Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) affects about five to ten percent of all women of reproductive age, making it the most common endocrine disorder in women. The signature features of the syndrome include irregular or absent menstrual cycles, failure of ovulation, infertility, hirsutism (male pattern hair growth), acne and accelerated scalp hair loss.

Diagnosis requires the presence of two out of three of the following: (1) irregular ovulation or absence of ovulation; (2) clinical and/or biochemical signs of excess male hormones (hyperandrogenism); (3) polycystic ovaries, with the exclusion of other causes such as congenital adrenal hyperplasia, androgen-secreting tumors and Cushing’s syndrome.

Chinese medical diagnosis and treatment

According to Chinese medicine, polycystic ovary syndrome occurs when a lack of yang qi or a blockage of the flow of qi and blood (or both) allows phlegm or blood (or both) to build up in the ovaries. The condition typically involves hypofunction of the reproductive and digestive systems, along with some stagnation of liver function.

The ideal treatment plan for polycystic ovary syndrome will include acupuncture, herbal medicine, exercise, and diet changes.

Acupuncture

A 2009 Swedish study (reported here ) found that acupuncture reduces sympathetic (fight or flight) nervous system activity and testosterone levels, and improves menstrual cycle regularity, in women with polycystic ovary syndrome (PCOS).

A 2010 Swedish study (reported here ) confirmed these results.

Herbal Medicine

In September 2011, The Journal of Chinese Integrative Medicine reported results of a study comparing the efficacy of Tian Gui Capsule, a traditional Chinese herbal formula, to metformin (a drug commonly prescribed for PCOS) and Diane-35 (a birth-control pill containing 2 mg cyproterone acetate and 35 μg ethinylestradiol). Read the full text of the report here.

The study showed that women who used the herbal formula for three months had reduced testosterone and insulin levels, reduced growth of unwanted hair, and reduced volume of both ovaries (i.e. reduced the cysts). The women taking these herbs also had reduced skin pigmentation and improved skin elasticity. There were few complaints of digestive upset or other side effects, and women who started the study complaining of constipation reported improved elimination.

In comparison, the women who used metformin also had reduced testosterone and insulin levels, but Tian Gui produced a greater reduction of testosterone levels. Further, among metformin users only one of two ovaries reduced in volume, and many of the women complained of gastrointestinal upset, diarrhea, and other side effects.

The women who took the birth control pill (Diane-35) for three months showed improved signs of acne and hirsutism, had lowered serum testosterone and improved insulin function. In addition, both the left and right ovary volumes significantly reduced. However, during and after the course of treatment, the women using birth control had increases in body weight, BMI, and fasting blood glucose. In addition, these patients complained of breast pain, gastrointestinal upset, weight gain and other side effects (common to use of hormones). This indicated that Diane-35 does not improve glucose metabolism in PCOS and may cause weight gain that will worsen the condition.

The authors concluded that neither the metformin nor the hormonal pill is a good choice for long term treatment of PCOS (because of side effects) but that Tian Gui Formula can treat PCOS with minimal side effects, and over a long term, in patients who have kidney qi and yin vacuity.

Several other studies have been done on other Chinese herbal combination formulas that address kidney qi (or yang) and yin vacuity, the typical presentation of a PCOS patient.

Several studies have found that herbal medicines can reduce male hormone levels and unwanted hair growth in women with polycystic ovary syndrome (PCOS).

In all cases, you need to consult an herbalist to get an herbal combination correct for your pattern of imbalance.

Diet

Diet profoundly affects insulin function and sex hormone levels. A diet high in fatty meats, saturated fats and sugars induces insulin resistance, raises levels of growth factors that promote cyst formation, and raises levels of both estrogen and testosterone. Elevated estrogen levels will typically cause breast tenderness and increase the risk of breast cancer and elevated testosterone will produce acne and unwanted facial and body hair growth.

Exercise

Vigorous physical activity improves glucose tolerance and reduces elevated hormone levels in PCOS patients. The ideal weekly activity pattern includes one or two 15-30 minute sessions of brief high intensity strength training or interval training, four to seven 15-30 minute sessions of flexibility and balance training (including stretching, hatha yoga, or tai chi chuan), and frequent, even daily, walks of 1 to 4 miles. Of these listed, high intensity strength training and interval sprint training may have the greatest benefits for improving insulin function.

However, don't let the perfect be the enemy of improvement. Any increase of physical activity at first (e.g. daily walking) will help.



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