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PCOS

Definition

Polycystic ovary syndrome (PCOS) is a term to describe multiple cysts/follicles on the ovaries. The European definition of PCOS is now outlined as having three clear symptoms: an increase in testosterone levels, irregular or no ovulation and multiple cysts on the ovaries (12 or more follicles measuring 2-9mm). In America, the definition of PCOS does not include multiple cysts on the ovaries, in case you find different information on the internet.

Prevalence

Around 34% of women undergoing IVF were found to have PCO; cysts on the ovaries but without the hormonal abnormalities. These multiple cysts are mainly empty follicles and don’t contain a maturing egg. Some cysts may actually be dermoid cysts. In women that don’t ovulate, PCOS accounts for around 50% of cases. Asian women are more likely to suffer from PCOS as well as being insulin resistant.

Symptoms

The symptoms of PCOS usually start from puberty and include the three main characteristics listed above as well as:

  • Acne
  • Alopecia (hair loss)
  • Anxiety and depression
  • Autistic traits
  • Decreased SHBG levels
  • Dysmenorrhea
  • Greater levels of oestrone than oestradiol
  • High blood pressure
  • Higher levels of prolactin
  • Higher levels of LH (in around 40% of women)
  • Higher levels of androstenedione
  • Increased distribution of body hair (hirsutism)
  • Insulin resistance
  • Irregular menstrual cycles
  • Obesity (in around 40-50% of women)
  • Male style cognitive functioning
  • Reduced blood flow to the uterus

Testing

The presence of cysts is found using an ultrasound (an MRI is better), whilst the levels of testosterone are measured using a blood test. Irregular ovulation is determined by either an ultrasound mid-cycle or a progesterone blood test 7 days before the cycle ends. If they are less than 5cm in diameter, then surgery is not often recommended. However, larger cysts that obstruct fertility may need to be removed. Any type of surgery is invasive and not recommended unless it is absolutely necessary. Otherwise, a blood test can check levels of insulin-like growth factor (IGF)-I, which are often high in women with PCOS.

Causes

In slim women with PCOS, higher levels of LH are often found, whereas women who are overweight, tend not have higher levels of LH but rather higher levels of insulin (hyperinsulinemic) and testosterone. Metformin is often prescribed for women with high insulin levels, as it’s also used for insulin resistant diabetes. If your doctor wants to check your LH levels for PCOS, a blood test is normally taken around day 8 of the menstrual cycle and if it is PCOS, the LH level will be above 10 IU/L. Western medicine believes that high levels of insulin cause greater levels of androgens (testosterone, androstenedione and SHBG) and therefore a greater number of follicles (cysts) to grow causing multiple (poly) growths, when some should naturally die off. These multiple follicles then release high levels of estrogen s. In Chinese medicine, high level of testosterones is too much yang, which causes accelerated growth.

The increase in the number of follicles also leads to the excessive release of inhibin, which reduces the amount of FSH released by the pituitary gland, which then reduces follicle growth and the chance of one dominant follicle maturing.

Long-term expose of estrogen s to the endometrium can lead to over-enlargement of the lining as estrogen s maintain and build the endometrial lining. Excessive oestrogen can also lead to possible ovarian and breast cancers. Some women may also develop type II diabetes.

In woman with PCOS, higher levels of insulin suppressing the production of SHBG by the liver also cause higher levels of testosterone. SHBG binds to circulating testosterone making it inactive, therefore less of it is able to feed follicle growth. As there is already higher than normal levels of testosterone in the body caused by lower levels of SHBG, it is not advisable to take DHEA supplements as DHEA increases levels of testosterone.

A lack of cortisone can lead to high levels of testosterone and possibly PCOS.

Consumption of red and white meat can increase levels of insulin-like growth factor (IGF)-I, which increases levels of androgens such as testosterone and oestrogen.

The causes of PCOS are:

  1. Poor diet (excessive damp)
  2. Lack of exercise (excessive phlegm)
  3. Emotional stress (qi stagnation)
  4. Overwork (yin deficiency)
  5. Long term contraceptive pill use (yin excess)
  6. Consumption of both red and white meat

Risks

If women with PCOS fall pregnant, there is an increased risk of having a spontaneous miscarriage. In Chinese medicine this increased risk of spontaneous miscarriage is due to the obstruction of qi and blood to the uterus caused by damp and blood stasis, which is the cause of PCOS. Treatment using acupuncture and Chinese herbs can reduce this risk by removing the blood stasis and damp obstruction allowing adequate blood flow to the foetus.

Women with PCOS are more likely to give birth to a baby with Autism, due to higher than normal levels of testosterone during pregnancy. These high levels of testosterone cause a decrease in levels of oxytocin, which is also attributed to repetitive and anti-social traits of Autism.

Treatment

One part of treatment for PCOS in both western and Chinese medicine is to reduce weight. This is achieved through a good diet and regular exercise in both medical paradigms. Metformin is usually prescribed to reduce insulin levels although recent large research studies have failed to show any benefit. Clomid is also prescribed to try and induce ovulation. Recent research has shown that combining clomid with Chinese herbs significantly improves PCOS. If this fails, laser surgery (laparoscopic ovarian drilling) or heat therapy is sometimes used. In women who are not trying to conceive, oral contraceptives are prescribed to reduce LH levels and therefore testosterone. Unfortunately, long-term use of oral contraceptives can cause infertility. It is therefore ideal to loose weight before medication is prescribed.

Women with PCOS can still try IVF but the protocol will be different than normal. Lower doses of FSH drugs are used to prevent multi follicle growth. It’s ideal to have 1 or 2 mature follicles and no more. If after taking the stimulation drugs there are 3 or more follicles, some IVF clinics will cancel the cycle because there is a considerable increased risk of developing ovarian hyperstimulation syndrome (OHSS). This is caused by there being large amounts of testosterone circulating which reacts with the FSH fertility drugs causing an excessive amount of oestrogen. This excessive amount of oestrogen then leads to OHSS. IVM is often a better option than IVF as there is less chance of being hyperstimulated.

In Chinese medicine, issues to do with the digestive system in women will be looked at and treated. Most women with PCOS will have dampness with some heat and stasis. Apart from reducing the intake of damp and heat causing foods, a Chinese medicine doctor can boost the spleen and kidney’s function of transforming dampness inside the body. Acupuncture can help regulate blood flow, water metabolism and improve digestive function. Research has shown that acupuncture helps to regulate insulin levels, thereby regulating testosterone and PCOS. Using Chinese herbs in conjunction with acupuncture is more effective at reducing dampness and stasis. I prescribe a very effective formula for treating this condition. Chinese herbs that reduce damp and stasis are used with others to help invigorate the uterus, whilst biotin in food or supplements helps to regulate insulin levels. B complex vitamins such as myo-inositol, can help egg maturation in women with PCOS.

By reducing sympathetic nerve activity and balancing hormone levels, acupuncture has been shown in studies to better regulate the menstrual cycle, reduce the number of ovarian cysts, stimulate ovulation, enhance blastocyst implantation and regulate the menstrual cycle in women with PCOS. It can also help to control effects such as obesity and anorexia.

In women with PCOS, AMH levels are higher than they should be as there are more eggs trying to mature. Acupuncture has been shown to reduce AMH levels and the ovaries thereby regulating them and improving PCOS and fertility.

Acupuncture For PCOS

Acupuncture has also been shown to affect hormone levels by promoting the release of beta-endorphin in the brain, which affects the release of gonadotropin releasing hormone by the hypothalamus, follicle stimulating hormone from the pituitary gland, and estrogen and progesterone levels from the ovary, thereby regulating normal function of the reproductive system. This helps to treat the secondary causes of PCOS that are pituitary originating, whilst the excessive yang in the uterus can be treated using Chinese herbs.

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