Polycystic Ovarian Syndrome, or PCOS, is a health issue marked by hormonal imbalances that do not allow a woman’s eggs to develop properly. Women with PCOS may not ovulate very regularly and this can make it challenging to conceive a baby.
Fortunately, PCOS is more commonly diagnosed and understood these days. The root cause of PCOS is connected to genetic and environmental factors that may be out of our control. However, there is much that can be done to improve ovulation and egg quality with properly recommended nutritional supplements, herbal medicine, dietary therapy, exercise, and a proper lifestyle.
Criteria that can include PCOS diagnosis can include delayed ovulation or menstrual cycles, high androgenic hormones like testosterone, and/ or polycystic ovaries on ultrasound. Only two out of three of these criteria are necessary for a PCOS diagnosis. It is widely thought that both insulin regulation and high circulating androgen hormones such as testosterone are key players that contribute to PCOS. It is also now acknowledged that there are different types of PCOS. This means that clinically the treatment that works for one person may not be what someone else needs.
Women with PCOS are prone to blood sugar regulation issues. Blood sugar regulation is a complicated hormonal process in itself. When most people eat carbohydrates and sugary snacks the body releases a hormone called insulin. Insulin brings the sugar circulating in our bloodstream after a meal back into our cells so it can be used for energy or stored as fat. Some people develop insulin resistance where cells stop responding to insulin’s signal to let in sugar or glucose. This makes the body secrete even more insulin leaving circulating insulin levels high in the bloodstream
When insulin levels are high it can cause the theca cells on the outside of the ovarian follicles to produce more androgens such as testosterone. In addition, high circulating luteinizing hormone (LH) also causes the theca cells in the ovaries to produce more testosterone. While LH is high FSH remains low and this means that the eggs will not mature properly. The reason for high LH is thought to be complex and includes feedback loops that impact the pulses of the gonadotropin-releasing hormone (GnRH) in the brain.
Correcting blood sugar regulation will begin to improve egg quality so that ovulation may be possible or may occur more frequently. Dietary changes are essential to make this possible. Working with a health care practitioner who can give you the support to make empowering changes in your diet that are practical can be very helpful. A diet that works for one person may not be the right diet for another person. For most people adjusting macronutrient ratios is more effective and more sustainable than calorie-restricted types of diets. There are also supplements that have been shown to help support blood sugar regulation and decrease any inflammation that may have occurred as a result of the blood sugar regulation issues.
Exercise is proven in research studies to help with PCOS. Even small amounts of exercise have been shown to be helpful for PCOS. The type of exercise that is helpful can differ from person to person. For example, if you are starting a new type of diet doing too much cardiovascular exercise could trigger cravings for sugar and carbohydrates in some people. If you find this to be true, shifting to lower-intensity exercises such as lifting weights may be more helpful. Lifting weights boosts muscle. Muscle likes to use the glucose circulating in your blood as fuel. This can help to lower blood sugar and insulin levels.
For women who are already ovulating fairly regularly, working on blood sugar regulation may be enough to improve egg quality and conceive a baby. However, some women may need stronger hormone support to bring their cycles back regularly. The reason for this is that many women with PCOS have high and constant luteinizing hormone (LH) levels. LH is the hormone that you are checking for with ovulation predictor kits. It is the hormone the brain releases that gives the signal for the egg to be released every month. However, if you only have immature eggs that are not ready for ovulation, this will not happen. LH signals can be interrupted with appropriately timed progesterone supplements. Some women will only need herbal medicine that helps to support progesterone while others will need stronger forms of progesterone to interrupt this cycle.
Other factors that functional medicine practitioners will screen for in PCOS patients include thyroid issues, adrenal issues that could cause androgen excess, digestive issues, and environmental issues.
Acupuncture has also been shown to be helpful for PCOS in many research studies. Acupuncture has multiple physiologic effects. One way that acupuncture helps PCOS is through the release of beta-endorphins. Beta-endorphins modulate the release of hormones such as GnRH and CRH (corticotropin-releasing hormone) which can alter reproductive, adrenal, and pancreatic function. On a local level, acupuncture has been shown to increase glucose uptake and microcirculation.
In summary, there are many effective functional medicine treatment options for PCOS. By using functional medicine tools to make diet and lifestyle changes, you can increase your chances of natural conception or increase your egg quality to make assisted reproductive technologies (ART) more effective. This will not only improve your quality of life, but epigenetic research has shown that it can improve the quality of life of your children and grandchildren.
Johansson, Julia, and Elisabet Stener-Victorin. “Polycystic ovary syndrome: effect and mechanisms of acupuncture for ovulation induction.” Evidence-Based Complementary and Alternative Medicine 2013 (2013).
Jedel, Elizabeth, et al. “Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial.” American Journal of Physiology-Endocrinology and Metabolism 300.1 (2011): E37-E45.
Franks, Stephen, Jaroslav Stark, and Kate Hardy. “Follicle dynamics and anovulation in polycystic ovary syndrome.” Human reproduction update 14.4 (2008): 367-378.