saturated fat and cholesterol. (Schmid, 175-200) (Campbell-McBride, Put) (Shilhavy, 51-58) (Mullenix, et al) (Knopp and Retzlaff)(Siri-Tarino, et al)(Petursson, et al) (Colpo)

For hundreds of years, gardeners, farmers and scientists have been cross-breeding plants and animals within the same species to create one breed with the most desirable traits.  Genetically modified organisms (GMOs) were first introduced into the food supply in 1994 when foreign genetic proteins from other species were introduced into the DNA of plants and animals.  The goal was to produce food with higher nutrient content. Unfortunately, that goal has not been met, and GMOs are grown with more pesticides and herbicides compared to conventional crops.

The Institute for Responsible Technology concluded in 2009 that, “The only published human feeding study revealed what may be the most dangerous problem from GM foods.  The gene inserted into GM soy transfers into the DNA of bacteria living inside our intestines and continues to function.  This means that long after we stop eating GMOs, we may still have potentially harmful GM proteins produced continuously inside of us. Put more plainly, eating a corn chip produced from Bt corn might transform our intestinal bacteria into living pesticide factories, possibly for the rest of our lives.  When evidence of gene transfer is reported at medical conferences around the US, doctors often respond by citing the huge increase of gastrointestinal problems among their patients over the last decade.  GM foods might be colonizing the gut flora of North Americans.”

The Institute for Responsible Technology also reported that, “The experience of actual GM-fed experimental animals is scary.  When GM soy was fed to female rats, most of their babies died within three weeks—compared to a 10% death rate among the control group fed natural soy.  The GM-fed babies were also smaller, and later had problems getting pregnant.

When male rats were fed GM soy, their testicles actually changed color—from the normal pink to dark blue.  Mice fed GM soy had altered young sperm.  Even the embryos of GM fed parent mice had significant changes in their DNA.  Mice fed GM corn in an Austrian government study had fewer babies, which were also smaller than normal.

Reproductive problems also plague livestock.  Investigations in the state of Haryana, India revealed that most buffalo that ate GM cottonseed had complications such as premature deliveries, abortions, infertility, and prolapsed uteruses.  Many calves died.  In the US, about two dozen farmers reported thousands of pigs became sterile after consuming certain GM corn varieties.  Some had false pregnancies; others gave birth to bags of water. Cows and bulls also became infertile when fed the same corn.” (Smith)

For these reasons, studies show that PCOS women, and really, all childbearing women should avoid genetically modified foods.  Fortunately, soy products and corn products are already not recommended for PCOS and childbearing women because they are so processed and usually contain other harmful ingredients.  The best way to avoid GMO is to eat organic, avoid processed foods and know your farmer and food source.

Alcohol cannot be consumed by women with PCOS, nor can smoking be a habit because of the risk for hypertension and heart disease that goes with them. (Mayo clinic, “High blood”)  Toxic substances, including smoking, is a potential cause for PCOS.  Alcohol, basically fermented sugar, spikes insulin and glucose leading to the issue of insulin resistance, the pathology of PCOS.  It also affects gut flora and abnormal gut flora is a potential cause of PCOS.

Several studies have shown that large amounts of caffeine affect hormones and fertility whether from coffee or other substances like soda and chocolate.  In a study published in Fertility and Sterility in 2001, women who consumed more than 100 mg of caffeine or two cups of coffee per day had significantly higher estradiol levels during the follicular phase of their cycle, and women who consumed more than 500 mg of caffeine had 70% more estradiol in their blood. (Lucero, et al)  This, of course, affects ovulation since the follicular phase must produce an ovum under a hormonal imbalance.  A study from the Division of Research at Kaiser Permanente showed that high intakes of caffeine, 200 mg or more per day, during pregnancy increased the risk of miscarriage. (Weng, Odouli and Li)  A study from the Nevada School of Medicine showed that high caffeine intake compromises fallopian tube cilia and specialized pacemaker cell activity so that ovum do not move through the fallopian tubes as effectively.  The researchers are studying further to see if this could be linked with ectopic pregnancy. (McMillin)  By this evidence, it is highly recommended that PCOS women avoid smoking, alcohol and caffeine as much as possible.

In addition to using food as medicine and avoiding detrimental substances, Vitamin D is a beneficial supplement according to one study of thirteen women with PCOS.  When treated with Vitamin D supplementation, all of the women with irregular menstruation or dysfunctional bleeding had regular menstruation and no dysfunctional bleeding or became pregnant after 2 months. (“Vitamin D”)  This study was done in New York City in 1999, and it is interesting that calcium therapy was added to the Vitamin D supplementation (Thys-Jacobs, et al), as Vitamin D is required for proper calcium metabolism. (Masterjohn)  In a 2011 study from Austria, it was found that low levels of Vitamin D were linked to PCOS and the metabolic and endocrine disruptions associated with it. (Wehr, et al)
 
Vitamin D is necessary to make sex hormones and helps regulate cell growth and differentiation. (Planck, What 59)  It has been shown that Vitamin D plays a crucial role in blood sugar metabolism and is beneficial for preventing diabetes, metabolic syndrome, and insulin resistance.   Studies have shown that low levels of Vitamin D are linked to higher rates of insulin resistance, weaker pancreatic function and obesity. (“Vitamin D”) (“PCOS and”)  Cod liver oil is a good source of Vitamin D with Vitamin A for those who prefer to avoid synthetic Vitamin D.

Botanical medicine is a complementary modality which many people are using with more and more frequency.  Peony and licorice is a traditional Chinese combination known as Shakuyaku-Kanzo-To which has been traditionally, anecdotally and scientifically proven as an effective treatment for PCOS.  White peony, also called Paeonia lactiflora, is a hormonal regulator that has been shown to positively influence low progesterone, reduce elevated androgens including testosterone, and modulate estrogen and prolactin. The active constituent in Paenoia lactiflora seems to be paeoniflorin, a monoterpene glycoside which is thought to act directly on the ovary to reduce the production of androgens in a dose-dependant manner.  Paeoniflorin also increases the activity of aromatase enzymes which promotes the synthesis of estradiol from testosterone.  Aromatase is also necessary for follicle maturation, ovulation, corpus luteum function, steroid hormone synthesis, and the regulation of conversion of androgens to estrogens.  In addition, the feedback mechanisms of the pituitary and hypothalamus rely on aromatase to regulate prolactin and GnHR.  It is thought that Paeonia lactiflora improves progesterone levels by normalizing ovarian function when the activity of aromatase is inhibited. (Romm, 183) (Trickey, 357-358)

Licorice, also called Glycyrrhiza glabra, is an adaptogen with many beneficial properties, including its ability to reduce testosterone produced by the ovaries and a possible role in the treatment of hirsutism.  Together licorice and peony have the unique abilities to reduce testosterone levels and improve estradiol to testosterone ratios after four weeks of administration.  It has also been proposed that this formula acts on the ovary first by promoting the activity of aromatase enzyme leading to a greater synthesis of estradiol from testosterone, and improved pregnancy rates.  Peony and licorice combination stimulates pituitary dopamine receptors which might be responsible for the improving LH to FSH ratio and a significantly lower LH to FSH ratio. (Trickey, 358)

In a study consisting of eight women with hyperandrogenism and oligomenorrhea, the peony licorice combination was given for 2 to 8 weeks.  The result was regulation of LH to FSH ratios, lowered serum testosterone levels and seven of the eight women began to regularly ovulate.  In another study with twenty women diagnosed with PCOS, this combination resulted in lowering testosterone in 90% of the women and 25% conceived. (Yaginuma) (Romm, 183)  The trials with the peony and licorice combination did not show any side effects.

Another option for PCOS women who seek an alternative to pharmaceuticals and surgery is homeopathy.  A branch of alternative medicine based on the principles that you can treat ‘like with like’, homeopathy assumes that an individual can be treated with minute doses of natural materials which in large doses would be expected to create the same symptoms. (“What is”) (Chaplin)  Homeopathy also takes into account the emotional state of the patient and a complete case history in order to act at the level of the psycho-neuro-endocrinal axis.  Therefore, one woman with PCOS may take a completely different remedy from another in order to have the same results. (Joshi)  Today, these highly diluted substances are mainly given in tablet form, the method used for the past 200 years, but the principles of treating ‘like with like’ dates back to Hippocrates (460-377 BC). (“What is”) (Chaplin)

Homeopathic medicines, also called remedies, are formulated in specialist pharmacies using a deliberate and careful process of dilution and succussion, a form of vigorous shaking.  Science has not been able to explain how homeopathically prepared minute substances have biological effects on the body, but we do know that biological effects are clearly seen under experimental conditions. ( “What is”)  In essence, homeopathy is nanopharmacology at its best.  People have made the correlation that atomic bombs are never referred to as an extremely small bomb.  In actuality, there is very real power to atoms smashing together. (Ullman) Because of the dilution that the remedies go through, many raise the idea that homeopathics are just water and do not have any helpful affects, or any or few solute molecules, at such high dilutions.  Interestingly, in using nearly 2,000 references to scientific literature, Dr. Martin Chaplin has proven that “homeopathic water” and “regular water” are not the same. (Chaplin, “Memory”) (Chaplin, “That Spirit”)  Consequently, homeopaths credit the power of these remedies to the fact that water has memory, and the structure of water changes when diluted and agitated vigorously as in homeopathics.

Other theories for the biological effects of homeopathics have come from scientists in France and Belgium.  They discovered that vigorous shaking of the water in glass bottles caused small silica fragments or chips to fall into the water, raising the question of whether the silica helps to store the information in the water or if the initial natural substance interacts with the silica in some way to create the biological effects.  Chemists and physicists have discovered that there is increased release of heat from water in which homeopathic remedies have been prepared even when the repeated process of dilution suggests that there are no molecules remaining of the original medicinal substance. (Ullman)

In 2005, an overview of positive homeopathy research and surveys was compiled by the European Network of Homeopathic Researchers.  One study they included looked at the effects of homeopathy for PCOS.  36 women fitting the mental picture of homeopathic remedy Pulsatilla were given Pulsatilla 6C, every 4 hours during the day for the two weeks following the menstrual cycle.  This was continued for 4 cycles.  At the end of the trial, 30 of the 36 women had normal ovulating follicles and no symptoms of PCOS. (“An Overview”)  Testimonials of the effectiveness and curative nature of homeopathics for women with PCOS are easily found. (Deanwood) (Bienchen)

Unlike almost every other healing modality or allopathic option, homeopathics are non-toxic, have no side effects and either work or do not.  Taking homeopathics has zero risk and can only help or do nothing.

Another option is phototherapy. Night lighting, also called phototherapy or lunaception, is the use of artificial light when sleeping during particular times of the month to regulate ovulation and the menstrual cycle.  Often used for promoting fertility or natural family planning, night lighting is based on stories from the beginning of time and being promoted and understood today through modern research.  John Rock, OB/GYN, and E.M Dewan, a physicist, discovered that women’s cycles regulated when they started sleeping in complete darkness on Days 1 through 13 of their cycle, sleeping with a 100-watt bulb on all night (under a lampshade in their bedroom) on Days 14-17 and then returning to sleeping in complete darkness until their next menstrual cycle began.  Their study included 41 women and the women not exposed to the regimen of light and darkness had varied cycles from 25 to 38 days, whereas the women with the regimen of light reflecting that of the moon had 29 day cycles. (“The Science”)

The Couple to Couple League, which has taught Natural Family Planning since 1971, conducted a study to see if women with very long or very short cycles could develop a more normal cycle length with the concept of lunaception. 92% of the women in the study experienced reduction in cycle irregularity.  In 1976, Joy DeFelice, a Natural Family Planning teacher and registered nurse taught her students the concepts of lunaception and found that sleeping in darkness alone, and seldom in light, normalized their hormonal patterns.  Together, the Couple to Couple League and Joy DeFelice found their research showed that eliminating light helped women create healthy menstrual cycles in a variety of situations. (Singer, “Fertility”)(Singer, 161)

Women with anovulatory cycles became ovulatory.  Women with unclear mucus readings developed discernible, healthy mucus buildup.  Ovulation occurred in sync with fertile mucus buildup.  Cycles that had been short (twenty-six days or less) or very long (thirty-five days or more) became twenty-seven to thirty-one days long.  FSH levels became healthy.  Spotting at various times during the cycle was significantly reduced.  Progesterone levels were strengthened.  Women with a history of miscarriage(s) were able to sustain pregnancy.  During breast-feeding, an infertile mucus pattern was easily established.  During weaning or bottle-feeding, sleeping in darkness (and then introducing light during a slippery mucus patch) helped trigger a return to ovulatory cycles.  Premenopausal women developed a more discernible mucus pattern; and the intensity of their premenopausal symptoms, including hot flashes, sleeplessness and mood changes, was reduced. (Singer, 161)

The circadian rhythm of the moon is responsible for the phenomenon of lunaception because the pineal gland in the brain, responsible for regulating sleep, appetite and the onset of puberty, is regulated by melatonin.  In order to be produced, it must be night and it must be dark as bright light suppresses melatonin secretion. The hypothalamus gland, also in the brain, is richly supplied with melatonin receptors and responsible for the body’s overall homeostasis including blood pressure, emotions, temperature, and the endocrine system.  The hormones from the hypothalamus stimulate the anterior pituitary gland to secrete its hormones which then stimulate the thyroid, adrenals, and the ovaries.  Interestingly, the ovaries also have melatonin receptors.  Consequently, the absence or presence of melatonin and light or darkness while sleeping has a large impact on the menstrual cycle.  Without the melatonin produced from sleeping in darkness, the hypothalamus will not have what it needs to function for optimal fertility. (Singer, “Fertility”)(Singer, 158-163)

Rock and Dewan concluded that there is statistical evidence that phototherapy can regularize the menstrual cycle, influence the time of ovulation and reduce the length of menstrual cycles longer than 28 days.  The Sleep Center at the University of California had the same results along with another study from 2002. (“Clinical”)  A study from 2007 concluded that phototherapy or lunaception “is a promising method to overcome infertility.” (Danilenko and Samoilova)

To practice lunaception with all of its proven benefits, women must sleep in total darkness, meaning after fifteen minutes of the lights off, they still cannot see their hands in front of their face.  Bedroom windows may need to be covered with room-darkening blinds or curtains backed in light-blocking fabric.  Light from under the door can be blocked with a towel and all light from technological devices like computers, phones, and digital clocks, also needs to be covered up and blocked. (Singer, 158-163)

In addition, another option for PCOS women is acupuncture, a 3000 year old form of Chinese medicine where small, sterile, disposable needles are placed at specific points on the body, depending on the condition and bioelectromagnetic meridian points that are called for. (Dang)  By western explanation, acupuncture points have electrical sensitivity and stimulating these points by inserting acupuncture needles stimulates nerves that are connected to the hypothalamic-pituitary system.  Because the hypothalamic-pituitary glands are responsible for producing neurotransmitters and hormones, the body’s natural pain-killing hormones which play a large part in the endocrine system, and thus control the serotonin production from the brain, acupuncture not only has an overall calming effect but is very effective for depression, infertility, PMS, arthritis, back pain and more. Physiological effects that have been noted after acupuncture include increased circulation, decreased inflammation, pain and muscle spasm relief, and increased T-cell count which supports the immune system. (Joswick)

A 2010 randomized controlled trial of 84 women with PCOS published in the American Journal of Physiology- Endocrinology and Metabolism showed that electro-acupuncture lowered androgen levels, increased cycle regularity, and decreased acne.  Specifically, this study showed that exercise and electro-acupuncture together had the best effect compared to exercise alone or mentioning the importance of lifestyle to PCOS patients with no follow-up or supported goals. (Jedel, et al)

A meta-analysis of four studies was conducted by the South Western Sydney Clinical School of Australia in 2010 and showed that acupuncture is a safe and effective treatment for women with PCOS and did not have the side effects associated with pharmacologic treatment of PCOS.  After reviewing the studies, it is thought that acupuncture may have a role in treating PCOS by increasing blood flow to the ovaries, reducing ovarian volume and the number of ovarian cysts, controlling hyperglycemia through increasing insulin sensitivity and decreasing blood glucose and insulin levels, reducing cortisol levels and assisting in weight loss and anorexia. (Lim and Wong)

Acupuncture is considered to be extremely safe and any side effects are extremely rare.  Patients report a pin prick feeling when needles are inserted and sometimes feel a dull ache around the area where needles are inserted. (Joswick)  Acupuncture is an option for PCOS women with less risk and similar, if not better, success rates when compared to allopathic medicine, especially for infertility and the etiology of PCOS.

In conclusion, research has shown that prescriptions and surgery are not necessarily the best option for women with PCOS, especially if their goal is erasing symptoms and promoting fertility.  In fact, research and science show that lifestyle is the cause of the etiology of PCOS and the solution. Because of this, there is no reason PCOS and its symptoms should rule women’s lives.  Instead, PCOS should be a way for women to become stronger, healthier and more confident as they learn about the syndrome that they possess and the best way to heal their bodies. Logic says, and women know, that most women are more likely to choose the natural option before the allopathic option.  In this case, those choices are based on evidence-based research and time-honored traditions.  All women with PCOS should be presented with all of their options and have access to knowledge and research.  This will allow them to have children of their own, lead productive, optimally healthy lives and take responsibility for their own future health and the health of their families, in a naturally healthy way.  Women need to know that a diagnosis of Polycystic Ovarian Syndrome is just the beginning, and a lifetime of health and fertility is an option for them, if they so choose.

©Bethany Stricker

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