Polycystic Ovary Syndrome (PCOS)

So, what is PCOS?

PCOS is the most common endocrine-metabolic disorder in premenopausal women, with a prevalence of between 5% and 15% (Rosenfield and Ehrmann, 2016). The cause is unknown however it tends to result in ovarian dysfunction that is influenced by external factors, such as hormonal disturbances and excess levels of insulin circulating in the blood (Balen, 2004 abstract).

In a standard cycle, several follicles will develop on the ovary surface, a single egg maturing in one of these at a more rapid pace than the eggs contained in the other follicles. This egg is released and the remaining follicles transpire. A woman with PCOS will have a number of underdeveloped follicles remaining on the ovary surface which have stopped developing (Glenville, 2010).

Excess levels of hormones such as androgens (male hormones) and luteinizing hormone (stimulates the release of an egg) is arguably the defining feature of PCOS (Rotstein, 2018). This causes symptoms such as excess hair, acne and lack of ovulation (Diamanti-Kandarakis and Farid, 2009). Rotstein (2018) states that 50-70% of women with PCOS exhibit metabolic abnormalities, including poor glucose tolerance and hyperinsulinaemia i.e. an over production of insulin to control blood sugar levels. Obesity and hormonal abnormalities exacerbate the level of insulin resistance (IR) which is evidenced by the fact that women with PCOS show a higher level of IR than those with the same BMI who do not have PCOS (Rotstein, 2018).

So, how can I boost my fertility naturally when I have PCOS?

Vitamin D

A deficiency of vitamin D is very common in women with PCOS, particularly in those with obesity (Conway et al. 2014). Vitamin D levels can be increased through sun exposure and foods rich in vitamin D include egg yolk, cheese, fish or foods fortified with vitamin D. I would recommend taking a vitamin D supplement (particularly during winter when sun exposure is lower) or multi vitamin supplement containing vitamin D daily. One of my personal favourites is Terranova who do a full spectrum multi as well as one specifically for women. 

Healthy Gut

Overwhelming evidence advocates the link between diet, gut microbiome and PCOS. Studies suggest that disturbances in bowel bacterial flora i.e. gut dysbiosis, brought about by a poor diet creates an increase in gut permeability (Tremellen and Pearce, 2012). This activates the immune system which interferes with insulin receptor function, increasing insulin levels in the blood and up regulating the production of androgens in the ovaries which affects follicular development (Tremellen and Pearce, 2012).

Help to increase gut microbiome diversity through daily probiotic intake or fermented foods such a kefir, tempeh, kombucha or miso.

It is also important to regulate blood sugar levels through a well balanced diet rich in fruit, vegetables, wholegrains and fibre. Aim for at least 5 portions of fruit and vegetables a day with emphasis on a rainbow of colours in order to consume a full spectrum of nutrients. Avoid refined carbohydrates and instead consume complex carbohydrates such as sweet potato, wholegrains and beans.

Environmental Toxins

Correlations have also been drawn between environmental toxins triggering and driving hormonal disruption. For example, evidence suggests that higher levels of BPA exposure can lead to elevated androgen levels, which can then lead to impaired metabolism of BPA (Merkin et al. 2016). Therefore, steps should be taken to minimise exposure to such chemicals. Avoid BPA contaminated products as well as processed foods with additives as these may disturb hormonal balance in the body. It is advisable to buy organic produce where possible in order to minimise toxin consumption in the form of pesticides and other harmful chemicals used to treat food.

Stress

Regarding stress reduction to stabilise hormonal imbalances, studies have incorporated the use of acupuncture and low-frequency electroacupuncture (EA) in the treatment of hyperandrogenism and menstrual frequency (Mahalingaiah and Diamanti-Kandarakis, 2015). A randomised controlled trial of 84 women with PCOS incorporating a 16-week programme of EA had a 25% decrease in serum testosterone as well as an increase in menstrual frequency from 0.28 per month at baseline to 0.69 per month (Mahalingaiah and Diamanti-Kandarakis, 2015). 

Exercise 

Other studies, comparing the impact of exercise between overweight women with and without PCOS, have supported the hypothesis that exercise training improves insulin resistance in women with PCOS (Mahalingaiah and Diamanti-Kandarakis, 2015). For patients who are overweight exercise is imperative in order to balance hormones and improve insulin sensitivity. It is advisable to aim for at least 30 minutes of exercise a day, which could incorporate brisk walking, swimming or any other form of exercise that gets the heart rate up and aids weight loss.

What functional tests are available to determine a suitable protocol?

Functional testing might incorporate various gastrointestinal tests, such as stool testing or SIBO breath testing, to establish whether this is a driver/mediator and the best protocol to adopt.

Tests including heavy metal testing and non-heavy metal toxic burden testing can also help determine the toxins present from plastics or other chemicals in the body and may be adopted to assess the level of potency of these endocrine disruptors and thus develop an appropriate protocol.

References

Arentz, S., Abbott, J., Smith, C. and Bensoussan, A. (2014). ‘Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings’, BMC Complementary and Alternative Medicine, 14(1) [online]. Available at: https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-14-511 (Accessed 20 September 2018). 

Balen, A. (2004). ‘The pathophysiology of polycystic ovary syndrome: trying to understand PCOS and its endocrinology’, Best Practice & Research Clinical Obstetrics & Gynaecology, 18(5), pp.685-706 [online]. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15380141 (Accessed: 14 September 2018). 

Conway, G., Dewailly, D., Diamanti-Kandarakis, E., Escobar-Morreale, H., Franks, S., Gambineri, A., Kelestimur, F., Macut, D., Micic, D., Pasquali, R., Pfeifer, M., Pignatelli, D., Pugeat, M. and Yildiz, B. (2014). ‘The polycystic ovary syndrome: a position statement from the European Society of Endocrinology’, European Journal of Endocrinology, 71(4), pp.1-29 [online]. Available at: https://www.ese-hormones.org/media/1112/conway_etalreviewpcos.pdf (Accessed: 18 September 2018).

Diamanti-Kandarakis, E. and Farid, N. (2009). Diagnosis and management of Polycystic ovary syndrome. New York: Springer, pp.105-110.

Escobar-Morreale, H. (2018). ‘Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment’, Nature Reviews Endocrinology, 14(5), pp.270-284 [online]. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29569621 (Accessed: 8 September 2018). 

Glenville, M. (2010). The natural health bible for women. London: Duncan Baird.

Glenville, M. (2001). The natural health handbook for women. London: Piatkus, pp.27-45.

Glenville, M. (2012). Natural solutions to PCOS. London: Macmillan.

Mahalingaiah, S. and Diamanti-Kandarakis, E. (2015). ‘Targets to treat metabolic syndrome in polycystic ovary syndrome’. Expert Opinion on Therapeutic Targets, 19(11), pp.1561-1574 [online]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4883581/ (Accessed: 20 September 2018). 

Merkin, S., Phy, J., Sites, C. and Yang, D. (2016). ‘Environmental determinants of polycystic ovary syndrome’, Fertility and Sterility, 106(1), pp.16-24 [online]. Available at: https://www.fertstert.org/article/S0015-0282(16)61278-5/fulltext (Accessed: 20 September 2018). 

Rosenfield, R. and Ehrmann, D. (2016). ‘The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited’, Endocrine Reviews, 37 (5), pp.467-520.

Rotstein, A. (2018). Polycystic ovarian syndrome (PCOS). [Online]. Available at: http://www.pathophys.org/pcos/#Pathogenesis_and_risk_factors (Accessed: 18 September 2018). 

Rutkowska, A. and Diamanti-Kandarakis, E. (2016). ‘Polycystic ovary syndrome and environmental toxins’, Fertility and Sterility, 106(4), pp.948-958.

Tremellen, K. and Pearce, K. (2012). ‘Dysbiosis of Gut Microbiota (DOGMA) – A novel theory for the development of Polycystic Ovarian Syndrome’, Medical Hypotheses, 79(1), pp.104-112 [online]. Available at: https://www.sciencedirect.com/science/article/pii/S0306987712001703 (Accessed: 17 September 2018).

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joanna@joannaholdennutrition.co.uk

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