Options for Treating Polycystic Ovarian Syndrome (PCOS)
Supporting reproductive health is all about prevention and education, screening, diagnosis, and appropriate management. But what about those pesky aliments that seem to evade parts of the system? Like, for example, Polycystic Ovarian Syndrome or PCOS.
PCOS is one of the most common endocrine disorders occurring in up to 10% of people with ovaries, yet it’s diagnosis still remains elusive, troublesome, and controversial. For many years scientific studies have focused on the diagnostic criteria for PCOS, but to date the argument still remains.
What are the obstacles to a clear and defined diagnosis?
As the name suggests, PCOS is a syndrome, not a disease. This may seem trivial, however when broken down a syndrome is essentially a mere collection of signs and symptoms, or characteristics, which are variously associated with said syndrome. On the other hand, most diseases exhibit a constant element on which a diagnosis could be based – typically referred to as a ‘gold standard’. Diagnosis is also difficult for those afflicted with PCOS as it is considered what is known as a ‘diagnosis of exclusion’; basically meaning that before a PCOS diagnosis is confirmed, all other viable diagnostic options have been ruled out
What are the ‘characteristics’ of PCOS?
Typically those that may have PCOS present to their health care provider with:
Mild obesity
Hirsutism (excessive body hair where hair is normally absent, such as on the chin)
Irregular menstrual periods or lack of menstrual periods
Irregular/infrequent/lack of ovulation (yes, PCOS can lead to fertility issues)
Acne
Balding on the sides of the head
Areas of thickened, darkened skin may appear in the armpit, on the nape of the neck, and in skinfolds
Again, the above is not diagnostic criteria. That is, not all PCOS patients are obese, or not all patients struggle with fertility. These are just some of the characteristics that may lead a health care provider to consider PCOS as a potential diagnosis.
The good new is, once there is a confirmed PCOS diagnosis there are many treatment modalities that a Naturopathic Physician can offer. These include, but are not limited to:
Supplement prescription
Nutrition and exercise counselling
Botanical medicine
Acupuncture
Hormone therapies
The take home message here is that PCOS is a difficult syndrome to diagnose, so if you are exhibiting any of the above characteristics ask your doctor (MD or ND) about PCOS.
It can be tough, but think positively about the process - as soon there is a diagnosis there can be treatment!
If you have or know someone that has been diagnosed with PCOS it is not all that surprising since PCOS is the most common endocrine disorder in those of child bearing age. It is a difficult syndrome to get a clear diagnosis, but once you do there are several treatment options.
Nutritional Supplements
Oftentimes it is beneficial for PCOS patients to take nutritional supplement like chromium, calcium, and vitamin D. Chromium is a trace mineral that enhances the action of insulin
Non obese patients with PCOS given 1000 mcg/day for two months were able to improve their insulin sensitivity by 30%; obese PCOS patients insulin sensitivity improved by 38% Calcium and Vitamin D
Calcium given with vitamin D plays an important role in reproductive health
Vitamin D deficiency is common in those that struggle with PCOS
Low vitamin D levels are associated with insulin resistance, ovulatory and menstrual irregularities, lower pregnancy success, increased facial hair, excess progesterone, obesity, and elevated cardiovascular risk factors
Weight Reduction
One of the most successful but difficult therapy to ‘administer’ is weight reduction.
Why is weight loss so important?
The reason weight loss is such an important therapy is because it brings about the greatest global improvement in the physiology that affects PCOS. Weight loss has been linked to to:
Improved metabolic patterns within the body (e.g., superior insulin sensitivity)
Regulation of menstrual cycles
Decreased progesterone, which restores ovulation
Reduces risk of diabetes, hypertension, hyperlipidemia, and uterine cancer
Weight loss should not be too drastic or rapid, but rather it should be achieved through consistent lifestyle modification that can be supported by a Naturopathic Physician. Even a 5% reduction in weight has been shown to be very beneficial.
Weight loss can be supported and achieved with nutrition and exercise counselling. Most often physicians suggest a whole foods diet, reducing refined carbohydrates and overall caloric intake. Fibre (vegetable, legumes, whole grains, flax) and protein intake is often increased; and to complete the picture, it is suggested that PCOS patients exercise for one hour per day (as easy as three 20 minute brisk walks!)
When nutritional modifications and exercise are not enough
Although nutrition and exercise were the only therapies touched on in this article, it is worth noting that a naturopathic doctor can also employ the use modalities such as:
Acupuncture
Based on scientific research, acupuncture is a safe and effective treatment for PCOS and can aid in weight reduction
Chinese herbal medicine is also and effective adjunctive treatment
Botanical Medicine
Nettle root, flaxseed, soy, green tea, bitter melon, licorice, saw palmetto, smilax, and saguinaria have all been shown to be effective for treating PCOS via various methods (i.e., effects insulin, balances hormones, etc.)
Pharmaceuticals
If need be, a naturopathic doctor (in BC) can employ the use of prescription drugs to help patients with their PCOS symptoms
The bottom line is that PCOS is a complicated, multifactorial condition that is difficult to diagnose. However, once there is a diagnosis it is important to seek treatment, as there are long-term implications and risks.
References:
Carmina E, Lobo RA. Polycystic Ovary Syndrome (PCOS): Arguably the Most Common Endocrinopathy Is Associated with Significant Morbidity in Women. The Journal of Clinical Endocrinology & Metabolism. 84(6):1897-1899. 1999.
Dewailly D. Diagnostic Criteria for PCOS: Is there a need for a rethink? Best Practice & Research Clinical Obstetrics & Gynaecology. 37:5-11. 2016.
Lim CE, Wong WS. Current evidence of acupuncture on polycystic ovarian syndrome. Gynecology Endocrinology. 26(6):473-478. 2010.
Richardson MR. Current Perspectives in Polycystic Ovary Syndrome. American Family Physician. 68(4):697-705. 2003.
Tori Hudson. Women’s Encyclopedia of Natural Medicine. 2008