What is PCOS? What PCOS Is and Isn't ▪ PCOS is also known as Stein-Leventhal Syndrome or Polycystic Ovary Disease (PCOD). ▪ Affects an estimated 6-10% of all women and most don't even know they have it. ▪ Is treatable, but not curable, by medications, changes in diet and exercise. ▪ Is one of the leading causes of infertility in women. ▪ Has been identified for 75 years and they still aren't sure what causes it. ▪ Affects far more than just reproduction. ▪ IT IS NOT just a cosmetic problem. Can include the following symptoms: ▪ Irregular or absent menses ▪ Numerous cysts on the ovaries in many, but not all, cases ▪ High blood pressure ▪ Acne ▪ Elevated insulin levels, Insulin Resistance, or Diabetes ▪ Infertility ▪ Excess hair on the face and body ▪ Thinning of the scalp hair (alopecia) ▪ Weight Problems or obesity that is centered around your mid section What a Polycystic Ovary looks like: The many cysts in a polycystic ovary are follicles that have matured but, due to abnormal hormone levels, were never released. In a normal ovary, a single egg develops and is released each month. (Source: http://onhealth.com). I think I may have PCOS. What do I do? One of the most important issues is determining whether you have PCOS. There are other endocrine disorders that are similar to PCOS, and it is important that you work with your doctor to determine if you have PCOS, or something else. You can take our short quiz to help you determine how likely you are to have PCOS. Insulin-sensitizing Medications Aid Polycystic Ovary Syndrome, Even Without Insulin Resistance, Obesity: Presented at ENDO By Paula Moyer Special to DG News SAN FRANCISCO, CA -- June 20, 2002 -- Treatment with insulin-sensitizing medications such as metformin (Glucophage®) promotes ovulation and reduces testosterone levels in women with polycystic ovary syndrome (PCOS), even if they are relatively lean and insulin-responsive. These findings, reported at ENDO 2002, the 84th Annual Meeting of the Endocrine Society, indicate that physicians may want to use insulin-sensitizing therapy in all women with PCOS, rather than relying on clinical assessments of insulin sensitivity, according to the investigators. "Even if a woman with PCOS doesn't have obesity or other symptoms that would lead the physician to suspect insulin resistance, insulin-sensitizing drugs are effective," lead investigator Jean-Patrice Baillargeon, MD, said. "It was a surprising outcome to see that relatively lean women will have lower insulin levels, begin to ovulate, and have lower testosterone levels." Dr. Baillargeon is a clinical research fellow in endocrinology at Virginia Commonwealth University in Richmond, Virginia, United States and collaborated in his research with John Nestler, professor of medicine at Virginia Commonwealth University. Dr. Baillargeon is currently on leave from his position as a professor of medicine at the University of Sherbrooke in Sherbrooke, Quebec, Canada. In this study sponsored by the National Institutes of Health, Dr. Baillargeon and colleagues randomly assigned 100 women with PCOS who were neither overweight nor hypertensive to receive metformin, rosiglitazone (Avandia®), combination therapy, or placebo. The doses for the insulin sensitizers were 850 mg twice daily for metformin and 4 mg twice daily for rosiglitazone. Every six months, the investigations assessed the women with respect to number of ovulations during the observation period, any changes in systolic blood pressure, and changes in free testosterone. The average body mass index (BMI) for the women was 24.5, which is considered to be within normal weight. The metformin monotherapy group had a mean of 3.3 ovulations during this period, compared to 2.4 for the rosiglitazone monotherapy group and 3.4 for the combination group. The placebo arm had a mean of 0.4 ovulations during the study period (p<0.0001). The metformin group had a mean reduction of 4.3 mm Hg in systolic blood pressure, compared to 2.6 mm Hg for the rosiglitazone group, 4.5 mm Hg for the combination group, and 1.0 mm Hg for the placebo group (p=0.012). Free testosterone levels dropped 12.8 pmol/L in the metformin group, 12.3 pmol/L in the rosiglitazone group, 21.9 pmol/L in the combination group, and 1.2 pmol/L in the placebo group (p=0.0001). "If using an insulin sensitizer, rosiglitazone alone will not produce sufficient change in PCOS symptoms," Dr. Baillergeon said. "Either metformin monotherapy or combination therapy should be used." Title: Polycystic Ovaries Can Lead To Coronary Artery Calcification, Says University Of Pittsburgh "Polycystic Ovaries Can Lead To Coronary Artery Calcification, Says University Of Pittsburgh" HONOLULU, HI -- April 29, 2002 -- Women with polycystic ovary syndrome (PCOS) are at risk for premature calcification in their coronary arteries - an early indication of cardiovascular disease - according to Evelyn O. Talbott, Dr.P.H., professor of epidemiology at the University of Pittsburgh Graduate School of Public Health. However, controlling weight and insulin sensitivity may reduce the risk. PCOS, characterized by menstrual irregularities, chronic anovulation, excess hair growth and infertility, is a common reproductive endocrine disorder affecting five percent of the female population. Women with PCOS also experience several metabolic abnormalities, including insulin resistance, increased circulating insulin levels, abnormal blood lipid levels and increased central obesity ("apple body shape"). Until recently, PCOS was not recognized as a single, multi-dimensional disorder. Women suffering from it were instead treated for individual symptoms, particularly irregular menstrual periods and infertility. "Preliminary results from our study suggest an association between the metabolic abnormalities experienced by women with PCOS, collectively termed metabolic Syndrome X or metabolic cardiovascular syndrome, and premature atherosclerosis in the coronary arteries," said Dr. Talbott. Coronary calcium deposits are an indicator of early, subclinical cardiovascular disease. In the study, researchers used electron beam computed tomography (EBCT) to scan coronary arteries of 41 women with PCOS, and 43 controls. Their average age was 47. Scans showed an increased prevalence of coronary artery calcification among women with PCOS, with 65.9 percent of women with PCOS showing coronary calcium deposits, compared with 34.9 percent of women in the control group. The excess calcification among women with PCOS was shown to be related to increased circulating insulin concentrations, low HDL cholesterol levels (the "good" cholesterol) and increased waist circumference. These results suggest to Dr. Talbott that women with PCOS may be able to reduce their risk of coronary artery disease by addressing specific components of the metabolic cardiovascular syndrome. "These results highlight the need to reduce central obesity and improve insulin sensitivity in young women with PCOS. Dietary intervention and exercise in the teens and 20s, coupled with the use of insulin-sensitizing agents in select individuals, may help to prevent adverse cardiovascular outcomes, such as angina and heart attack, in later life," said Dr. Talbott. On July 9, 2002 the National Institute of Health (NIH) aborted the most thorough study ever conducted on hormone replacement therapy (HRT). This startling event was front- page news for several days and has caused a firestorm of controversy and confusion. Many of you are wondering if this development is relevant to you. In this issue, we'll talk about hormones and the study that was cancelled. WHAT DO HORMONES DO? WHAT ARE THEIR SIDE EFFECTS? Hormones are essentially chemical messengers that tell your cells what to do. Most hormones are created in various glands and tissues in your body and are carried in your bloodstream. Once a hormone gets into your bloodstream, it will encounter a cell or an enzyme. CELL RECEPTORS. When a hormone encounters a target cell, a specific interaction occurs. The desired interaction depends on the presence of a receptor site on the cell wall, and a corresponding, unique shape of the hormone. The interaction is similar to a lock- and-key relationship. If the hormone "key" fits the cell receptor "lock", the hormone delivers its message to the cell and the cell carries out the instruction given to it by the hormone. However, dietary deficiencies or high demands for nutrients caused by chronic stress can prevent the cell from creating a proper receptor site. The hormone can arrive at the cell, but no receptor doorway appears. Even if you have enough hormones, they may not communicate properly with your cells if you have a poor diet and are under chronic stress. Some chemical compounds, either natural or synthetic, can fit into a cell receptor designed for a hormone - just like the wrong key can sometimes fit into a lock. When a compound is similar in shape to a certain hormone, it may be able to lock into the cell receptor for that hormone. But since it has a slightly different structure than the hormone, it will deliver a different instruction to your cell and your cell will function in a different way. Or a compound may simply occupy the receptor, thus preventing the ideal hormone from locking into that receptor. Whether the chemical is good, bad or neutral depends on the specific compound. The problem is that there are tens of thousands of chemical compounds in our foods and water, in our environment, and in pharmaceuticals that may compete for the same cell hormone receptor sites. Each of these may deliver a message to your cells that is different from your own hormone, or they may prevent your hormone from docking into the cell. ENZYMES. Another thing that can happen with a hormone circulating in your bloodstream is that it may encounter an enzyme. There are many hundreds of different enzymes in your body, each having a specialized function. An enzyme is something that causes a chemical reaction to occur. When an enzyme and hormone meet, another lock-and-key situation occurs. If the hormone-key fits into the enzyme-lock, the enzyme changes (metabolizes) the hormone into something else. The hormone may be changed into a slightly different hormone, or converted into a substance that is to be excreted from the body. Keep in mind that hormones need to be broken down and excreted. If not, they can build up and eventually cause serious health problems. Enzymatic action is a crucial part of the removal process. Nutritional deficiencies may prevent you from forming the enzymes necessary for properly managing your hormones. The enzyme picture is also clouded by the introduction of numerous environmental chemicals and pharmaceuticals into your body. One example of many is ethinyl estradial, a synthetic estrogen derivative found in most birth control pills. It is structurally similar to but different from the estrogens you produce inside your body. It is able to compete for estrogen receptor sites on cells in your body and thus exert an estrogen-like effect. However, your body has never seen ethinyl estradiol before. You were not born with enzymes to optimally metabolize this chemical. When you have a foreign, synthetic chemical floating around in your body, there's a risk it may not be metabolized in an optimal way. The result is that your body becomes hormonally and metabolically unbalanced. You would then probably experience "side effects" or potential long-term adverse health consequences. BOTTOM LINE: Many pharmaceutical products, including hormone derivatives, offer relief of symptoms, which is an obvious benefit. However, unintended, unforeseen and undesirable long- term metabolic consequences can occur because your body is not optimally equipped to handle these foreign compounds. HORMONE REPLACEMENT BOMBSHELL - SHOULD YOU BE CONCERNED? In mid-July, the NIH prematurely ended a large HRT study. The study, called the Women's Health Initiative (WHI), was initiated in 1993 and scheduled to conclude in 2005. It is the first and only large study to compare the effects of hormone replacement therapy vs. placebos in 16,000 healthy women. After reviewing the data collected thus far, the researchers realized that the women who had been on HRT longer than five years developed a small but significant increase in invasive breast cancer, heart attacks, strokes and blood clots as compared to the women on placebo. Therefore they stopped the study because, on balance, the HRT was not benefiting the long-term health of the study participants, even though it relieved menopausal symptoms in many cases. The results of this study have relevance for women with PCOS because many are taking birth control pills on a long-term basis, in an effort to have regular monthly cycles of bleeding. Birth control pills are a form of HRT. Birth control pills are similar to the medication (Prempro) used in the WHI study in that they both contain an estrogen derivative and a progesterone derivative. Although the two products are certainly not identical, they have similarities. Even though the WHI was studying menopausal women on HRT, all women who are on long-term HRT should take notice. Until there is a similar long-term study of large numbers of younger women taking the compounds found in birth control pills, and comparing them to matched controls taking a placebo, one should carefully assess the risks and benefits of any hormone treatment. And, consider other therapies that may achieve similar results. WOMEN'S HEALTH INITIATIVE STUDY: WHAT WENT WRONG? Apparently the problem was Prempro, the medication used in the WHI study. It's commonly prescribed for the relief of menopausal symptoms, and for prevention of osteoporosis and heart disease in women. Of course, you're probably not taking Prempro or a similar product for these problems. But read on and to see how Prempro may be relevant to you. Prempro is a combination of conjugated estrogens (Premarin) and medroxyprogesterone (Provera). PREMARIN. Premarin is a combination of human and horse estrogens. "Estrogen" is a term used to describe a family of three related hormones found in your body: estriol, estrone, and estradiol. Premarin is predominantly estrone and a smaller amount of estradiol. It has no estriol. Premarin also contains a horse estrogen called equilin. This horse estrogen is extracted from the urine of pregnant mares. Horse estrogen does not naturally exist in the human body, although it has a powerful estrogen-like effect. Therefore a woman might raise two questions about Premarin. First, why is estriol not included? Estriol is one of three essential estrogens in the human body. Medical studies indicate estriol reduces symptoms of menopause, and may have a cancer- preventive effect as well as other health benefits. With Premarin, you end up receiving an unbalanced ratio of estrogens. Second, what are the consequences of introducing a horse estrogen into your body? Horse estrogens are structurally different from human estrogens; your body is not able to metabolize a horse estrogen the same way a horse does. Therefore, metabolic problems, i.e., "side effects", are the probable result. PROVERA. The other drug found in Prempro is Provera, which is a synthetic progestin called medroxyprogesterone acetate. A progestin is a synthetic substitute that is similar to, but structurally different from progesterone Medroxyprogesterone acetate was created in the lab and, like horse estrogen, does not naturally occur in your body. Progesterone is the sex hormone that naturally occurs in your body. Provera is not progesterone. A progestin is not progesterone. When you take Provera, you are not getting progesterone; you are taking an artificial compound that is foreign to your body. So it's not surprising that Provera has become associated with health risks. Progestins are associated with side effects so unpleasant that some women simply quit taking their prescriptions. On the other hand, progesterone, taken appropriately, has an excellent compliance record, in large part because of the minimal side effects. Another question a woman might ask is this: Why should I take a synthetic, artificial substance like medroxyprogesterone? Why not take progesterone itself? We'll answer these questions later in this article. BOTTOM LINE: First of all, Prempro has a number of possible side effects, including headaches, irritability, restlessness, mood changes, nausea, increase in uterine fibroids, changes in vaginal bleeding, weight changes, changes in sleep patterns, fatigue, upset stomach, bloating, acne, breast tenderness, and changes in sex drive. Secondly, according to the WHI study, a woman is ultimately better off taking a placebo than Prempro hence the reason why they ended the study. So what, then, is the compelling reason to take Prempro or similar products on a long-term basis? BIRTH CONTROL PILLS AND PCOS Now let's turn our attention to the birth control pills you may be taking. Prior to menopause, most women naturally produce estrogen and progesterone in a rhythmic fashion in order to regulate ovulation and menstruation. In women with PCOS, this natural hormonal rhythm is disturbed. Birth control pills are commonly prescribed in an attempt to restore this rhythm because they contain a combination of drugs that have estrogen-like and progesterone-like activity. The Pill causes a monthly bleed in most women, which seems like a "normal" period. Although the shedding of the lining of the uterus is an important health benefit of birth control pills, many women do not actually ovulate while taking them, and therefore are not experiencing all of the complex hormonal interactions that occur with a natural cycle. Continuation of this activity on a long-term basis could have unintended consequences. Let's take a look at the estrogen part of the Pill. Nearly all birth control pills contain a synthetic estrogen called ethinyl estradiol, which is structurally different from any of the estrogens you have in your body (estrone, estradiol, and estriol). However, because it's a foreign molecule to your body, ethinyl estradiol is not metabolized in your liver the same way as your own estrogens are. Therefore, ethinyl estradiol remains longer in your body and has more time to exert its estrogen-like effects. The long-term health effects of consuming ethinyl estradiol are open to question. But it does appear to have a more potent effect than your own estrogens. While ethinyl estradiol is in nearly every birth control pill, the progestin part of the pill is different in most cases. Why do birth control pills have so many different types of progestins? The reason you are likely to hear is that one type produces better results than another. However, it is more likely that the various brands use different progestins to differentiate their products. There are many pros and cons of the various progestins, in fact, too many to completely cover it in this article. Our main point is that they are all synthetic derivatives of progesterone. Progesterone is a sex hormone your body produces. Progestins are not progesterone. BOTTOM LINE: Synthetic hormone derivatives do not work the same in your body as your own hormones do because they are structurally and biochemically different from your own hormones. Long-term consumption of synthetic derivatives can result in negative health consequences. NATURAL VS. SYNTHETIC HORMONES There's a lot of talk - and confusion - about "natural" vs. "synthetic" hormones. We don't use this classification because it doesn't clarify the important issue. Instead, we place all hormones into two basic categories: "native" and "foreign". NATIVE HORMONES. A native hormone is a hormone that your body produces, i.e., it is "native" to your body. However, a number of native hormones can be created in the laboratory. They are structurally and biochemically IDENTICAL to the hormone you produce in your body. For example, progesterone can be developed in a laboratory, as well as in your body. The laboratory version is identical to the one in your body and when you take the laboratory progesterone, it behaves exactly the same as your own progesterone. FOREIGN HORMONES. A foreign hormone is a chemical compound that is not naturally found in your body. Foreign hormones are structurally and biochemically distinct from the native hormones that they seek to imitate. A foreign hormone can be either natural or synthetic. For example, equilin is natural horse estrogen that many women take. An example of a synthetic hormone is ethinyl estradial, found in most birth control pills. Whether natural or synthetic, they are foreign hormones because they are not the same as your own hormones. NATIVE VS. FOREIGN. So which hormone should you take - a native hormone or a foreign one? Many would suggest that taking a native hormone is healthier for you than taking a foreign hormone. But as a practical matter, your medical doctor will probably steer you in the direction of foreign hormones. This usually occurs for several reasons -- there have been no large scale studies done on native hormone therapy because these studies are expensive and are usually funded by pharmaceutical companies and most physicians do not study native hormone therapy in medical school. WHAT ARE YOUR HORMONE REPLACEMENT OPTIONS? Before discussing options, we want to make one thing clear: we are NOT recommending that you abandon your current hormone therapy, whatever it may be. Your current therapy MAY be the best option for you. We DO recommend that you educate yourself and consider all of the available options. There's no "right" or "wrong" answer to HRT. There is only the "best" answer for you, according to your unique health needs and goals. Here are some options to consider: 1. Consult with a physician who is knowledgeable about "native" hormone therapy. If you're unsatisfied with your physician's insistence on using conventional hormone replacement therapy with foreign hormones, you may want to get a second opinion. We suggest you find a naturopathic physician, a holistic-oriented medical doctor, or an osteopathic physician. They are the most likely to be knowledgeable about native hormone therapies. You can visit these websites for directories of doctors in your area. Naturopathic physicians Medical doctors - members of the American College for Advancement of Medicine Osteopathic physicians 2. Use native hormones. Hormone therapy using native hormones such as progesterone, estriol, estradiol and estrone allows the physician to customize hormone therapy according to your specific lab results and medical condition. There is no "one size fits all" approach. Your prescription can be filled by a compounding pharmacy that will create a customized medication just for you. There are about 1,500 compounding pharmacies scattered around the country. WARNING: It is foolish and risky for you to experiment on your own with progesterone creams. Progesterone is a powerful hormone and we urge you consult with a knowledgeable physician first about its proper use. Progesterone from creams is starting to show up in abnormally high levels in women's diagnostic lab assessments. It can take months to clear this excess progesterone out of the body. Read labels of all cosmetic creams. Some contain progesterone and you may be exposed without knowing it. 3. Improve your diet. Diet profoundly affects your hormonal balance. One striking example is Japanese women who consume a traditional diet. These women seldom experience unpleasant menopausal symptoms. In fact, hot flushes are so rare in Japan that there is not even a word in the Japanese language to describe them. Plus, Japanese women have a much lower rate of breast cancer. There are dozens of ways that food can help you maintain healthy hormonal balance throughout your life. 4. Modify your lifestyle and environment. How you behave can reduce hormonal problems. Regular exercise, stress management, low alcohol consumption, and smoking cessation all help to normalize your hormones. There are numerous estrogen mimics or hormone disrupting chemicals in your environment, which can disturb your hormonal balance. It's to your advantage to reduce your exposure to chemicals such as herbicides, pesticides, solvents and artificial food additives. 5. Consider special herbs and supplements. There are vitamins, minerals and herbs that can help you to better manage your hormones. Some of them also tonify and nourish your reproductive and glandular systems. A licensed naturopathic physician can be a good source of information on the safe and effective use of herbal medicines and nutritional supplements. CAUTION: Some herbs and specialty nutrients will influence your hormonal balance, which may necessitate a review or modification of your hormonal medication by a knowledgeable physician. Also be aware that there is significant variability in the quality of any particular nutrient. Therefore selection of a trustworthy brand is an important factor. 6. Make sure your liver is healthy. One of the primary functions of your liver is to metabolize or detoxify hormones and other substances that accumulate in your body, and to prepare them for removal. This function is important for maintaining proper hormonal balance; if your liver did not do this job, hormones would simply build up in your body until they became toxic, creating serious symptoms. What is polycystic ovary syndrome (PCOS)? Polycystic (pah-lee-SIS-tik) ovary syndrome (PCOS) is a health problem that can affect a woman's menstrual cycle, ability to have children, hormones, heart, blood vessels, and appearance. With PCOS, women typically have: • high levels of androgens (AN-druh-junz). These are sometimes called male hormones, although females also make them. • missed or irregular periods • many small cysts (sists) in their ovaries. Cysts are fluid-filled sacs. How many women have polycystic ovary syndrome (PCOS)? About one in ten women of childbearing age has PCOS. It can occur in girls as young as 11 years old. PCOS is the most common cause of female infertility (not being able to get pregnant). What causes polycystic ovary syndrome (PCOS)? The cause of PCOS is unknown. Most researchers think that more than one factor could play a role in developing PCOS. Genes are thought to be one factor. Women with PCOS tend to have a mother or sister with PCOS. Researchers also think insulin could be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. For many women with PCOS, their bodies have problems using insulin so that too much insulin is in the body. Excess insulin appears to increase production of androgen. This hormone is made in fat cells, the ovaries, and the adrenal gland. Levels of androgen that are higher than normal can lead to acne, excessive hair growth, weight gain, and problems with ovulation. Does polycystic ovary syndrome (PCOS) run in families? Most researchers think that PCOS runs in families. Women with PCOS tend to have a mother or sister with PCOS. Still, there is no proof that PCOS is inherited. What are the symptoms of polycystic ovary syndrome (PCOS)? Not all women with PCOS share the same symptoms. These are some of the symptoms of PCOS: • infrequent menstrual periods, no menstrual periods, and/or irregular bleeding • infertility (not able to get pregnant) because of not ovulating • increased hair growth on the face, chest, stomach, back, thumbs, or toes— a condition called hirsutism (HER-suh-tiz-um) • ovarian cysts • acne, oily skin, or dandruff • weight gain or obesity, usually carrying extra weight around the waist • insulin resistance or type 2 diabetes • high cholesterol • high blood pressure • male-pattern baldness or thinning hair • patches of thickened and dark brown or black skin on the neck, arms, breasts, or thighs • skin tags, or tiny excess flaps of skin in the armpits or neck area • pelvic pain • anxiety or depression due to appearance and/or infertility • sleep apnea—excessive snoring and times when breathing stops while asleep What is PCOS? Understanding PCOS is easier if one tries to picture what goes on inside our ovaries every month. (For more on monthly cycles, please refer to our articles on menstruation, where you will also find links to information on irregular periods.) Each month our ovaries begin to ripen a number of follicles. You may be surprised to hear that normal follicles are cysts, in that they are pockets of tissue filled with benign fluid and hormones, mostly estrogen. The amount of immature follicles changes with each cycle — but during normal times, one or two follicles grow stronger than the others and produce an egg. When we ovulate, the egg in the dominant follicle pops out and flows into the fallopian tube on its way to the uterus. This event is caused by and in turn triggers a host of hormonal secretions, including estrogen and progesterone, which work together to prepare the body to support a pregnancy if the egg is fertilized or a normal monthly period if it is not. In PCOS, the egg is not released due to a series of alterations that take place not only in the ovaries, but in the normal hormonal pathways upstream of the ovaries as well. There is no one set scenario for how these alterations take place, and there are lots of theories and various subtypes of PCOS being proposed, but the end result is the same: no ovulation and no resulting pregnancy or period. Polycystic ovaries When ovaries become polycystic they create a lot of follicles that form like a pearl necklace on the ovaries. No one follicle becomes dominant and ovulation can’t occur. For the most part, these multiple ovarian cysts are not dangerous in themselves — unlike larger ovarian cysts, which can cause pain and rupture. But they do bring with them a range of uncomfortable side effects. Because a woman with PCOS doesn’t ovulate, her natural sequence of hormonal events gets interrupted, her levels of estrogen and androgens (testosterone and DHEA) remain high, and her body reacts with symptoms. What are the symptoms of PCOS? The most common symptoms of PCOS are irregular or absent periods, infertility, increased hair growth and unusual weight gain, even with dieting or increased exercise. Women with PCOS will often go for months without a period and then start bleeding heavily for days. This occurs when the uterine lining has gotten too thick and the body must naturally shed it. Because PCOS disrupts ovulation it can be very difficult to become pregnant. Other signs of PCOS include acne, high blood pressure, obesity, and abnormal facial and body hair growth (due to too much testosterone). One of the less recognizable symptoms of PCOS is depression, which can be misread as a bipolar illness. While depression stems from many factors, we think it is always a good idea to consider PCOS if patients have other symptoms. In some medical practices antidepressants are prescribed which do not alleviate the underlying issues and therefore are not very helpful. PCOS and insulin resistance Another telltale symptom of PCOS is steady, significant weight gain — even with reduced caloric intake. Some women report that they’re gaining weight no matter what they do. It’s not unusual for patients with PCOS to tell me they’ve recently gained 60 or more pounds in less than a year, despite dieting all the time and exercise. This weight usually accumulates around their middle. Why do women with PCOS gain weight at such alarming rates? The research is showing that PCOS is strongly linked with insulin resistance. Insulin resistance — a condition some people get by eating too many carbohydrates — leads to sustained high levels of insulin in the bloodstream. It is possible that this extra insulin hitches onto the receptors lining the ovary and stimulates cyst production. This is an issue that should be monitored because women with insulin resistance have a much higher risk of developing other serious health problems, like diabetes and heart disease. In fact, if you’re headed down the path to PCOS, what that means is that you’re now getting into the category of metabolic syndrome. This is a category you want to get out of as fast as you can, because with all the damaging inflammatory processes going on with this syndrome there is potential for serious problems down the road. Another interesting consideration for some is that while many people think of PCOS as a condition that only affects women who are overweight, we do from time to time see women who are thin who have insulin resistance and PCOS. Though not often, at our clinic we do see from time to time see thin women with insulin resistance and PCOS. On the bright side, women with insulin resistance and PCOS respond very well to modifications in their diet, adding nutritional support in the form of soy and other functional foods, multivitamins, minerals and omega-3’s, and beginning an exercise program. We’ve found that our patients often get normal periods as their insulin levels normalize. This is something that’s always treatable and easily treatable, which for us as practitioners is very exciting! Should I see a doctor if I think I have PCOS? If any of these symptoms describe what you’ve been feeling, it’s important to see your healthcare practitioner. If I suspect PCOS in a woman I will do a complete evaluation, including checking for insulin resistance. This work-up includes a physical examination, a fasting lipid profile, a glucose test, hormone levels, and an insulin test (before and two hours after a high-carbohydrate meal). A blood sample is very informative for testing elevated thyroid and prolactin levels. If these tests come up positive, I also look for an altered FSH-to-LH ratio and increased levels of androgens. Occasionally I will suggest a pelvic ultrasound. It can be possible to see the pearl-necklace pattern of cysts on some women’s ovaries. If there is any abdominal pain or pressure around the ovaries, an evaluation is certainly necessary. In most cases a woman will be monitored on a regular basis to make sure her cysts are not at risk for rupture. If a patient has been trying to get pregnant for more than a year, I usually refer her to a fertility specialist, especially if she is over the age of 35. Ovulation stimulants, like Clomid, can be helpful for many would-be moms who have PCOS. When a non- menopausal woman skips a period for more than four months, pregnancy should be considered. Having regular menstrual periods is important to prevent osteoporosis and maintain the protective effects of estrogen elsewhere in the body. Occasionally a woman with PCOS will simply not get her period. If she is not pregnant, I advise stimulating a period after four months with the use of micronized progesterone (a bioidentical hormone). Other practitioners will sometimes suggest synthetic progestins such as Provera or Aygestin. This protects the lining of the uterus from becoming too thick or unusual. What is the treatment for polycystic ovarian syndrome? Traditionally, doctors have overlooked PCOS unless it is diagnosed relative to infertility or irregular bleeding. If diagnosed, it was and often still is commonly treated with birth control pills. The Pill lessens the symptoms of PCOS by short-circuiting ovulation and giving the ovaries a rest from follicle production. This is always an option for women looking to avoid pregnancy. Testosterone levels will go down on the Pill, and it is good for regulating cycles but it won’t address the basic issue of insulin resistance. Some doctors are now prescribing a diabetes drug called metformin (Glucophage), for blood sugar control, but in my experience if a woman with PCOS doesn’t attend to some of her lifestyle choices — such as following a low glycemic-load diet — her ovaries become polycystic again when she goes off either type of pill. This is particularly irksome for women trying to get pregnant. At our medical practice, we treat PCOS with a combination approach, whether it is a chronic problem in younger women or a temporary condition of perimenopause. We’ve helped countless women reduce their polycystic ovaries through nutritional supplements, gentle endocrine support, enriched nutrition and regular exercise. This support is available at-home through our Personal Program. Our Nurse-Educators can explain all your options, including phytotherapy to gently reset your progesterone, testosterone, and estrogen pathways; bioidentical progesterone to jumpstart regular monthly periods; extra omega-3’s and functional foods to reduce proinflammatory mediators that arise from extra weight and insulin resistance; and other natural ways to help your body detoxify hormone metabolites and recover balance. This personalized combination approach is an effective way to bring the body back into hormonal balance. If you have PCOS or think you do, I hope that you will take heart in realizing there are many things you can do to alleviate your symptoms naturally, without drugs. Like any condition related to hormone imbalance, taking the right steps to improve your lifestyle and nutrition will do wonders to restore your well-deserved good health. Polycystic Ovarian Syndrome (PCOS), also known as Polycystic Ovarian Disease, is often caused by a hormonal imbalance brought on by Insulin Resistance-related obesity. It's a disorder that affects an estimated 5 to 10 percent of all women, and is one of the leading causes of infertility. The root cause of PCOS is Insulin Resistance. Symptoms of PCOS can vary widely from woman to woman and may include: irregular or completely absent periods, ovarian cysts, Hirsutism (excessive facial or body hair), Alopecia (male pattern hair loss), obesity, acne, skin tags, Acanthosis Nigricans (brown skin patches), high cholesterol levels, exhaustion or lack of mental alertness, decreased sex drive, excess male hormones and infertility. Current studies clearly link PCOS and Insulin Resistance. A report released in the British Journal of Obstetrics and Gynecology in 2000 indicated that up to 40 percent of women with PCOS have either impaired glucose tolerance or Type 2 Diabetes by age 40. In addition, with PCOS, high levels of insulin stimulate the ovaries to produce large amounts of testosterone (a male hormone), which can possibly prevent the ovaries from releasing an egg each month, thus causing infertility. High testosterone levels can also cause excessive hair growth, male pattern baldness and acne. PCOS is one of the most common endocrine (or hormonal) disorders and is characterized by multiple abnormal cysts in the ovaries. Most women who seek medical help for this condition do so because of infertility problems, irregular periods, acne or other skin conditions or unusual hair growth. Researchers have also found a link between PCOS and other metabolic conditions such as high levels of obesity, LDL (the "bad" cholesterol) and high blood pressure. These are all risk factors for coronary heart disease, as well as symptoms of Metabolic Syndrome (also known as Syndrome X, this disorder substantially increases your chances of developing Cardiovascular Disease). These findings substantially raised the bar on the seriousness of the condition and made it even more important that physicians correctly diagnose PCOS and recommend appropriate therapy. Because insulin production of the pancreas is thrown off by the Insulin Resistance, there is an inhibited conversion of food to energy and an increase in the amount of stored fats. When glucose cannot enter the cells efficiently it remains in the blood stream, causing elevated blood sugar - whereupon it is sent to the liver, which converts it to fat and stores it throughout the body. When the body takes in calories, it has a choice of either burning those calories for energy or converting them to fat and storing them. In patients with PCOS, Insulin Resistance encourages the storage of fat and the production of excessive amounts of testosterone. At the present time, there are no cures for PCOS - even removal of the ovaries will not completely eliminate this syndrome. But there are ways to address the underlying issue of Insulin Resistance, although a single approach will simply not work when trying to reverse the effects of this syndrome. A complete system is needed to reverse PCOS. This should include neutraceuticals (vitamins, herbs and minerals that are disease specific) as well as a realistic exercise program, nutritional guidance and a support network that will help you change unhealthy lifestyle choices. Metformin (Glucophage) is a pharmaceutical drug often prescribed for women with PCOS (Polycystic Ovarian Syndrome). It is an insulin-sensitizing biguanide commonly used to treat elevated blood glucose levels in people with Type 2 Diabetes. Metformin is used as an off-label prescription for PCOS. This means that it was originally used only for individuals with Type 2 Diabetes but is now prescribed for PCOS patients because it has similar actions in both groups. Many women with PCOS are insulin resistant. With this condition, the ability of cells to respond to the action of insulin in transporting glucose (sugar) from the blood stream into muscle and tissue is greatly diminished. Metformin improves the cell’s response to insulin, and helps move glucose into the cell. As a result, your body will not be required to make as much insulin (1). PCOS and Metformin Studies PCOS and it’s symptoms of hyperandrogenism (acne, hirsutism, alopecia), reproductive disorders (irregular menses, anovulation, infertility, polycystic ovaries), and metabolic disturbances (weight gain) have been linked to hyperinsulinemia and Insulin Resistance (2). Therefore, it makes sense to address the hyperinsulinemia and Insulin Resistance caused by this condition. Studies have reported the treatment of Metformin to improve hirsutism, induce ovulation and normalize menstrual cycles (1). For example, according to one study, which looked at 39 women with PCOS and hyperinsulinemia (excess insulin in the blood), treatment with Metformin for women with PCOS resulted in a decline of insulin as well as total and free testosterone, leading to significant improvement of clinical manifestations of Hyperandrogenism (the excessive production of androgens in women) and an improvement in menstrual cycles (3). However, studies have also shown weight loss through exercise and changes in diet and lifestyle alone to be as effective in regulating menstrual cycles and showing improvement in hyperandrogenism (4, 5). Metformin – Side Effects Many women prescribed Metformin must discontinue its use due to the gastrointestinal side effects. The most commonly reported adverse effects include diarrhea, gas and bloating, abdominal discomfort, nausea, and vomiting (1, 6). Insulin Resistance has many factors that contribute to its presence in the body. In essence, our environment and lifestyles have evolved too rapidly for our bodies to keep pace. We are still genetically "wired" to thrive on the entrenched habits of our ancestors who consumed different, nutrient-rich foods, a diet low in carbohydrates and also sustained greater levels of movement and exercise. Some people may also have a genetic predisposition to Insulin Resistance. Others develop Insulin Resistance through unhealthy lifestyles. Over time, the above factors have damaged the complex ability of our bodies' cells to properly utilize insulin to convert glucose to energy. Unhealthy diets cause the pancreas to overproduce insulin that overwhelms the cell which, in turn, protects itself by reducing the number of receptor sites on its surface. This results in devastating effects: • Insulin, which acts like a key in a lock, is less effective in opening up the cell and allowing glucose in to be converted to energy. • Without enough receptor sites, insulin bounces off the cell and enters the blood stream where it causes a variety of conditions including unbalanced hormones such as in PCOS (Polycystic Ovarian Syndrome) and Cardiovascular Disease. • Unable to enter the cell, glucose is converted to fat, leading to weight gain which can result in obesity. • Eventually many health-related functions fail and cause numerous serious diseases besides PCOS, such as Metabolic Syndrome (Syndrome X) and Pre-Diabetes leading to Type 2 Diabetes. PCOS AND INSULIN RESISTANCE PCOS (Polycystic Ovarian Syndrome) is a hormonal imbalance linked to the way the body processes insulin after it has been produced by the pancreas to regulate blood sugar (glucose). The underlying cause of PCOS, Insulin Resistance, has many factors that contribute to its presence in the body. In essence, our environment and lifestyles have evolved too rapidly for our bodies to keep pace. We are still genetically “wired” to thrive on the entrenched habits of our ancestors, who consumed different, nutrient-rich foods, a diet low in carbohydrates and who sustained greater levels of movement and exercise. Some people may also have a genetic predisposition to Insulin Resistance, while others develop the condition through high stress and unhealthy lifestyles. INSULIN RESISTANCE NEGATIVELY AFFECTS GLUCOSE AND INSULIN LEVELS Over time, the above factors have damaged the complex ability of the body’s cells to properly utilize insulin to convert glucose to energy. This process creates Insulin Resistance, which causes PCOS in two distinct ways. First, Insulin Resistance vastly reduces the number of insulin receptor sites or doorways on the walls of your cells. The average healthy person has some 20,000 receptor sites per cell, while the average overweight individual with PCOS can have as few as 5,000. If you have too few receptor sites, glucose bounces off the cell wall, instead of passing through the insulin door to be burned as energy. With the cell door almost closed to it, glucose remains in the blood stream, causing elevated levels of blood sugar, which are sent to the liver. Once there, the sugar is converted into fat and stored via the blood stream throughout the body. This process can lead to weight gain and obesity, key factors in creating PCOS. The second way that Insulin Resistance causes PCOS is by raising insulin levels in the blood stream. Unhealthy lifestyles and genetic conditions cause the pancreas to overproduce insulin. The cell is, in turn, overwhelmed by this excess insulin and protects itself by reducing the number of its insulin receptor sites. This process leaves too few sites for insulin to carry out its normal function, which is to attach itself to the cell wall and act as a key in a lock allowing glucose to pass through the cell wall and be converted into energy. The vastly-reduced number of receptor sites in Insulin Resistant people causes an excess of insulin “rejected” by the cell to free-float in the blood stream, creating unbalanced hormone levels in PCOS sufferers. Excess insulin stimulates the ovaries to produce large amounts of the male hormone testosterone, which may prevent the ovaries from releasing an egg each month, thus causing infertility. High levels of insulin also increase the conversion of androgens (male hormones) to estrogens (female hormones), upsetting a delicate balance between the two and having a direct effect on weight gain and the formation of cystic follicles or cysts in the ovary.