September 5th, 2010 | Posted in Female Problems
Polycystic ovary syndrome is a complete misnomer for a common condition affecting women, classically during their fertile years. First of all there are no “cysts” per se, just small follicles in the ovary which get stuck at a certain stage of development before they can get to the stage of producing an egg (at about 6-8 mm). This is the reason these patients are often infertile – i.e. because they are not producing eggs.
As many as 20% of women are thought to have polycystic ovaries, although most cases are mild, and only about 5% to 10% of women develop problems as a result. PCOS is caused by a hormonal imbalance, where the ovaries produce too many male hormones, which block the normal growth of the egg follicles. As a result, multiple small cysts develop, and the ovaries can then enlarge to up to four times their normal size.
Why does this happen?
In fact the reason these women have this condition appears ultimately related to evolutionary pressures on human populations related to food (or more particularly the absence of food). Women with PCO are insulin resistant and therefore store energy very efficiently i.e. “super savers”. This is all well and good in time of famine when the food supply is poor. In these circumstances, they will utilise these body stores (body fat), their body mass is reduced (they slim down), they consequently become more sensitive to insulin, and then begin to ovulate (produce an egg).
In summary then they appear to be designed for times of famine (a common situation during human existence on planet earth). In contrast, today we eat highly processed foods (especially carbohydrates) of all sorts – biscuits, breakfast cereal, cakes, crisps, tortilla chips, pizza, white bread, pasta, etc. Intake of these “high glycaemic” foods (i.e. high sugar) immediately elevates the insulin level and most of what has been consumed is stored for the future (the body is still waiting for famine, remember?). This surge of insulin then drops the blood sugar and the unwilling victim (maybe you) is starving again only an hour or two having eaten – and looking for another “hit” (e.g. that enticing maple pecan pastry with the mid-morning coffee). Thus the body lurches from sugar high to sugar low, storing for posterity along the way.
PCOS and Insulin
Insulin is produced by the pancreas to regulate blood glucose levels. Many women with PCOS are insulin-resistant — that is, muscle, fat and liver cells cannot use insulin properly. The pancreas produces more insulin to keep up with the demand and, eventually, the pancreas cannot keep up with the demand and excess glucose builds up in the blood. Women with PCOS who are insulin-resistant have an increased risk of developing Type 11 diabetes (non-insulin-dependent diabetes). These women should seek to maintain optimum weight and avoid blood sugar fluctuations. They should seek nutritional help.
The problem with this is, further induced resistance to insulin and the condition therefore gets worse over time. A downward spiral into metabolic no-woman’s land. One serious long term health consequence associated with this worsening insulin resistance and associated truncal obesity (i.e. expanding waistline) is the increased risk of metabolic syndrome arising from this. The features of this condition are high cholesterol, high blood pressure, diabetes in later life, and ultimately heart disease. In fact, men also have these although it has no similar effect on their fertility (i.e. polycystic testicles). Thus a tendency to PCOS caused by insulin resistance can be inherited on the male side although the full genetic picture has yet to be made clear.
TWO OUT OF THREE CRITERIA ARE REQUIRED FOR A DIAGNOSIS of PCOS:
Key Issues for Women with PCOS
****NB It is important to exclude other causes of irregular cycles and exclude other causes of androgen excess.
Women, especially a young woman, can be devastated by a diagnosis of PCO or PCOS. Sometimes a ‘throwaway ad-hoc’ remark by ultrasono-graphers can be frightening, so the terms should not be flung around lightly.
TREATMENT FOR PCOS
The good news is that PCOS responds well to changes in diet and exercise
Sp 6, Cv3, Cv4, Zigong—‘Acupuncture normalises function of hypothalmic-pituitary-ovarian axis—Chen BY. EA (4-5Hz mA (bearable intensity) (G6805)Acupuncture and Electro-therapeutics Research, 1997:22(2) 97-108.
a low glycaemic index diet
The answer to the problem of high sugar releasing foods is to eat foods which release small amounts of glucose and therefore reduce the corresponding surges of insulin. These then level out the glucose / insulin levels allowing your body to use the food energy consumed for daily activity rather that storing most of it for future use around the liver or in fat.
These foods include
The striking thing about many of these is how “natural” they are – the long and the short of it is that many (if not most) of us are poorly designed to cope with the highly processed foods that surround us – and this explains to a large extent (along with sedentary lifestyles), the epidemic of obesity evident in Western countries.
Other Information:
The reason for the lower tummy pain is that the uncontrolled insulin resistance is associated with an elevation of LH from the pituitary gland. This in turn stimulates the theca cells in the centre (“stroma” or substance) of the ovary to produce lots of male hormone. These cells enlarge and stretch the cortex (outside skin) of the ovary causing the ill defined pain. Clearly the condition must be metabolically out of control for the cortex to stretch and pain is therefore not a particularly good sign.
Male hormones (also called androgens e.g. androstenedione or dihydroepian-drosterone) are produced by both women and men – it is just the proportion and absolute amounts of each which vary. In fact is essential for the ovary (i.e. theca cells) to produce male hormones which are then converted by other cells in the ovary (called granulosa cells) to female hormones. This female hormone is called oestradiol and is essential for ‘oestrus’ i.e. egg production and is, therefore, important for women. But as the polycystic ovary becomes a factory for industrial levels of male hormone production, so the unwanted effects of these androgens (“androgenic effects”) become apparent. This is mostly acne on the face and / or unwanted facial hair (hirsuitism) on the upper lip, chin, around the nipples or on the tummy.
Dong Quai (‘female ginseng’) -capsules
Possible Side Effects and Safety Concerns
