Yesterday our Infertility Treatment Centre at Mahim witnessed 3 new female patients of Infertility with PCOS or Polycystic Ovarian Syndrome . Surprisingly two of them had normal menstrual cycles every month. Since we have developed our specialized Infertility treatment protocol few years back, we have regularly consulted females with infertility problems, majority of them coming to us after 2 to 3 failed cycles of IVF. And about 70% of them were suffering from PCOS. So I thought of writing on PCOS or Polycystic Ovarian Syndrome for lay people to understand, what exactly happens inside their body in PCOS.
What Is Polycystic Ovarian Syndrome (PCOS)?
Polycystic Ovary Syndrome (PCOS) is a leading cause of infertility in females; estimates show that one out of every 10 women could be diagnosed with PCOS. The problem is that many times the condition is misdiagnosed. PCOS refers to multiple cysts on the ovaries and a host of other problems that go along with them, including anovulation (lack of ovulation) and menstrual abnormalities, hirsutism (facial hair), male pattern baldness, acne, and often obesity. Such women may also have varying degrees of insulin resistance and an increased incidence of Type II diabetes, unfavorable lipid patterns (usually high triglycerides), and a low bone density. Laboratory tests often show higher than normal circulating androgens, especially testosterone.
PCOS occurs when a woman doesn’t ovulate, which causes a disruption in the normal, cyclical interrelationship among her hormones, brain and ovaries. Normally, the hypothalamus, a regulatory center in the brain, monitors the hormone output of the ovaries and synchronizes the normal menstrual cycle. When monthly bleeding ends, the hypothalamus secretes gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland in the brain to release follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones direct an ovary to start making estrogen (mostly estradiol), and stimulate the maturation of eggs in about 120 follicles.
The first follicle that ovulates, releasing its egg into the fallopian tube for a journey to the uterus, quickly changes into the corpus luteum, which is a factory for making progesterone, and raises progesterone’s concentrations to 200 to 300 times higher than that of estradiol. This huge surge of progesterone simultaneously puts the uterine lining in its secretory or ripening phase, and turns off further ovulation by either ovary.
If fertilization does not occur, the ovary stops its elevated production of both estrogen and progesterone. The sudden fall in the concentrations of these hormones causes shedding of the blood-rich uterine lining and bleeding (menstruation). Then, in response to low hormone levels, there is a rise in GnRH and the cycle starts all over again.
But what happens to this cycle if, for some reason, ovulation is unsuccessful? For example, if the follicle migrates to the outside of the ovary, but does not “pop” the egg and release it, the follicle becomes a cyst, and the normal progesterone surge does not occur. The lack of progesterone is detected by the hypothalamus, which continues to try to stimulate the ovary by increasing its production of GnRH, which increases the pituitary production of FSH and LH. This stimulates the ovary to make more estrogen and androgens, which stimulates more follicles toward ovulation. If these additional follicles are also unable to produce a matured ovum or make progesterone, the menstrual cycle is dominated by increased estrogen and androgen production without progesterone. This is the fundamental abnormality that creates PCOS.
What are the common signs and symptoms of Polycystic Ovarian Syndrome (PCOS )?
The symptoms of PCOS can vary from woman to woman and may include excessive weight gain, irregular or completely absent periods, ovarian cysts, excessive facial or body hair known as hirsutism, male pattern hair loss, obesity, acne, skin tags, high cholesterol levels, exhaustion or lack of mental alertness, depression, anxiety, decreased sex drive, excess male hormones and infertility.
What tests do I have to do to determine whether I have Polycystic Ovarian Syndrome (PCOS )?
The diagnostic criteria are not definitive for PCOS. There are a few tests that help confirm insulin resistance such as a fasting insulin blood test and cholesterol panels [specifically triglycerides]. Testosterone, cortisol and DHEA should also be tested.
A pelvic scan of the ovaries should be done for knowing the number of visible cysts. The non-appearance of cysts does not confirm that one does not have PCOS.
Lifestyle Factors that Cause Dysfunctional Follicles
There are other factors that contribute to dysfunctional follicles. These include stress (leading to the production of high cortisol levels by the adrenal glands), lack of exercise, and poor nutrition. Stress alone can cause anovulatory cycles. Birth control pills shut down normal ovary function, and sometimes it never recovers when the pills are stopped. Our diets are full of petrochemical contaminants — also xenobiotics — that derail normal metabolism. We take prescription drugs such as Prozac that impair the functioning of our limbic brain, including the hypothalamus, which may affect the menstrual cycle.
The Diet Connection to PCOS
By far the biggest lifestyle contributor to PCOS is poor diet. Young women with PCOS tend to eat far too much sugar and highly refined carbohydrates. These foods cause an unhealthy rise in insulin levels. According to Jerilyn Prior, M.D., insulin stimulates androgen receptors on the outside of the ovary, causing the typical PCOS symptoms of excess hair (on the face, arms, legs), thin hair (on the head), and acne. Eventually, this type of diet will cause obesity, which will cause insulin resistance (the inability of the cells to take in insulin), which will aggravate the PCOS even more. The androgens also play a role in blocking the release of the egg from the follicle.
When you look at the whole picture of PCOS, you can understand why the hormone-blocking and insulin-lowering drugs don’t work for very long. These approaches don’t address the underlying cause of the problem. They only suppress symptoms. Improvement is only temporary and both types of drugs have terribly unpleasant side effects.
By the same token, you can’t just take progesterone, and you can’t just cut out the sugar. You usually need to do both. Exercise and good nutrition are also very important in maintaining hormone balance.
Other health problems associated with PCOS.
Women with PCOS have a greater chance of developing type 2 diabetes, cardiovascular disease (CVD), and cancer. Recent studies found more than 50 percent of women with PCOS will have a diagnosis of diabetes or pre-diabetes before the age of 40, four to seven times higher risk of heart attack, and are at greater risk of having high blood pressure, with high LDL’s and low HDL’s the opposite of what is needed for optimal health.
The chance of getting endometrial cancer is another concern for women with PCOS. Irregular menstrual periods and the absence of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium to shed its lining each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy bleeding or irregular bleeding.Over time, this can lead to endometrial hyperplasia, which can predispose a woman to develop cancer.
Treatment of Polycystic Ovarian Syndrome (PCOS)?
Conventionally doctors tend to prescribe two treatments, both of which affect symptoms only, and neither of which is particularly successful. One treatment is temporary chemical castration, using birth control pills, androgens (male hormones), androgen blockers, synthetic estrogens, Lupron or similar drugs that block hormone production. The other is prescribing the oral drugs for Type II diabetes, which reduce insulin resistance.
Welling Homeopathy strives to uncover the root cause of the infertility. As there can be many causes, a detailed history and analysis through our unique CUREplus analysis helps to rule out unrelated diseases and narrow down the list to the one causing the health issue. In the last few years, the four step infertility treatment protocol from Welling Homeopathy has shown to be highly effective in helping a women with Polycystic Ovarian Syndrome (PCOS) to regain a regular menstrual cycle and her fertility.