Polycystic Ovarian Syndrome, or 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 subfertility. The principal features are obesity, anovulation (resulting in irregular menstruation) oramenorrhea, acne, and excessive amounts or effects of androgenic (masculinizing) hormones. The symptoms and severity of the syndrome vary greatly among women.
PCOS was first recognized as a medical disease or syndrome in the West in 1845 in France. Its most distinctive sign is the pathologic appearance of sclerocystic changes on the larger than average ovaries, which appeared to have a thick, shiny, white coating overlying many rows of cysts on the surface of the ovary. These ovarian changes give PCOS its name. In 1990 a National Institute of Health conference decided the two most consistent elements which comprise the disorder of PCOS include elevated androgenic hormones and chronic lack of ovulation. Yet PCOS has a multitude of other symptoms as well, including obesity, acne, facial hair and increased body hair, and thinning of the hair on the head.
Most of the symptoms of PCOS are caused by the state of the ovary. The capsule of the ovary is thickened and waxy. Multiple small cysts exist inside the ovary which are not the same as active follicles, but have been arrested in their development. These cysts and the connective tissue surrounding them, the stroma, produce male hormones called androgens. Testosterone is very similar in chemical composition to estrogen, but it causes the male type effects so often seen in PCOS. The brain detects circulating levels of sex hormone, and inhibits ovulation accordingly.
Luteinizing hormone is often elevated higher than FSH in a woman with PCOS, and remains elevated throughout the cycle. LH stimulates the cells of the ovary to produce androgens, which block follicular development, causing the follicles to degenerate. This process is thought to be a result of an altered feedback mechanism within the hypothalamic – pituitary – ovarian axis, and makes ovulation unlikely.
Impaired glucose tolerance and insulin abnormalities are also a factor in many cases of PCOS, and have to do with another endocrine gland, the pancreas. Insulin resistance affects ovulation by producing higher amounts of circulating insulin, which stimulates the activity of enzymes which help to manufacture androgens in the ovary. High insulin levels further may cause overstimulation of androgen receptors, leading to follicular atresia of developing eggs.
The etiology of this disease remains unknown. Doctors and scientists have been unable to pinpoint the actual causative factor, and thus have been unable to treat it effectively. Woman with PCOS are at risk for other health hazards like disorders in lipid metabolism, obesity and its health concerns, vascular disease and cancer.
So, how does PCOS affect fertility? By affecting the ability to ovulate. Less estrogen is produced, but more LH and testosterone. This affects not only the quality of the follicle, but also the state of the endometrium. As a result, menstrual cycles become more erratic and less predictable. Women with PCOS will often very long cycles and very heavy bleeding; or amenorrhea, or anovulation with scanty bleeding. (Each presentation, by the way, is addressed using different treatment protocols with Oriental Medicine.) When an egg is released, it is often released later in the cycle, and it is of poorer quality because of the surroundings in which it has been developing. Remember that follicular development is a process that takes approximately one hundred days within the ovary. Eggs are meant to develop in an estrogen and progesterone rich environment, not in an androgenic setting.
Treatment
Treatment must first and foremost be based upon your individual diagnostic pattern.
Women diagnosed with polycystic ovarian syndrome historically do not respond positively to Western assisted reproductive techniques including in-vitro procedures; nor do they respond well to clomid alone, or any hormonal manipulation which does not address the state of the ovary’s endocrine milleau over the previous three or more months of development. If they do become pregnant, they are at higher risk of miscarriage, again presumably because of the health of the egg and therefore the developing embryo.
Chinese medicine seeks to redress the entire hormonal milleau.
Polycystic Ovarian Syndrome – The Traditional Eastern View
In Traditional Chinese Medicine, Polycystic Ovarian Syndrome is seen as a heterogenous disorder, consisting of quite a few possible pattern discriminations. They are broken down into two main subcategories:
Vacuity （虚证）
- Kidney yang vacuity
- Kidney yin vacuity
- Spleen qi vacuity
The deficiency of Kidney and Spleen will further develop and intermingle with repletion symptoms.
- Spleen Phlegm dampness, Disharmony of Heart and Spleen
- Heart Liver Qi depression/depressive heat
- Stagnation of Qi and Stasis of Blood
They all have manifestations in the way in which the body ovulates, however. Most women with PCOS ovulate later in the cycle, if at all. Treatment will be based upon these differentiations of Wang, Wen, Wen, Qie and Zhang Fu, Qi Blood Yin and Yang.
Anovulatory women should begin to notice signs of ovulation after a couple months of treatment. Women with belated ovulation will often notice that their ovulation comes earlier and earlier in the cycle until they ovulate normally on cycle day fourteen.
Most women with PCOS also have endocrine abnormalities which are affected by diet.
Dietary Therapy [1]
If you are overweight, this condition responds much better to weight loss. Fat cells store estrogen, and there is usually relatively too much circulating estrogen and LH in women with PCOS. The liver metabolizes these hormones, so a healthy functioning liver is mandatory for proper therapeutic effect. Include dietary sources of the B vitamins, which keep the liver healthy.
Because of the insulin resistance and impaired glucose metabolism found in PCOS, it is very important to modify dietary intake if you have this condition.
Insulin is a hormone secreted by the beta cells of the pancrease and is designed to maintain the blood glucose level within a certain range. Insulin stores glucose in the form of fat. Insulin resistance means that the body’s response to insulin in various tissues is impaired. Hence, the pancreas secretes more insulin. When the body fails to respond to insulin, glucose intolerance and diabetes and its many complications may become the eventual result.
The best natural management for insulin resistance and impaired glucose metabolism is to lower the level of sugar intake from the diet, and eliminate the ingestion of any food substance that the body can utilizes as simple sugar.
- Cut out all forms of refined sugar
- Cut out all forms of refined carbohydrates. The body immediately turns these into sugar. This includes white bread, pasta, potatoes, white rice, most breakfast cereals, rice cakes, popcorn, or any starchy, low fiber food.
- Do not adhere to the fertility diets that advocate massive yam consumption. This can actually delay or prevent ovulation if you have PCOS.
- Avoid soda, fruit juice, and any drink which rapidly raises the blood sugar level.
- Consume adequate amounts of protein, either in vegetarian form or in the form of lean meat which has not been treated hormonally.
- Eat as many fresh vegetables as you wish.
- Eat only complex, whole grains.
- Eat fruits like berries which are not too sweet.
- Avoid milk and dairy products which tend to exacerbate the condition of internal dampness.
- Eliminate alcohol and caffeine.
- Increase your dietary fiber intake.
- Exercise.
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