PCOS is a disorder of the endocrine system, a network of glands throughout the body that produce potent chemical messengers called hormones. These hormones control many aspects of normal body functioning and imbalances in their activity can result in mild to severe health consequences. In PCOS, the hormone imbalances primarily affect female reproductive function and represent the major cause of female-related infertility. This is quite a common problem, affecting 5-10% of women regardless of ethnic origin. In the past, treatment of PCOS was mainly confined to women that sought assistance in becoming pregnant or to those that wanted relief from cosmetic conditions (excess hair and acne) that often accompany the disorder. However, research over the past decade has revealed that there are other consequences of PCOS that impose a major health concern. These include significantly higher risks of obesity, diabetes, heart disease, and certain cancers. For this reason, PCOS is receiving more attention as the medical community is being called upon to become more aware of the disorder. Many of the conditions associated with PCOS can be improved by early intervention, which include lifestyle changes and/or medication. So whether infertility is a problem or not, women with PCOS are encouraged to seek medical advice.
What causes PCOS? In most cases of PCOS, the ovaries produce an excess of "male" hormones called androgens. Androgens (like testosterone) are considered "male" because men produce much larger quantities of them than women do, and it is the activity of these hormones that largely gives men their unique characteristics. However, women also produce androgens in much smaller quantities, and these androgens are essential to female health. Women with PCOS produce larger quantities of androgens than other women (a condition called hyperandrogenaemia), but these levels are not nearly as high as those found in men. Also, it is possible to acquire PCOS by having an increased sensitivity to normal levels of androgen. In the ovary, an egg develops inside of a structure called a follicle. During a menstrual cycle, many follicles begin to grow, but only one releases its egg (ovulation) at mid-cycle. Those that do not ovulate normally die. Androgens are necessary for follicle growth, but too much androgen causes too many follicles to grow per cycle. In PCOS, these follicles often do not ovulate (anovulation) and resist the normal death process, leading to accumulation of numerous ovarian "cysts".
While androgen activity appears to be the primary dysfunction in PCOS it is now known that women with this disorder can also have irregular insulin and/or LH (luteinizing hormone) activity. Insulin comes from the pancreas and is involved in regulating the body’s energy supply and use. LH comes from the pituitary gland and is involved in regulating the female menstrual cycle. Excess production or sensitivity of either of these hormones can result in increased androgen production by the ovaries. Being overweight can cause insulin levels to rise and may intensify the symptoms of PCOS. However, not all women who are overweight develop the disorder.
What symptoms could you experience? With the most extreme form of PCOS, you would tend to be overweight, have no or very few periods, be prone to acne, grow unusually heavy body hair, often on the face, breasts and inside of the legs, and be susceptible to mood swings. And with this can come problems with fertility and often recurrent miscarriages. Women with PCOS may be seven times more likely to develop diabetes because of problems with blood sugar balance. When do symptoms of PCOS appear? Most often, symptoms first appear around puberty, although some women do not develop symptoms until their early to mid-20’s or occasionally after having a baby. Some research indicates that women with PCOS start menstruating at an early age.
Is PCOS a genetic condition? PCOS and variations of its symptoms frequently run in families, indicating that genes are somehow involved in the process. As with most complex ailments, genes cannot be considered the sole cause; one inherits a genetic predisposition to the condition. Androgen excess, insulin dysfunction, and obesity are all heritable features. In PCOS, lifestyle factors (especially diet and exercise) appear to have a large influence on the appearance and severity of symptoms.
If consulting a physician, be aware that many general practitioners are still not aware of PCOS and its wider implications. It is important to contact a doctor with some knowledge and experience of the disorder. The websites mentioned above offer advice on finding and consulting
What are your choices? Over the last few years, research into the nutritional approach to PCOS has revolutionised the treatment of this problem.
As women with PCOS lose weight, hormone levels start to return to normal. Testosterone levels fall, serum insulin levels go down, SHBG levels go up and the symptoms of PCOS diminish, with significant improvements in the growth of excess hair as the women lose weight.
Along with the weight loss comes a remarkable change in ovarian function. In one study, 82 percent of the women who were not previously ovulating showed improvements, with a number of successful pregnancies during the study, even though many of these women had a long-standing history of infertility.
So dramatic have been some of the results, that it has now been suggested that changing a woman’s diet should be the first move if she is overweight and failing to conceive. One study found that 11 out of 12 women who had been overweight and not ovulating conceived naturally after reducing their weight.
In general, women with high levels of luteinising hormone (LH) in the first half of their menstrual cycle seem to have a greater risk of miscarriage. So miscarriages are more likely to occur in women with PCOS because of the high levels of LH. But, in a study of women with PCOS who were asked to change their diets, the rate of miscarriages dropped from 75 percent to 18 percent once they had lost weight.
Supplements The supplements recommended below have been studied in clinical trials and have been found to be effective in connection with PCOS. For best results you should take them over a period of three months, at the end of which you should be reassessed in order to monitor improvements and changes and then adjust the supplement programme according to your new condition.
If you been using the Pill to regulate your periods, you may have an even greater imbalance between a number of key vitamins and minerals. Correcting this imbalance will go a long way towards treating the root cause of the problem.
Multivitamins and Minerals A good quality multivitamin and mineral would form the foundation of your supplement programme to make sure that you are getting a ‘little bit of everything’. You then add in those nutrients in slightly higher amounts which are known to be helpful for PCOS.
Chromium Chromium is an extremely important mineral if you have PCOS. It helps to encourage the formation of glucose tolerance factor (GTF) which is a substance released by the liver and required to make insulin more efficient. A deficiency of chromium can lead to insulin resistance, which is a key problem in the case of PCOS; too much insulin can be circulating but it is unable to control your blood sugar (glucose) levels.
Chromium is the most widely researched mineral used in the treatment of overweight. It helps to control cravings and reduces hunger. Chromium also helps to control fat and cholesterol in the blood. One study showed that people who took chromium over a ten-week period lost an average of 1.9kg (4.2lb) of fat while those on a placebo (sugar tablet) lost only 0.2kg (0.4lb)
If you are diabetic and on medication, you should speak to your doctor before taking chromium
B vitamins The B vitamins are very important in helping to correct the symptoms of PCOS. Vitamins B2, B3, B5 and B6 are particularly useful for controlling weight, and here’s why: Vitamin B2 helps to turn fat, sugar and protein into energy. B3 is a component of the glucose tolerance factor (GTF), which is released every time blood sugar rises, and vitamin B3 helps to keep the levels in balance. Vitamin B5 has been shown to help with weight loss because it helps to control fat metabolism. B6 is also important for maintaining hormone balance and, together with B2 and B3, is necessary for normal thyroid hormone production. Any deficiencies in these vitamins can affect thyroid function and consequently affect the metabolism.
The B vitamins are also essential for the liver to convert your ‘old’ hormones into harmless substances which can then be excreted from the body.
Zinc Zinc is one of the key minerals that we need in our daily diets and it has a wide range of functions. Unfortunately, because our soil has been depleted by overfarming, there is very little natural zinc found in our food. Furthermore, processing and refining strip out what little might be remaining. So no matter how good your diet, you may not be getting anywhere near the levels of zinc that you need. There are two approaches to this: you can eat whole organic food, which has much more rigorous controls on farming methods, or you can add a zinc supplement to your diet. But why is it so important?
Zinc is an important mineral for appetite control and a deficiency can cause a loss of taste and smell, creating a need for stronger-tasting foods, including those that are saltier, sugarier and/or spicier (in other words, often more fattening!). Zinc is also necessary for the correct action of many hormones, including insulin, so it is extremely important in balancing blood sugar. It also functions together with vitamins A and E in the manufacture of thyroid hormone.
Magnesium Magnesium levels have been found to be low in people with diabetes and there is a strong link between magnesium deficiency and insulin resistance. It is, therefore, an important mineral to include if you are suffering from PCOS.
Co-Enzyme Q10 This is a vitamin-like substance that is contained in nearly every cell of your body. It is important for energy production and normal carbohydrate metabolism (the way our bodies break down the carbohydrates we eat in order to turn them into energy). One study showed that people on a low-fat diet doubled their weight loss when they supplemented with Co-Q10 as compared to those who did not take it. Co-Q10 has also been proved useful in controlling blood sugar levels.
Garcinia cambogia If you are really struggling with sugar cravings, or you find it difficult to resist bingeing on just about anything, this is the supplement for you. Garcinia cambogia is a small tropical fruit called the ‘Malabar tamarind’. It comes from central Asia, where the rind is used in Thai and Indian cooking. The garcinia contains HCA (hydroxy-citric acid) which enables carbohydrates to be turned into usable energy instead of being deposited as fat. The HCA in this fruit seems to curb appetite, reduce food intake and inhibit the formation of fat and cholesterol. It seems to be particularly helpful when teamed with chromium. I use one which combines the HCA and chromium in the same capsules which saves you taking two different supplements.
Herbs (see caution below) Herbs are extremely useful in the treatment of PCOS. Making changes and adding supplements to your diet will help to control weight and balance blood sugar, while herbs go a step further, targeting any problems involving hormone balance.
Herbs can also be very beneficial in encouraging the function of your liver, in order to make sure that it is metabolising the hormones efficiently and then eliminating them.
Agnus castus (Vitex/chastetree berry) This is one of the most important herbs for PCOS because it helps to stimulate and normalise the function of the pituitary gland, which controls the release of LH (luteinising hormone).
Saw Palmetto (Serenoa repens) Saw palmetto is a herb that is traditionally considered in light of its success in treating prostate problems caused by an imbalance of hormones (including excess testosterone). It is a small palm tree found in North America and the berries of the tree are used in tinctures or capsule form.
Research has shown that saw palmetto works as an anti-androgen, which can be very helpful given the high levels of testosterone in PCOS.
I would suggest that you add saw palmetto to your treatment plan if you have excess hair growth, or have been told you have high levels of androgens. Otherwise, take agnus castus on its own.
Milk Thistle (Silybum marianum) This is one of the key herbs for the liver, which acts as your waste disposal unit,, and it is therefore essential for the treatment of PCOS. It helps to protect your liver cells against damage and to promote the healing of damaged cells, so improving the general functioning of the liver and all its detoxifying properties.
Caution You should not take any of the above herbs if you are taking, The Pill, Fertillity drugs, HRT or any other hormonal treatment or other medication unless they are recommended by a registered, experienced practitioner.