What is PCOS?

September is PCOS Awareness month and I’m going to share with you basics of PCOS and some of the supplements that may help you. They say there is no cure for but I don’t think so and believe that it can be reversed. Don’t say you got it from your mama or sister and give up on it because you have the power to change the epigenetic factors to better cope with the symptoms.

What is PCOS?

PCOS stands of Poly Cystic Ovarian Syndrome. “Poly” means many, “Cystic” refers to the ovarian cysts and  “Syndrome” means that there are a collection of signs and symptoms. PCOS is one of the common disorders where between 5 to 10 percent of women of childbearing age in the United States, or roughly 5 million, have PCOS. Most women may not even know they have PCOS until they are diagnosed.

Symptoms of PCOS

These are the typical symptoms. But PCOS can happen to women of all weight ranges and those who eat and exercise well.

  • Irregular or absence of menstrual periods
  • Excessive facial hair growth
  • Acne
  • Male-pattern scalp hair thinning
  • Overweight  (can happen in all weight ranges)
  • Higher risk of developing diabetes and obstructive sleep apnea (especially if overweight/obese)
  • Difficult to conceive (infertility treatment will be recommended after 12 months of trying)
  • Mood changes – Depression, anxiety, easily stressed out

Ovulation

Normal Ovulation

Normally, women menstruate every month, about 28 days per cycle. The days can range between 21 to 35 days. This cycle is regulated by 3 organs – Hypothalamus, pituitary (both in the brain) and ovaries. Every month, the hypothalamus produces a hormone called gonadotropin release hormone (GnRH). This wakes up the pituitary to release 2 hormones called the Follicle Stimulating Hormone (FSH) and Luteinishing Hormone (LH), both of these have direct effect on the ovaries. FSH stimulates the growth of the follicles before the release of an egg. Its buddy LH helps FSH to pop the egg out of the ovary, so that it’s out of the house and ready for a date with Mr. Sperm on ovulation day. Ratio of LH and FSH is 1:1.

PCOS Ovulation

Whereas women with PCOS only get a few periods a year (fewer than 8 per year) or have cycles that are more than 35 days and generally do not ovulate regularly.  On an ultrasound, the ovaries will be packed full of immature follicles. Unfortunately, these follicles usually do not get big enough and mature enough and no egg will pop out of the ovary. Why? Because their buddy system is messed up,  LH is 2 to 3 times more than FSH!  Ratio of LH and FSH is 2~3:1. 

 

Credit: youngwomenshealth.org

Diagnosis of PCOS

Rotterdam criteria is used and this requires you to fulfill 2 out of 3 of the following conditions:

  1. Menstrual irregularities

    Prolonged cycle of more than 35 days, few periods (less than 8 per year), no period or heavy period.  I’d say changing a ‘For-heavy-flow’ sanitary pad every 2 hours is considered heavy.

  2. Polycyctic ovaries

    On a ultrasound, presence of 12 or more follicles 2-9mm in diameter and/or an increased ovarian volume >10 ml (without cyst or dominant follicle in either ovary).

  3. High level of androgen

    Androgen means male hormones, mainly testosterone and androstenedione. Both men and women produces androgen but in women, the androgen is converted to estrogen. But when there’s too much male hormones, women will have start showing male characteristics such as facial hair, acne and no period.

 

Causes of PCOS?

There is no clear-cut cause for PCOS but these are the predisposing factors.

Excess insulin

Insulin is the hormone produced in the pancreas that allows cells to use sugar, your body’s primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels will always be high and your body produces more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation.

Inflammation

This term is used to describe white blood cells production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens. Inflammation can also lead to problems in the gut, heart and blood vessels.

Heredity

Research suggests that certain genes might be linked to PCOS. It is estimated that 20 to 40% of women with PCOS have an affected mother or sister. Yes, maybe you got it from your mama but don’t give up now because PCOS can be controlled and reversed.

Excess androgen

The ovaries produce abnormally high levels of androgen (male hormones), resulting in manly hair and acne.

Lifestyle

Excess exposure to hormones in food, environmental toxin from household goods like cosmetics, shampoos or sudden climate changes may influence the hormonal system.

Is PCO same as PCOS?

They are similar but for PCO (Polycyctic Ovary), there are only immature follicles without the elevated androgens or other symptoms of PCOS. PCO ultrasound scan will present with small follicles sitting in the ovary. They appear to be quite small, usually no bigger than 8mm in diameter (normal matured follicle is about 20mm).

 

7 Supplements to consider for PCOS

Consult your doctor first and get the good grade supplements. These are supplements and should only “supplement” your diet. Eating low sugar, low GI, plant based diet with good fats is still the key.

  1. Magnesium

    Magnesium glycinate is the most absorbable form and gentlest on the stomach. Good for those who experience menstrual cramps. It also improves insulin resistance, it’s anti-inflammatory, regulates the adrenal hormones and helps with migraine too.

  2. Vitamin B Complex

    Vitamin B is a water solube vitamin consisting of B1,B2,B3,B5,B6,B7,B9 and B12. They are key players in maintaining cell health and help unlock the energy in foods to keep you energised. B vitamins are found in highest abundance in animal products such as lean beef, salmon and eggs. The B12 vitamin is not abundantly available from plants so  B12 deficiency may be concern for vegans.

  3. Vitamin D

    Get some sun! Depending on how fair or dark, the time of the year, the amount of sun need to produce Vitamin D would differ. For supplements, NIH recommends 600IU but those with PCOS will need more. As Vitamin D is fat soluble and cannot be pee-ed out, it will take longer for the body to get rid of it. Vitamin D Council suggests that we can take up to 10,000 IU per day, in Vitamin D3 form (not D2).

  4. Omega-3

    Studies show that omega-3s can aid in reducing testosterone. Studies on PCOS were done with participants taking 4g of Omega 3 fatty acids with 720mg of EPA and 480mg of DHA. It’s important to find a good quality fish Omega 3 supplement with low mercury levels like this.

  5. Ashwagandha 南非醉茄

    Ash…what? It’s a Indian Ginseng’and the word literally means “horse smell”. It is a popular all rounder adaptogen known for anti-inflammatory, anti-oxidant, and antistressor properties. Adaptogens are used to “adapt” and cope with the daily stressors, whether it’s physical,mental or environmental. Studies show that taking a specific ashwagandha root extract (KSM66, Ixoreal Biomed) 300 mg twice daily after food for 60 days appears to improve symptoms of stress.

    P.S. GINSENG NOTES
    – Korean Ginseng (used in TCM): Aka Asian or Red ginseng. Very potent and highly sought after. Strong perk-me-up powerful Qi boosting effect on the body. To be taken with precaution for those with heaty body type, high blood pressure, constipation.
    – American Ginseng (Used in TCM) : Mild Qi booster, nourish Yin and not so heaty. Good for hustle-bustle people with heaty body type.
    – Siberian Ginseng: Discovered by the Russian and does not belong to the ginseng family hence it’s not a true ginseng.  Apprently it contains contains ginsenosides, referred to as eleutherosides, which enable ginseng to balance and counterbalance the effects of stress.
    – Brazilian Ginseng: Use to capitalise on gingseng popularity and also known as an aphrodisiac.

  6. Inositol

    Inositol is not a pharmaceutical drug.  It is a naturally occurring substance produced in the human body that belongs to the vitamin B complex group, formally known as B8. The  2 effective forms of inositol are D-chiro-inositol and myo-inositol. They have the effect of lowering triglyceride and testosterone levels, modestly decrease blood pressure. 2 major brands that offers the mixture of these 2 forms of inositol are Ovasitol by Theralogix, and Inofolic Combi by LOLI Pharma.

  7. Vitex

    Also known as Chaste Tree Berry. It is a TCM herb called “Man Jing Zi 蔓荆子“. It acts on the pituitary gland to promote progesterone by promoting ovulation. It raises LH hormone, so it is not suitable for those with high LH to begin with.  If you do use it,  take it in the first part of the cycle as Vitex is used to promote ovulation. It is not advisable to take with fertility or IVF drugs and should not be taken for too long. Take for max 6 months then take a break for 1 to 2 months.

    When it comes to supplements, take one type at a time. Take for 1 month and see how you feel. If all is good, add on another one. Continue taking it for 3 months. Our blood’s lifespan is 90 to 120 days and our eggs takes about the same time to mature, so it’s best to continue and see how it affects your cycle.

 

There is no No.1 supplement, must-eat, must-dos or one-size-fit-all treatment for PCOS. It just doesn’t work like that. The pill will not fix the problem because it’s just a band-aid, you need to get to the root cause of the problem. Eating correctly to maintain happy gut health is crucial!

I know they say there is no cure for PCOS but it can be reversed and managed very well if you do it right and take some self care time to listen to your body. Stop saying it’s genetic so you can’t fit it. We can fix it from the epigenetic side.

If you change nothing, nothing changes.

I will be writing more posts exploring PCOS and TCM so stay tuned!

 


References:
https://www.singhealth.com.sg/PatientCare/ConditionsAndTreatments/Pages/Polycystic-Ovary-Syndrome.aspx
https://www.webmd.com/women/what-is-pcos
https://www.webmd.com/vitamins/ai/ingredientmono-299/inositol

2 Replies to “What is PCOS?”

  1. Hello,
    What causes Pcos in lean women with no periods, vaginal dryness, recurrent utis? What can be done? Is Vitex a good supplement to raise estrogen?

    1. Hi Maddy,
      In terms of TCM it’s due to Liver, Spleen and Kidney deficiency (one will be more prevailing). Usually, dryness is due to yin deficiency and UTI due to damp heat / infection in your lower abdomen. Treatment will be to remove dampness first. Best if you can seek TCM treatment. They have a lot of good herbs to clear that. Take cranberry juice, wear cotton underwear, no douches.

      There are some info on Vitex on my blog too. Vitex will rise progesterone and promote ovulation. It raises LH hormones so it’s not good to take if your LH is already high. It helps with PMS and androgen excess. If you do decide to take, take your follicular phase and take 1 week break every month.

      Please consult with your gynae first before taking any herbs/meds. Hope this helps!

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