Polycystic ovary syndrome, also known as polycystic ovary disease (PCOD) affects five to ten percent of women in North America and is the leading cause of ovulatory based infertility.

Women with PCOS have high levels of male hormones (androgens) which interfere with the normal production of female hormones like estrogen. This results in the ovaries filling with cysts or creating immature follicles that are unable to generate eggs.

Along with reduced fertility women with PCOS are at a heightened risk for:

• Type 2 Diabetes
• Heart Disease
• Some forms of cancer

WHAT ARE THE SYMPTOMS?
Some women with PCOS have no symptoms. More often, however, women will experience some or all of the following symptoms:

• Weight gain or obesity
• Excessive hair growth (hirsutism) and/or abnormal hair growth
• Irregular periods or complete absence of menstruation (amenorrhea)
• Acne
• Enlarged ovaries covered with cysts
• Insulin resistance/hyperinsulinemia

HOW IS PCOS DIAGNOSED?
If your medical doctor suspects that you have PCOS she may recommend that you have a blood test to test for elevated LH (luteinizing hormone) and serum testosterone and an ultrasound of the ovaries to determine if cysts are present (about 20% of all women will have ovarian cysts visible on the ultrasound, so having the cysts does not necessarily mean you have PCOS).

From a Chinese medical perspective, it is always important to look at the individual pattern diagnosis. Your practitioner will do a thorough evaluation of physical and emotional signs and symptoms as well as analyzing your diet and lifestyle and checking your tongue and pulse. Although every diagnosis in Chinese medicine is individual, the most common TCM diagnosis patterns for PCOS is kidney yang deficiency with phlegm and dampness.

WHAT IS THE CAUSE?

No one knows the exact cause of PCOS. Women with PCOS frequently have a mother or sister with the condition but there is not yet enough evidence to say there is a genetic link to this disorder. Many women with PCOS have a weight problem. So researchers are looking at the relationship between PCOS and the body’s ability to use insulin.

PCOS often results in increased insulin resistance, glucose intolerance, impaired glucose metabolism, elevated lipid profile, high blood pressure, mood swings, and irritability. This means that the body has a reduced capacity to metabolize insulin and glucose. The pancreas works harder to produce insulin, but the insulin cannot do its work of transporting glucose (sugar) into the cells because of a hormonal imbalance or because of too many fat cells The excess insulin in the blood leads to excess glucose in the blood and sets the conditions for prediabetes, weight gain and diabesity. If untreated, PCOS can lead to overweight, obesity, heart disease, diabetes and some cancers.

HOW DOES INSULIN AFFECT FERTILITY?

Insulin is a hormone that regulates the change of sugar, starches, and other food into energy for the body’s use or for storage. Excess insulin causes a rise in male hormones which can lead to acne, excessive hair growth, weight gain, and ovulation problems. As well, insulin blocks the liver from producing sex hormone binding globulin --a hormone that restricts which cells are affected by testosterone. So high insulin levels increase the amount of male hormones circulating in the blood and also amplify the effects on these hormones on all the cells. In turn high levels of insulin stimulate the ovaries to overproduce androgens. Excess androgens cause the follicles to develop too quickly & then to shut down prematurely before they produce an egg. To make matters worse insulin insensitivity contributes to gain weight, especially in the belly area and insulin insensitivity makes it harder to loose the weight. If that wasn't bad enough this excess fat sets up a negative feed back system: The adipocite or fat derived hormone litpton inhitbits the stimulatory effect of FHS Obesity is associated with gonatrophin resistance. This is a classic example of a too much yang and not enough yin, In Chinese Medicine this condition can have a number of linked patterns of deficiency and excess that have an impact on the way the body ovulates.

HOW IS PCOS  TREATED?

Treatment depends on the severity of the condition. For both Western and Chinese medicine the first line of treatment is diet and weight control. With some women, reducing insulin levels and improving insulin sensitivity through weight loss, a low glycemic diet and exercise may restore normal ovulation. For more severe cases, Western treatment may also include fertility drugs, insulin regulating drugs and, in some cases, assisted reproductive therapies like In vitro fertilization.

The Chinese approach is to treat the underlying condition that is causing the hormonal imbalance as well as to alleviate symptoms. Typically a personalized treatment plan to rebalance hormones and regulate the menstrual period takes at least 3-6 months.

Acupuncture 2-5 times a week over a 16 week period has shown to benefit women with PCOS. This research demonstrated that receiving low frequency electro stim acupuncture (EA) over a 16 week period helped women regain ovulation and also lower testosterone levels.  The study concluded "Low-frequency Electro-acupuncture (EA) and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS. Low-frequency EA was superior to physical exercise and may be useful for treating hyperandrogenism and oligo/amenorrhea"

As mentioned diet and lifestyle play a crucial role in  treating  PCOS. The goal is to regulate the blood sugar, decrease insulin resistance and improve glucose metabolism. This will help to stabilize insulin levels, moods and weight. Following an  anti inflammatory, low glycemic diet can  keep your blood sugar stable, improve insulin sensitivity, and reduce phlegm.

TEN TIPS TO KICKSTART YOUR PCOS DIET

1. Eat low  Glycemic Index (GI) carbohydrates such as vegetables and whole grains. It is very important for women with PCOS to completely avoid refined carbohydrates including sugar, white flour, whole wheat flour and products made from them eg  pasta, breads, desserts, pop, and candy)
2. Keep your blood sugar stable with a daily schedule of meals and snacks every three to five hours that includes some protein and good fats (for example some nuts/nut butter, seeds/seed butter, hardboiled egg, hummus dip). Protein foods take up to 5 hours to digest while carbohydrate foods digest within 30 minutes.
3. Eat at least five servings a day of vegetables including two of leafy greens
4. Have a daily serving of legumes like black beans or lentils.
5. Enjoy grass or pasture fed meat up to three times a week
6. Eat at least three daily servings of fruits like berries --which have a lower glycemic impact eAch fruit as part of a meal or with a protein.
7. Limit or eliminate milk and dairy as these can aggravate internal dampness. If you do have dairy have only non homogenized full fat milk
8. Pay careful attention to portion sizes in order to moderate glucose load and minimize insulin resistance
9. Add one or two Tbsp of cinnamon on cereal each morning to help decrease insulin resistance.
10. Include prebiotic and probiotic foods which promote the growth of beneficial bacteria in the intestinal tract. Prebiotics are found in whole grains, onions, bananas, garlic, honey, leeks, artichokes and some fortified foods. Probiotic foods are found in fermented foods (sauerkraut, live culture yogurt, kim chi, miso).

In addition get your heart rate up with at least 30 minutes of  vigorous exercise every day. Studies have shown that exercise can reverse diabetes and improve insulin sensitivity as well as help with weight control.

Just losing five to ten percent of your body weight, if you are overweight, can restore your menstrual periods and reduce distressing symptoms like facial hair and acne. However it is important not to exercise too hard. Over exercise depletes your yin and can raise your testosterone levels. This is not the time to start you marathon training. Balance is the key!

Supplements

• Chlorophyll: reduces symptoms of hypoglycaemia without raising blood glucose level
• B vitamins, magnesium, alpha lipoeic acid and conjugated linoleic acid: improve insulin resistance
• N-acetylcysteine (NAC)  - Regulates blood sugar and is a strong anti oxidant
• Saw Plamento - blocks the production of DHT (dihydrtestosterone)
• Bitter Melon and fenugreek - Regulate blood glucose

In addition to dietary therapy, exercise and life style changes, your practitioner may prescribe acupuncture and herbal formulas. Some promising studies have shown Chinese herbs to be more effective than Western medicine in stimulating ovulation. 

After a couple months of treatment you should begin to notice signs of ovulation like increased mid-month vaginal discharge and elevated  Basal Body Temperature (BBT). You may notice, if you have very long cycles, that ovulation comes earlier in the cycle indicating healthier egg production. As well your skin should clear up and your excess hair should diminish.

In general, lifestyle changes which include weight loss. insulin control and TCM treatment with herbs and acupuncture have proven to be very effective in the treatment of PCOS