Balanced hormones aid in getting knocked-up

The Georgia Straight - Health Features
Thursday, March 5, 2009

Like a lot of women, Karen Barré had always had irregular periods, but she never gave them much thought. At least, the Langley resident didn’t worry about them too much until she wanted to have a baby. After more than a year of trying to conceive, Barré went to her doctor and found out the explanation for her wonky menstrual cycles and her inability to get pregnant: polycystic ovary syndrome.

“I guess I fit a lot of the criteria for it,” Barré, 31, tells the Georgia Straight on the line from her home. Besides infrequent periods and fertility problems, she had started gaining weight in her early 20s and couldn’t seem to lose it, even with regular exercise and a healthy diet. She was lucky her doctor knew to test her for PCOS given that she didn’t have any other of the hormonal condition’s telltale signs, such as acne,  facial hair, the development of skin tags, excessive bleeding during her periods, and hair thinning or loss.

Still, Barré wasn’t exactly open to hearing the news.

“I wasn’t willing to accept the diagnosis,” Barré explains. “I really didn’t want to do Clomid [a fertility drug] or take drugs that had a lot of side effects.” In January 2008, she went to see a doctor of traditional Chinese medicine.

“I was pregnant three months later,” says Barré, who is now the mother of an eight-week-old girl.

There are many approaches to treatment for PCOS, which, according to the Canadian Women’s Health  network, affects 6%-10% of women. PCOS causes the ovaries to produce high levels of androgen, a male hormone. Consequently, the eggs that the ovaries would normally produce develop into tiny sacs filled with liquid. The cysts build up in the ovaries and can become enlarged.

Jerrilyn Prior, a doctor and professor of endocrinology and metabolism at UBC, prefers a different name for the condition: "anovulatory androgen excess." "'Polycystic ovary syndrome' is wrong because you can have many cysts in the ovaries but not have this syndrome,” says Prior, who in 2002 founded the Centre for Menstrual Cycle and Ovulation Research. "The term doesn’t emphasize the importance of not ovulating, which is the real problem. Anovulatory androgen excess implies that it’s not a disease but a condition that can be successfully treated."

When she started working in her field in 1977, Prior says, the condition was largely treated by dermatologists and gynecologists. Difficult cases ended up in her hands. She ended up writing a handout on symptoms and treatment that she gave out to as many physicians as she could. "Family doctors should be treating this," she says. "There’s no reason to see a specialist.... It’s a normonal imbalance, and it’s treatable." PCOS, or AAE, is commonly treated with the birth-control pill, which helps reduce facial hair.

The problem with the pill, according to Prior, is that it doesn’t restore hormonal balance. She says that women with AAE don’t make enough progesterone, which causes the increase in male hormones and leads to irregular periods and infertility. She treats the condition with cyclic progesterone therapy.

"Progesterone is usually missing, so replacing it makes sense," she explains. "Taking progesterone for two weeks every month may get the hypothalamus thinking cyclically gain.... I’ve seen women take this therapy and totally reverse their AAE. They’ve gone on to get pregnant on their own without IVF [in vitro fertilization]."

"This is a syndrome with emotional overtones," Prior adds. "For women who have facial hair and acne and increased body hair and weight gain, it can be devastating." To combat those troubling symptoms, Prior has also used spironolactone, a drug that blocks male hormones.

The condition is also linked to insulin resistance, Type 2 diabetes, and heart disease, Prior says. 

Consequently, diet, exercise, and lifestyle play a role in its treatment. Lorne Brown agrees. The doctor of traditional Chinese medicine is the founder of Acubalance Wellness Centre, which specializes in treating infertility and reproductive health. "With some women, weight loss, a low glycemic-index diet, and exercise may help decrease insulin resistance and start normal ovulation," Brown says in a phone interview. "Exercise also reduces cortisol, the stress hormone. Chronic stress leads to an increase in visceral abdominal fat, that stubborn belly fat that puts people at risk of heart disease and hypertension... and that’s really dangerous for health. Anything that is destressing — meditation, yoga, acupuncture, exercise —will help reduce cortisol levels.... There are so many things women can do naturally to help with PCOS."

Acupuncture, Brown adds, holds great promise in treating PCOS. He points to a review published last year in the Journal of Neuroendocrinology that found that electric acupuncture stimulates ovarian blood flow and could increase insulin sensitivity. Although more study is needed into the Chinese modality’s effectiveness, one advantage of acupuncture over harmaceutical approaches is its lack of side effects.

Brown has posted on the Acubalance Web site a diet specifically to treat PCOS. Among the suggestions are for women to eliminate refined carbohydrates (such as white pasta and flour), have a daily serving of legumes, limit dairy products, and add one or two tablespoons of cinnamon to cereal each morning, which is said to help decrease insulin resistance. Brown’s approach appealed to Barré because she valued traditional Chinese medicine’s holistic philosophy.

“Even having acupuncture, I was in a quiet room with aromatherapy and meditative music; I started to relax,” Barré says. “I started to feel positive and hopeful.”

Karen Barré’s wonky menstrual cycles turned out to be polycystic ovary syndrome, but acupuncture and other traditional Chinese medical treatments helped her become pregnant with baby Addison.

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Gail Johnson