PCOS treatment options - Part II of "Understanding PCOS"

Part II: Finding the best help for managing PCOS

 

By Mary Sabo, L.Ac DACM

As we saw in PART I of this blog, PCOS is a common disorder affecting follicle development and ovulation in women of reproductive age.  For details on the definition and diagnosis, please read PART I.  In this PART II blog, we’ll discuss treatment options for supporting ovarian function and overall health in women with PCOS. Whether you are trying to conceive, or just trying to get your body more balanced, read on for helpful tips!

There are many treatment options when it comes to managing PCOS. Let's look at some from Western medicine as well as the Chinese medicine approach and other holistic options.  Sometimes it is best to combine the approaches, or start with one and try more, if needed. If you aren't sure which might be your best option, talk to your doctor or acupuncturist for specific advice on your unique presentation.

Prescription drugs

Obviously, when it comes to prescription drugs, you'll need to talk to your doctor, who will help you understand which treatment might be best for you, but below is a quick run down of the most commonly used drugs for PCOS.

  1. Clomid and letrozole trick the brain into stimulating the ovary harder and can help promote ovulation in women trying to conceive, but these drugs can also have major side effects and lead to a higher risk of multiples. They are also not appropriate for women who are trying to correct PCOS, but not trying to get pregnant.
  2. Gonadotropins like Follistim, Menopur, and Gonal F are injection medications that directly stimulate the ovary to develop the follicles containing eggs, and are only appropriate for women struggling to conceive.  Women with PCOS tend to have an exaggerated response to these medications and make a lot of follicles, so the risk of multiples is even higher and most women with PCOS only use them during an In Vitro Fertilization (IVF) cycle.  
  3. Metformin is a diabetes management drug and because one of the main components of PCOS is insulin resistance, it can help balance blood sugar and insulin levels, which helps restore ovulation. Metformin can also have some unpleasant side effects and should be combined with appropriate diet and lifestyle changes.  Also, for women who are not experiencing insulin resistance and just have polycystic ovaries (PCO), it may not be helpful for promoting ovulation.

Natural Remedies

Fortunately, PCOS and PCO respond really well to acupuncture, Chinese herbs, supplements, exercise and dietary changes. In fact, one review study analyzing the current research on acupuncture for PCOS found that acupuncture alone can help improve the communication between the brain and ovaries, promote ovulation, and regulate the menstrual cycle[i]. In women with PCOS receiving regular acupuncture, testosterone levels decrease and become more normal and ovulation frequency and regularity increases[ii]

In Chinese medicine, PCOS is viewed as stagnation of qi, which is easy to see as the follicles literally get stuck in the middle of developing in the ovary. Often the qi stagnation is combined with underlying patterns of Spleen Qi deficiency (digestive weakness), dampness, and heat.  Some patients also present with other compounding patterns like blood deficiency or yang deficiency. Chinese herbs to correct these patterns can enhance the effects of acupuncture when it comes to correcting PCOS. A study done on rats with PCOS showed that when acupuncture and Chinese herbs are combined, response is stronger than either alone[iii].  Supplements like Myo-Inositol can also be helpful for PCOS either alone or in combination with herbs and acupuncture. 

Finally, dietary changes and exercise can be hugely important when it comes to managing PCOS.  As we discussed, this population can have difficulty processing sugars and carbohydrates due to insulin resistance, so it is important to adopt a diet that is low in sugar and carbs and emphasizes non-starchy vegetables, healthy fats, and lean proteins. This population may also be at risk for food sensitivities, so doing an elimination diet to explore possible food triggers or getting tested for food allergies is also worthwhile. Exercise is very helpful for increasing insulin sensitivity in cells, so starting an exercise routine or increasing daily activity can be extremely helpful.

Need more help?  If you are in the NYC area, book an appointment for an acupuncture session and we’ll create a customized plan based on your unique body and goals.  If you are not in NYC, look for a qualified acupuncturist and herbalist in your area who is familiar with PCOS and can assist you in your healing. 

 

[i] Julia Johansson and Elisabet Stener-Victorin. Polycystic Ovary Syndrome: Effect and Mechanisms of Acupuncture for Ovulation Induction. Evid Based Complement Alternat Med. 2013; 2013: 762615. Published online 2013 Sep 2.

[ii] Julia Johansson, Leanne Redman, Paula P. Veldhuis, Antonina Sazonova, Fernand Labrie, Göran Holm, Gudmundur Johannsson, and Elisabet Stener-Victorin. Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab. 2013 May 1; 304(9): E934–E943. Published online 2013 Mar 12.

[iii] Rui-Jie Ma,1 Jue Zhou,2 Jian-Qiao Fang,1 Dan-Hong Yang,1 and Fan Qu3,4 Combination of Acupuncture and Chinese Medicinal Herbs in Treating Model Rats With Polycystic Ovary Syndrome. Afr J Tradit Complement Altern Med. 2011; 8(4): 353–361. Published online 2011 Jun 1.

 

 

"What is PCOS and how is it treated naturally?" Part I

Part I: Understanding PCOS and getting a diagnosis

Photo by wildpixel/iStock / Getty Images
Photo by wildpixel/iStock / Getty Images

By Mary Sabo, L.Ac DACM

Polycystic Ovarian Syndrome or PCOS is the most common endocrine disorder among women of reproductive age. With the wide spread use of birth control pills, which externally regulate the menstrual cycle, PCOS is becoming more and more common.  A lot of my patients get concerned that the pill may have caused their PCOS, but this doesn’t seem to be the case. It is more likely that the pill just masks the dysfunction that is occurring over time. It is not fully understood why so many women are being diagnosed with PCOS, but diet and genetic factors are likely part of it.  Since PCOS can present in many different ways, let’s take a closer look at this ovarian disorder.

PCOS is associated with an increased number or congestion of follicles in the ovary that can lead to some or all of the following:

  1. anovolution (absence of ovulation)
  2. increased levels of androgen hormones like testosterone or DHEA
  3. long cycles
  4. amenorrhea (absence of a period)
  5. thinning hair on their head and increased body hair growth in places such as around the nipples, on the chest or abdomen, and on the face
  6. acne
  7. digestive problems
  8. insulin resistance

Occasionally, the only sign or symptom is irregular periods or anovulation (which may or may not be obvious as some women continue having regular periods) and the diagnosis is made just through transvaginal ultrasound.  This is referred to as simply polycystic ovaries (PCO) without the “syndrome” involving elevated testosterone levels and insulin resistance.  Some women don't realize they have PCO or PCOS because they still get periods and some may even ovulate some or all cycles. Women on hormonal birth control typically have no symptoms and it is not until they discontinue use that they begin noticing symptoms or simply do not get periods.

The diagnosis of PCOS is made through a blood test looking for increased testosterone and DHEA levels along with a transvaginal ultrasound to look at the number of follicles in the ovary. Some doctors may also measure hemoglobin A1C or insulin and blood glucose levels, all of which can reflect the presence of insulin resistance. Blood tests may also reveal elevated Luteinizing Hormone (LH) and lowered Follicle Stimulating Hormone (FSH) from the pituitary gland and high Antimüllerian Hormone (AMH). Some of the Reproductive Endocrinologists I frequently share patients with consider an ovary containing more than 15 visible antral follicles on an ultrasound polycystic, even in cases where androgens are not elevated, but symptoms are present.  

If you have a diagnosis of PCOS or PCO or suspect you might be at risk, there are lots of options to help you!  See PCOS PART II of this blog for treatment options and tips on naturally supporting your ovarian function. If you are in the NYC area and need support for your hormone health or fertility, contact us or schedule a session online and we will work with you to form a customized plan to help you manage your symptoms and meet your goals.