I released a long-held sigh of relief today when I came across an announcement from the National Institutes of Health, declaring their decision to rename polycystic ovarian syndrome (PCOS). A minor thing to get worked up over? I think not. PCOS is a leading cause of infertility in young women, and a significant risk factor for type 2 diabetes, high cholesterol, and hypertension. Despite the name, PCOS often presents without any ovarian cysts. Why is this a concern? A misleading name will do exactly that: mislead.
As a naturopathic physician specializing in women’s health and endocrine disorders, I’ve had the opportunity to see how prevalent PCOS is, and how frequently it goes undiagnosed. Without ovarian pain, or confirmed ovarian cysts, a focused diagnostic work up for the hormonal disorder is often overlooked. Sometimes this is an oversight by the healthcare practitioner, but in many cases, it is related to patients not knowing when to seek care. Of the women I have diagnosed with PCOS, most have responded to my first mention of its name with something along the lines of “PCOS? Not me, I don’t have any cysts.” They’re half right.
What is PCOS?
Polycystic ovarian syndrome is a complex metabolic and hormonal disorder that involves both hyperandrogenism (elevated levels of androgen hormones, such as testosterone) and insulin resistance. Hormone and blood sugar imbalances effect the entire body, causing a wide variety of symptoms:
Irregular menstrual cycle, or complete loss of cycle
Infertility (Unable to conceive after 12+ months)
Excess hair growth on the face, back and chest
Thinning hair (scalp)
Weight gain, especially around the trunk
Depression and anxiety
As you can see above, ovarian cysts are a very small piece of a very large puzzle. Their absence does not rule out a diagnosis of PCOS, nor does their presence guarantee one. In fact, single and even multiple ovarian cysts can exist women without any history of the condition.
With so many young women effected and at increased risk for life-altering diseases, early diagnosis and treatment of PCOS is invaluable. If you have irregular cycles in combination with any of the symptoms listed above, please do not hesitate to speak with your healthcare provider.
Are there natural treatment options?
There are many natural treatment options available to help balance your hormones, address insulin resistance and improve metabolic function. For my patients, I use a combination of dietary counseling, weight loss plans, bio-identical hormones, nutritional supplements and botanicals. Subclinical hypothyroidism is also present as well, and treatment with natural supplements or thyroid hormone replacement leads to significant improvement. Many women respond beautifully to these interventions, allowing them to avoid treatment through surgery, diabetes medications, birth control pills or anti-androgen medications.
Diet: Insulin resistance and elevated blood sugar are highly responsive to dietary modifications.
Weight Loss: Specific dietary changes, metabolic support and HCG Diet when appropriate.
Bio-Identical Hormones: Bio-identical progesterone in combination with aggressive treatment of insulin resistance (high insulin stimulates increased androgen production).
Nutritional Supplements: Specific to hormone metabolism, blood sugar balance and endocrine system support.
Botanicals: Specific to estrogen, testosterone and progesterone balance, as well as blood sugar metabolism.
Dr. Kaley Bourgeois
“Panel recommends changing name of common disorder in women.” NIH News. National Institutes of Health, 23 Jan 2013. Web. 25 Jan 2013. <http://www.nih.gov/news/health/jan2013/od-23.htm>.
Low progesterone production is a significant and frequent finding in the realm of women’s healthcare. It is no wonder that the term estrogen dominance can be found throughout magazines, health blogs and other sources of medical media. While estrogen dominance does exist, the label is often over-used and does not differentiate between the unique forms of hormone imbalance facing women of all ages.
Names and labels aside, low progesterone is at the root cause of various symptoms, including infertility, irregular cycles, painful & heavy periods, breast pain, premenstrual syndrome, poor sleep, and more. In addition to its direct roles in menstruation and pregnancy, progesterone is involved in multiple physiological processes such as water balance, and nervous system function. At healthy levels, it prevents excess water retention, and helps to calm the nervous system through its effect on neurotransmitters in the brain. For these reasons, low progesterone can cause pre-menstrual symptoms like bloating and weight gain, mood changes and poor sleep.
Lets discuss a few of the common health complaints linked to progesterone deficiency:
Progesterone has the unique job of sustaining a healthy uterine lining for the two weeks following ovulation. This short window is necessary for conception. Furthermore, the ovaries must produce enough progesterone to support pregnancy for the first 10 weeks, until the placenta takes over.
The term luteal phase defect refers to a period of less than 10 days between ovulation and the 1st day of bleeding. Many women suffer from this symptom of progesterone deficiency without knowing it, even if they have a seemingly normal, 28 day cycle. Every women struggling with infertility should consider progesterone deficiency as a potential causes; your healthcare practitioner can help your to properly track your cycle, and order blood tests when needed.
Progesterone deficiency often plays a role in menstrual cycles that are irregular. If your cycle does not occur on a monthly basis, or the time between your menstruation changes, you likely have an imbalance between progesterone and estrogen. This imbalance may be relative (meaning your progesterone is within normal range, but your estrogen levels are high), or purely due to low production of the hormone.
Uterine Fibroids & Endometriosis
Estrogen plays the role of stimulating tissue growth in the uterus to prepare for ovulation and pregnancy. Progesterone is responsible for balancing this and other effects of estrogen so that the tissue does not grow in excess.
When this balance fails, patients may develop signs of excess estrogen stimulation, including endometrial hyperplasia (overgrowth of uterine lining) and fibroids (benign tumors of the uterus). Insufficient progesterone is also suspected to play a role in endometriosis, a painful condition in which uterine tissue grows outside of the uterus. Though fibroids and endometrial hyperplasia are more common in middle-aged women heading toward menopause, all three may occur in young women and play a role in infertility.
Thankfully, low progesterone and associated hormone imbalances can often be corrected via botanical therapies, physiological hormone replacement, or both. When properly dosed, studies show that Vitex agnus-castus can significantly increase progesterone production. Likewise, there are hormone precursors that can be safely supplemented by your healthcare practitioner to support your body’s hormone production. When indicated, physiological doses of bio-identical progesterone can also reverse the symptoms of progesterone deficiency.
Dr. Kaley Bourgeois
Natural Medicines Comprehensive Database. Updated Jan 4, 2013.