Polycystic Ovarian Syndrome
Polycystic ovary syndrome (PCOS) may be the most common endocrine disorder in women. It is estimated to be present in 5% to 10% of premenopausal women. Despite its prevalence, the etiology of PCOS has yet to be determined. The diagnosis of PCOS, also known as Stein Leventhal Syndrome, is complicated by the lack of standard diagnostic criteria, and the fact that very few patients present with identical clinical symptoms. PCOS is a loosely defined, heterogeneous disorder. It is characterized by the presence of polycystic ovaries associated with one or more of the following conditions: hirsutism, obesity, anovulation, infertility, menstrual disorders, hyperinsulinemia, insulin resistance, and hormonal imbalances. Included in the differential diagnosis of PCOS is Cushing’s syndrome, hyperprolactinemia, congenital adrenal hyperplasia, idiopathic hirsutism, and androgen-secreting tumors. In addition to the distressing symptoms of PCOS, patients with this syndrome are at increased risk for a variety of serious medical complications. These include non-insulin dependent diabetes mellitus (NIDDM), hyperlipidemia, hypertension, cardiovascular disease, endometrial cancer, ovarian cancer, and possibly breast cancer. As a result, the proper diagnosis and treatment of this syndrome is vitally important. The presence of polycystic ovaries is a primary diagnostic criterion of PCOS. Polycystic ovaries are detected by transvaginal ultrasound. They appear as increased ovarian central stroma with the presence of eight or more peripheral follicular cysts 10mm or less in diameter. It is important to remember, however, that polycystic ovaries may be present in women without PCOS, or may be indicative of syndromes other than PCOS. The role of insulin resistance is that insulin resistance, a condition characterized by decreased tissue sensitivity to insulin, is a key component of the clinical picture of PCOS. Insulin resistance leads to increased insulin production (hyperinsulinemia), progressive pancreatic beta-cell deficiency, and impaired glucose tolerance, eventually leading to the development of NIDDM. Obesity is highly correlated with insulin resistance, and approximately 50% of women with PCOS have central obesity (belly fat). In addition to obesity, genetic predisposition, pregnancy, drugs (such as corticosteroids), and lifestyle factors (such as smoking) contribute to insulin resistance. As it relates to PCOS, a growing body of evidence points to insulin resistance as a cause of the hormonal disturbances seen in the hypothalamic-pituitary-ovarian axis in patients with PCOS. Typically, the hormonal profile in PCOS shows increased gonadotropin-releasing hormone (GnRh), increased luteinizing hormone (LH), pulse frequency, increased LH, normal follicular-stimulating hormone (FSH) (resulting in increased LH/FSH ratio), elevated testosterone, and elevated insulin. Additionally, about 50% of women have elevated DHEA-S levels, and approximately 20% of PCOS patients have elevated prolactin levels. Other lifestyle factors in PCOS include weight management and exercise as top priorities in a PCOS treatment plan.
A naturopathic approach to treating someone with PCOS would start with a complete hormone panel to discover any hormone imbalances as well as a fasting blood sugar and insulin test followed by a two hour post prandial blood sugar and insulin test to rule out underlying insulin resistance as a cause to the PCOS. Most often the imbalance in the hormones is estrogen dominance which can also be accompanied by low progesterone. Therefore treatment would start with an estrogen detoxification program. Estrogen is detoxified through the same p450 enzymatic pathway as caffeine and alcohol so one way to maximize the detoxification of estrogen is to eliminate caffeine and alcohol from the diet. Clinical nutrition may also be added to assist. If insulin resistance is determined on lab findings a low glycemic, high protein meal plan may be recommended to help address the underlying insulin resistance, as well as an individualized exercise program. Bio-identical progesterone may be prescribed or botanical natural progesterone if progesterone is low.