Treatments for PCOS

PCOS Treatments

There are three main approaches to the treatment of PolyCystic Ovary Syndrome (PCOS), based on :

Weight loss.
Western medication or surgery.
Complementary therapies, including supplements.

(i) Weight loss

The chances of having PCOS increases with weight, which makes weight loss the first line of treatment for most women with PCOS. Weight loss can dramatically change hormone levels to improve fertility and reduce other health conditions, including diabetes, hypertension and high cholesterol.

Losing just 5% of your body weight usually alters hormone balance enough to normalize ovulation and make natural pregnancy possible. When women lose 10% of their body weight, it reduces the fat in the body by 30%. When this happens, nearly every woman ovulates normally! i For women of 180lbs, that’s just a 9lbs reduction.

The good news is that when obese women with PCOS follow a[show_to accesslevel=” premium” no_access=’

‘] 1200 kcal/day diet this happens:

Three quarters lose 5% of their weight, and a third lose 10%.
All reduce their BMI, body fat and waist and hip circumferences.
The ovaries significantly shrink in size, as do the number of cysts in them.
Two-thirds of non-ovulating women resume regular cycles.
A third get pregnant when they lose at least 5% of their weight.

PCOS stems from problems with sugar metabolism and insulin resistance for many women (including many average weight women). The reason for this is that high insulin levels stimulate the ovaries to produce testosterone. Genetics and the environment contribute to PCOS, and some people are more prone to insulin resistance than others on the same diet. This is simply because their ancestors had become well adapted to low carb and sugar diets.

Diet is a tricky subject, and the best way to lose weight usually involves joining a support group, cutting calories (especially sugar) and taking regular exercise at the same time. The relationship between PCOS and high insulin levels makes a diabetic-type diet ideal, but also bear in mind that:

Increasing protein in the diet reduces PCOS rates (we strongly advise vegetable protein) ⁱⁱ
A high-fat diet contributes to PCOS (and insulin resistance) developing ⁱⁱⁱ
A low carb diet reduces PCOS (and insulin resistance) ^iv
Losing weight by dieting is far more effective than taking metformin type drugs for obese and overweight women with insulin resistance and PCOS ^v

There’s more information on weight and fertility in lifestyle and types that are personal, effective and inexpensive.

(ii) Medication

Doctors often suggest drugs for PCOS. The usual is birth control pills as they offer more regular periods and less hair growth. Still, they do stop you from having a baby…! Women trying to conceive and wanting a medicated answer are best off seeing a reproductive endocrinologist for a proper evaluation. The treatment they’ll usually recommend is:

Clomiphene citrate (clomid)^vi is inexpensive and often successful, especially for younger women. We think it’s less appropriate for Tired or older women as it thins the womb lining, which can be an issue for them. Clomid also carries a risk of ovarian hyper-stimulation syndrome (OHSS). The side effects including hot flushes, mood swings, visual disturbances, breast tenderness, nausea and pelvic discomfort. Natural alternatives to clomid include black cohosh, and they avoid the side effects. If clomid doesn’t do the trick, the options are then usually:
Gonadotropins are hormones that directly affect the ovaries (usually FSH). These are expensive and increase the risk of multiple pregnancies and ovarian hyper-stimulation syndrome (OHSS), so a low-dose regimen with ultrasound monitoring is usually offered. ^vii
Ovarian drilling involves laparoscopic surgery where 4-10 small follicles are punctured and often triggers normal ovulation or ovulation along with Clomid or FSH. However, it also destroys ovarian tissue and reduces ovarian reserve.
Metformin is often prescribed alongside clomid for women with PCOS. The guidelines for metformin use in PCOS advise restricting it to women with glucose intolerance. There’s some debate about its routine use for PCOS, and there are viable, healthy alternatives. ^viii

(iii) Supplements and Complementary treatments

There’s some compelling evidence on complementary and supplements for treating PCOS:

Herbal medicine

Medicinal herbs have been used to raise fertility for centuries, and there are many formulas specifically to improve ovulation. A meta-analysis of published research showed that herbal medicine is 3x more effective than clomid in getting live births without the side effects. ^ix

Acupuncture

Research for acupuncture has shown evidence it can:

Improve metabolic and hormonal systems long term. ^x
reduce androgens and acne.
promote ovulation and the frequency of periods. ^xi

Inositols

Inositols are DCI-IPG mediators that control sugar metabolism in cells. They determine whether sugar that arrives in cells is stored as fat or burnt to power it. They’re also known as vitamin B₈ (vitamins must come from the diet, and gut bacteria synthesize some inositol from glucose they don’t quite qualify). They’re critical in PCOS because:

Insulin controls sugar levels in the blood, but not in the cells.
A deficiency of IPG mediators (inositols) can cause insulin resistance (and a loss of sugar level control in the blood).
Insulin resistance is a significant contributor to PCOS as the body compensates for the lack of sugar level control by increasing insulin levels (hyperinsulinemia).
Hyperinsulinemia stimulates the ovaries to increase their production of testosterone. It also reduces sex hormone-binding globulin SHBG in the blood, raising testosterone’s bio-availability.
High testosterone levels are the central defining feature of PCOS.
Medications that increase insulin sensitivity (such as metformin) are often part of PCOS treatment.
There’s strong evidence that women with PCOS are chronically deficient in inositols, and a recent review stated:

“The effects of metformin in improving insulin action in PCOS women was achieved through the release of DCI-IPG mediators” ^xii

The main types of inositol are myo-inositol and d-chiro-inositol (myo-inositol appears to be most beneficial to PCOS). Most inositol comes from our diet, which further underlines the importance of the diet for fertility. When women with PCOS (of all BMIs ^xiii) supplement with inositol, there are some amazing benefits:

Reduced insulin resistance, and it’s a safer and more effective treatment than metformin ^xiv
Reduced testosterone levels (by over half) ^xv
Reduced hyper-androgenism (male features)
Reduced hirsutism and acne ^xvi
Lower BMIs
Better ovulation rates ^xvii
Better egg quality (supplementing for 3 months at 2g daily) ^xviii
Better IVF-ET or ICSI clinical pregnancy rates ^xix
Improved egg quality and reduced miscarriage rates ^xx
Reduced need for IVF stimulation drugs and risk of OHSS ^xxi
Better implantation rates in pre-treated women ^xxii
Reduced blood lipids (cholesterol) ^xxiii
Improved effectiveness of clomid treatment ^xxiv
Reduced the risk of gestational diabetes (from 54% to 17.4%) ^{xxv xxvi}

The research into myo-inositol in pregnancy shows it’s relatively safe (water-soluble, so any excess gets excreted). A healthy diet is the best way to get inositols. This also helps achieve a balanced mix of vitamins, minerals, proteins, carbohydrates, fats and fibre to support the microbiome. Inositols are available as supplements, and most PCOS trials choose 2-4g a day. The best dietary sources of inositol are:

Nuts and seeds.
Wholegrains (in descending order): chickpeas, brown rice, wheat germ, lentils, barley, oats, whole wheat flour, buckwheat.
Fruit and vegetables: banana, stone fruits, citrus (except lemons), cantaloupes, strawberries, cauliflower, swiss chard and leafy greens.
All beans and peas (mainly soy, lima, and kidney).
Mushrooms and yeast.
Beef (especially liver), but you get more B₈ per gram from lentils.
Egg yolk.
Sardines and other oily fish.

Do’s for inositols	Don’ts for inositols
Wholefoods	Processed grains like white bread
Fresh food	Tinned, frozen or salted food
	Drink more than 2 coffees a day (it destroys it)
Take probiotics	Take antibiotics long-term (unless vital)
Buy organic meat	Buy meat raised with steroids or antibiotics

Several other conditions are linked to inositol deficiency, including skin rashes, acne, neuropathy, muscle weakness, depression, and OCD. Also, tiredness, raised cholesterol, eye problems, hardening of the arteries, digestive problems (including Candida infections). There’s some good evidence that supplementing helps anxiety or panic attacks (at doses of 18g a day).

Black cohosh

Black cohosh (Cimicifuga racemose) extract is a possible alternative (or addition)^xxvii to clomid. One study found nearly double the pregnancy rates with the black cohosh (at 20mg/day for ten days starting on day 2 of the cycle). There were significant, positive differences in the FSH/LH ratios, with lower LH levels in the black cohosh group. The black cohosh group also had significantly thicker womb linings and higher progesterone levels than the clomid group, making it especially attractive to older women. ^xxviii

Antioxidants

Antioxidants are essential for all areas of health, and PCOS is associated with low antioxidant levels and high oxidative stress levels. ^xxix There’s evidence that increasing the amounts and range of antioxidants in the diet reduces PCOS development. We recommend taking “food-state supplements’ as they’re very well-tolerated and absorbed.

Vitamin D

Vitamin D deficiency is associated with PCOS, ^xxx as well as endometriosis and infertility. ^xxxiVitamin D is vital for the hormonal health of both sexes. It’s been suggested that having enough vitamin D in the diet may reduce the chances of getting PCOS and limit its development once started.

Minerals

Selenium deficiency is linked to high testosterone and LH levels and the development of PCOS. ^xxxii
Magnesium and chromium levels in the blood serum are significantly lower in PCOS women with insulin resistance. ^xxxiii

Suggested action

The suggestion from morefertile^® is that women with PCOS:

Make a considerable effort to increase whole foods and fresh vegetables/fruit in their diet.
Take an inositol (vitamin B₈) supplement.
Take a good quality multivitamin a day.
Have Chinese medicine treatment to activate their ovaries.

Support resources

Verity is a self-help organization for women whose lives are affected by PCOS www.verity-pcos.org.uk.
Infertility Network UK infertilitynetworkuk.com.

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