Polycystic Ovarian Syndrome or PCOS affects approximately 5-10% of the female population in developing countries like India and China mainly due to its rapid nutritional transitions owing to its adaptation to Western diets and lifestyle. Its prevalence is about 15-20% among infertile women. Though its etiology (cause) is quite unclear some experts claim it to be an X-linked dominant condition ( It refers to genetic conditions associated with mutations in genes on the X chromosome) and polycystic ovary syndrome treatment is not just medicines but involves whole lifestyle changes. Before we get into more details about this, we need to know what PCOS is.
What is Polycystic Ovarian Syndrome?
Polycystic Ovarian Syndrome termed as PCOS is a complex metabolic, endocrine, and reproductive disorder associated with chronic oligo-anovulation and polycystic ovarian morphology.
The word “polycystic” means “many cysts”. It was first described by Italian physician Antonio Vallisneri in 1721. Though it affects almost 26.7 % of women in the childbearing years (15y-44y), in a study conducted by the National Institutes of Health (NIH), United States 70% of the women with PCOS were undiagnosed with not much polycystic ovary syndrome treatment options available.
How is Polycystic Ovarian Syndrome caused?
It is caused mainly due to an imbalance of the female sex hormones. The ovaries along with the uterus and the fallopian tubes are an integral part of the female reproductive system. They contain your lifetime supply of eggs. These eggs are mature and are contained in a fluid-filled structure called a follicle. The pituitary gland located at the base of the brain secretes GnRH(Gonadotropin-releasing hormone) which secretes Follicle Stimulating Hormone (FSH) or Luteinizing Hormone (LH) in the bloodstream. After they reach the ovary, several eggs start to mature and the ovaries secrete estrogen(the main female sex hormone). Once it reaches a certain level the pituitary sends a surge of LH to the ovaries causing the most mature follicle(Graafian Follicle) to rupture thus releasing the egg(ovulation). The egg then travels to the Fallopian Tube (Ampulla) where it awaits fertilization and the remaining eggs and follicles dissolve. If the egg isn’t fertilized then it is shed at the next menstrual period.
If you have PCOS, instead of the release of GnRH in a regular cyclic fashion, it is released rapidly throughout the day which disrupts the release of FSH and LH. LH secretion increases and FSH secretion decreases. LH stimulates the ovarian theca cells(endocrine cells associated with ovarian follicles) to produce androgen so its increase leads to an increase in androgen production and a Decrease in FSH prevents the ovarian granulosa cells from aromatizing androgens(male sex hormone) into estrogens and decrease in estrogen levels inhibits ovulation. As the eggs aren’t released they solidify and turn into fluid-filled sacs called cysts. Additionally, your blood might contain high levels of insulin which along with LH is responsible for high levels of testosterone( an androgen) which contributes to the physical features associated with PCOS and polycystic ovary syndrome treatment options.
What are the types of Polycystic Ovarian Syndrome?
According to a consensus in 2003 by Rotterdam European Society for Human Reproduction on PCOS, there are three phenotypes of PCOS-
- Most severe– This phenotype is the most common type affecting almost 75% of the female population and is characterized by the presence of ovarian cysts, excess androgen, and irregular ovulation.
- Less severe– This is polycystic ovary which is associated with excess androgen secretion but with ovulation.
- Mild– This is also polycystic ovary with ovulatory dysfunction but without androgen excess.
Do you have Polycystic Ovarian Syndrome?
You can discover it either during your first period or maybe when you have gained a lot of weight or maybe due to a difficult pregnancy.
Some of the most common symptoms of PCOS are:
- Irregular Periods
If you don’t ovulate regularly then your uterine lining doesn’t shed every month. According to a study conducted by the Office on Women’s Health, a woman on PCOS can get less than eight periods a year.
Growth of excess or unwanted body hair on women’s face and body is called Hirsutism. Though all women have facial and body hair, the main difference between typical hair on a woman’s body and face and Hirsutism is the texture of the hair present. In the latter, it is usually coarse and dark. Women with this condition often grow hair in a male-type pattern.
According to a study by The American College of Obstetricians and Gynecologists, almost 70% of women with PCOS have Hirsutism.
- Weight Gain
Due to insulin resistance, you might start gaining weight if you have PCOS. A study by The American Society of Obstetricians and Gynecologists, almost 80% of women having PCOS are overweight or obese.
If you see dark patches in your body creases like in the neck or under the breasts you might have PCOS.
- Male-pattern baldness
In addition to the above physical symptoms, you also might also notice thinning and falling out of scalp hair if you have PCOS and you may fail to find any polycystic ovary syndrome treatment.
Two of the main reasons for the appearance of hormonal acne is increased levels of testosterone and generalized inflammation. A study conducted by Dr. Mark Vanderpump, a London-based endocrinologist expert nearly 30% of women with Polycystic Ovarian Syndrome (PCOS) struggle with acne.
How is PCOS diagnosed clinically?
Sonographic Criteria of PCO includes-
- Presence of 19 or more follicles in each ovary measuring 2-9 mm in diameter.
- Increased ovarian volume.
- Even if one ovary is affected it will be effective in determining PCO.
- It doesn’t apply to women who take oral contraceptives (OCP).
- If a person has a cyst or a follicle from growing anovulation it‘s important to conduct ultrasonography in the absence of the cyst to determine the exact volume of the ovary without the cyst.
According to 2003 criteria by Rotterdam European Society for Human Reproduction on PCOS, a patient needs to fulfill any 2 of the 3 parameters to be diagnosed with PCOS
- Clinical or biochemical androgens (oversecretion of androgen).
- Oligo- or anovulation (irregular ovulation).
- Polycystic ovaries.
This excluded other rare endocrinopathies like Cushing Syndrome, tumors, and hyperprolactinemia(high levels of prolactin in the blood).
Test For Hirsutism
Hirsutism is a very common disorder so it is also evaluated using the Ferriman-Gallewey scale which is a clinical representation of terminal hair on the patient in a male type pattern distribution.
Here nine body parts are evaluated and a score of 1 to 4 is given for each area of the body.
- Upper lip.
- Upper and Lower Arm.
- Upper Abdomen and Lower Abdomen.
- Upper arms.
The total score is counted and is evaluated accordingly.
- Score=0————-Absence of terminal hair
- Score< 8 is———-Normal,
- Score= 8 to 15—-Mild Hirsutism
- Score > 15 ———Severe Hirsutism
This testing is very crude and leaves out ethnic groups like Asians, Eskimos and Native Americans who have very different hair follicles and also hairs in varying numbers, some of them might have increased levels of androgen without physical appearance of terminal hairs. So blood testing is carried out to measure male hormones.
Testing for Hyperandrogenism
- Total T-levels(Testosterone) in the plasma in the early morning (Cycle Day 4-10) –
T levels lower down during menses and vary by 25% during the follicular phase with the highest levels in the mornings.
- Total T with free T(amount of biologically active testosterone) in a reliable laboratory.
- 17-OHP4 ( 17- hydroxyprogesterone) is measured in women –
Our adrenal gland (located on top of the kidneys) can also produce excess male hormones generally through various types of genetic diseases or rare tumors. This hormone is reflective of a type of genetic disease called Late-onset Congenital Adrenal Hyperplasia.
- DHEAS ( Dehydroepiandrosterone sulfate) another mild hormone produced by the adrenal gland is also measured.
What Causes Polycystic Ovarian Syndrome?
The exact reason for PCOS is yet to be unknown however as oversecretion of androgens are one of the factors associated with it, genes, insulin resistance, and inflammation has all been linked to excess androgen production.
A study conducted by Evanthia Diamanti Kandarakis, Helen Kandarakis, and Richard S.Legro in 2006 stated that genes definitely contributed to PCOS.
Another study conducted by Pritam Kumar Panda and Hetalkumar Panchal further concluded that more than one gene was responsible for PCOS.
- Insulin Resistance
In a study conducted by the National Institute of Health(NIH), the United States almost 70% of women with PCOS suffer from insulin resistance and the complementary hyperinsulinemia (excess insulin in the blood). Insulin resistance means that the body becomes resistant to insulin.
Insulin is a hormone secreted by Pancreas that is responsible for the utilization of glucose in our body. As the body is unable to use glucose optimally, the need for insulin increases and it is produced in excess amounts by the pancreas which leads to hyperinsulinemia and this excess insulin triggers the ovaries to produce more male hormones.
This study states hyperinsulinemia as a common factor in maintaining hyperandrogenemia(excess androgen levels in the blood), acting directly to induce excess androgen production by theca cells and also as a co-gonadotropin increasing the effect of LH stimulus seen in a majority of women with PCOS.
Moreover, this insulin resistance has been found to be associated with obesity too.
According to a study conducted by the National Institutes of Health (NIH), the United States chronic low-grade inflammation is a major contributor to the pathogenesis of Polycystic Ovarian Syndrome(PCOS). It also stated that a dietary trigger like glucose is capable of encouraging oxidative stress and inflammatory response from mononuclear cells (MNC) of women with PCOS and this phenomenon is independent of obesity.
How Can Polycystic Ovarian Syndrome affect your life?
Women with PCOS don’t ovulate regularly so they don’t release as many eggs as needed for fertilization. According to a study conducted by The American College of Obstetricians and Gynecologists, PCOS is regarded as one of the primary causes of infertility in women.
- Endometrial Cancer
As women with PCOS don’t ovulate regularly i.e. their uterine lining (endometrium) isn’t shed regularly, the lining can build-up and become thick and thus increase your risk of endometrial cancer.
A study published by the Reproductive Psychiatry and Women’s Health on 20th September 2017 concluded that women with PCOS are at increased risk of depressive symptoms or anxiety symptoms. Though the exact reason for women with PCOS having a higher risk of depression and anxiety is unknown, it states obesity, insulin resistance, and elevated androgens to be a contributor to this state, though partially.
- Metabolic Syndrome
As earlier mentioned a study concluded that 80% of overweight or obese women to be suffering from PCOS. Both obesity and PCOS can lead to a host of other problems like high blood pressure and sugar and also increased level of low-density lipoprotein (LDL- bad cholesterol) thus consequently decreased levels of high-density lipoprotein (HDL- good cholesterol). They are together termed as metabolic syndrome and contribute to diabetes, heart disease, and stroke.
- Obstructive Sleep Apnea (OSA)
It is a condition where breathing stops involuntarily for a brief period of time during sleep and these brief periods are known as apneic episodes. A study conducted by David A. Ehrmann the risk of OSA is at least 5-10% higher in women with PCOS as compared to women without PCOS.
- Type II Diabetes
PCOS is related to an imbalance of hormones including insulin and diabetes also affects the body’s ability to create or utilize insulin. Type I Diabetes is caused due to a lack of insulin while Type II Diabetes develops due to insulin resistance. Type II Diabetes is more common than Type I.
A person with PCOS is at higher risk for developing this type of diabetes as insulin resistance is a major symptom of PCOS too. According to a study conducted by The Endocrine Society, women with PCOS are four times more likely to develop Type II Diabetes than women without PCOS. According to another report by the Office on Women’s Health, around half of the population with PCOS were diagnosed with diabetes or prediabetes before the age of 40.
How to treat Polycystic Ovarian Syndrome?
According to a report published in The Journal of Clinical Endocrinology and metabolism(JCEM), lifestyle modification is often used to treat the hormonal imbalance caused by PCOS. It further stated that though pharmaceutical agents like Metformin(Mt), oral contraceptives pills (OCPs) and anti-androgen agents (AA) are frequently used, they can cause certain side-effects-
- Mt is associated with fatal and non-fatal Lactic Acidosis( Lactic Acid production > Lactic Acid Clearance) even though the incidence ranges from 1 to 17 cases per 100,000 patients – years.
- OCPs have also been associated with weight gain and cardiovascular and thromboembolic (blood vessel obstruction)events.
- AA use has been associated with hepatic toxicity that could be fatal.
The risk and nature of these side effects must be considered when choosing these therapies.
In a Cochrane Database Systematic Review Article, Treatment options for Polycystic Ovarian Syndrome, Alternative Medicine has been mentioned as a possible treatment option for this condition. Alternative Medicine includes many things such as homeopathy, acupuncture, acupressure, and massage therapy.
Can Homeopathy cure PCOS?
According to a clinical trial obtained from CenterWatch Homeopathy is the dominant option to treat Polycystic Ovarian Syndrome(PCOS). It mentions “Homeopathy can be defined as a system of drug therapeutics based on the law of similars. Polycystic Ovarian Syndrome has a specific set of problems that needs an individualistic approach. The concept of individualization takes into consideration the total response of the individual to an unfavorable environment. The homeopathic approach towards management of Polycystic Ovarian Syndrome is constitutional taking into account the patient’s physical symptoms along with their mental and genetic makeup. Early intervention with Homeopathy can assist in preventing further progress and hence deterioration caused by Polycystic Ovarian Syndrome. “
This report further states that homeopathic constitutional treatment will help to balance the hyperactivity of the glands, regulate hormonal balance, and dissolve the cysts thus resuming normal functioning. It can further help to restore normal ovulation and menstrual cycle and eliminate the need for hormone therapies and surgeries. It concluded that as Homeopathy works towards nature it has no side-effects and are safe, easy, and effective way to cure PCOS.
As mentioned earlier lifestyle changes play a major factor in curing PCOS, so let’s get to know what changes should we follow to cure PCOS.
What lifestyle changes should you follow for polycystic ovary syndrome treatment?
- Connection With Moon
A woman’s body has a very strong connection with the moon. The 28 days of revolution cycle and the 28 days of the menstrual cycle isn’t merely a coincidence. A study conducted by the National Institute of Health(NIH), the United States in 1986 confirmed a synchronous relationship between the menstrual cycle and lunar rhythm. Among 826 female volunteers with a normal menstrual cycle, aged between 16-25, almost 28.3% menstruated around the new moon while only about 8.5-12.6 % menstruated at other times. Ancient wisdom also suggests that ideally, a woman should menstruate on her periods on a new moon night.
As a woman, you can balance your hormones just by sitting in the moonlight. If you suffer from PCOS sit in the moonlight for at least 15 minutes before going to bed. Additionally, you can also keep water in a container under the moon and drink this moonlight charged water is amongst the most used polycystic ovary syndrome treatment. So what are you waiting for? Ditch the blue light of your phone and head to the moonlight.
A yogic lifestyle is a form of holistic mind-body medicine known to reduce stress. According to a clinical trial obtained from CenterWatch, a recent randomized controlled trial found holistic yoga program for 12 weeks to be significantly better than physical exercise in reducing Anti-Mullerian Hormone(AMH- decreases follicle secretion in the ovary), Luteinizing Hormone (LH) and Testosterone, modified Ferriman-Gallewey Score for Hirsutism and improving menstrual frequencies in /polycystic Ovarian Syndrome patients. It was also found to prevent cardiovascular diseases and diabetes.
Following yogic practices were found to have maximum benefits on patients suffering from PCOS:
However bad be your condition, your FOOD is your MEDICINE. Avoid packaged foods and consume fresh foods.
When you consume carbohydrates it is converted into glucose by the body and insulin is needed to convert it into usable energy. Now all these carbs are rated on a uniform scale called The Glycemic Index (GI scale) marked from 0-100 with 100 being the mark of sugar. This scale indicates how fast a carbohydrate is digested. Foods on the higher side of this scale termed as high GI carbs cause a high amount of insulin spike. This constantly high levels of insulin due to sugar consumption or consumption of high GI Food messes up the hormonal balance of the body. Additionally, people with PCOS suffer from insulin-resistance so they need to consume more amounts of that food to have that same insulin spike in their body, thus further messing up the hormonal balance.
So now your aim should be to normalize this insulin in your body and that can be done through your diet.
Four Tips to Remember
- Avoid High GI Foods.
- Have A High Protein Diet.
- Stay Hydrated.
- Limit your sugar intake.
- Decrease your fat percentage (responsible for insulin resistance too).
Probable Diet Plan
Early Morning– Moon Charged Water.
2-3 tsp. Ghee(it provides lubrication to the body).
Breakfast – A small bowl of fruit+ Protein.
Lunch– Complex Carbs (Brown Rice / 2-3 Rotis) + Lean Protein (Paneer or 2-3 egg whites)= Dal + Salad.
Snack– Another small bowl of fruit.
Dinner– Repeat what you had in lunch but increase the protein and limit carbohydrate intake.
- Avoid Stimulants
Any substance that increases the physiological or nervous activity of your body is a stimulant. Tea and Coffee are examples of stimulants. According to Neha Ranglani. a Nutrition and Lifestyle Educator “ Both of these work like drug and that is the reason we are so addicted to it. They are known to increase the insulin levels of our body and are proven to have a negative impact on women with PCOS. You can switch to better alternatives like green tea, matcha tea, or ginger-lemon water.”
- Avoid Plastics
Plastics contain BPA(bisphenol A) and this, when it comes into contact with food, leaches chemicals like Xenoestrogens that mimic the natural female sex hormone estrogen and bind to hormone receptor sites and completely messes up the body’s hormonal balance.
According to a study in Environmental Health Perspectives, even plastics that don’t contain BPA can also release chemicals that act like the sex hormone estrogen. So What are you waiting for? Ditch all of your plastic containers and bottles and switch to glass or stainless steel containers. You can also use clay, brass, or iron cookware which are healthier than aluminum and non-stick utensils.
A body of a woman reacts very rapidly to hormonal fluctuations. Irregular bedtime and attending phone calls before sleep or watching TV before sleep can disturb your peaceful sleep pattern which is essential for the absorption of minerals from the food to be utilized by your body to maintain your hormonal balance.
The ideal time for your night sleep is 9 pm-6 am. Make sure to set up a routine and have a designated time to sleep. Make it a point to sleep and wake up at the exact same time every day.
The Bottom Line
Though PCOs looks like a very complicated problem affecting so many women across the world through their reproductive ages, it is still curable. You are not alone. You are one among the 116 million women suffering from PCOS worldwide (3.4 % of the female population – estimated by The World Health Organization). I have myself been there and these lifestyle changes have served me in good purpose. If you doubt you have PCOS get an appointment and consult a doctor. What I have covered here is just the type of the iceberg. Read, Read, and read everything about this and also try to understand your body and its needs. Adjust your food habits and lifestyle pattern and look after your body. Your body needs you and nobody would be able to care for YOUR body the way you will be. Hopefully, soon you will be on your way to put a PERIOD on your PERIOD problems.