Polycystic ovarian syndrome (PCOS) is the most common endocrine dysfunction of reproductive-aged women (ages 15 to 44).
It is a hormonal problem that affects over 15% of young women, with adverse effects persisting far into the menopause years. It can make it harder to get pregnant and increase your risk for pregnancy complications and miscarriage.
The worse part is that many women who have PCOS, aren’t aware that they have it, leading them to suffer without getting proper treatment.
Doctors don’t know exactly what causes PCOS. They believe that high levels of male hormones, also known as androgens, prevent the ovaries from producing female hormones and making eggs normally.
Genes, insulin resistance and inflammation have all been linked to excess androgen production. However, weight loss and other treatments can improve your odds of having a healthy pregnancy.
As PCOS is an indistinct syndrome with great variation in severity of symptoms, the name for this condition and its diagnostic profile will likely change when more is known.
Regardless of the name and definition for this condition, proper treatment is critical. Due to its uncertain nature, we should be looking at an integrative approach.
Lack of ovulation
Italian physician Dr Antonio Vallisneri first described its symptoms in 1721. The three main features of PCOS are high male hormone levels, ovarian cysts and irregular periods.
Often, PCOS patients have many small sacs filled with fluid in their ovaries – a condition known as polycystic ovaries. These sacs contain immature eggs that are unable to undergo ovulation.
As ovulation is associated with the production of progesterone, luteinising hormone, oestrogen and follicle-stimulating hormone, the lack of this reproductive event results in a drop of these female hormones.
Meanwhile, male hormones dominate and interrupt the menstrual cycle, resulting in either irregular or no periods, known medically as oligomenorrhoea or amenorrhea respectively.
Common complications that can occur due to PCOS include: infertility, miscarriage, insulin resistance, gestational or type 2 diabetes, higher risk of heart disease, skin problems and hirsutism, anxiety, depression, fatigue and troubled sleep.
Birth control pills are a common treatment for the irregular periods of PCOS.
Areas of concern
The treatment of PCOS involves addressing several key areas of concern:
• Managing fertility concerns, like getting pregnant.
• Managing insulin resistance and the onset of diabetes.
• Decreasing the imbalance of male and female hormones.
• Managing the risk of cardiac (heart) problems.
In diagnosing PCOS, patients may undergo the following tests:
• A physical examination of your pelvis, where your doctor checks for growths and abnormalities in your uterus.
• Blood tests, where your doctor looks for abnormally high levels of male hormones and imbalances of other hormones.
• Tests should also be looking for abnormalities in triglyceride, insulin and cholesterol levels to predict if you might be at risk for diabetes and heart disease.
• Ultrasound, which checks to see if there are cysts in your ovaries and/or uterus.
Integrated approach
The usual treatment for PCOS is the prescription of oral contraceptive pills to help regulate your menses or reduce acne.
Because many PCOS patients experience symptoms similar to diabetes, metformin – the medication that helps to lower inflammation and regulate blood sugar – is also used in treatment.
However, here are a few steps that take a more holistic and integrative approach to lessening the symptoms of PCOS:
• Weight loss
Patients should develop a weight-loss plan, especially those with a body mass index (BMI) greater than 31.
Even a 5% loss of body weight can result in significant improvements in metabolic and hormonal balance.
• Taking supplements
Approximately 2,000 units of vitamin D3 daily may decrease insulin resistance.
Other supplements that may help to manage insulin resistance are alpha-lipoic acid (200-400mg/day), chromium picolinate (up to 1,000mcg/day) and pinitol (up to 1,200mg daily).
• Taking D-chiro-inositol
Taking 1,200 mg/day of this not only helps with insulin resistance, but may also reduce testosterone levels.
It can be combined or substituted with myo-inositol (up to 4g/day).
• Treating oestrogen dominance
Oestrogen dominance may contribute to hormonal imbalance.
Eat more cruciferous vegetables, support a healthy oestrogen metabolism or consider hormone therapy.
• Change in diet
A low-carbohydrate, low-glycaemic index diet that is also high in fibre, helps to counter high levels of glucose in the bloodstream, and thus, is beneficial for women with PCOS.
Losing weight is one way to manage the symptoms of PCOS as it can help improve your metabolism and hormone balance.
• Decrease inflammation
Reduce consumption of processed foods, red meat and saturated fats to help decrease inflammation.
Supplementing with omega-3 fats from fish, flax seeds, walnuts or supplements, will help as well.
• Take cinnamon cassia
Cinnamon cassia is said to reduce blood glucose levels, and as it’s a natural ingredient, there’s no harm adding it to your tea, oatmeal or yoghurt.
The suggested dose is a quarter to one teaspoon of powdered cinnamon or 200-300mg of cassia extract.
• Manage anxiety
Women who have PCOS often have increased activity in their sympathetic nervous system activity, due to issues like anxiety and depression.
Use stress management, breathing and relaxation exercises, and mindfulness practices, to lessen the impact of anxiety and improve heart rate variability.
• Exercise
• Minimise alcohol consumption
• Trying alternative therapies
Homeopathy or ayuverdic therapy can be considered if a patient is interested to try alternative treatments. A few smaller studies have indicated that women with PCOS who receive acupuncture saw increased ovulation rates and lowered sympathetic tone.
If you have irregular periods, increasing acne or weight gain, or have had an extended period of infertility, you may be experiencing PCOS. It’s time to make an appointment with your doctor to find out for sure if you have this condition and to discuss the possibility of a holistic and intergrative approach to managing it.
By Datuk Dr Nor Ashikin Mokhtar
Published in Star Newspaper, Novamber 11, 2019
