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HEALTH CONCERN? BioHealth Health Concerns

Polycystic Ovarian Syndrome (PCOS)

Contributing Author: Tranchitella, Tracy N.D.

TracyTracy Tranchitella, N.D. is a Doctor of Naturopathic Medicine who specializes in providing nutritional and homeopathic consultations, lifestyle counseling, botanical medicine and women's health assessments and detoxification programs. She graduated in 1998 from the Southwest College of Naturopathic Medicine (SCNM) in Tempe, Arizona. Currently, she lives and practices in Temecula, California. Dr. Tranchitella is licensed in the State of California and a member of the American Association of Naturopathic Physicians (AANP) and the California Association of Naturopathic Physicians (CANP).

» Website: Sunrise Medical


In my article titled “Metabolic Syndrome and Weight Loss” I discussed this condition and its relationship to the development of diabetes, heart disease, polycystic ovaries, chronic inflammation and cancer.  Polycystic Ovarian Syndrome (PCOS) also known as Stein-Leventhal Syndrome can occur in women with symptoms similar to those found in Metabolic Syndrome particularly in the area of insulin resistance.  PCOS is reported to be the most common endocrine disorder occurring in women of reproductive age.  PCOS can occur as early as puberty and presents with the following symptoms of menstrual irregularities, infertility, male pattern hair growth (hirsuitism), acne and weight gain.

How PCOS Develops
In PCOS we commonly see elevated testosterone and insulin levels.  Controversy exists, however, as to which condition precedes the other.  In other words, is it the elevated insulin that leads to an increase in testosterone or is it elevated testosterone that leads to increased insulin levels?  When we consider how common Metabolic Syndrome is in the general population, we can view PCOS as the feminized version of that syndrome having long term consequences on reproduction, weight management and hormonal balance.

The difficulty in trying to determine the root cause of PCOS exists in the complex and interrelated functions of the endocrine system.  This system works through a series of feedback loops where the secretion of one hormone will inhibit or promote the production of another hormone.  In essence, the endocrine system is like a control panel where turning on one switch turns off another switch which further turns on another switch somewhere else and so on.

What we do know is that the ovaries have receptors for insulin.  If insulin is high, it will stimulate the production of testosterone and suppress the production of proteins that bind and inactivate the testosterone.  The effect of this is an increased expression of the testosterone (acne, hirsuitism) and suppression of ovulation.  Additionally, testosterone further promotes insulin resistance by decreasing particular proteins that facilitate the transport of glucose into the cells.  Here we are in that loop where we don’t know what exactly causes what.

If a woman continues to have anovulatory cycles, the result is an imbalance between estrogen and progesterone.  Progesterone is produced in the ovaries after ovulation.  If a woman is not ovulating, she is not producing progesterone which leaves her with a relative excess of estrogen.  Clinically this manifests as irregular menses and/or heavy bleeding during a period.

The additional effects of elevated insulin contribute to weight gain, blood lipid abnormalities and the long term consequences of heart disease and diabetes.

Making A Diagnosis
What we know about PCOS is what we see clinically and in a patient’s lab work.  Typically we will find elevated total and free testosterone, decreased sex hormone binding globulin (SHBG), elevated insulin and leutinizing hormone (LH) with normal to mildly elevated follicle stimulating hormone (FSH).  An ovarian ultrasound will reveal multiple cysts on each ovary where the follicle has ruptured due to anovulatory cycles.   The patient’s family history may reveal diabetes, menstrual irregularities and infertility showing that PCOS has a genetic component.

Treatment of PCOS
Conventional treatment of PCOS usually involves the use of pharmaceutical agents designed to treat hyperinsulinemia, hirsuitism and benign prostatic hyperplasia (BPH).  A typical regimen may include oral contraceptives to regulate the menstrual cycle and Metformin (Glucophage) to increase insulin sensitivity.  Studies have shown that Metformin improves states of hyperandrogenism (elevated testosterone) and restores ovulation in women with PCOS.

In terms of lifestyle interventions, weight reduction is essential in overweight women.  A weight loss of 10-12% of body mass can increase insulin sensitivity, increase SHBG (to bind testosterone) and restore ovulation.  The addition of antiandrogenic and insulin regulating agents should be added only to enhance the effects of weight loss.  Because of the insulin resistance, weight loss can be very difficult in this population.  It is important to also evaluate thyroid function as it relates to metabolic rate.

The diet should be low in carbohydrates from starches and contain plenty of low glycemic veggies.  Protein should be moderate and fat should come as a condiment, in nuts and seeds, avocados, olive oil, etc.  When it comes to more specific dietary guidelines, you can refer to a book entitled “The Rosedale Diet” by Ron Rosedale, MD.

Herbs and supplements can also play a crucial role in managing PCOS.  Supplements that address insulin sensitivity such as chromium, vanadium, B-complex, biotin, zinc, alpha lipoic acid, fiber and essential fats (fish, flax oil) can be helpful.  Herbs to manage blood sugar include fenugreek, gymnema, bitter melon and cinnamon.  In reducing the effect of testosterone it is vital to address one’s stress level as it can stimulate production of adrenal hormones such as DHEA which can convert to testosterone.  Herbs that have an antiandrogenic effect include saw palmetto, nettles and vitex.