The incidence of polycystic ovary syndrome is on the rise among women. Currently, the disorder affects between 6-10% of the population and disproportionally affects younger women who have just started menstruating. PCOS begins in the ovaries as a hormonal disorder where excessive androgen (male hormones) production interferes with normal egg development. Instead of releasing an egg during ovulation, the ovaries form fluid-filled cysts that can become enlarged and painful. As the condition progresses, women develop estrogen dominance that can have profound long-term health consequences. The development of PCOS is strongly correlated with obesity and insulin resistance, however, 50% of women who are diagnosed are normal weight or underweight with regular menstrual cycles and no visible signs of excess androgen exposure (hirsutism). If you are presenting with any of the following signs or symptoms I would advise that you inform your health care provider: dysmenorrhea/anovulation; fertility problems; excessive hair growth on the face; thinning hair; weight gain; blood glucose instability; adrenal dysfunction with high cortisol; elevated luteinizing hormone, testosterone, androgens, prolactin, and estrogens; and ovarian pain.
Historically, the etiology of PCOS was determined by excessive androgen production and genetics, since the disorder seems to run in families. Exposure to androgens during fetal development can prevent certain genes from functioning normally, which may lead to a male pattern of abdominal fat distribution. This can predispose a woman to an increased risk of insulin resistance and inflammation. Other research has shown a correlation between hyperinsulinemia and insulin resistance as key instigators in the onset of the condition. Elevated insulin causes the body to produce excess androgens (testosterone, androstenedione) which disrupt the production of luteinizing and follicle-stimulating hormones, both of which control the menstrual cycle and ovulation.
When diagnosing PCOS practitioners need to do an accurate differential diagnosis to eliminate other disorders that may share the same symptoms. Patients will generally exhibit at least two of the three symptoms: anovulation/irregular periods, hyperandrogenism, and ovarian cysts. Typical lab work would reveal elevated testosterone and other hormones, and blood sugar abnormalities.
Conventional medical treatment for PCOS has primarily relied on prescription medications. Oral contraceptives are often prescribed to treat the symptoms of irregular menstrual cycles and excessive hair growth (androgen exposure). This treatment is certainly not without risk since oral contraceptives can actually increase insulin activity over time, while at the same time depleting certain B vitamins and possibly increasing the risk of heart disease and breast cancer. The diabetic drug Metformin is commonly prescribed to help lower insulin levels which can have a positive effect on hormone levels and ovulation. In certain patients who have experienced infertility, the medication Clomid is used to induce ovulation. Caution should be used when considering this drug due to its uncomfortable side effects and cancer risk.
For many women suffering from PCOS, nutritional products combined with healthy diet and lifestyle choices can provide significant improvements. Based on research and clinical experience, the following dietary factors and nutritional supplements are being used by integrative physicians as part of treatment protocol:
Since elevated insulin and insulin resistance are almost always found in women with PCOS, adopting a sugar-free, carbohydrate-controlled diet is typically recommended. A diet with limited refined carbohydrates from sugars and grains can help normalize blood glucose levels and reduce the body’s resistance to insulin. Increasing intake of clean proteins, plant fibers, and healthy fats can have a significant effect on the glucose abnormalities seen in PCOS, as well as, help achieve a healthy body fat percentage. A lifestyle technique to combat PCOS that has attracted the attention of many clinicians is the practice of intermittent fasting. Popularized by the respected nephrologist, Jason Fung, MD, his patients who have switched to a carbohydrate-controlled diet with weekly intermittent fasting (16-36 hours) have seen incredible results. Healthy stress control measures and exercise should also be part of a successful treatment program. Uncontrolled stress can increase androgen levels by way of elevated cortisol activity. Exercise in the form of anaerobic/aerobic training has been shown to lower cortisol and have a normalizing effect on stress levels.
Blood glucose imbalances
A key treatment focus when using nutritional supplements is to address insulin resistance that’s commonly diagnosed in women with PCOS. Clinicians are using chromium, gymnema sylvestre, fenugreek, bitter melon, and alpha lipoic acid. These nutritional products have the potential to improve glucose tolerance and circulating insulin levels. Also, the consumption of healthy fats in the form of flaxseed oil and fish oil can improve insulin resistance by keeping cell membranes functioning properly, reducing inflammation, and protecting insulin receptor sites.
Protecting the body from excessive estrogen production and activity should be a primary concern among clinicians treating PCOS. In women who have low progesterone that resulted from an estrogen dominant condition, bioidentical progesterone can be helpful in regulating the menstrual cycle. Supplement combinations that support hepatic and adrenal functions, including the B vitamin family, can be used to reduce excess androgens and assist in the metabolism of harmful estrogens. Botanicals like saw palmetto and vitex (chaste tree berry) may help normalize testosterone and luteinizing hormone respectively.
If you have PCOS or suffer from symptoms of estrogen dominance, it’s advisable to have a medical evaluation. You can talk with your doctor about the best treatment options available.
Michael Chase, MS, NTP
Nutrition Science and Dietetics
Schauch, Marita. Making Sense of Women’s Health. Ontario: ActNatural, 2012. Print.