“My hormones are off.”
Probably more than 50% of my intake forms for new female patients have this kind of sentence written in the “Reason for Appointment” section. There are a wide variety of hormonal problems that women experience and aside from PMS, Polycystic Ovarian Syndrome (PCOS) is one of the most common.
What is PCOS actually?
Polycystic Ovarian Syndrome (PCOS) is an inadequately named condition that affects much more than just a woman’s ovaries. Women with PCOS can experience a wide variety of symptoms including those of having high testosterone such as hair growth in abnormal places and acne, symptoms of insulin resistance such as weight gain and high blood sugar and, of course, menstrual irregularities. It is very important to understand the whole-body effects of PCOS because, without appropriate treatment, it can put a person at higher risk of developing Type 2 Diabetes, cardiovascular disease and endometrial cancer. While all of these issues can cause distress, menstrual problems leading to difficulties getting pregnant is likely to be the most upsetting for women wanting to start a family. 1
Why is it so hard to get pregnant with PCOS?
Simply put, the reason some women with PCOS can’t get pregnant is because they don’t ovulate. Often we see high levels of luteinizing hormone (LH), which in normal amounts causes the ovary to produce testosterone and releases the mature egg during ovulation. There are also lower levels of follicle stimulating hormone (FSH), which in normal amounts converts testosterone to estrogen and causes eggs in the ovary to mature prior to ovulation. This means that when the time comes for ovulation, there is no mature egg to release. I also mentioned insulin resistance above. Insulin acts in the ovaries to increase the action of LH and having high levels of insulin is probably another main cause of keeping eggs from maturing completely. So, no ovulation, no mature egg for the sperm to fertilize, and no pregnancy. 2
So, is it still possible to get pregnant with PCOS?
YES! Working with a doctor who understands the complex metabolic and hormonal effects of PCOS is important especially because many of the symptoms associated with PCOS can be minimized or even reversed with diet and exercise.
Conventional medicine uses two main medications to help induce ovulation:
- Metformin is used to normalize insulin-resistance and may reduce risk of miscarriage early in pregnancy.
- Clomiphene (clomid) makes the ovary produce more mature eggs. 3
Naturopathic medicine encourages the body to start ovulating on its own by regulating the hormonal imbalances with:
- Blood sugar regulation and insulin sensitization through diet and exercise and natural products
- Encouraging a balanced ratio of testosterone, estrogen and progesterone in order to ovulate
- Improving egg health and quality
- Addressing emotional health and stress 4
Small changes with a big impact.
By using one or a combination of both of the above approaches, studies have shown a significant increase in pregnancy rate for women with PCOS. Diet and exercise are essential to successful treatment for both pregnancy and long-term outcomes as they can decrease, or even reverse, insulin resistance and development of Type 2 Diabetes and cardiovascular disease. Weight loss alone has been shown to be very effective. For example, in one study, a weight loss of 7% of body weight was associated with 63% of participants regaining their menstrual cycle after 3 months. 5
Some natural products that may also be recommended include myoinositol, cinnamon, flaxseed, Gymnema sylvestre, Black Cohosh and n-acetyl cysteine among others. Click on the hyperlinks to read more information about these individual herbs and nutrients. Some of these therapies may take time (several months to a year) for hormones to balance and to improve egg quality (an egg takes 3 months to mature before ovulation), but overall health improvement will likely be experienced very quickly. 6
Emotional stress is also just as important to address as physical health since stress is directly related to ovulation, insulin sensitivity and weight gain.
Lastly, adopting new habits for the purpose of a successful pregnancy will also help you raise healthy kids who start off life with healthy habits and grow up to healthy adults who produce healthy kids. Like the butterfly effect, your healthy habits will ripple through all your generations to come.
For more information on a naturopathic approach to PCOS you may want to check out Dr. Tori Hudson’s Polycystic Ovarian Syndrome overview.
- (J Obstet Gynaecol Can. 2010 May;32(5):423-5, 426-8; Nat Rev Endocrinol. 2011 Apr;7(4):219-31; N Engl J Med. 2005 Mar 24;352(12):1223-36.)
- (Endocrinol Metab Clin North Am. 1999 Jun;28(2):361-78; Am Fam Physician. 2000 Sep 1;62(5):1079-1088)
- (Hum Reprod. 2002 Nov;17(11):2858-64; Diabetes Care June 2013 vol. 36 no. 6 1477-1482; J Hum Reprod Sci. 2009 Jan-Jun; 2(1): 18–22)
- (J Acad Nutr Diet. 2013 Apr;113(4):520-45, Gynecol Endocrinol. 2015 Feb;31(2):131-5, Iran J Reprod Med. 2013 Aug;11(8):611-8, m J Obstet Gynecol. 2011 Apr;204(4):352.e1-6, Gynecol Endocrinol. 2015 Aug 4:1-4, N Am J Med Sci. 2015 Jul;7(7):310-6)
- (N Am J Med Sci. 2015 Jul;7(7):310-6).
- (Eur J Obstet Gynecol Reprod Biol. May 2013;168(1):60-63, Diabetes Care. 2003;26:3215-3218., Gynecological Endrocrinology 2014; 30(3): 205-208, European Journal of Obstetrics and Gynecology and Reproductive Biology. 2011;159:127-131