Poly-Cystic Ovary Syndrome (PCOS)

Poly-Cystic Ovary Syndrome (PCOS) Overview:

PCOS remains not well understood despite its commonality. Up to 7% of young women are affected. Despite its name, polycystic ovaries are not technically cysts but do have a cystic appearance.

There are several factors that are implicated with PCOS, including obesity, insulin resistance, and hyperinsulinemia. Later in life, many PCOS sufferers suffer type 2 diabetes and cardiovascular disease. As a result of these associations, metformin, a common antidiabetic drug, has become a common treatment for stabilise cycles and comorbidities of this condition.

 

Aetiology:

+ Potential Causes

  • Genetic factors
  • Environmental factors
  • Insulin resistance increases ovarian androgen production and/or reduces hepatic Sex hormone-binding globulin (SHBG).

+ Pathophysiology

  • Ovulatory function is suppressed. Even a slight increase in testosterone in a woman’s body can suppress normal menstruation and ovulation.
  • The combination of increased levels of androgens and insulin resistance underpin the features of PCOS.

+ Risk Factors

  • Family history of diabetes
  • Insulin resistance/Metabolic syndrome

+ Comorbidities

  • Infertility
  • Diabetes
  • Abnormal uterine bleeding
  • Endometrial cancer
  • Colon cancer
  • Metabolic syndrome
  • Insulin resistance
  • Central obesity
  • Pre-diabetes
  • Hyperlipidaemia
  • Mood disturbances (effects of hyperglycaemia)
  • Endometrial carcinoma
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Symptoms:

Hirsutism

Oily Skin

Acne

Infertility

Hyperglycemia

Obesity

Amenorrhoea

Abnormal uterine bleeding


Diagnostic Considerations:

Diagnostic Criteria For PCOS:

Diagnosis requires at least 2 of the following:

Finding Examples
1. Oligo-ovulation or anovulation ---
2. Hyperandrogenism Hirsutism, acne, raised LH, infertility, obesity, and raised androgen index
3. Polycystic ovaries on ultrasound • >12 follicles measuring between 2 and 9mm in diameter and/or ovarian volume >10ml

• 1 ovary sufficient for diagnosis

Other conditions must also first be ruled out, such as hypothyroidism, hyperoprolactinemia, congenital adrenal hyperplasia, androgen-secreting tumours, and Cushing's Syndrome.

 

Lab Results With PCOS

Hormone Normal Range Typical Findings In PCOS
Testosterone insert High
SHBG insert Low
FAI insert High
LH insert High
FSH insert Low or Normal
LH:FSH Ratio insert High
PL insert Normal or High
TSH insert Low, normal, or High
Oestrone insert Low, Normal, or High
HbA1C insert insert
Triglycerides insert insert
 

Therapeutic Aims:

1. Address Insulin Resistance

Through blood glucose regulation, insulin potentiators, and reduction in central obesity.

  • Thermogenics (Coleus forskohlii)
  • Pancreatics (Licorice?)
  • Glucose Regulators (Gymnema, Panax ginseng, Pinus spp., Polygonum, Berberine containing herbs, Galega, Trigonella, Codonopsis)
  • Hepatics (Silybum marianum, Cynara scolymus)

2. Regulate Female Sex Hormones

Reduce excess androgen levels

  • Vitex agnus-castus
  • 5-alpha-reductase inhibitors (Serenoa repens)
  • 17β-hydroxysteroid dehydrogenase inhibitors (Serenoa repens, Glycyrrhiza glabra, Smilax spp.)
  • Aromatase Upregulators (Paeonia lactiflora, Glycyrrhiza glabra)
  • Phytoestrogens (Humulus lupulus)
  • LH Inhibitors (Cimicifuga racemosa, Humulus lupulus)

3. Improve Fertility (If Applicable)

...

  • HPO axis Modulators (Cimicifuga racemosa, Paeonia lactiflora, Vitex agnus-castus)
  • Ovarian Tonics (Tribulus terrestris, Asparagus racemosus, Aletris farinosa, Cimicifuga racemosa, Dioscorea villosa, Trillium erectum, Chamaelerium luteum)

4. Support Adrenals And Reduce Cortisol Secretion

insert

  • Adrenal Tonics (Rehmannia glutinosa, Glycyrrhiza glabra)
  • Adaptogens ()
  • Nervines ()

5.

...

  • ...
 

Differential Diagnosis:

  • ...
 

Cautions:

Women with PCOS are ata significantly increased risk for developing endometiral cancer and have a high prevalence with diabetes.

 

Herbs For PCOS:

  • White peony
  • Tribulus terrestris
  • Asparagus racemosa
  • Aletris farinosa
  • Cimicifuga racemosa
  • Dioscorea villosa
  • Trillium erectum
  • Chamaelirium luteum
 

PCOS Formula

Herb Name Ratio Amount in mL
Vitex agnus-castus 1:2 20 mL
Glycyrrhiza glabra 1:1 15 mL
Paeonia lactiflora 1:2 30 mL
Gymnema sylvestre 1:1 25 mL
Schisandra chinenseis 1:2 20 mL
Total 110 mL

PCOS Formula #2

Herb Name Ratio Amount in mL
Cinnamomum verum 1:2 20 mL
Glycyrrhiza glabra 1:1 20 mL
Paeonia lactiflora 1:2 20 mL
Hypericum perforatum 1:1 20 mL
Tribulus terrestris 1:2 30 mL
Total 110 mL

Author:

Justin Cooke

The Sunlight Experiment

Updated: November 2017


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References:

  1. Bone, K., & Mills, S. (2013). Principles and Practice of Phytotherapy-E-Book: Modern Herbal Medicine. Elsevier Health Sciences.