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Naturopathic Causes and Treatment of Polycystic Ovarian Syndrome

PCOS Polycystic Ovarian Syndrome (PCOS) is one of the most common female endocrine disorders affecting approximately 5%-10% of women of reproductive age (12–45 years old) and is thought to be one of the leading causes of female infertility. The principal features are obesity, anovulation (resulting in irregular menstruation) or amenorrhoea, acne, and excessive amounts or effects of androgenic (masculinising) hormones. The symptoms and severity of the syndrome vary greatly among women. While the causes are unknown, insulin resistance, diabetes and obesity are all strongly correlated with PCOS.

PCOS can present in any age during the reproductive years. Due to its often vague presentation it can take years to reach a diagnosis. Serum insulin, insulin resistance and homocysteine levels are significantly higher in subjects having PCOS but have no significant effect on fertility.

Symptoms of PCOS may include some or all of the following:

  • Oligomenorrhoea, amenorrhoea — irregular, few, or absent menstrual periods.
  • Infertility, generally resulting from chronic anovulation (lack of ovulation).
  • Hirsutism (increased abnormal, male pattern hair growth.
  • Approximately three-fourths of patients with PCOS have evidence of hyperandrogenaemia (high androgen levels)

Excessive mild symptoms of hyperandrogenism such as acne or hypermenorrhoea are frequent in adolescent girls and are often associated with irregular menstrual cycles. In most instances, these symptoms are transient and only reflect the immaturity of the hypothalamic-pituitary-ovarian axis during the first years following menarche.

Diagnosis

  • Case history taking, specifically for menstrual pattern, obesity, hirsutism, and the absence of breast development.
  • Gynaecologic ultrasonography is the major diagnostic tool, specifically looking for small ovarian follicles. These are believed to be the result of disturbed ovarian function with failed ovulation, reflected by the infrequent or absent menstruation that is typical of the condition. In normal menstrual cycle one egg is released from a dominant follicle - essentially a cyst that bursts to release the egg. After ovulation the follicle remnant is transformed into a progesterone producing corpus luteum, which shrinks and disappears after approximately 12–14 days. In PCOS, there is a so-called "follicular arrest", i.e., several follicles develop to a size of 5–7 mm, but not further. According to the Rotterdam criteria, 12 or more small follicles should be seen in a ovary on ultrasound examination. The follicles may be oriented in the periphery, giving the appearance of a 'string of pearls'. The numerous follicles contribute to the increased size of the ovaries, that is, 1.5 to 3 times larger than normal.
  • Laparoscopic examination may reveal a thickened, smooth, pearl-white outer surface of the ovary. (This would usually be an incidental finding if laparoscopy were performed for some other reason, as it would not be routine to examine the ovaries in this way to confirm a diagnosis of PCOS).
  • Serum (blood) levels of androgens (male hormones), including androstenedione, testosterone and Dehydroepiandrosterone sulphate may be elevated. The free testosterone level is thought to be the best measure, with ~60% of PCOS patients demonstrating supranormal levels.
  • The Free Androgen Index (FAI) of the ratio of testosterone to sex hormone-binding globulin (SHBG), is meant to be a predictor of free testosterone, but is a poor parameter for this and is no better than testosterone alone as a marker for PCOS, possibly because FAI is correlated with the degree of obesity. There are often low levels of SHBG, particularly among obese women.

Common assessments for associated conditions or risks

  • Fasting biochemical screen and lipid profile
  • 2-hour oral glucose tolerance test (GTT) in patients with risk factors (obesity, family history, history of gestational diabetes) and may indicate impaired glucose tolerance (insulin resistance) in 15-30% of women with PCOS. Frank diabetes can be seen in 65–68% of women with this condition. Insulin resistance can be observed in both normal weight and overweight patients.
  • Fasting insulin level or GTT with insulin levels (also called IGTT). A hypoglycemic response in which the two-hour insulin level is higher and the blood sugar lower than fasting is consistent with insulin resistance. Elevated insulin levels have been helpful to predict response to medication and may indicate women who will need higher dosages of metformin to lower insulin levels. Elevated blood sugar and insulin values do not predict who responds to an insulin-lowering medication, low-glycemic diet, and exercise.

Glucose tolerance testing (GTT) instead of fasting glucose can increase diagnosis of increased glucose tolerance and frank diabetes among patients with PCOS according to a prospective controlled trial. While fasting glucose levels may remain within normal limits, oral glucose tests revealed that up to 38% of asymptomatic women with PCOS (versus 8.5% in the general population) actually had impaired glucose tolerance, 7.5% of those with frank diabetes according to ADA guidelines.

For exclusion of other disorders that may cause similar symptoms:

  • Prolactin to rule out hyperprolactinemia
  • TSH to rule out hypothyroidism
  • 17-hydroxyprogesterone to rule out 21-hydroxylase deficiency (congenital adrenal hyperplasia). Many such women may appear similar to PCOS and be made worse by insulin resistance or obesity, but they can be greatly helped by adrenal suppression with low-dose glucocorticoid therapy.

Differential diagnosis

Other causes of irregular or absent menstruation and hirsutism, such as congenital adrenal hyperplasia, Cushing's syndrome, hyperprolactinemia, androgen secreting neoplasms, and other pituitary or adrenal disorders, should be investigated. PCOS has been reported in other insulin resistant situations such as acromegaly.

Pathogenesis

Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, either through the release of excessive luteinising hormone (LH) by the anterior pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus.

The syndrome acquired its most widely used name due to the common sign on ultrasound examination of multiple (poly) ovarian cysts. These "cysts" are actually immature follicles, not cysts ("polyfollicular ovary syndrome" would have been a more accurate name).

Insulin resistance and PCOS

PCOS is characterised by a complex set of symptoms, and the cause cannot be determined for all patients. However, research to date suggests that insulin resistance could be a leading cause. PCOS may also have a genetic predisposition, and further research into this possibility is taking place. No specific gene has been identified, and it is thought that many genes could contribute to the development of PCOS.

Also, hyperinsulinemia increases GnRH pulse frequency, LH over FSH dominance, increased ovarian androgen production, decreased follicular maturation, and decreased SHBG binding; all these steps lead to the development of PCOS. Insulin resistance is a common finding among patients of normal weight as well as those overweight patients.

Obesity and PCOS

A majority of patients with PCOS have insulin resistance and/or are obese. Their elevated insulin levels contribute to or cause the abnormalities seen in the hypothalamic-pituitary-ovarian axis that lead to PCOS. Adipose tissue possesses aromatase, an enzyme that converts androstenedione to oestrone and testosterone to oestradiol. The excess of adipose tissue in obese patients creates the paradox of having both excess androgens (which are responsible for hirsutism and virilization) and oestrogens (which inhibits FSH via negative feedback). Inflammation PCOS may be associated with chronic inflammation, with several investigators correlating inflammatory mediators with anovulation and other PCOS symptoms.

Medical Management

  • Medical treatment of PCOS is tailored to the patient's goals.
  • Lowering of insulin levels
  • Restoration of fertility
  • Treatment of hirsutism or acne
  • Restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial cancer.

General interventions that help to reduce weight or insulin resistance can be beneficial for all these aims, because they address what is believed to be the underlying cause of the syndrome.

Insulin lowering diet

Where PCOS is associated with overweight or obesity, successful weight loss is the most effective method of restoring normal ovulation/menstruation, Some experts recommend a low GI diet in which a significant part of total carbohydrates are obtained from fruit, vegetables and whole grain sources.

Medications

Medications such as metformin, and the newer thiazolidinedione (glitazones) that reduce insulin resistance by improving insulin sensitivity through have been an obvious approach and initial studies seemed to show effectiveness.

Infertility

Not all women with PCOS have difficulty becoming pregnant. For those who do, anovulation is a common cause. Ovulation may be predicted by the use of urine tests that detect the preovulatory LH surge, called ovulation predictor kits (OPKs). However, OPKs are not always accurate when testing on women with PCOS. Charting of cervical mucus may also be used to predict ovulation, or certain fertility monitors (those that track urinary hormones or changes in saliva) may be used. Methods that predict ovulation may be used to time intercourse or insemination appropriately. While not useful for predicting ovulation, basal body temperatures may be used to confirm ovulation.

For overweight women with PCOS, who are anovulatory, diet adjustments and weight loss are associated with resumption of spontaneous ovulation. For those who after weightloss still are anovulatory or for anovulatory lean women, clomiphene citrate and FSH are the principal treatments used to help infertility. The most drastic increase in ovulation rate occurs with a combination of diet modification, weight loss, and treatment with metformin and clomiphene citrate.

For patients who do not respond to clomiphene, diet and lifestylemodification, there are options available including assisted reproductive technology procedures such as controlled ovarian hyperstimulation with FSH injections and in vitro fertilisation (IVF).

Hirsutism and acne

When appropriate (e.g. in women of child-bearing age who require contraception), a standard contraceptive pill may be effective in reducing hirsutism. Other drugs with anti-androgen effects include flutamide and spironolactone, some improvement in hirsutism. Spironolactone is probably the most-commonly used drug in the US. Metformin can reduce hirsutism, perhaps by reducing insulin resistance, and is often used if there are other features such as insulin resistance, diabetes or obesity that should also benefit from metformin.

For removal of facial hairs, electrolysis or laser treatments are faster and more efficient alternatives than the above mentioned medical therapies.

Menstrual irregularity and endometrial hyperplasia

If fertility is not the primary aim, then menstruation can usually be regulated with a contraceptive pill. The purpose of regulating menstruation is essentially for the woman's convenience, and perhaps her sense of well-being; there is no medical requirement for regular periods, so long as they occur sufficiently often (see below). (a contraceptive pill containing cyproterone acetate) is also beneficial for hirsutism, and is therefore often prescribed in PCOS.

If a regular menstrual cycle is not desired, then therapy for an irregular cycle is not necessarily required - most experts consider that if a menstrual bleed occurs at least every three months, then the endometrium (womb lining) is being shed sufficiently often to prevent an increased risk of endometrial abnormalities or cancer.

Women with PCOS are at risk for the following:

  • Endometrial hyperplasia and endometrial cancer (cancer of the uterine lining) are possible, due to overaccumulation of uterine lining, and also lack of progesterone resulting in prolonged stimulation of uterine cells by oestrogen. It is however clear if this risk is directly due to the syndrome or from the associated obesity, hyperinsulinemia, and hyperandrogenism
  • Insulin resistance/Type II diabetes. A review published in 2010 concluded that women with PCOS had an elevated prevalence of insulin resistance and type II diabetes, also when controlling for body mass index(BMI).
  • High blood pressure
  • Depression/Anxiety
  • Dyslipidemia- disorders of lipid metabolism — cholesterol and triglycerides. PCOS patients show decreased removal of atherosclerosis-inducing remnants, seemingly independent on insulin resistance/Type II diabetes.
  • Cardiovascular disease
  • Strokes
  • Weight gain
  • Miscarriage
  • Acanthosis nigricans (patches of darkened skin under the arms, in the groin area, on the back of the neck)
  • Autoimmune thyroiditis

Complementary Medicine

Naturopathic causes of PCOS

  1. Hyperinsulinaemia
  2. Insulin resistance
  3. Hyperhomocystinaemia
  4. Obesity
  5. Excess inflammatory mediators
  6. Decreased SHBG
  7. Serum insulin, insulin resistance and homocysteine levels are significantly higher in subjects having PCOS but have no significant effect on fertility.
  8. Poor enterohepatic function
  9. Pelvic congestion

Insulin resistance and PCOS

Insulin resistance (IR) is a physiological condition where the natural hormone, insulin, becomes less effective at lowering blood sugars leading to hyperglycaemia and resultant health problems. Certain cell types such as fat and muscle cells require insulin to absorb glucose. When these cells fail to respond adequately to circulating insulin, blood glucose levels rise. The liver helps regulate glucose levels by reducing its secretion of glucose in the presence of insulin. This normal reduction in the liver’s glucose production may not occur in people with insulin resistance. See also Carahealth health articles, Insulin resistance.

Hyperhomocysteinaemia and PCOS

Hyperhomocysteinaemia is a medical condition characterised by an abnormally large level of homocysteine in the blood. Hyperhomocysteinaemia is a risk factor for Coronary artery disease. Coronary artery disease is when plaque builds up inside the coronary arteries. These arteries supply the heart with blood. A high level of homocysteine makes a person more prone to have blood clots which may result in heart attacks and strokes. Hyperhomocysteinaemia also damages the linings of veins and arteries.

Studies have found that homocysteine levels are significantly higher in PCOS patients than in the controls. There is a strong association between serum homocysteine and insulin resistance in women with PCOS that contributes to the long-term complications of PCOS, since hyperhomocysteinemia is associated with early atherosclerosis.

Hypothalamic pituitary ovarian axis dysfunction

The hypothalamic-pituitary-gonadal axis ( HPG axis) is referring to the effects of the hypothalamus, pituitary gland and gonads as if these individual endocrine glands were a single entity as a whole.

The hypothalamic-pituitary-gonadal axis is a critical part in the development and regulation of a number of the body's systems, such as the reproductive, and immune systems. Fluctuations in the hormones cause changes in the hormones produced by each gland and have various widespread and local effects on the body. This axis controls development, reproduction, and aging in animals.

In relation to reproductive disorders such as PCOS, the hypothalamus produces gonadotropin-releasing hormone (GnRH). The anterior portion of the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and the gonads produce oestrogen and testosterone.

Naturopathic treatment principles for PCOS

1. Improve insulin sensitivity

2. Lower homocysteine levels

3. Regulate the hypothalamic-pituitary-ovarian-axis

4. Promote weight loss

5. Encourage regular exercise

6. Reduce inflammation

7. Increase Sex hormone Binding Globulin (SHBG)

Improve insulin sensitivity

Some of the best ideas for preventing and reversing insulin resistance come from emerging treatments for adult-onset diabetes, the condition in which insulin resistance is most severe. One approach aims at reducing glucose levels (and consequently insulin levels) and the other uses vitamins to counteract free radicals generated by glucose. Nutrients are involved as cofactors in insulin production and utilisation.

Alpha-lipoic acid

Alpha-lipoic plays a fundamental role in converting glucose to energy. Researchers have known from animal experiments that it can lower and stabilise glucose levels and, in Germany, alpha-lipoic acid is sold as a "drug" for the treatment of diabetic polyneuropathy, a type of severe nerve pain. Alpha-lipoic acid stimulates insulin activity, which safely lowers and stabilises glucose levels. It also improves insulin sensitivity and increases glucose tolerance.

Vanadium

Vanadium, found in vanadyl sulfate supplements, also improves insulin's ability to transport glucose into cells. With insulin working efficiently, the body needs and produces less of it.

Chromium

Chromium helps lower glucose levels as it is a component of the "glucose tolerance factor," a molecule essential for normal insulin function and glucose metabolism. 200 mcg of chromium picolinate daily safely lowers and stabilises blood sugar levels in diabetics in just four months. Taking 1,000 mcg of chromium daily leads to glucose and insulin levels comparable to those of normal people.

Zinc

Zinc is involved in virtually all aspects of insulin metabolism including synthesis, secretion and utilisation. Zinc also has a protective effect against beta cell destruction in the pancreas, and has well-known anti-viral effects. People with insulin resistance and Type 2 diabetes (NIDDM) also have low zinc levels, caused by excess loss of zinc in their urine, which may impair immune function. Specifically in realtion to PCOS, zinc is a natural 5 alpha reductase inhibitor and inhibits the conversion of testosterone to a stronger masculinising testosterone called dihydrotestosterone.DHT. Zinc (15-50 mg per day) is recommended. Take zinc with food to prevent stomach upset. If you take over 30 milligrams of zinc on a daily basis for more than one or two months, you should also take 1 to 2 milligrams of copper each day to maintain a proper mineral balance.

Omega-3 fatty acids

The omega-3 fatty acids, or fish oils, also improve insulin sensitivity and reduce insulin resistance, according to a recent animal study by Margaret T. Behme, M.D., of University Hospital, London, Ontario. The omega-3 fatty acids restore a balance disrupted by excessive consumption of omega-6 fatty acids and saturated fats. Vitamin E Vitamin E as a powerful antioxidant prevents "oxidative stress" caused by excessive glucose and free radicals in diabetics and insulin resistant patients.

D-chiro-inositol (DCI)

D-chiro-inositol (DCI) offers a well-tolerated and effective alternative treatment for PCOS. It has been evaluated in two peer-reviewed, double-blind studies and found to help both lean and obese women with PCOS; diminishing many of the primary clinical presentations of PCOS. It has no documented side-effects and is a naturally occurring human metabolite known to be involved in insulin metabolism.

Mushrooms

Research has shown the Maitake mushroom (Grifola frondosa) has a hypoglycemic effect, and may be beneficial for the management of diabetes and insulin resistance. The reason Maitake lowers blood sugar is due to the fact the mushroom naturally acts as an alpha glucosidase inhibitor. Other mushrooms like Reishi, Agaricus blazei, Agrocybe cylindracea and Cordyceps have been noted to lower blood sugar levels to a certain extent, although the mechanism is currently unknown.

Lower homocysteine

As a consequence of the biochemical reactions in which homocysteine is involved, deficiencies of the vitamins folic acid, pyridoxine (B6), or B12 can lead to high homocysteine levels. Supplementation with pyridoxine, folic acid, B12 or trimethylglycine (betaine) reduces the concentration of homocysteine in the bloodstream.

Regulate the Hypothalamic Pituitary Ovarian axis

HPO Regulators (Hypothalamus-Pituitary-Ovarian) include the herbs Black Cohosh (Cimicifuga racemosa), and Chaste berry (Vitex Agnus castus). Black Cohosh treats arthritis aches and pains, menopause hot flashes, painful periods, thinning of the vaginal wall and PMS. Vitex Vitex Agnus castus is a prime herb for the treatment of PMS and hormonal irregularity.

Weight Loss

Where PCOS is associated with overweight or obesity, successful weight loss is the most effective method of restoring normal ovulation/menstruation, Some experts recommend a low GI diet in which a significant part of total carbohydrates are obtained from fruit, vegetables and whole grain sources. Regular exercise and maintaining a healthy weight will help reduce the hormonal imbalance, restore ovulation and fertility, and improve acne and hirsutism.

Dietary Advice for insulin resistance in PCOS

Eat foods high in fibre

Foods high in fibre help lower blood cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are all good sources of fibre.

Reduce saturated fat

Saturated fat raises blood cholesterol level. Saturated fat is found in meats, poultry skin, butter, dairy products with fat, shortening, lard, and tropical oils such as palm oil.

Coconut oil is the new olive oil

Coconut oil, as a virgin coconut oil, is cholesterol free. Coconut oil contains medium-chain triglycerides, when these are digested they go straight to the liver and are transformed into energy, not fat.Coconut oil contains fewer calories than many other oils and fats. Coconut oil is high in lauric acid, which is a key constituent of breast milk. Lauric acid is believed to have both anti–viral and anti–fungal properties, helping to prevent and treat health problems such as yeast infections and candida. Coconut oil oil has been used for centuries in Eastern Ayurvedic Medicine to prevent and treat conditions including diabetes, viral infections and cardiovascular problems. Coconut oil is thermogenic, which means it helps to increase the body’s metabolism, contributing to increased energy levels and weight loss.

Avoid trans/ hydrogenated fats

Trans fats raises blood cholesterol. They are often in crackers, biscuits, snack foods, commercially prepared baked goods, cake mixes, microwave popcorn, fried foods and even salad dressings. Some margarines have trans fat. Check the label for trans fat. Some big chains are now cottoning on that we want these removed.

Increase physical activity

Aim for at least 30 minutes of exercise most days of the week. Think of ways to increase physical activity, such as taking the stairs instead of the elevator. Reach and maintain a healthy body weight Being a healthy weight range can lower your risk of diabetes, heart disease and stroke but even many types of cancer including colon, breast and prostate.

Reduce inflammation

Inflammatory cytokines such as tumour necrosis factor alpha play a role in the pathophysiology of PCOS. Basically, limit pro-inflammatory foods and eat liberal amounts of anti-inflammatory foods.

Antiinflammatory Food List

Fresh fish: mackerel, sardines, tuna, salmon, trout, and oily fatty fish types.

Colourful fresh vegetables: tomatoes, peppers, peas, spinach, kale, parsley, radishes, carrots (raw), celery, onions, garlic, cucumbers, etc

Colourful fresh fruit: apples, pears, kiwi, oranges (not juiced), grapefruit, peaches, plums, melons, strawberries, blueberries, blackberries, currants, many others

Lean chicken, turkey, well trimmed grass-fed beef and bison, venisonDried nuts, seeds, beans

Herbs and spices (no salt)

Green and brown teas, extra virgin olive oils

FishOil ,Omega-3EPA/DHA BorageOil, GLA

Greentea, EGCG

Magnesium(Citrate)

Vitamin-C

Vitamin-E (Gamma)

Proinflammatory Food List

Fatty meat, chops, hamburger, butter, margarine, most cooking and omega-6 vegetable oils, including soybean, corn, safflower, sunflower, peanut, cottonseed oils and many others

All grain fed meats, farm raised fishAll fried foods, grilled or BBQ meats

All dairy products, milk and eggs

High Fructose Corn Syrup, HFCS, simple carbohydrates: sugars, pasta, rice, potatoes, breads, pastries

Artificial sweeteners

Alcohol, tobacco and other addictive habits.

Avoid pollution.

Avoid insecticides.

Avoid harsh cleaning fluids containing SLEs and parabens

Compounds in herbs and food act as natural anti-inflammatories including quercetin, berberine, genestin etc which act to inhibit COX and LOX and lower inflammatory mediators such IL6 and TNF alpha. For more detailed information on how inflammation leads to excess and overgrowth, see also Carahealth Anti-Cancer.

Increase SHBG

Sex hormone-binding globulin (SHBG) is a glycoprotein that binds to sex hormones, specifically testosterone and oestradiol. Other steroid hormones such as progesterone, cortisol, and other corticosteroids are bound by transcortin. Conditions with low SHBG include polycystic ovary syndrome diabetes, and hypothyroidism. Conditions with high SHBG include pregnancy, hyperthyroidism and anorexia nervosa. There has recently been research to link high SHBG levels with breast and testicular cancer as well.

A low fat high fibre diet with regular exercise naturally increase SHBG and decreases the risk of hormone dependant cancers TymchukCN,etal., Effects of diet and exercise on insulin, sex hormone-binding globulin,andprostate-specificantigen. Nutr Cancer 1998;31(2):127-31.

Increase isoflavones found naturally in soy products such as tofu and tempeh, chickpeas and kudzu root. Isoflavones are phytoestrogenic therfore protect the body from the negative effects pf oestrogen excess. They also increase SHBG. Brassicacaea family vegetables such as brocolli, cauliflower,cabbage, curly kale,  pakchoi ect., also increase SHBG thereby improving the removal of excess hormones form circulation.Nettle root also normalises SHBG. See below.

Herbal Medicine for PCOS

Carahealth Polycystic Ovarian Syndrome - Treat the causes of PCOS

Indications

Anovulation (lack of ovulation)

Hirsutism

Acne

Male pattern baldness due to;

  • Excess androgens
  • Excess Luteinizing hormone &
  • Insulin resistance

This tincture contains Chaste Tree Vitex agnus cactus, Milk thistle Silybum marinarum Saw palmetto Serenoa serrulata, and Nettle root Urtica dioic. This mix is formulated to address the causes of Poly Cystic Ovarian Syndrome (PCOS), which are excessive amounts of male hormones (androgens), produced by the ovaries and adrenal glands resulting from the release of excessive luteinizing hormone (LH) by the anterior pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia). The tincture improves insulin sensitivity, regulates the hypothalamic pituitary ovarian axis, balances hormones by improving liver function and prevents the conversion of excess masculinising hormones. The mix alleviates the symptoms, oligomenorrhoea, amenorrhoea, chronic anovulation (lack of ovulation), hirsutism, male pattern baldness in women and acne, obesity, depression and a deepening of voice.

Chaste Tree Vitex agnus cactus – Vitex is a uterine tonic dopaminergic, and prolactin inhibiting. Its primary function is to regulate hormone levels via the Hypothalamic Pituitary Ovarian (HPA) access. Increased levels of the hormone prolactin are often responsible for menstrual irregularities and premenstrual syndrome. Agnus-castus has been shown to inhibit its production and clinical trials have demonstrated that this can help regularise the menstrual cycle, improving PMS symptoms of breast tenderness, mood swings, fluid retention and headache. Vitex is used to treat acne with a hormonal cause. As a hormonal regulator it is specific for Poly Cystic Ovarian Syndrome (PCOS). For women who are trying to get pregnant, vitex balances oestrogen and progesterone levels thereby regulating ovulation and increasing chance of conception. The berries are considered a tonic herb for both the male and female reproductive systems.

Milk thistle Silybum marinarum Milk thistle is astringent, bitter, cholagogue, demulcent, diaphoretic, diuretic, emetic, emmenagogue, galactogogue, hepatic, stimulant, stomachic and tonic. Milk thislet is the trophorestorative of the liver. Milk Thistle can be used to increase the secretion and flow of bile from the liver and gall bladder and contains constituents, which protect liver cells from chemical damage. Silymarin, an extract from the seed, acts on the membranes of the liver cells preventing the entry of virus toxins and other toxic compounds and thus preventing damage to the cells from toxic chemicals and medications. It is used internally in the treatment of liver and gall bladder diseases, jaundice, cirrhosis, hepatitis and poisoning. It is indicated in skin complaints associated with a sluggish liver. As a galactogogue it specifically stimulates the flow of breast milk. Milk thistle also lowers cholesterol levels, reducing insulin resistance and reduces the growth of cancer cells in breast, cervical and prostate cancers. Regeneration of the liver is particularly important in the treatment of cancer since this disease is always characterised by a severely compromised and often partially destroyed liver.

Saw palmetto Serenoa serrulata Saw palmetto is diuretic, urinary antiseptic, endocrine agent, anabolic agent, relaxant, sedative, tonic to the male reproductive system, particularly the prostate, reduces congestive catarrhal conditions of the respiratory system and reputed aphrodisiac. It is indicated for chronic or sub-acute cystitis, prostatic hypertrophy, catarrh of the genito-urinary tract, testicular atrophy and sex hormone disorders. It is known as the 'plant catheter' because of its tonic effect on the neck of the bladder and on the prostate. It is normally prescribed for debilitated conditions of the male reproductive system such as testicular atrophy, low libido and impotence. As a natural 5 alpha reductase inhibitor, Saw palmetto inhibits the conversion of weak testosterone to cancer causing testosterone called DHT. It is specific for prostate cancer and Benign Prostatic Hyperplasia (BPH) and Poly Cystic Ovarian Syndrome PCOS and male pattern baldness. Serenoa is also believed to be effective for functional infertility in women and to increase the supply of mother's milk. The berries have a toning and soothing influence on mucous membranes throughout the body as well as an expectorant property, making this a useful remedy for colds and catarrh. It has a traditional use for asthma and bronchitis. The berries are used to treat urinary disorders and enuresis, and are of value in all infections of the urinary tract. Serenoa is reputed to be mildly sedative to the nervous system.

Nettle root Urtica dioica Nettle is a mild diuretic, astringent, tonic, haemostatic, dermatological agent; extracts are reported to have hypoglycaemic properties. The root is indicated in the symptomatic treatment of micturition disorders such as nocturia, dysuria and urine retention and in benign prostatic hyperplasia. Urtica is rich in iron and vitamin C, making it a useful remedy in anaemia and other debilitated states, the presence of the vitamin C ensuring that the iron is properly absorbed. The herb has an important effect on the kidney and on fluid and uric acid excretion, so is of benefit in gout and other arthritic conditions, particularly if there is an element of anaemia. It has been shown experimentally to have both hypoglycaemic and hyperglycaemic properties, the hypoglycaemic component being ‘urticin’. Urtica is a natural 5 alpha reductase inhibitor, that is, it prevents the conversion of testosterone to dihydrotestosterone (DHT), a potent cancer causing testosterone and a mascukinising hormone seen in excess in woman with PCOS. In a clinical trial, men with benign prostatic hypertrophy (Stages I and II) were treated with a dried standardised Urtica root extract for 20 weeks. An increased binding capacity of SHBG to testosterone and dihydrotestosterone results in hyperplasia as a compensation for a decrease in hormones. Nettle root normalises SHBG. Other clinical trials have reported improvements in urinary flow, and reduced urinary frequency, nocturia and residual urine after six months treatment.

Fenugreek seeds Trigonella foenum-graecum Fenugreek is antii-inflammatory, anticancer, cardiotonic, carminative, demulcent, deobstruent, diuretic, emollient, expectorant, febrifuge, galactogogue, hypoglycaemic, hypocholesterolamic, hypotensive, laxative, parasiticide, and restorative. Fenugreek is much used in herbal medicine, especially in North Africa, the Middle East and India. Research has shown that the seeds can inhibit cancer of the liver, lower blood cholesterol levels and also have an antidiabetic effect. The seed yields a strong mucilage and is therefore useful in the treatment of inflammation and ulcers of the stomach and intestines. The seed is very nourishing and body-building and is one of the most efficacious tonics in cases of physical debility caused by anaemia or by infectious diseases, especially where a nervous factor is involved. It is also used in the treatment of late-onset diabetes, poor digestion (especially in convalescence), insufficient lactation, painful menstruation, labour pains etc. The seeds freshen bad breath and restore a dulled sense of taste. Compounds extracted from the plant have shown cardiotonic, hypoglycaemic, diuretic, anti-inflammatory and hypotensive activity. One of its constituent alkaloids, called 'trigonelline', has shown potential for use in cancer therapy. The seed contains the saponin diosgenin, an important substance in the synthesis of oral contraceptives and sex hormones. Fenugreek acts as a carminative to lessen any colic associated with constipation. In Ayurvedic medicine, Methi (Trigonella foenum-graecum) is known to have anti-carcinogenic properties and reduce blood cholesterol levels. It is also used as a laxative. The seeds should not be prescribed medicinally for pregnant women since they can induce uterine contractions.

Lifestyle Advise

Quit smoking

A pilot study has also found evidence that Tai Chi and Qigong reduce the severity of type 2 diabetes.

Carina is available to lecture for your group or institution on this subject.

Carina Harkin BHSc.Nat.BHSc.Hom.BHSc.Acu. is a practitioner of 11 years, complementary medicine lecturer of 4 years and mother of six in Galway, Ireland who practices what she teaches.

For an appointment call Carina directly on 083 34 66 333.

All products are available through www.carahealth.ie. Remember, we are here for a good time not a long time, enjoy your food life!

Carahealth Galway, Acupuncture, Naturopathy, Homeopathy, Herbal Medicine, Nutrition, Nutritional therapy, Flower essences, Iridology, Short Courses, Cosmetic Acupuncture

Naturopathic Causes and Treatment of Polycystic Ovary Syndrome PCOS

Polycystic Ovary Syndrome (PCOS) is one of the most common female endocrine disorders affecting approximately 5%-10% of women of reproductive age (12–45 years old) and is thought to be one of the leading causes of female infertility.

The principal features are obesity, anovulation (resulting in irregular menstruation) or amenorrhoea, acne, and excessive amounts or effects of androgenic (masculinising) hormones. The symptoms and severity of the syndrome vary greatly among women. While the causes are unknown, insulin resistance, diabetes and obesity are all strongly correlated with PCOS.

 

PCOS can present in any age during the reproductive years. Due to its often vague presentation it can take years to reach a diagnosis.

 

Serum insulin, insulin resistance and homocysteine levels are significantly higher in subjects having PCOS but have no significant effect on fertility.

 

Symptoms of PCOS may include some or all of the following:

  • Oligomenorrhoea, amenorrhoea — irregular, few, or absent menstrual periods.
  • Infertility, generally resulting from chronic anovulation (lack of ovulation).
  • Hirsutism (increased abnormal, male pattern hair growth.
  • Approximately three-fourths of patients with PCOS have evidence of hyperandrogenaemia (high androgen levels)

 

Excessive mild symptoms of hyperandrogenism such as acne or hypermenorrhoea are frequent in adolescent girls and are often associated with irregular menstrual cycles. In most instances, these symptoms are transient and only reflect the immaturity of the hypothalamic-pituitary-ovarian axis during the first years following menarche.

 

Diagnosis

  • Case history taking, specifically for menstrual pattern, obesity, hirsutism, and the absence of breast development.

 

  • Gynaecologic ultrasonography is the major diagnostic tool, specifically looking for small ovarian follicles. These are believed to be the result of disturbed ovarian function with failed ovulation, reflected by the infrequent or absent menstruation that is typical of the condition. In normal menstrual cycle one egg is released from a dominant follicle - essentially a cyst that bursts to release the egg. After ovulation the follicle remnant is transformed into a progesterone producing corpus luteum, which shrinks and disappears after approximately 12–14 days. In PCOS, there is a so-called "follicular arrest", i.e., several follicles develop to a size of 5–7 mm, but not further. According to the Rotterdam criteria, 12 or more small follicles should be seen in a ovary on ultrasound examination. The follicles may be oriented in the periphery, giving the appearance of a 'string of pearls'. The numerous follicles contribute to the increased size of the ovaries, that is, 1.5 to 3 times larger than normal.

 

  • Laparoscopic examination may reveal a thickened, smooth, pearl-white outer surface of the ovary. (This would usually be an incidental finding if laparoscopy were performed for some other reason, as it would not be routine to examine the ovaries in this way to confirm a diagnosis of PCOS).

 

  • Serum (blood) levels of androgens (male hormones), including androstenedione, testosterone and Dehydroepiandrosterone sulphate may be elevated. The free testosterone level is thought to be the best measure, with ~60% of PCOS patients demonstrating supranormal levels.

 

  • The Free Androgen Index (FAI) of the ratio of testosterone to sex hormone-binding globulin (SHBG), is meant to be a predictor of free testosterone, but is a poor parameter for this and is no better than testosterone alone as a marker for PCOS, possibly because FAI is correlated with the degree of obesity. There are often low levels of SHBG, particularly among obese women.

 

Common assessments for associated conditions or risks
  • Fasting biochemical screen and lipid profile

 

  • 2-hour oral glucose tolerance test (GTT) in patients with risk factors (obesity, family history, history of gestational diabetes) and may indicate impaired glucose tolerance (insulin resistance) in 15-30% of women with PCOS. Frank diabetes can be seen in 65–68% of women with this condition. Insulin resistance can be observed in both normal weight and overweight patients.

 

  • Fasting insulin level or GTT with insulin levels (also called IGTT). A hypoglycemic response in which the two-hour insulin level is higher and the blood sugar lower than fasting is consistent with insulin resistance. Elevated insulin levels have been helpful to predict response to medication and may indicate women who will need higher dosages of metformin to lower insulin levels. Elevated blood sugar and insulin values do not predict who responds to an insulin-lowering medication, low-glycemic diet, and exercise.

 

Glucose tolerance testing (GTT) instead of fasting glucose can increase diagnosis of increased glucose tolerance and frank diabetes among patients with PCOS according to a prospective controlled trial. While fasting glucose levels may remain within normal limits, oral glucose tests revealed that up to 38% of asymptomatic women with PCOS (versus 8.5% in the general population) actually had impaired glucose tolerance, 7.5% of those with frank diabetes according to ADA guidelines.

 

For exclusion of other disorders that may cause similar symptoms:

  • Prolactin to rule out hyperprolactinemia

 

  • TSH to rule out hypothyroidism

 

  • 17-hydroxyprogesterone to rule out 21-hydroxylase deficiency (congenital adrenal hyperplasia). Many such women may appear similar to PCOS and be made worse by insulin resistance or obesity, but they can be greatly helped by adrenal suppression with low-dose glucocorticoid therapy.

 

Differential diagnosis

Other causes of irregular or absent menstruation and hirsutism, such as congenital adrenal hyperplasia, Cushing's syndrome, hyperprolactinemia, androgen secreting neoplasms, and other pituitary or adrenal disorders, should be investigated. PCOS has been reported in other insulin resistant situations such as acromegaly.

 

Pathogenesis

Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, either through the release of excessive luteinising hormone (LH) by the anterior pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus.

 

The syndrome acquired its most widely used name due to the common sign on ultrasound examination of multiple (poly) ovarian cysts. These "cysts" are actually immature follicles, not cysts ("polyfollicular ovary syndrome" would have been a more accurate name).

 

Insulin resistance the leading cause

PCOS is characterised by a complex set of symptoms, and the cause cannot be determined for all patients. However, research to date suggests that insulin resistance could be a leading cause. PCOS may also have a genetic predisposition, and further research into this possibility is taking place. No specific gene has been identified, and it is thought that many genes could contribute to the development of PCOS.

 

Also, hyperinsulinemia increases GnRH pulse frequency, LH over FSH dominance, increased ovarian androgen production, decreased follicular maturation, and decreased SHBG binding; all these steps lead to the development of PCOS. Insulin resistance is a common finding among patients of normal weight as well as those overweight patients.

 

Obesity

A majority of patients with PCOS have insulin resistance and/or are obese. Their elevated insulin levels contribute to or cause the abnormalities seen in the hypothalamic-pituitary-ovarian axis that lead to PCOS. Adipose tissue possesses aromatase, an enzyme that converts androstenedione to oestrone and testosterone to oestradiol. The excess of adipose tissue in obese patients creates the paradox of having both excess androgens (which are responsible for hirsutism and virilization) and oestrogens (which inhibits FSH via negative feedback).

 

Inflammation

PCOS may be associated with chronic inflammation, with several investigators correlating inflammatory mediators with anovulation and other PCOS symptoms.

 

Medical Management

Medical treatment of PCOS is tailored to the patient's goals.

 

  • Lowering of insulin levels
  • Restoration of fertility
  • Treatment of hirsutism or acne
  • Restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial cancer.

 

General interventions that help to reduce weight or insulin resistance can be beneficial for all these aims, because they address what is believed to be the underlying cause of the syndrome.

 

Insulin lowering

Diet

Where PCOS is associated with overweight or obesity, successful weight loss is the most effective method of restoring normal ovulation/menstruation, Some experts recommend a low GI diet in which a significant part of total carbohydrates are obtained from fruit, vegetables and whole grain sources.

 

Medications

Medications such as metformin, and the newer thiazolidinedione (glitazones) that reduce insulin resistance by improving insulin sensitivity through have been an obvious approach and initial studies seemed to show effectiveness.

 

Infertility

Not all women with PCOS have difficulty becoming pregnant. For those who do, anovulation is a common cause. Ovulation may be predicted by the use of urine tests that detect the preovulatory LH surge, called ovulation predictor kits (OPKs). However, OPKs are not always accurate when testing on women with PCOS. Charting of cervical mucus may also be used to predict ovulation, or certain fertility monitors (those that track urinary hormones or changes in saliva) may be used. Methods that predict ovulation may be used to time intercourse or insemination appropriately.

 

While not useful for predicting ovulation, basal body temperatures may be used to confirm ovulation.

 

For overweight women with PCOS, who are anovulatory, diet adjustments and weight loss are associated with resumption of spontaneous ovulation. For those who after weightloss still are anovulatory or for anovulatory lean women, clomiphene citrate and FSH are the principal treatments used to help infertility.

 

The most drastic increase in ovulation rate occurs with a combination of diet modification, weight loss, and treatment with metformin and clomiphene citrate.

It is currently unknown if diet change and weight loss alone have an effect on live birth rates comparable to those reported with clomiphene and metformin.

 

For patients who do not respond to clomiphene, diet and lifestylemodification, there are options available including assisted reproductive technology procedures such as controlled ovarian hyperstimulation with FSH injections and in vitro fertilisation (IVF).

 

Hirsutism and acne

When appropriate (e.g. in women of child-bearing age who require contraception), a standard contraceptive pill may be effective in reducing hirsutism.

 

Other drugs with anti-androgen effects include flutamide and spironolactone, some improvement in hirsutism. Spironolactone is probably the most-commonly used drug in the US. Metformin can reduce hirsutism, perhaps by reducing insulin resistance, and is often used if there are other features such as insulin resistance, diabetes or obesity that should also benefit from metformin.

 

For removal of facial hairs, electrolysis or laser treatments are faster and more efficient alternatives than the above mentioned medical therapies.

 

Menstrual irregularity and endometrial hyperplasia

If fertility is not the primary aim, then menstruation can usually be regulated with a contraceptive pill. The purpose of regulating menstruation is essentially for the woman's convenience, and perhaps her sense of well-being; there is no medical requirement for regular periods, so long as they occur sufficiently often (see below). (a contraceptive pill containing cyproterone acetate) is also beneficial for hirsutism, and is therefore often prescribed in PCOS.

 

If a regular menstrual cycle is not desired, then therapy for an irregular cycle is not necessarily required - most experts consider that if a menstrual bleed occurs at least every three months, then the endometrium (womb lining) is being shed sufficiently often to prevent an increased risk of endometrial abnormalities or cancer.

 

Women with PCOS are at risk for the following:

  • Endometrial hyperplasia and endometrial cancer (cancer of the uterine lining) are possible, due to overaccumulation of uterine lining, and also lack of progesterone resulting in prolonged stimulation of uterine cells by oestrogen. It is however clear if this risk is directly due to the syndrome or from the associated obesity, hyperinsulinemia, and hyperandrogenism
  • Insulin resistance/Type II diabetes. A review published in 2010 concluded that women with PCOS had an elevated prevalence of insulin resistance and type II diabetes, also when controlling for body mass index(BMI).
  • High blood pressure
  • Depression/Anxiety
  • Dyslipidemia- disorders of lipid metabolism — cholesterol and triglycerides. PCOS patients show decreased removal of atherosclerosis-inducing remnants, seemingly independent on insulin resistance/Type II diabetes.
  • Cardiovascular disease
  • Strokes
  • Weight gain
  • Miscarriage
  • Acanthosis nigricans (patches of darkened skin under the arms, in the groin area, on the back of the neck)
  • Autoimmune thyroiditis

 

Complementary medicine

Naturopathic causes of PCOS

· Hyperinsulinaemia

· Insulin resistance

· Hyperhomocystinaemia

· Obesity

· Excess inflammatory mediators

· Decreased SHBG

Serum insulin, insulin resistance and homocysteine levels are significantly higher in subjects having PCOS but have no significant effect on fertility.

 

Insulin resistance and PCOS

Insulin resistance (IR) is a physiological condition where the natural hormone, insulin, becomes less effective at lowering blood sugars leading to hyperglycaemia and resultant health problems. Certain cell types such as fat and muscle cells require insulin to absorb glucose. When these cells fail to respond adequately to circulating insulin, blood glucose levels rise. The liver helps regulate glucose levels by reducing its secretion of glucose in the presence of insulin. This normal reduction in the liver’s glucose production may not occur in people with insulin resistance.

 

See also Carahealth health articles, Insulin resistance.

 

Hyperhomocysteinaemia and PCOS

Hyperhomocysteinaemia is a medical condition characterised by an abnormally large level of homocysteine in the blood. Hyperhomocysteinaemia is a risk factor for Coronary artery disease. Coronary artery disease is when plaque builds up inside the coronary arteries. These arteries supply the heart with blood. A high level of homocysteine makes a person more prone to have blood clots which may result in heart attacks and strokes. Hyperhomocysteinaemia also damages the linings of veins and arteries.
Studies have found that homocysteine levels are significantly higher in PCOS patients than in the controls. There is a strong association between serum homocysteine and insulin resistance in women with PCOS that contributes to the long-term complications of PCOS, since hyperhomocysteinemia is associated with early atherosclerosis.

 

Hypothalamic pituitary ovarian axis dysfunction
The hypothalamic-pituitary-gonadal axis ( HPG axis) is referring to the effects of the hypothalamus, pituitary gland and gonads as if these individual endocrine glands were a single entity as a whole.

The hypothalamic-pituitary-gonadal axis is a critical part in the development and regulation of a number of the body's systems, such as the reproductive, and immune systems. Fluctuations in the hormones cause changes in the hormones produced by each gland and have various widespread and local effects on the body. This axis controls development, reproduction, and aging in animals.

In relation to reproductive disorders such as PCOS, the hypothalamus produces gonadotropin-releasing hormone (GnRH). The anterior portion of the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and the gonads produce oestrogen and testosterone.

Treatment principals

1. Improve insulin sensitivity

2. Lower homocysteine levels

3. Regulate the hypothalamic-pituitary-ovarian-axis

4. Promote weight loss

5. Encourage regular exercise

6. Reduce inflammation

7. Increase Sex hormone Binding Globulin (SHBG)

Improve insulin sensitivity

 

Some of the best ideas for preventing and reversing insulin resistance come from emerging treatments for adult-onset diabetes, the condition in which insulin resistance is most severe. One approach aims at reducing glucose levels (and consequently insulin levels) and the other uses vitamins to counteract free radicals generated by glucose. Nutrients are involved as cofactors in insulin production and utilisation.

 

Alpha-lipoic acid.

Alpha-lipoic plays a fundamental role in converting glucose to energy. Researchers have known from animal experiments that it can lower and stabilise glucose levels and, in Germany, alpha-lipoic acid is sold as a "drug" for the treatment of diabetic polyneuropathy, a type of severe nerve pain. Alpha-lipoic acid stimulates insulin activity, which safely lowers and stabilises glucose levels. It also improves insulin sensitivity and increases glucose tolerance.

 

Vanadium

Vanadium, found in vanadyl sulfate supplements, also improves insulin's ability to transport glucose into cells. With insulin working efficiently, the body needs and produces less of it.

 

Chromium

Chromium helps lower glucose levels as it is a component of the "glucose tolerance factor," a molecule essential for normal insulin function and glucose metabolism. 200 mcg of chromium picolinate daily safely lowers and stabilises blood sugar levels in diabetics in just four months. Taking 1,000 mcg of chromium daily leads to glucose and insulin levels comparable to those of normal people.

 

Zinc

Zinc is involved in virtually all aspects of insulin metabolism including synthesis, secretion and utilisation. Zinc also has a protective effect against beta cell destruction, and has well-known anti-viral effects. People with insulin resistance and Type 2 diabetes (NIDDM) also have low zinc levels, caused by excess loss of zinc in their urine, which may impair immune function. Zinc (15-50 mg per day) is recommended. Take zinc with food to prevent stomach upset. If you take over 30 milligrams of zinc on a daily basis for more than one or two months, you should also take 1 to 2 milligrams of copper each day to maintain a proper mineral balance.

 

Omega-3 fatty acids

The omega-3 fatty acids, or fish oils, also improve insulin sensitivity and reduce insulin resistance, according to a recent animal study by Margaret T. Behme, M.D., of University Hospital, London, Ontario. The omega-3 fatty acids restore a balance disrupted by excessive consumption of omega-6 fatty acids and saturated fats.

 

Vitamin E

Vitamin E as a powerful antioxidant prevents "oxidative stress" caused by excessive glucose and free radicals in diabetics and insulin resistant patients.

 

D-chiro-inositol (DCI)

D-chiro-inositol (DCI) offers a well-tolerated and effective alternative treatment for PCOS. It has been evaluated in two peer-reviewed, double-blind studies and found to help both lean and obese women with PCOS; diminishing many of the primary clinical presentations of PCOS. It has no documented side-effects and is a naturally occurring human metabolite known to be involved in insulin metabolism.

 

Zinc

Zinc deficiency has been suggested to play a role in the development of diabetes in humans. Zinc is involved in virtually all aspects of insulin metabolism including synthesis, secretion and utilisation. Zinc also has a protective effect against beta cell destruction, and has well-known anti-viral effects. People with Type 2 diabetes (NIDDM) also have low zinc levels, caused by excess loss of zinc in their urine, which may impair immune function.

Zinc supplements have lowered blood sugar levels in people with IDDM. People with NIDDM are recommended to supplement their diet with moderate amounts of zinc (15-50 mg per day) as a way to correct for the deficit. Note: Take zinc with food to prevent stomach upset. If you take over 30 milligrams of zinc on a daily basis for more than one or two months, you should also take 1 to 2 milligrams of copper each day to maintain a proper mineral balance.

 

Mushrooms

Research has shown the Maitake mushroom (Grifola frondosa) has a hypoglycemic effect, and may be beneficial for the management of diabetes and insulin resistance. The reason Maitake lowers blood sugar is due to the fact the mushroom naturally acts as an alpha glucosidase inhibitor. Other mushrooms like Reishi, Agaricus blazei, Agrocybe cylindracea and Cordyceps have been noted to lower blood sugar levels to a certain extent, although the mechanism is currently unknown.

 

Lower homocysteine

As a consequence of the biochemical reactions in which homocysteine is involved, deficiencies of the vitamins folic acid, pyridoxine (B6), or B12 can lead to high homocysteine levels. Supplementation with pyridoxine, folic acid, B12 or trimethylglycine (betaine) reduces the concentration of homocysteine in the bloodstream.

 

Regulate the Hypothalamic Pituitary Ovarian axis

HPO Regulators (Hypothalamus-Pituitary-Ovarian) include the herbs Black Cohosh (Cimicifuga racemosa), and Chaste berry (Vitex Agnus castus). Black Cohosh treats arthritis aches and pains, menopause hot flashes, painful periods, thinning of the vaginal wall and PMS.  Vitex Vitex Agnus castus is a prime herb for the treatment of PMS and hormonal irregularity.

Lose weight

Where PCOS is associated with overweight or obesity, successful weight loss is the most effective method of restoring normal ovulation/menstruation, Some experts recommend a low GI diet in which a significant part of total carbohydrates are obtained from fruit, vegetables and whole grain sources. Regular exercise and maintaining a healthy weight will help reduce the hormonal imbalance, restore ovulation and fertility, and improve acne and hirsutism.

 

Dietary Advice for insulin resistance in PCOS

Eat foods high in fibre

Foods high in fibre help lower blood cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are all good sources of fibre.

 

Reduce saturated fat

Saturated fat raises blood cholesterol level. Saturated fat is found in meats, poultry skin, butter, dairy products with fat, shortening, lard, and tropical oils such as palm oil.

 

Coconut oil is the new olive oil

Coconut oil, as a virgin coconut oil, is cholesterol free. Coconut oil contains medium-chain triglycerides, when these are digested they go straight to the liver and are transformed into energy, not fat. Coconut oil contains fewer calories than many other oils and fats. Coconut oil is high in lauric acid, which is a key constituent of breast milk. Lauric acid is believed to have both anti–viral and anti–fungal properties, helping to prevent and treat health problems such as yeast infections and candida. Coconut oil oil has been used for centuries in Eastern Ayurvedic Medicine to prevent and treat conditions including diabetes, viral infections and cardiovascular problems. Coconut oil is thermogenic, which means it helps to increase the body’s metabolism, contributing to increased energy levels and weight loss.

 

Avoid trans/ hydrogenated fats

Trans fats raises blood cholesterol. They are often in crackers, biscuits, snack foods, commercially prepared baked goods, cake mixes, microwave popcorn, fried foods and even salad dressings. Some margarines have trans fat. Check the label for trans fat. Some big chains are now cottoning on that we want these removed.

 

Increase physical activity

Aim for at least 30 minutes of exercise most days of the week. Think of ways to increase physical activity, such as taking the stairs instead of the elevator. Reach and maintain a healthy body weight Being a healthy weight range can lower your risk of diabetes, heart disease and stroke but even many types of cancer including colon, breast and prostate.

 

Reduce inflammation

Inflammatory cytokines such as tumour necrosis factor alpha play a role in the pathophysiology of PCOS. Basically, limit pro-inflammatory foods and eat liberal amounts of anti-inflammatory foods.

 

Anti-Inflammatory Food List

Pro-inflammatory Food List

Fresh fish: mackerel, sardines, tuna, salmon, trout, and oily fatty fish types.
Colourful fresh vegetables: tomatoes, peppers, peas, spinach, kale, parsley, radishes, carrots (raw), celery, onions, garlic, cucumbers, etc.
Colourful fresh fruit: apples, pears, kiwi, oranges (not juiced), grapefruit, peaches, plums, melons, strawberries, blueberries, blackberries, currants, many others
Lean chicken, turkey, well trimmed grass-fed beef and bison, venison
Dried nuts, seeds, beans
Herbs and spices (no salt)
Green and brown teas
Extra virgin olive oils

FishOil,Omega-3EPA/DHA
BorageOil,GLA
Greentea,EGCG
Magnesium(Citrate)
Vitamin-C
Vitamin-E (Gamma)

Fatty meat, Chops, hamburger
butter, margarine, most cooking and omega-6 vegetable oils, including soybean, corn, safflower, sunflower, peanut, cottonseed oils and many others
All grain fed meats, farm raised fish
All fried foods, grilled or BBQ meats
All dairy products, milk and eggs
High Fructose Corn Syrup, HFCS, simple carbohydrates: sugars, pasta, rice, potatoes, breads, pastries
Artificial sweeteners
Alcohol, tobacco and other addictive habits

Avoid pollution
Avoid insecticides
Avoid harsh cleaning fluids containing SLEs and parabens

 

 

Compounds in herbs and food act as natural anti-inflammatories including quercetin, berberine, genestin etc which act to inhibit COX and LOX and lower inflammatory mediators such IL6 and TNF alpha. For more detailed information see also Carahealth Anti-Cancer.

 

Increase SHBG

Sex hormone-binding globulin (SHBG) is a glycoprotein that binds to sex hormones, specifically testosterone and oestradiol. Other steroid hormones such as progesterone, cortisol, and other corticosteroids are bound by transcortin. Conditions with low SHBG include polycystic ovary syndrome diabetes, and hypothyroidism. Conditions with high SHBG include pregnancy, hyperthyroidism and anorexia nervosa. There has recently been research to link high SHBG levels with breast and testicular cancer as well. Nettle root also normalises SHBG. See below.

# Increase isoflavones – found in legumes, such as soya, lentils, chickpeas and beans. Isoflavones are a type of phytoestrogen which has an adaptogenic effect on oestrogen levels. This means that if oestrogen levels are low it helps balance them by increasing levels and decreasing them if levels are high. Phytoestrogens have also been found to increase SHBG. Oestrogen binds to SHBG so the more SHBG, the less active oestrogen there is in the body. # Increase cruciferous vegetables – broccoli, cauliflower, cabbage, brussel sprouts, bok choy and kale. These also increase SHBG, which will bind to excess oestrogens.

A low fat high fibre diet with regular exercise naturally increase SHBG and decreases the risk of hormone dependant cancers

TymchukCN,etal., Effects of diet and exercise on insulin, sex hormone-binding globulin,andprostate-specificantigen.
Nutr Cancer 1998;31(2):127-31.

Herbal Medicine

 

Carahealth Polycystic Ovarian Syndrome - Treat the causes of PCOS

Indications

Anovulation (lack of ovulation)

Hirsutism

Acne

Male pattern baldness

due to;

Excess androgens

Excess Luteinizing hormone &

Insulin resistance

This tincture contains Chaste Tree Vitex agnus cactus, Milk thistle Silybum marinarum Saw palmetto Serenoa serrulata, and Nettle root Urtica dioic. This mix is formulated to address the causes of Poly Cystic Ovarian Syndrome (PCOS), which are excessive amounts of male hormones (androgens), produced by the ovaries and adrenal glands resulting from the release of excessive luteinizing hormone (LH) by the anterior pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia). The tincture improves insulin sensitivity, regulates the hypothalamic pituitary ovarian axis, balances hormones by improving liver function and prevents the conversion of excess masculinising hormones. The mix alleviates the symptoms, oligomenorrhoea, amenorrhoea, chronic anovulation (lack of ovulation), hirsutism, male pattern baldness in women and acne, obesity, depression and a deepening of voice.

Chaste Tree Vitex agnus cactus – Vitex is a uterine tonic dopaminergic, and prolactin inhibiting. Its primary function is to regulate hormone levels via the Hypothalamic Pituitary Ovarian (HPA) access. Increased levels of the hormone prolactin are often responsible for menstrual irregularities and premenstrual syndrome. Agnus-castus has been shown to inhibit its production and clinical trials have demonstrated that this can help regularise the menstrual cycle, improving PMS symptoms of breast tenderness, mood swings, fluid retention and headache. Vitex is used to treat acne with a hormonal cause. As a hormonal regulator it is specific for Poly Cystic Ovarian Syndrome (PCOS). For women who are trying to get pregnant, vitex balances oestrogen and progesterone levels thereby regulating ovulation and increasing chance of conception. The berries are considered a tonic herb for both the male and female reproductive systems.

 

Milk thistle Silybum marinarum – Milk thistle is astringent, bitter, cholagogue, demulcent, diaphoretic, diuretic, emetic, emmenagogue, galactogogue, hepatic, stimulant, stomachic and tonic. Milk thislet is the trophorestorative of the liver. Milk Thistle can be used to increase the secretion and flow of bile from the liver and gall bladder and contains constituents, which protect liver cells from chemical damage. Silymarin, an extract from the seed, acts on the membranes of the liver cells preventing the entry of virus toxins and other toxic compounds and thus preventing damage to the cells from toxic chemicals and medications. It is used internally in the treatment of liver and gall bladder diseases, jaundice, cirrhosis, hepatitis and poisoning. It is indicated in skin complaints associated with a sluggish liver. As a galactogogue it specifically stimulates the flow of breast milk. Milk thistle also lowers cholesterol levels, reducing insulin resistance and reduces the growth of cancer cells in breast, cervical and prostate cancers. Regeneration of the liver is particularly important in the treatment of cancer since this disease is always characterised by a severely compromised and often partially destroyed liver.

 

Saw palmetto Serenoa serrulata – Saw palmetto is diuretic, urinary antiseptic, endocrine agent, anabolic agent, relaxant, sedative, tonic to the male reproductive system, particularly the prostate, reduces congestive catarrhal conditions of the respiratory system and reputed aphrodisiac. It is indicated for chronic or sub-acute cystitis, prostatic hypertrophy, catarrh of the genito-urinary tract, testicular atrophy and sex hormone disorders. It is known as the 'plant catheter' because of its tonic effect on the neck of the bladder and on the prostate. It is normally prescribed for debilitated conditions of the male reproductive system such as testicular atrophy, low libido and impotence. As a natural 5 alpha reductase inhibitor, Saw palmetto inhibits the conversion of weak testosterone to cancer causing testosterone called DHT. It is specific for prostate cancer and Benign Prostatic Hyperplasia (BPH) and Poly Cystic Ovarian Syndrome PCOS and male pattern baldness. Serenoa is also believed to be effective for functional infertility in women and to increase the supply of mother's milk. The berries have a toning and soothing influence on mucous membranes throughout the body as well as an expectorant property, making this a useful remedy for colds and catarrh. It has a traditional use for asthma and bronchitis. The berries are used to treat urinary disorders and enuresis, and are of value in all infections of the urinary tract. Serenoa is reputed to be mildly sedative to the nervous system.

 

Nettle root Urtica dioica – Nettle is a mild diuretic, astringent, tonic, haemostatic, dermatological agent; extracts are reported to have hypoglycaemic properties. The root is indicated in the symptomatic treatment of micturition disorders such as nocturia, dysuria and urine retention and in benign prostatic hyperplasia. Urtica is rich in iron and vitamin C, making it a useful remedy in anaemia and other debilitated states, the presence of the vitamin C ensuring that the iron is properly absorbed. The herb has an important effect on the kidney and on fluid and uric acid excretion, so is of benefit in gout and other arthritic conditions, particularly if there is an element of anaemia. It has been shown experimentally to have both hypoglycaemic and hyperglycaemic properties, the hypoglycaemic component being ‘urticin’. Urtica is a natural 5 alpha reductase inhibitor, that is, it prevents the conversion of testosterone to dihydrotestosterone (DHT), a potent cancer causing testosterone and a mascukinising hormone seen in excess in woman with PCOS. In a clinical trial, men with benign prostatic hypertrophy (Stages I and II) were treated with a dried standardised Urtica root extract for 20 weeks. An increased binding capacity of SHBG to testosterone and dihydrotestosterone results in hyperplasia as a compensation for a decrease in hormones. Nettle root normalises SHBG. Other clinical trials have reported improvements in urinary flow, and reduced urinary frequency, nocturia and residual urine after six months treatment.

 

Fenugreek seeds Trigonella foenum-graecum – Fenugreek is antii-inflammatory, anticancer, cardiotonic, carminative, demulcent, deobstruent, diuretic, emollient, expectorant, febrifuge, galactogogue, hypoglycaemic, hypocholesterolamic, hypotensive, laxative, parasiticide, and restorative. Fenugreek is much used in herbal medicine, especially in North Africa, the Middle East and India. Research has shown that the seeds can inhibit cancer of the liver, lower blood cholesterol levels and also have an antidiabetic effect. The seed yields a strong mucilage and is therefore useful in the treatment of inflammation and ulcers of the stomach and intestines. The seed is very nourishing and body-building and is one of the most efficacious tonics in cases of physical debility caused by anaemia or by infectious diseases, especially where a nervous factor is involved. It is also used in the treatment of late-onset diabetes, poor digestion (especially in convalescence), insufficient lactation, painful menstruation, labour pains etc. The seeds freshen bad breath and restore a dulled sense of taste. Compounds extracted from the plant have shown cardiotonic, hypoglycaemic, diuretic, anti-inflammatory and hypotensive activity. One of its constituent alkaloids, called 'trigonelline', has shown potential for use in cancer therapy. The seed contains the saponin diosgenin, an important substance in the synthesis of oral contraceptives and sex hormones. Fenugreek acts as a carminative to lessen any colic associated with constipation. In Ayurvedic medicine, Methi (Trigonella foenum-graecum) is known to have anti-carcinogenic properties and reduce blood cholesterol levels. It is also used as a laxative. The seeds should not be prescribed medicinally for pregnant women since they can induce uterine contractions.

 

Lifestyle Advise

Quit smoking

A pilot study has also found evidence that Tai Chi and Qigong reduce the severity of type 2 diabetes.

 

Carina Harkin BHSc.Nat.BHSc.Hom.BHSc.Acu. is a practitioner of 10 years, complementary medicine lecturer of 4 years and mother of six in Galway, Ireland who practices what she teaches.

 

For an appointment call Carina directly on 083 34 66 333.

 

All products are available through www.carahealth.ie. Remember, we are here for a good time not a long time, enjoy your food life!

 

Carahealth Galway Ireland. Acupuncture, Naturopathy, Homeopathy, Herbal Medicine, Nutrition, Nutritional therapy, Flower essences, Iridology, Short Courses, Cosmetic Acupuncture

 

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