PCOS and Sex Hormones:
The typical menstrual cycle of someone with PCOS tends to be irregular. The reason for this is because the hypothalamus in the brain is releasing Gonadotrophin Releasing Hormone (GnRH) at a higher frequency than is normal. This frequency increase of GnRH causes the pituitary gland to release Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) in a way that is not optimal for achieving fertilization and pregnancy. LH and FSH are increased and decreased, respectively, relative to normal secretion in someone without PCOS. Also, the abnormal secretion of LH and FSH will, in turn, lead to excessive production of androgens (e.g. androstenedione and testosterone). It also increases levels of estrone, a type of estrogen that is normally elevated only in post-menopausal women. This causes relatively lower levels of progesterone.
Overall, this process makes it less likely that mature eggs will be developed and released from the follicles. The follicles grow in the ovaries, but do not mature, instead becoming fluid filled cysts hence the name, Polycystic Ovarian Syndrome or PCOS. This aberration in hormones makes it extremely unlikely that pregnancy can occur, thus leading to infertility.
In fact, the abnormal hormonal environment not only leads to PCOS and infertility, but can also cause uterine hypertrophy or endometrial hyperplasia leading to excessive and painful menstruation. Furthermore, higher levels of androgens create some of the stereotypical symptoms of PCOS (e.g. facial hair, acne, oily skin, and hair thinning on the head).
PCOS and Insulin Resistance:
Although the exact mechanism of how PCOS causes insulin resistance has not been completely elucidated, there are many hormonal associations that can shed some light. For example, excess androgens appear to cause weight gain in the torso and fat accumulation in the liver. Fat accumulation in the liver is strongly association with insulin resistance. Overtime, as the body tries to compensate for insulin resistance by secreting more and more insulin, one will increase their risk of type 2 diabetes, as well as cardiovascular disease and even cancer.
Insulin also signals the ovaries to secrete more testosterone, and inhibit hepatic sex-hormone binding globulin (SHBG) production, which leads to an increased level of bioactive testosterone. This has the potential to create a vicious cycle of more insulin, creating more androgens, creating more fat deposition, and so on.
The more fat one has, the more inflamed they tend to be. It is well -known that PCOS suffers have increased inflammatory markers, and one very important inflammatory marker, that tends to be elevated in PCOS, is Cardiac CRP. It is a pretty good the predictor of future heart attack risk. The higher it is, then, the more likely you will have a cardiovascular event.
Natural Solutions for PCOS:
Having a basic understanding of the hormonal aberrations of PCOS helps determine what lifestyle changes and supplement choices should be considered. A more simplistic approach based on all the biochemistry above would be to think about PCOS as a combination of Hormonal Imbalance, Diabetes/Insulin Resistance, and Inflammation; all of which can make pregnancy more difficult.
- Vitex 8-10 – This herb, aka Chasteberry, has a long history of use and shown to be very safe. It is well tolerated, and reported adverse effects are minor. In addition, there is more evidence that it helps in relieving symptoms of PMS than with PCOS. However, a recent, double-blind placebo-controlled pilot study of 30 women showed an increasing trend in midluteal phase progesterone level, and an increased number of pregnancies in the 15 women who took a nutritional supplement containing chasteberry for five months.
- DIM (Diindolylmethane) 11,12 – This supplement helps to optimize estrogen balance, and may even help lower androgens. It is also considered very safe to use.
- Vitamin D 13,14 – Vitamin D, which is actually a hormone, has been shown in numerous studies to help mitigate the symptoms of PCOS. It has also been shown to optimize chances of conception by improving follicular develpment.
- Avoid xenoestrogens (environmental toxins) 15 – Xenoestrogens are environmental pollutants that mimic estrogens in the body in a detrimental way. One very good way to help minimize your exposure is to use the website: cosmeticsdatabase.com or www.ewg.org. You can look up all of your cosmetic products, from toothpastes to shampoos to make-up, and make sure that you are not increasing your exposure to these estrogen-like compounds.
1) Berberine 5 – One of my favorite prescription medications is Metformin because of the benefits it begets the body. The problem is, that for some people, it also has plenty of negative side-effects. A natural alternative to Metformin is Berberine. It has similar insulin sensitizing effects without the potential negative side-effects of Metformin. Berberine can also be used in conjunction with Metformin for a more enhanced effect.
2) Magnesium 4,16-18 – Magnesium is a mineral that appears to sensitize the body to insulin. It is has been shown that women with PCOS tend to have lower serum levels of magnesium. Magnesium is very safe, and has numerous benefits for the body. Try ME’s Metabolic Magnesium if you are looking to add this mineral to your regiment.
3) Multi-vitamin – A multi-vitamin should be foundational supplementation for someone suffering from PCOS and infertility. In addition to containing minerals like magnesium and chromium that help with glucose regulation, a good MV for PCOS should also have complete complexes of B-vitamins and vitamin E, vitamin D, and anti-glycation compounds (benfothiamine, carnosine, and alpha lipoic acid). The MV that fits this criteria the best is Metabolic Effect’s Metabolic Complex, aka Metabolic Synergy by Designs for Health. Also, anyone trying to get pregnant or dealing with infertility should, at the very least, be on a good pre-natal vitamin.
4) Alpha Lipoic Acid 6,7,27,28 – ALA has many benefits for someone suffering with insulin resistance and PCOS. It helps to improve glucose status, and is a powerful anti-oxidant, with the potential to prevent and treat, diabetic complications.
Curcumin 1 – Curcumin has been show to have anti-inflammatory effects by lowering a number of inflammatory markers, one of which is C-reactive protein in the body. It is a wonderful, well-tolerated anti-inflammatory with minimal negative side-effects.
Ginger 2 – Ginger is another great anti-inflammatory that is well-tolerated and very safe. It also seems to help with blood sugar control.
Fish Oil 3,21,22 – Many studies have shown fish oil helps to reduce inflammation. Fish oil supplementation is also very important in women trying to get pregnant.
Red Yeast Rice (Monacolin) 23,24 – Monacolin, as found in Red Yeast Rice, is beginning to show benefit for people suffering with PCOS. It has a lipid lowering effects and also appears to lower androgens.
Inositol (aka myo-inositol) 7,19,20 – Inositol has been shown to improve pregnancy rates in women with PCOS.
Melatonin 25,26 – Melatonin appears to play a role in PCOS and infertility. Thus, supplementation may improve chances of pregnancy.
PCOS is a condition that can be greatly helped with lifestyle change and supplementation. Although, the exact cause is not clear with some evidence showing a possible genetic predisposition, and/or an in-utero component, and/or a lifestyle etiology; PCOS, and its associated infertility risk, can be improved greatly without prescription drug interventions. The above supplements all have evidence showing positive results on PCOS, and associated signs and symptoms, in both human and animal studies.
Metabolic Effect has assembled an entire education on diet and exercise as it pertains to PCOS.
Check out the PCOS Program.