Polycystic Ovary Syndrome (PCOS) – Herbal Treatment
December 29, 2012 2 Comments
by Savvas Ioannides N.D.
Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and is now recognized as a complex endocrine disorder with multiple possible etiologies and clinical manifestations. It is defined as hyperandrogenism (increased male hormones) and chronic anovulation (luck of ovulation) in cases in which secondary causes of these signs have been excluded.
PCOS Symptom Presentation
- Anovulatory Infertility
- Obesity and weight gain
- Insulin resistance is uniquely associated with PCOS. In obese women with PCOS, 30-40% of these have impaired glucose tolerance or diabetes. Weight gain especially around the trunk (apple body shape or android body shape) especially after the age of 30 indicates insulin resistance or diabetes
- Acanthosis nigricans
- Irregular menses and amenorrhea
- Dysfunctional uterine bleeding
- Alopecia (hair loss)
- Hirsutism &/or virilization
- Mood changes such as irritability and depression
- Fatigue possibly due to dysglycaemia (insulin resistance)
- Family history of non-insulin dependent diabetes mellitus.
- The diagnosis is suspected if women have at least 2 typical symptoms (mild obesity, hirsutism, and irregular menses or amenorrhea)
- Elevated LH levels and low FSH is classical PCOS hormonal profile
- Unopposed oestrogen due to the lack of ovulation and the reduced production of corpus luteum allowing endometrial overgrowth that increases the risk of endometrial cancer
- Oestrogen stimulates the release of LH, however since ovulation does not occur, LH levels remain high. High LH adversely affects the egg quality and can lead to increased miscarriage rates
- There is an increased risk of cardiovascular disease and many women with PCOS have abnormal lipid levels
- Decreased sex hormone-binding glubulin (SHBG)
|Blood tests||Lipid and lipoprotein studies – cholesterol, LDL, HDL, triglycerides.|
|Hormonal tests||Including oestrogen, progesterone, free testosterone levels, dehydroepiandrosterone sulfate level (DHEAS), prolactin levels, and (SHBG).|
|Fasting glucose, glucose tolerance test and insulin levels||Insulin sensitivity is associated with PCOS. Approximately 10% of women with PCOS have type 2 diabetes mellitus, and 30-40% of women with PCOS have impaired glucose tolerance by the age of 40 years.|
|Ultrasonography||A transvaginal ultrasound imaging (sonogram) or a pelvic ultrasound may be done to demonstrate the presence of polycystic ovaries and other abnormalities. Diagnosis is confirmed by ultrasonography showing > 10 follicles per ovary; follicles usually occur in the periphery and resemble a string of pearls.|
- Decrease body weight. The aim is to achieve a BMI of 21-22.
- Decrease insulin resistance and incorporate a low glycaemic diet
- Re-establish ovulation and reduce endometrial hyperplasia
- Prevent/reduce musculinizing effects
- Increase exercise
- Decrease triglyceride and LDL cholesterol and increase HDL cholesterol in blood
- Improve hepatic function
- Reduce stress levels
- Implement a preconception care protocol
Herbal treatment will focus on balancing hormonal levels, hepatic clearance of oestrogen, female reproductive toning, adaptogens, weight loss and anti-diabetic herbs.
|Cinnamomum zeylanicum (Cinnamon)||Antibacterial, carminative, enhances insulin sensitivity because MHCP (a water-soluble compound) activates the key enzymes that stimulate insulin receptors, while inhibiting the enzymes that deactivated them|
|Glycyrrhiza glabra (Licorice)||Glycyrrhenetic acid seems to inhibit the enzyme 17β-hydroxysteroid dehydrogenase, which converts androstenedione to testosterone in the ovary. Glycyrrhenetic acid also inhibits 11β-hydroxysteroid dehydrogenase, which results in decreased conversion of cortisol to cortisone and the state of apparent mineralocorticoid excess. In PCOS, elevated 11β-hydroxysteroid dehydrogenase is responsible for androgen excess, possibly via its effect on glucose metabolism.|
|Gymnema sylvestre (Gymnema)||Gymnema is used as an antidiabetic, hypoglycaemic, lipid-lowering agent and to support weight reduction. Gymnema is indicated for PCOS, due to its insulin modulating activity and the added benefits of reducing the elevated triglycerides associated with PCOS.|
|Paeonia lactiflora (Peony)||The active constituent in Paeonia lactiflora is thought to act directly on the ovary to reduce the production of androgens in a dose-dependent manner. It increases the activity or aromatase, which promotes the synthesis of oestradiol from testosterone. Formulas containing Peony may also improve progesterone levels by normalizing ovarian function when the activity of aromatase is inhibited. It has been used to treat hyperprolactinaemia, ovarian failure and androgen excess. The biofeedback in the pituitary and hypothalamus rely on aromatase to regulate prolactin and GnRH.Licorice and Peony combination reduces testosterone levels and improves the oestradiol to testosterone ratios after 4 weeks of administration. Pregnancy rates also improve. After prolonged administration, LH to FSH ratio is significantly lower. This combination stimulates pituitary dopamine receptors, which seem to be responsible for the gradually improving LH/FSH ratio.|
|Schisandra chinensis (Schisandra)||Schisandra is a hepatoprotective, adaptogenic, nervine and antioxidant. It helps to improve liver function in terms of detoxification and hormone clearance. As an adaptogen, it will improve mental, physical and sensory performance and help to cope with stress.|
|Vitex agnus-castus (Chaste Tree)||Vitex has demonstrated to down-regulate the production of excess prolactin via a dopaminergic activity. Hyperprolactinaemia is a common condition in PCOS. It has also shown to have an anti-androgenic effect. It is beneficial for ovulatory factors associated with PCOS. Clinical experience has shown that it is valuable in PCOS, especially when combined with other herbs, probably because of its action in reducing prolactin.|
|Zingiber officinale (Ginger)||Ginger is a circulatory stimulant, anti-inflammatory, spasmolytic and digestive stimulant. It is also hypoglycaemic, antioxidant and antihepatotoxic. It is useful in amenorrhoea brought up by cold.|
The list above is not exhausted and there are more herbal remedies that might be indicated in a case of PCOS depending on the presentation of the person since the condition is multifaceted. Nutrition is of utmost importance and nessessary multiple nutrient supplementation is warranted.
Exercising daily is essential especially in the morning as it increases metabolism – a minimum of 45 minutes 4-5 times a week of aerobic exercise to help lose weight, improve insulin resistance, lower cholesterol, increases SHBG and maintain cardiovascular health. If possible get a personal trainer to help achieve ideal body weight.