PCOS Basics
PCOS is a common problem among women.
1 out of 10 women have PCOS.
Initially, many of the symptoms of PCOS — acne, excessive hair growth, and irregular periods — are viewed as unpleasant but unrelated. Many women are not diagnosed until the symptoms become advanced.
There is no single, quick test to identify PCOS. Accurate diagnosis depends on the experienced skills of the clinician, a detailed medical history and laboratory studies.
What is PCOS?
Polycystic ovary syndrome (PCOS) is a hormone imbalance that can cause irregular periods, metabolic changes, unwanted hair growth, and acne.
PCOS can be mild to severe.
What causes PCOS?
The underlying pathophysiology responsible for PCOS is multi-factorial and likely heterogeneous among affected individuals.
Studies suggest that for some women, body mass index and insulin resistance contribute to PCOS pathophysiology.
Intrinsic ovarian differences in steroidogenesis, neuroendocrine dysfunction, insulin resistance/hyperinsulinemia, nutrient excess, ectopic fat storage, inflammatory factors, genetic influences, and epigenetic changes interact with environmental exposure to culminate in PCOS.
Multiple aspects of the hypothalamic-pituitary-ovarian (HPO) axisare dysfunctional.
Despite apparent autosomal dominant family patterns, no single gene defect has been identified.
Researchers believe that stress and environmental factors (including nutrition, exercise, pollution and other environmental exposures) play a role in the development of PCOS.
Other possible causes include excessive prenatal exposure to androgen/testosterone and excessive insulin production.
In addition to genetic factors, epigenetic modifications may influence development of PCOS.
Epigenetic modifications include DNA methylation, post-translational histone modification, non-coding RNA, chromatin remodeling, and possibly mitochondrial DNA changes
What are the types of PCOS?
Insulin-resistant PCOS : This is the most common type of PCOS. This type of PCOS is associated with high levels of insulin, which prevents ovulation and triggers the ovaries to create testosterone. This type of PCOS is associated with metabolic abnormalities such as altered glucose tolerance, elevated cholesterol, weight gain. With this type of PCOS it is important to limit sugar intake. A period of almost six to nine months is needed to improve from this type of PCOS as it is a slow process.
Inflammatory PCOS: PCOS due to inflammation, ovulation is prevented, hormones become imbalanced and androgens are produced. Inflammation is caused due to stress, toxins of environment and inflammatory diet. Being overweight can lead to inflammation. Nutritional interventions such as stopping consumption of inflammatory foods like dairy products, sugar or wheat may be helpful. Supplements such as magnesium may be beneficial as it has anti-inflammatory effects. The process of improvement takes about nine months as it is a slow process.
Other: PCOS can be associated with thyroid disease, deficiency of iodine (ovaries need iodine), vegetarian diet (resulting in zinc deficiency (ovaries need zinc) and artificial sweeteners.
What is Insulin resistance?
Up to 70 percent of women with PCOS have insulin resistance, meaning that their cells can’t use insulin properly.
Insulin is a hormone the pancreas produces to help the body use sugar from foods for energy.
When cells can’t use insulin properly, the body’s demand for insulin increases. The pancreas makes more insulin to compensate. Extra insulin triggers the ovaries to produce more male hormones.
Being overweight for ones body habitus is a major cause of insulin resistance. Both being overweight for ones body habitus and insulin resistance can increase the risk for type 2 diabetes.
What are the signs of PCOS?
The most common signs of PCOS include:
Irregular periods that come every few months, not at all, or too frequently.
Extra hair on the face or other parts of the body, called hirsutism.
Acne
Weight gain and/or trouble losing weight
Patches of dark skin on the back of the neck and other areas, called acanthosis nigricans
Hair loss
Overweight for ones body habitus
Polycystic ovaries on ultrasound imaging.
Polycystic ovaries are not present in all women diagnosed with PCOS. Also, many women with regular menstrual periods and normal testosterone levels have cystic ovaries. It is important to make the distinction between polycystic ovaries and polycystic ovary syndrome. Polycystic ovaries are often, but not always, seen in women with PCOS. However, approximately 20 percent of women without menstrual or hormonal abnormalities have polycystic ovaries. The syndrome is thus defined by the menstrual and hormonal abnormalities with or without polycystic ovaries.
No two women have exactly the same symptoms.
What health concerns also occur with PCOS?
Reduced fertility for some women, not all
Insulin resistance
Diabetes
Lipid abnormalities
Obstructive sleep apnea :This condition causes repeated pauses in breathing during the night, which interrupt sleep.
Sleep apnea is more common in women who are overweight for their body habitus — especially if they also have PCOS. The risk for sleep apnea is 5 to 10 times higher in women who are both overweight for their body habitus and with PCOS, when compared to those without PCOS.
Cardiovascular disease
Up to 80 percent of women with PCOS are overweight for their body habitus
High blood sugar
High blood pressure
Low HDL “good” cholesterol
High LDL “bad” cholesterol
Depression and anxiety
Endometrial hyperplasia and endometrial cancer (the risk of endometrial cancer is three times higher in women with PCOS if not managed properly)
How does PCOS affect hormones?
PCOS disrupts the balance of both follicle-stimulating hormone (FSH), the hormone that causes the follicle and egg to develop and luteinizing hormone (LH), the hormone that causes the follicle to release the egg. The result is that a small cyst is formed in the ovary, which disrupts the hormonal balance.
PCOS is caused by an imbalance in the hormones in the body.
PCOS usually happens when a hormone called LH (from the pituitary gland) or levels of insulin (from the pancreas) are too high, which then causes the ovaries to make extra amounts of testosterone.
All normal ovaries also make a little bit of the androgen testosterone. In PCOS the ovaries make more androgens and testosterone.
The pancreas is an organ that makes insulin. High levels of insulin can also cause the ovaries to make more of the hormone testosterone.
Having PCOS means that your ovaries aren't getting the right (hormonal) signals from your pituitary gland. Without these signals, you will not ovulate (make eggs) every month. Your period may be irregular, or you may not have a period at all.
The menstrual cycle starts when the brain sends LH and FSH to the ovaries.
A big surge of LH is the signal that causes the ovaries to ovulate, or release an egg.
The egg travels down the fallopian tube and into the uterus. Progesterone from the ovary causes the lining of the uterus to thicken.
If the egg isn't fertilized, the lining of the uterus is shed. This is a menstrual period.
After the menstrual period, the cycle begins all over again.
A menstrual cycle with PCOS.
LH levels are often high when the menstrual cycle starts. The levels of LH are also higher than FSH levels.
Because the LH levels are already quite high, there is no LH surge.
Without this LH surge, ovulation does not occur, and periods are irregular.
Women with PCOS may ovulate occasionally or not at all, so periods may be too close together, or more commonly too far apart. Some women may not get a period at all.
What types of tests are used to diagnose PCOS?
Because there is such variability in the clinical presentation of PCOS, there is not universal agreement among health professionals on how to best define the syndrome.
Menstrual cycle history and and general health are reviewed.
A complete physical examination.
An ultrasound test is generally recommended. This is a test that uses sound waves to make a picture of your reproductive organs (ovaries and uterus) and bladder (where your urine is stored). In women with PCOS, the ovaries may be slightly larger (often >10cc in volume) and have multiple tiny cysts.
Blood tests to detect elevated levels of androgens, hormone levels and thyroid evaluation are usually performed.
Blood test to detect high levels of LH (luteinizing hormone) or an elevation in the ratio of LH to FSH (follicle stimulating hormone) are performed.
Blood tests to check your blood sugar, and lipids (including cholesterol) are used.
Physicians will also try to rule out other possible causes of irregular menstruation and excessive hair growth, such as Cushing's syndrome, congenital adrenal hyperplasia or other disorders of the pituitary, thyroid or adrenal glands.
How is the diagnosis of PCOS made?
Professional guidelines endorse use of the Rotterdam PCOS Diagnostic Criteria in adult women. Importantly, PCOS is a diagnosis of exclusion. Other disorders with similar clinical features need to be excluded from diagnostic consideration.
The Rotterdam criteria required fulfilling two of three findings:
(1) oligo-anovulation
(2) clinical and/or biochemical hyperandrogenism
(3) polycystic ovary morphology on ultrasound.
When both ovulatory dysfunction and hyperandrogenism occur in the adult woman, ultrasound is not necessary for diagnosis.
Why do I get acne and/or extra hair on my body?
Acne and extra hair on your face and body can happen if your body is making too much testosterone.
All women make testosterone, but if you have PCOS, your ovaries make a little bit more testosterone than they are supposed to.
Skin cells and hair follicles can be extremely sensitive to the small increases in testosterone found in young women with PCOS.
Why do I have patches of dark skin?
Women with PCOS may have higher levels of insulin in their blood. Higher levels of insulin can sometimes cause patches of darkened skin on the back of the neck, under your arms, and in your groin area (inside upper thighs).
Will PCOS affect my ability to have children some day?
Women with PCOS have a normal uterus and healthy eggs.
Some women with PCOS have trouble getting pregnant, but many women have no trouble at all.
What can I do about having PCOS?
The most important treatment for PCOS is working towards a healthy lifestyle that includes healthy eating and daily exercise.
There are also excellent medications to help you manage irregular periods, hair growth, and acne.
Supplement support can also be recommended. Inositols, NAC, resveratrol and curcumin may be beneficial.
How is PCOS Treated?
Treatment depends on several factors, including your symptoms, your other health problems, and whether you want to get pregnant.
Lifestyle Changes : The first action that is recommend for women with PCOS is to make lifestyle changes, anti inflammatory low glycemic index nutrition style and physical activity. These changes can minimize many PCOS symptoms and related conditions.
Insulin-Sensitizing Agents : These medications make the body more responsive to insulin and keep glucose levels more stable. In women with PCOS, they may also help: clear up acne and reduce hair growth, improve weight loss, lower cholesterol levels, make periods more regular, slightly reduce infertility.
While not approved by the U.S. Food and Drug Administration (FDA) specifically for treating PCOS, insulin-sensitizing medications may help you.
Metformin is an insulin sensitizing agent which is commonly prescribed.
Antiandrogens: These medications can lower androgen levels, or even prevent the body from producing the hormone. In women with PCOS, this helps to reduce excess hair growth and clear up acne. Just as with insulin-sensitizing medications, antiandrogens are not approved by the FDA for the treatment of PCOS but may be recommended.
Aldactone is a prescription medicine that can lessen hair growth and make hair lighter and finer. However, it can take up to 6–8 months to see an improvement.
The most common form of treatment for PCOS is the oral contraceptive pill; however, other kinds of hormonal therapy may include the vaginal ring and the patch.
Even if you do not require contraception, birth control pills may be prescribed because they contain the hormones that can help to treat PCOS.
Birth control pills (either taken continuously or in cycles) can:
Correct the hormone imbalance
Lower the level of testosterone (which will improve acne and lessen hair growth)
Regulate menstrual periods
Some women are treated with both Metformin and birth control pills at the same time, with or without Aldactone.
If you're overweight, losing weight may lessen some of the symptoms of PCOS.
A nutrition plan that helps manage insulin levels is the best approach.
Healthy eating can also keep your heart healthy and lower your risk of developing diabetes.
Nutrition recommendations
Choose nutritious, high–fiber carbohydrates instead of sugary or refined carbohydrates.
Balance carbohydrates with protein and healthy fats.
Eat small meals and healthy snacks throughout the day instead of large meals.
Studies comparing nutrition approaches for PCOS have found that low carbohydrate diets are effective for lowering insulin levels.
A low glycemic index approach that gets most carbohydrates from fruits, vegetables, and whole grains helps regulate the menstrual cycle are recommended.
Exercise regularly to help manage insulin levels.
Avoid inflammatory foods such as sugar, artificial sweetners, dairy, and consider limiting gluten.
Nutrition and lifestyle to treat PCOS
Treatment for PCOS usually starts with lifestyle changes including nutrition and exercise.
If you are overweight for your body habitus, Losing just 5 to 10 percent of body weight can help regulate the menstrual cycle and improve PCOS symptoms.
Weight loss can also:
Improve cholesterol levels
Lower insulin
Reduce heart disease and diabetes risks
A few studies have found that 30 minutes of moderate-intensity exercise at least 3 days a week can help women with PCOS.
Exercise is even more beneficial when combined with a healthy diet.
There is some evidence that acupuncture can help with improving PCOS, but more research is needed.
What else do I need to know?
It's important to follow–up regularly.
Because you have a slightly higher chance of developing diabetes, your health care provider may suggest that you have your blood sugar tested once a year.
Blood sugar test once a year.
A1C test (a test that tells how high your blood sugar has been the past 2–3 months) once a year.
Glucose tolerance test every few years.
LIFESTYLE to MANAGE PCOS
Exercise and PCOS
Women with PCOS experience higher rates of insulin resistance compared to women who don’t have the condition. Insulin resistance affects your body’s ability to use blood sugar for energy.
A lack of physical activity and excess body weight are potential contributing factors to insulin resistance, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Not all women with PCOS have overweight. The good news is physical exercise is something you can do for your health when you have PCOS, regardless of your weight.
Reducing BMI:
A meta-analysis of 16 studies related to PCOS and exercise found that vigorous intensity aerobic exercise was the most likely to reduce body mass index (BMI) and insulin resistance in women with PCOS, according to an article in the journal Frontiers in Physiology.
The researchers compared moderate exercise to vigorous exercise. They also found that vigorous exercise and healthy diet interventions resulted in the greatest decreases in BMI.
Managing weight:
A research review of lifestyle interventions in PCOS published in the journal Best Practice & Research Clinical Obstetrics & Gynecology found that exercise helped to reduce weight, abdominal fat, and fasting insulin levels.
The review also found exercise could help women of all weight levels with PCOS either lose or maintain their weight to help them look and feel healthier.
Any type of exercise helps:
A literature review of studies published in the journal Sports Medicine regarding types of exercises, such as strength training and aerobic activity, did not find one specific exercise type was the most beneficial to women with PCOS.
Some of the studies reviewed aerobic exercise and resistance training, riding a stationary bicycle versus riding a bicycle outside, and treadmill walking or jogging at a moderate intensity versus vigorous intensity. The authors did find there are many exercise types that could benefit women with PCOS.
The message from these and other studies is that exercise can usually help you when you have PCOS, and the best exercise is what you will do regularly. Bonus points if the exercise can be something you enjoy doing.
Exercise types to consider
Steady-state cardiovascular workouts: These are workouts that get your heart pumping, usually at about 50 to 70 percent of your maximum heart rate, if you are engaging in moderate exercise. You can calculate your maximum heart rate by subtracting your age from 220. Aerobic exercises in this category can include walking, riding a bicycle, dancing, or taking an aerobics class.
HIIT workouts: High-intensity interval training (HIIT) involves balancing intense exercise bursts with rest intervals. Typical exercises in a HIIT workout include things like burpees, tuck jumps, and mountain climbers. One study found that women reported greater enjoyment of HIIT exercises compared to those who engaged in continuous moderate to vigorous exercise. Enjoyment of exercise is an important factor for sticking with a routine long-term.
Interval training: Interval training is a way to exercise at different intensity levels, but not necessarily to the heart rate max you do with HIIT. This training type often involves doing different exercises in the same session to keep your heart rate up.
Mind-body exercises: Studies show that women with PCOS have an enhanced bodily response to stress and distress, according to an article in the journal Physical Exercise for Human Health. Mind-body exercises like yoga, Pilates, and tai chi can help not only burn calories, but also reduce stress levels that worsen your PCOS symptoms.
Strength training: Strength training involves using resistance bands, weights, or your own body weight to build muscle. This training type can help you build healthy muscles and bones. Increasing your muscle mass could help you to manage insulin resistance.
Exercise Summaries
CARDIO
Good for reducing insulin resistance, boosting fertility, stabilizing mood
Moderate exercise like brisk walking, jogging, cycling or swimming are all great activities that can help with PCOS. This type of exercise increases your bodies sensitivity to insulin, which reduces your risk of cardiovascular disease and type 2 diabetes. Doing 30 minutes or more a day can also help with weight management, symptoms of depression and anxiety, as well as improving frequency of menstrual cycles and ovulation. Not sure how to start running, easy download the free Nike Run Club app that provides your with guided runs to help you begin your running journey.
STRENGTH TRAINING
Good for reducing insulin resistance, increasing metabolic rate, improving body composition (more muscle and less fat tissue)
Bodyweight exercises like squats, push-ups, or tricep dips improve the function of insulin in your body, but can also boost your metabolism by building more muscle mass. More muscle simply means burning more calories while exercising, but also throughout the day even at rest. Combining resistance moves with cardio exercise is the best way to ensure you’re building a lean body, achieving a healthy physiology.
HIGH INTENSITY INTERVAL TRAINING
Good for increasing cardiovascular fitness and decreasing waist circumference
Intervals involve swapping between short bouts of high intensity work and lower intensity recovery. It’s a time efficient way of boosting your cardiovascular fitness, with extra benefits for PCOS. Going hard on the spin bike burns bucket-loads of calories, and reduces abdominal fat more effectively then say, a brisk walk. This can help you achieve a 5 – 10% weight loss, which studies show can decrease PCOS symptoms by reducing excess testosterone and improving insulin resistance.
CORE STRENGTH
Good for general well-being and injury prevention, preparing your body for pregnancy
Being above your ideal weight can cause lower back pain and poor posture, so including core training in your program is essential. These muscles support the spine and learning how to switch them on ensures you don’t injure yourself during exercise. Also if you’re trying to conceive, start training your pelvic floor muscles. These muscles are also part of your core and help prevent incontinence, boost sexual health, and improve pelvic stability.
The most effective exercise is the one you keep up with, so choose something you enjoy.
Nutrition and PCOS
Researchers have completed several studies regarding the “best” diet types for those with PCOS to follow. The Androgen Excess and PCOS Society used this research to make recommendations for women, which include:
If overweight, reduce current calorie intake by 500 to Kcalories per day.
Make total fat less than 30 percent of your total source of calories for the day. Saturated fats, like high-fat beef, butter, cheese, and full-fat dairy products, should represent less than 10 percent of your total calorie intake.
Switch out higher-fat foods for fiber, such as whole-grain breads and cereals, fruits, and “good” sources of fats, such as nuts and avocados.
Eat less than 200 milligrams of cholesterol a day.
Avoid trans fats whenever possible.
Incorporate an additional 5 to 10 grams of fiber in your diet per day , total of 25 to 30 grams of fiber.
Sample eating and workout plan
Exercise to improve your PCOS doesn’t have to take hours a week. Studies have found exercise sessions ranging from 30 minutes a day, three times a week, to three total hours per week improved metabolic and reproductive symptoms associated with PCOS.
The Androgen Excess and PCOS Society recommends getting at least 30 minutes of moderate to vigorous physical activity a day and increasing your activity effort when you can. Some of the ways you can incorporate exercise in your life include the following:
Create your own interval training session, where you set up about six stations and exercise at each for about one to two minutes at a time.
Examples could include:
squats
jumping jacks
lunges
bicep curls
crunches
Walk for 30 to 45 minutes a day on a treadmill or outdoors.
Take an aerobics class online or at a gym. Examples include step, dance, boxing, or spinning.
Take a HIIT class at a gym or using online resources. YouTube offers many workout videos that you can complete at home. Just ensure the routine is from a reputable provider.
Practice yoga, Pilates, or tai chi at a studio, gym, or using an online class. If you have not practiced before, you may wish to seek the guidance of a trainer to evaluate your form and safety.
If boredom is a factor in your commitment to an exercise routine, utilize a combination of these exercise types, such as completing a different exercise session type three times a week.
Healthy eating plan
Try to incorporate the following habits for healthy eating with each meal and snack:
Let each meal consist of a serving of lean proteins, such as skinless chicken, fish, or tofu.
Cook with healthful fats, such as olive oil.
Add a vegetable, such as broccoli, kale, spinach, and peppers.
Incorporate a serving of beans, nuts, or lentils.
Choose brightly colored fruits, such as red grapes, blueberries, oranges, and cherries.
Choose whole-grain bread and pasta options.
What supplements can help with PCOS?
Inositol
Inositol is known for its ability to improve insulin-receptor activity and restore insulin resistance.
One Study showed myo-inositol may decrease insulin resistance by approximately 70%. This helps restore hormones to a ratio required for ovulation to occur.
Another study, though relatively small, showed inositol’s ability to aid in restoring ovulation and lead to natural pregnancy.
Fish Oil
Fish oil supplements result in a list of health benefits for all women, including women with PCOS. Studies have shown that fish oil supplementation can improve ovulation, ovarian reserve, and overall fertility. Similar to inositol, fish oil is a useful supplement for PCOS patients because it can help to improve insulin resistance.
Inflammation is another key feature of PCOS. Fish oil is an important supplement for PCOS because it has anti-inflammatory properties. Fish oil supplements can also help to lower bad cholesterol for women with PCOS.
Vitamin D Supplements
67 to 85% of women with PCOS suffer from vitamin D deficiency. Low vitamin D levels may intensify PCOS symptoms, including insulin resistance, ovulatory, menstrual irregularities, infertility, hyperandrogenism, and obesity. Supplementing vitamin D has been shown to have beneficial effects on menstrual regularity and ovulation.
Vitamin D supplementation can positively impact pregnancy rates and fertility treatment outcomes.
N-Acetyl-Cysteine (NAC)
N-Acetyl-Cysteine (NAC) is used by the body to build anti-oxidants. Antioxidants produced from NAC help to protect and repair our cells from damage. By reducing cell damage, NAC helps to fight inflammation and oxidative stress that can harm fertility. NAC is not found naturally in any foods, so it must be taken in the form of a supplement.
For women with PCOS, NAC can help to reduce insulin sensitivity, lower testosterone levels, regulate ovulation, and improve fertility. In fact, research has shown that NAC is even more effective than metformin (a medication commonly prescribed to treat PCOS) for improving insulin resistance. By reducing testosterone levels, NAC can help to induce ovulation and regulate your menstrual cycle. Reducing testosterone also help to combat common secondary PCOS symptoms like acne and facial hair growth.
Carnitine Supplements for PCOS
Acetyl L-Carnitine (ALC) is an antioxidant that is naturally produced by the body. ALC helps the body turn fat into energy. A clinical study found that women with PCOS have significantly lower levels of L-carnitine when compared to women without PCOS. Low ALC levels may be linked to hyperandrogenism and insulin resistance, two common traits of women with PCOS.
A clinical trial in women with PCOS found that supplementing ALC with clomiphene (a common fertility drug used to induce ovulation in PCOS patients) provided a thicker endometrium and higher pregnancy rates.
Magnesium
Magnesium plays a role in over 300 enzyme reactions in the human body, including glucose metabolism. Rather unbelievably, more than 50% of American’s fail to meet the daily magnesium requirement through their diet. Women with PCOS have been shown to be 19 times more likely to be magnesium deficient than the general population.
Low magnesium levels may worsen insulin resistance, and as a result, it can affect hormonal balancing and signaling.
Magnesium supplements for PCOS patients may help to improve insulin resistance, reduce inflammation, and ease PMS symptoms.
Probiotics
Research suggests that many of the common symptoms of PCOS, including insulin resistance, sex hormone concentrations may negatively affect the diversity and composition of gut microbiota. Gut microbiota are critical to nutrient metabolism and maintenance of the structural integrity of the gut.
Probiotics are live microorganisms that can help to restore and improve gut health. Gut health is vital for controlling inflammation. Inflammation is a common symptom of PCOS and a key contributor to insulin resistance.
Research has shown that probiotic supplements can help to improve gut health, reduce inflammation, and correct hormonal imbalances for PCOS.
Taking probiotic supplements may also help to combat other symptoms of PCOS by normalizing the menstrual cycle and lowering androgen levels.
Zinc
Zinc is a strong antioxidant that helps to regulate the function of different enzymes. Zinc also helps to regulate cell growth, hormone release and impacts reproduction.
Although Zinc deficiency is fairly uncommon in the United States, it is more prevalent in women with PCOS. Zinc deficiency may be associated with common PCOS symptoms like insulin resistance and abnormal cholesterol levels.
In women with PCOS, zinc supplementation has a positive effect on many parameters, especially those related to insulin resistance In addition, zinc may help to improve hormonal imbalances and ovulation.
Zinc supplementation may also help to improve other common PCOS symptoms like acne, hair growth, weight management, and hair loss.
B Vitamin Supplements for PCOS
There are several types of B vitamins, but the most important for PCOS patients are vitamin B12 and folate (B9). Both B vitamins help to lower inflammation by breaking down the amino acid homocysteine. Homocysteine levels are commonly elevated in PCOS .
B vitamins can also help to correct hormonal imbalances and improve fertility in other ways. Folate supplementation can increase progesterone levels and lower the risk for anovulation. Other studies on how nutrients affect reproduction have shown that folate is essential to oocyte quality and growth, implantation, fetal growth, and organ development.
Coenzyme Q10 (Co-Q10)
Co-Q10 is known to have many positive effects on female fertility for both PCOS and non-PCOS patients. Research has shown that pre-supplementation with Co-Q10 can improve ovarian response for women undergoing IVF treatment.
Co-Q10 has also been shown to combat the age-related causes of infertility like reduced oocyte quantity and quality.
LIFESTYLE SUMMARY
PCOS : Natural Support and Resources
The management of hormonal imbalances such as those that occur in PCOS require support from not only traditional allopathic methods, but also support from how we live. Nutrition and lifestyle can have large impacts on our hormonal balance. For some women with PCOS attention to these aspects will be adequate and sufficient to help correct issues such as weight gain, acne, hair growth and metabolic disturbances; but for all women, even those requiring more medicinal interventions, attention to nutrition and lifestyle can have large positive health impacts.
Reduce Exposure to Toxins and Endocrine Disruptors
Use natural and organic cosmetics and skin care products with limited preservatives
Avoid parabens and phthalates, animal and petrochemical byproducts, artificial colors and sulfates
Limit exposure through better feminine products
Switch to organic nontoxic tampons pads and liners
A menstrual cup is also an option
Conventional tampons and pads are made with processing of cotton containing dioxins fragrances and pesticides
Menstrual cups are also better for the environment
Limit exposure to potentially toxic nail products
Remove copper aluminum and Teflon along with plastics from your kitchen opera cookware made of cast-iron stainless steel or ceramic
Pay attention to your cleaning products there are a number of nontoxic products now on the market
Avoid plastics with the associated be BPAs
Limit handling of thermal paper and receipts, they contain BPAs
Get rid of toxins from your body dry much dry brushing may be a good detoxification technique to read toxins from the skin
Pay attention to the health of your liver
Toxic Products to Minimize:
Plastic bottles
Plastic wrap
Plastic grocery bags
Canned goods
Receipts
Aluminum foil
Nonstick cookware and copper pots
Conventional cleaning products
Cosmetics nail polish and perfume with most chemicals
Non-organic pads and tampons
Resources
A good resource to determine what is in your products is the Environmental Working Group website at EWG.org
For organic feminine care products mylola.com
Assure Adequate Sleep
Sleep is important for proper metabolism and immune system function
Good sleep is essential to hormone balance
Ways to achieve good sleep
Make good choices throughout the day and keep caffeine and sugar consumption low
Have a sleep time ritual
Two hours before bed put screens away dim the lights stop drinking fluids and do not eat
Read a book, meditate, take a bath, use aromatherapy
Make sure your room is prepared for sleep
Have a dark room at night and keep your room a cooler temperature between 60 and 68°F; 62° is ideal
Use lavender oil to help you fall asleep; this may be used in a bath rubbed on the temples neck or using a pillow spray tray also using a sleep mask.
A sleep mask may be used to help
Participate in exercises of gratitude increasing positive thoughts and positive intentions
Focus on your favorite part of the day what you were grateful for and what you are looking forward to tomorrow
Breathe; breathing exercises may be beneficial.
One technique is below.
Close your eyes if they're open.
Take a few big, deep breaths.
Breathe in. As you do that, imagine that the air is filled with a sense of peace and calm. Try to feel it throughout your body.
Breathe out. While you're doing it, imagine that the air leaves with your stress and tension.
Now use a word or phrase with your breath. As you breathe in, say in your mind, "I breathe in peace and calm."
As you breathe out, say in your mind, "I breathe out stress and tension."
Continue for 10 to 20 minutes.
Reduce Stress
Stress may be emotional or physical. Stress may be also biological such as bacteria viruses molds and parasites
Chemical and environmental stressors include: toxins, xenoestrogens, pesticides and herbicides, heavy metals, industrial chemicals, smoke fumes, dust and synthetic drugs, extreme temperatures, noise, UV light, altitude, changes in barometric pressure, changes in allergens and radiation
Nutritional stressors such as food allergies and sensitivities, refined or processed foods nutrient depleted food, nutritional deficiencies, and extreme macro nutrient ratios such as very low-carb diets and free radicals can wreak havoc on the body.
All of the stressors may need attention.
Meditation to control emotional stress may be good for some individuals. This may lower cortisol levels help to manage blood sugar reduce inflammation and promote sleep.
Attention to ones surrounding environment and nutrition can also begin to help limit stress, for some can be very key to stress reduction
Ways to help with stress reduction include:
Headspace.com and calm.com or good resources for this.
Have a morning ritual to start out the day
Keep work life and home life separate
Limit clutter your environment
Give technology a rest
Be mindful and pay attention to your thoughts
Take time to that laugh
Learn to say no
Address any type of emotional trauma to start the process of recovery from it
Neurolinguistic programming NLP may be helpful
Pay attention to your posture
Do stretches and movements at length and an open the front of the body
Do exercises for the upper body to pull shoulders back
Keep your weight on your entire foot and I just your heel
Essential oils may also be helpful
Rose and lavender, along with bergamot, chamomile, frankincense or ylang ylang can be added to the shower or bath, a diffuser or a body blend in a carrier oil.
Stressors to look out for to address include: anxiety, depression, fear, worry, grief, mental illness, blood sugar imbalance, inadequate sleep, lack of physical activity, food allergies and sensitivities, refined and processed foods, nutrient depleted foods, nutritional deficiencies, a no carb diet, drugs, free radicals, high blood pressure, over strenuous exercise, excessive alcohol and drug use, infection, starvation, toxins. Herbicides, pesticides and fungicides, insecticides, heavy metals, industrial chemicals, smoke fumes, dust, synthetic drugs, bacteria, viruses, mold, parasites, extreme temperatures, noise, UV light, allergens, radiation and altitude changes.
Ways to Reduce the Effects of Stress
Meditation
Mindfulness and practicing gratitude: don’t let negative thoughts control your feelings and actions
Deep breathing
Digital detox
Separate work from home
De-clutter your environment
Living and laughing
Say “no” when appropriate and you can
Address past traumatic issues
Pay attention to posture
Essential oils
Restorative exercise
Exercise boosts serotonin and supports mood regulation; it increases bone density; it supports strength and confidence; builds muscle; and helps you to stand tall with great posture; improves insulin sensitivity; strengthens the pelvic floor; reduces inflammation; and improves tissue regeneration and waste product removal; improves sleep and helps regulate melatonin production; it provides digestive support
Easing into things will be better than starting all at once.
Aim for 30 minutes of restorative exercise each day.
Mindful Eating
Understand how your body composition affects hormone balance along with your overall health
Eat with control and balance
When eating engage all the senses including taste smell and vision to help improve the enjoyment of food
Eat food that you love
Sit while eating, away from technology
Do not deprive yourself
Don’t adhere to a diet; focus on healthy nutrition; be mindful with eating and make good food choices
Eat when you are hungry
Get rid of distractions during eating
Be grateful for what is on your plate
Use your nose when you eat
Chew your food adequately
Eat slowly and stop when you feel about 80% full
Enjoy eating; it should always be thought of as a pleasurable activity and not a chore
Eat appropriate calories for your body; do not starve or overeat
The basic principles of healthy eating
There are foods that you can enjoy in abundance, foods to avoid, and foods that you will want to eliminate completely
You will need to create, with or without a nutritionist, a meal plan of your own specifically tailored to your body type, schedule, preferences and culture
Drink more water
Spearmint tea may help women with hirsutism and PCOS through decrease of testosterone and increase of LH and FSH levels when use for 30 days
Marjoram may reduce DHEA improve insulin sensitivity
Improve nutrient density eliminate processed, refined foods, sugars
Up the intake of fresh whole foods to drastically reduce inflammation
Eat whole foods that are close to their natural form as possible
Eat local and organic
This should be done as much as possible. if you cannot get access to organic and cannot eat organic or local consider a fruit and veggie wash. This may be a natural way to remove wax chemicals and dust from produce
Foods to enjoy in abundance: vegetables eat the rainbow
Focus on low sugar fruits such as berries raspberries blueberries and blackberries
Don’t be afraid of good fats such as omega-3‘s such as avocados, nuts, seeds, coconut oil, and olive oil
Load up on beans: black beans and chickpeas
Adequate protein is important.
If you require meat in your nutrition, use organic hormone and antibiotic free animal proteins or wild caught low-count mercury fish and seafood like salmon, sardines, anchovies, mackerel, shrimp, crab, and muscles
Avoid: fast food, fried foods, hydrogenated oils such as soy bean, corn or vegetable oils
Avoid processed foods, artificial sweeteners, refined natural sugars, gluten, dairy, non-organic animal products, farmed seafood ,seafood high and heavy metals
Watch out for food sensitivities. You can try and elimination diet with eliminating items would you think that you may be sensitive to along with cutting out sugar, corn, gluten, dairy and soy, You can then re-introduce these one at a time leaving 2 to 3 days in between to see how you feel. With any elimination diet this can be a little stressful on the body. To start out with you may feel moody tired lethargic or off. You may want to work with a nutritionist to develop an elimination diet that is best for your body type and avoid eliminating unnecessary foods. People with a history of an eating disorder should not use elimination diet unless medically supervised.
Pay attention to alcohol
It can raise estrogen levels deplete the vitamins including B6, it can act as a depressant, it can dehydrate you and it is bad for the liver
Avoid sugar and hidden sugars, avoiding natural sugars also. A natural sugar may be in processed and unprocessed food such as fruits. Try to limit high sugar fruits like mango, pineapple, over ripe bananas as well as dried fruits. Also pay attention to the sugars and smoothies.
If you need to add some sweetness to your nutrition consider adding small amounts of raw unfiltered local honey; it is also an antioxidant, natural antibacterial and antifungal and has many other benefits. These benefits are only present in raw unfiltered honey. Local honey also has the added benefit of containing pollen particles that can improve seasonal allergy symptoms.
Limit gluten in your the diet. Gluten is found in hundreds of products from baked goods to salad dressings and sauces. It is a group of proteins found in wheat and other grains like rice and barley. Gluten is difficult for the body to digest and creates leaky gut, allowing food particles to slide through the intestine and cause inflammation and sometimes immune problems. Symptoms of gluten intolerance include: irritable bowel syndrome, headaches, migraines, joint and muscle, brain fog, eczema, psoriasis and autoimmune issues.
Gluten-free products may have a variety of compounds which may not be beneficial. Watch out for added sugars corn or maze-based products, chemical additives and preservatives. Try removing gluten-free products completely and replace with whole food replacements like sweet potato toast or cauliflower pizza dough, or make your own granola out of coconut flakes sliced almonds pumpkin and hemp seeds and cinnamon to replace traditional cereal
Limit dairy. Casein is the protein in dairy which may be problematic. It is a slow digesting protein and tends to provoke an inflammatory response in the body
If you have acne, PMS, sinus infections, eczema or hayfever these may also be signs that you may have a casein sensitivity and by removing the irritant from your diet symptoms may clear up and you’ll start to see results. Dairy products are also high in sugar in the form of lactose which is rapidly broke down into glucose and absorbed in the blood causing a quick quick release of insulin and increase in blood glucose. If dairy is important to you to: use organic and grass fed products and opt for hard cheeses or dairy from sheep, goats or buffalo. Dairy has been shown in multiple studies to be associate with increasing the development of acne the exact mechanism is unknown. If you do have acne eliminate dairy for 30 days to see if there is any improvement. it is also important to know that the blood sugar balance is crucial to even skin tone hyperglycemia can cause a chain reaction that increases follicular dysfunction in the skin and aggravate an existing tendency towards acne. Dairy alternatives may be coconut almond or cashew based beverages to replace milk. Coconut cream and coconut yogurt are also alternatives. Look for brands and have minimal ingredients and low sugar content and unsweetened a possible.
If you must, and feel better consuming animal products, use organic grass fed options which will contain higher levels of vitamin a B, along with omega 3 fatty acids, pasture raised cattle will also contain a more beneficial ratio of a mega 3 to 6 fatty acids leading to reduce levels of inflammation
Stay away from farmed seafood and avoid seafood high and heavy metals farmers fish are full of antibiotics, pesticides and other harmful compounds
Soy is controversial. Processing so I may read it to be more harmful for the body. If you consume soy, make sure that it is unprocessed.
Always listen to your body.
Ways to Optimize Nutrition:
Drink more water
Eat whole foods foods, foods that are in their most natural forms.
Eat local and organic Fill your plate with different colors.
Eat low sugar fruit to prevent rapid blood sugar surges like berries and melon
Eat a omega 3 fatty acids like avocado nuts and seeds; and coconut oil
Consume legumes with a pseudo-grain; for example black beans with quinoa
Eat organic hormone free and antibiotic free animal proteins or wild caught fish
Avoid fast food, fried food, and anything processed or artificial If it’s hydrogenated leave it behind this likely contains canola, soy bean, corn or vegetable oil
Enjoy in moderation or avoid: caffeine, alcohol,
Avoid high sugar foods, gluten, dairy, non-organic protein, seafood high in heavy metals, processed soy, vegetable oils
Watch out for food sensitivities
Try an elimination diet if you need to determine what you were sensitive to.
Readjust your diet as needed
Manage blood sugar
Low blood sugar can lead to decrease brain function and imbalance and may have an impact on both physical mental and emotional behavior
Mood swings may be an indicator of blood sugar imbalance. Highs in blood sugar may trigger anxiety hyperactivity or manic mood while low blood sugar triggers dizziness forgetfulness irritability anxiety depression and outbursts The basics of blood sugar management: look at the glycemic index of a food. This is a scale that classifies how the food will have on your blood sugar. This is measured over a period of two hours. The higher the number the more significant the impact and the faster it raises your blood sugar. A good rule is: avoid anything that is processed and avoid simple carbohydrates like white potatoes, white rice, high sugar fruits, dried fruits and refined sugar.
Life is about balance do your best to adhere to dietary principles but don’t beat yourself up if you don’t. Little steps are sometimes more important than the big experimental steps.
In order to manage your blood sugar make sure that you get a good nights sleep.
Skip your morning coffee
Choose low glycemic index foods
Eat breakfast
Eat until you’re 80% full
Move after meals
Eat every three hours
Don’t skip meals or wait long periods in between meals
Nuts maybe something that are useful for you. They can slow the absorption of sugar mitigating blood sugar affects of alcohol or high sugar foods.
Drink plenty of water
Incorporate cinnamon into your dishes it may increase insulin sensitivity; you can use 1 to 6 g in powder form or a cinnamon supplement.
Apple cider vinegar maybe also utilized to help with blood sugar levels.
Targeted Supplementation:
Alpha lipoic ccid An anti-oxidant that enhances the body’s ability for glucose control
Ashwagandha Adaptogenic herb that can help with stress
B complex vitamin Supports all your metabolism, reduces stress leve, and restores adrenal function, reduces fatigue, supports brain and nervous system, can also help to reduce cholesterol and improve circulation.
Cinnamon Supports blood sugar stabilization, reduces insulin resistance and decreases the severity of cramping with menses, lowers cholesterol levels
Co Q 10 An antioxidant that preserves and improves fertility, is necessary for energy production, can slow Alzheimer’s progression, and prevent migraines, can help to reduce blood pressure and improve clotting and affects immune system.
Evening Primrose Oil Helps progesterone production, can reduce the symptoms of PMS such as breast tenderness bloating acne or cramps, increases metabolic function and reduces inflammation, it can reduce the severity of eczema
Fish Oil A source of omega 3 fatty acids that improves insulin resistance, supports adrenal function, boosts mood and improves immunity, helps to manage cortisol levels and improve blood pressure, can help to manage menstrual cramps, can lower the risk of heart disease and is anti-inflammatory
Folate
Iodine Supports optimal health of the thyroid breast ovaries and uterus, prevents depression and weight gain, reduces hair loss, supports fertility and supports healthy blood pressure.
Inositol Decreases triglyceride and testosterone levels, reduces high blood pressure and improves ovulation and insulin sensitivity. Helps to balance hormones, increases fertility, boosts immunity, increases energy and improves sexual function
Magnesium Helps to regulate the nervous system reduce cortisol levels, improves insulin resistance and balance blood sugar, balance adrenal hormones, supports sleep. It also may affect pituitary health.
Probiotics Improve overall good health and balance the gut microbiome. The optimal probiotic for PCOS and hormone balance is in evolution.
Selenium A trace mineral required for thyroid function, supports detoxification of excess estrogen and environmental pollutants, helps in production of progesterone production and supports the immune system
Vitamin A Helps to support the immune system, supports ocular function and normalizes cellular growth
Vitamin C Boosts the immune system, minimizes the production of excess cortisol and reduces inflammation and may help to prevent cancer and supports ocular health.
Vitamin D3 A fat soluble hormone that decreases the risk of estrogen dominance, improves fertility, regulates ovulation, boosts mood, improves insulin sensitivity and supports bone health and boosts immune health and improves sexual satisfaction and orgasms.
Vitamin E An anti-oxidant that reduces the severity of cramps and PMS along with preventing excess blood clotting it helps to maintain normal menstrual flow and prevent cardiovascular disease and supports normal skin function
Vitex or Chaste Berry Increases levels of LH, decreases FSH, increases progesterone and increases vaginal mucus production and reduces PMS symptoms
Zinc A trace mineral that normalizes the stress response, stimulates secretion of mucus to protect gut lining, balances testosterone, helps follicles and promotes healthy ovulation, progesterone levels and supports the normalization of hormones and regulates the immune system and rate of healing to support metabolism and reduces eczema
Foods to Avoid:
High glycemic index foods
Dairy
Processed soy
Bad fats such as saturated, hydrogenated and transfats
Foods to Include:
Green leafy vegetables
Fruits
If you eat meat: pasture raised and grass fed.
Omega 3 fatty acids; you may need a supplement of you do not eat fatty fish. Up to 3 to 4 grams per day may be reasonable
SEED CYCLING
Hormone Support: Seed Cycling
Modern medicine should address modern health issues. Many of my patients state that they feel not well due to hormone imbalances. Many times this may be related to estrogen dominance. When looking through traditional allopathic medicine databases the term “estrogen dominance” does not appear, because it is not a recognized medical issue. Indeed, there is only one article that I located referencing “estrogen dominance” in PubMed.
Modern living and the stressors it brings through environmental exposures, light cycle interruption, increased lifetime exposure to estrogen due to reproductive and breast feeding trends can lead to hormone imbalance. Environmental exposures lead to endocrine disruption through xenoestrogens found in the environment, which include: BPAs in plastics, phthalates in fragrance, PCBs and parabens in preservatives.
A monthly ebb and flow of changes in the body is normal, but should not be debilitating.
In order to support healthy hormone balance, the following may be helpful:
Exercise
Stress management
Healthy plant based nutrition, as organic as possible
Adequate sleep
Healthy body weight
Limited exposure to toxins
Vitex
DIM
Seed cycling
Seed cycling is a method to support the body throughout the month by integrating different types of seeds during the menstrual cycle to achieve a better hormone balance.
The seeds used throughout the cycle include flax, pumpkin, sesame and sunflower. These seeds contain different nutrients that may be beneficial during specific times of the month. Lignans in sesame seeds and flax seeds can help the body bind excess estrogen.
Use organic seeds.
Sprinkle ground seeds onto salads, healthy smoothies etc.
During the first half of the cycle, the follicular phase, 1 tablespoon each of freshly grounded raw flax seeds and pumpkin seeds each day should be incorporated into nutrition.
During the second half of the cycle, the luteal phase, 1 tablespoon each of freshly ground raw sunflower seeds and sesame seeds each day should be incorporated into nutrition. If you do not need to limit oxalate exposure, use unhulled sesame seeds.
The data concerning cycling of nutrition for women is lacking in the medical literature. Indeed, if you search seed cycling in PubMed there are no results. Flax has been studied however and may lead to a lengthened luteal phase, increased ovulation.
If you try seed cycling, keep a journal and be patient. Remember most natural therapies take time as they are adjustments and support, and not a medicinal treatment.
SUPPLEMENTS TO LOWER TESTOSTERONE
Supplements to Decrease Testosterone Naturally
DIM 120mg
Calcium D Glucarate 200mg
Spearmint tea 2 cups per day
Black Cohosh 40mg BID
Saw Palmetto 160mg BID
Chaste Tree (Vitex) 20-40mg per day
Probiotic containing Bifidobacterium lactis
ELEVATED DHEA
Natural Treatments for Elevated DHEA
Dehydroepiandrosterone (DHEA) is the principal human C-19 steroid. DHEA has very low androgenic potency but serves as the major direct or indirect precursor for most sex steroids. DHEA is secreted by the adrenal gland and production is at least partly controlled by adrenocorticotropic hormone (ACTH).
The bulk of DHEA is secreted as a 3-sulfoconjugate dehydroepiandrosterone sulfate (DHEAS). Both hormones are albumin bound, but DHEAS binding is much tighter. As a result, circulating concentrations of DHEAS are much higher (>100-fold) compared to DHEA. In most clinical situations, DHEA and DHEAS results can be used interchangeably. In gonads and several other tissues, most notably skin, steroid sulfatases can convert DHEAS back to DHEA, which can then be metabolized to stronger androgens and to estrogens.
Within weeks after birth, DHEA/DHEAS levels fall by 80% or more and remain low until the onset of adrenarche at age 7 or 8 in girls and age 8 or 9 in boys. Adrenarche is a poorly understood phenomenon, peculiar to higher primates, that is characterized by a gradual rise in adrenal androgen production. It precedes puberty but is not casually linked to it. Early adrenarche is not associated with early puberty or with any reduction in final height or overt androgenization. However, girls with early adrenarche may be at increased risk of polycystic ovarian syndrome as adults.
Following adrenarche, DHEA/DHEAS levels increase until the age of 20 to a maximum roughly comparable to that observed at birth. Levels then decline over the next 40 to 60 years to around 20% of peak levels.
Elevated DHEA/DHEAS levels can cause signs or symptoms of hyperandrogenism in women. High levels may be due to PCOS, congenital adrenal hyperplasia, insulin, stress, elevated prolactin, alcohol and certain medications like ADD medications, Xanax and Wellbutrin.
Most mild-to-moderate elevations in DHEAS levels are of unknown origin. However, pronounced elevations of DHEA/DHEAS may be indicative of androgen-producing adrenal tumors. In small children, congenital adrenal hyperplasia (CAH) due to 3 beta-hydroxysteroid dehydrogenase deficiency is associated with excessive DHEA/DHEAS production. Lesser elevations may be observed in 21-hydroxylase deficiency (the most common form of CAH) and 11 beta-hydroxylase deficiency.
Origins of lower elevations of DHEA and DHEA-s include:
Chronic daily stress
PTSD
PCOS
Elevated prolactin
Non-classical adrenal hyperplasia
Symptoms of elevated DHEA include:
High DHEA can cause symptoms of androgen excess including oily skin, acne, sleep problems, headaches and mood disturbances.
In some cases, highly androgenic people may show high levels of both DHEA or testosterone without negative clinical consequence.
Symptoms include:
Difficulty in controlling weight
Acne or oily skin
Excess hair growth all over the body (hirsutism).
Male patterned baldness
Generalized fatigue or low energy
Irritability, anger or depression (and other changes in mood)
Infertility
Changes to your voice (a deeper voice in women)
Changes to muscle structure (increase in muscle mass)
Aggressive behavior
Reduction in breast size
Known history of PCOS
Recent history of stress
Management of elevated DHEA:
High DHEA can be managed with blood sugar balancing lifestyle, stress reduction and in appropriate cases Ashwagandha and other supplements.
If possible find and eliminate the source of stress
Manage stress
Consider supplementing with the adrenal adaptogen Ashwagandha has been shown to reduce enzyme production in individuals with adrenal hyperplasia.
Ashwagandha has also been shown to help balance cortisol levels which is also helpful if stress is worsening your DHEA. Dosing500mg per day but note that some people may need up to 2,000mg per day.
Consider further supplementation to improve adrenal function such as:
Alpha Lipoic Acid
Phosphatidyl Serine A dose of 200 mg of phosphatidylserine/phosphatidic acid complex per day may help to normalize ACTH and serum cortisol secretion in chronically-stressed individuals. 800 mg of phosphatidylserine per day blunted the stress-induced activation of the HPA axis.
L-Theanine: Found in green tea, L-theanine has been found in mice to protect normal ACTH secretion in the presence of stress via modulation of the HPA axis.
Hypericum perforatum: In patients with PCOS who also display symptoms of depression or anxiety related to stressors, St John’s wort has been found to attenuate the plasma increases of ACTH.20 As women with PCOS are at increased risk for depression and anxiety,
Melatonin When administered at bedtime in patients who are deficient in this hormone or who have sleep disorders, melatonin may help reduce ACTH stimulation of the adrenal gland.
Rhodiola rosea: The active ingredient in rhodiola, salidroside, has been found in animals to attenuate CRH expression in the hypothalamus and significantly reduce the levels of cortisol, thereby improving depressive symptoms and regulating the HPA axis.
Schizandra chinensis: This herb is often used in Traditional Chinese Medicine for the treatment of stress. A 2007 study found that schizandra was an effective protector against stress-related increases in cortisol, protein kinase, and nitric oxide in rabbits.
Lavandula officinalis: Inhalation of the vapor of lavender oil has been found to decrease plasma ACTH levels25 and reduce self-reported anxiety.
Some adaptogenic herbs may increase serum androgens, it is important to consider contraindications before prescribing commonly used adaptogen formulas.
Lifestyle
It’s important to not overlook the benefits of stress reduction via lifestyle modifications, including meditation, deep breathing, visualization and other mindfulness activities.
Quality sleep
Reduce refines carbohydrates and sugars
Restorative exercise
Gut Repair
There exists an important connection between the gut and the HPA axis. Probiotics that improve intestinal permeability have been found to attenuate the response of the HPA axis to stress. It’s also known that cortisol increases intestinal permeability through mast cell-dependent mechanisms; as such, women with PCOS who make excessive adrenal steroids may be at increased risk.
Anti-androgen Therapeutics
Many significant clinical problems related to excess adrenal androgens occur due to their conversion to testosterone or DHT. Anti-androgen therapies may be particularly beneficial for women with androgen-related hirsutism, acne, androgenetic alopecia, and androgen-related menstrual irregularities, who wish to avoid the side effects of conventional approaches such as spironolactone or finasteride.
Spearmint Tea: At a dosage of 1 cup BID, spearmint tea has been shown in 2 studies to have anti-androgenic properties. Over a 30-day period, spearmint tea brought about a significant reduction in free and total testosterone levels in a group of 42 women with confirmed PCOS and hirsutism.30
Glycerrhiza glabra: Licorice was found in a 2004 trial to significantly decrease testosterone levels in healthy female patients after 1 month of treatment. The study concluded that licorice may exert its anti-androgenic action through blocking 17-hydroxysteroid dehydrogenase and 17-20 lyase. The glycyrrhizin and glycyrrhetic acid constituents of licorice have significant anti-androgen effects, which may be helpful in reducing androgenic symptoms in women with PCOS.
Paeonia lactiflora: Peony is another popular anti-androgenic herb. It is often combined with Glycyrrhiza glabra in a ratio of 1:1 in Traditional Chinese Medicine for the treatment of PCOS. Studies have found that this combination is able to decrease the production of testosterone without altering the production of androstenedione and estradiol.
Camellia sinensis: For patients with androgenetic alopecia, hirsutism, or acne, Camellia sinensis (green tea) may be of benefit. Epigallocatechins in green tea are 5α-reductase inhibitors, which decrease the production of DHT. As green tea can also increase sex hormone-binding globulin, it can be helpful in patients with elevated free androgens.
Serenoa repens: Saw palmetto is a well-known plant-derived anti-androgen. By moderately inhibiting the enzyme 5α-reductase, saw palmetto shows promise in the treatment of androgenetic alopecia.
Ganoderma lucidum: Among its many health benefits, reishi mushroom exerts a significant anti-androgenic action.38 Research suggests that its triterpenoid fraction in an ethanol extract is able to inhibit both type 1 and type 2 5α-reductase.39 In addition, it appears to suppress the growth of cells that are stimulated by testosterone itself, suggesting that it may also have a role to play as an androgen receptor blocker.
Rosmarinus officinalis: As a topical therapy for androgenetic alopecia, rosemary leaf extract was found in a 2013 study to improve hair regrowth in mice with androgen-induced hair-growth interruption. The extract showed inhibitor activity upwards of 82.4% in inhibiting 5α-reductase, and also decreased the binding of DHT to androgen receptors.
High DHEA levels can be a very serious indicator of deeper problems, thus it is necessary to assure that possible origins of elevated levels are properly evaluated.
High DHEA levels in females are often associated with PCOS.
High levels of DHEA are associated with a higher risk of breast cancer.
High DHEA levels in females also may indicate an adrenal gland tumor or overactive adrenal glands
High DHEA levels in females also seem to be associated with Cushing’s syndrome
LOWERING ANDROGENS NATURAL METHODS
Naturally Occurring Anti-Androgens
Red reishi, which has been shown to reduce levels 5-alpha reductase, the enzyme that facilitates conversion of testosterone to dihydrotestosterone (DHT).
Licorice, which has phytoestrogen effects and reduces testosterone levels.
Chinese peony, which promotes the aromatization of testosterone into estrogen;
Green tea, which contains epigallocatechins and also inhibits 5-alpha reductase, thereby reducing the conversion of normal testosterone into the more potent DHT.
Black cohosh, which has been shown to kill both androgenresponsive and non-responsive human prostate cancer cells.
Chaste tree, which has a reduces prolactin from the anterior pituitary.
Saw palmetto extract, which is used as an anti-androgen although it shown no difference in comparison to placebo in clinical trials.
Details: Plant-Derived Anti-Androgen Therapies
Reishi (Ganoderma lucidum)
Red reishi, commonly known as LingZhi in Chinese, is a mushroom thought to have many health benefits. In a research study exploring the anti-androgenic effects of 20 species of mushrooms, reishi mushrooms had the strongest action in inhibiting testosterone (3). That study found that reishi mushrooms significantly reduced levels of 5-alpha reductase, preventing conversion of testosterone into the more potent DHT. High levels of DHT are a risk factor for conditions such as benign prostatatic hypertrophy (BPH), acne, and baldness.
Licorice (Glycyrrhiza glabra)
Licorice is a flavorful substance that has been used in food and medicinal remedies for thousands of years. It is also known as “sweet root,” licorice root contains a compound that is about 50 times sweeter than sugar. It has been used in both Eastern and Western medicine to treat a variety of illnesses ranging from the common cold to liver disease. Licorice affects the endocrine system because it contains isoflavones (phytoestrogens), which are chemicals found in plants that may mimic the effects of estrogen and relieve menopausal symptoms and menstrual disorders. Licorice may also reduce testosterone levels, which can contribute to hirsutism in women.
A small clinical trial published in 2004 by Armanini and colleagues found that licorice root significantly decreases testosterone levels in healthy female volunteers. Women taking daily licorice root experienced a drop in total testosterone levels after 1 month and testosterone levels returned to normal after discontinuation. It is unclear as to whether licorice root affects free testosterone levels. The endocrine effect is thought to be due to phytoestrogens and other chemicals found in licorice root, including the steroid glycyrrhizin and glycyrrhetic acid, which also have a weak anti-androgen effect.
White Peony (Paeonia lactiflora)
Chinese peony is a widely grown ornamental plant with several hundred selected cultivars. Many of the cultivars have double flowers with the stamens modified into additional petals. White peony has been important in traditional Chinese medicine and has been shown to affect human androgen levels in vitro. In a 1991 study in the American Journal of Chinese Medicine Takeuchi et al described the effects of paeoniflorin, a compound found in white peony that inhibited the production of testosterone and promoted the activity of aromatase, which converts testosterone into estrogen .To date, there have been no studies that translate or explore the clinical effects.
Green Tea (Camellia sinensis)
In addition to supporting the cardiovascular system and somewhat reducing the risk of cancer and type 2 diabetes, green tea may also have an important anti-androgen effect because it contains epigallocatechins, which inhibit the 5-alpha-reductase conversion of normal testosterone into DHT. As previously noted, this anti-androgen mechanism may help to reduce the risk of acne, and hair loss. As yet, no randomized controlled trials of green tea for these androgen dependent conditions have been conducted.
Spearmint (Mentha spicata [Labiatae])
Spearmint, usually taken in the form of tea, has been thought for many years to have testosterone reducing properties. It is commonly used in Middle Eastern regions as an herbal remedy for hirsutism in females. Its anti-androgenic properties reduce the level of free testosterone in the blood, while leaving total testosterone and DHEAS unaffected. One study has shown that drinking spearmint tea twice daily for 30 days (vs. chamomile tea, which was used as a control) significantly reduced plasma levels of gonadotropins and androgens in patients with hirsutism associated with polycystic ovarian syndrome. There was a significant change in patients’ self-reported dermatology-related quality of life indices. It is possible that sustained daily use of spearmint tea could result in further abatement of hirsutism.
Black Cohosh (Actaea racemosa)
Black cohosh (Actaea racemosa) is a plant of the buttercup family. Extracts from these plants are thought to possess analgesic, sedative, and anti-inflammatory properties. Black cohosh preparations (tinctures or tablets of dried materials) are used to treat symptoms associated with menopause, such as hot flashes.
Chaste Tree (Vitex agnus-castus)
Chaste tree (or chasteberry) is a native of the Mediterranean region and is traditionally used to correct hormone imbalances. In ancient times, it was believed to be an anaphrodisiac, hence the name chaste tree. Clinical studies have demonstrated effectiveness of medications produced from extract of the plant in the management of premenstrual syndrome (PMS) and cyclical mastalgia. The mechanism of action is presumed to be via dopaminergic effects resulting in changes of prolactin secretion from the anterior pituitary. At low doses, it blocks the activation of D2 receptors in the brain by competitive binding, causing a slight increase in prolactin release. In higher concentrations, the binding activity is sufficient to reduce the release of prolactin.
Saw Palmetto (Serenoa repens)
Saw palmetto is a small palm tree native to eastern regions of the United States. Its extract is believed to be a highly effective anti-androgen as it contains phytoesterols. This has been the subject of a great deal of research with regards to the treatment of androgenic alopecia and PCOS.
Summary of Effects of Plant Derived Anti-Androgens
Red Reishi (Ganoderma lucidum)
Reduction in 5-alpha-reducatase enzyme activity, reduction in DHT levels
Licorice (Glycyrrhiza glabra)
Reduction in total testosterone levels (effect on free testosterone levels not clear)
White Peony (Paeonia lactiflora) Paeoniflorin
Inhibits the production of testosterone and promotes the activity of aromatase - the enzyme that converts testosterone into estrogen
Green Tea (Camellia Sinensis)
Contains chemicals epigallocatechins, which inhibit the enzyme 5-alpha-reductase, and thereby reduce the conversion of normal testosterone into the more potent DHT
Spearmint (Mentha spicata[Labiatae])
Decreases free testosterone, increases LH, FSH and estradiol. Reduction in patient reported measures of hirsutism
Black Cohosh (Actaea racemosa)
Black cohosh extract has been shown to inhibit the proliferation of human breast cancer cells and kill both androgen-responsive and unresponsive human prostate cancer cells by induction of apoptosis and activation of caspases.
Chaste Tree (Vitex agnus-castus)
Clinical studies have demonstrated effectiveness of medications produced from extract of the plant in the management of premenstrual syndrome (PMS) and cyclical breast pain (mastalgia) as well reduction of mild hyperprolactinemia.
Saw Palmetto (Serenoa repens)
Summary
There is now a small amount of data showing that androgen, prolactin, and gonadotropin levels can be biochemically modulated by the active compounds contained within these natural sources.
Further work is clearly needed before the use of such compounds becomes part of routine practice.
There is currently a paucity of high quality data derived from rigorously conducted trials. However, there are a few clinical and pre-clinical studies, although small in number, that have demonstrated that some natural anti-androgens address the underlying pathophysiology and can have effects on endocrine mediated disorders.
What is now required are several larger, well-controlled, randomized studies aimed at proving their efficacy. While this group of treatments may be slow to find favor and may not be used first line, it does at least appear to be more acceptable to patients because of its perceived more natural origins.
Foods to Lower Androgens
Nuts
Nuts of any type are great for PCOS. Research has indicated that the monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) found in nuts have been shown to improve androgens as well as insulin and cholesterol levels in women with PCOS.
Fish
There is some evidence regarding the effect of omega-3 intake on androgen levels in women with PCOS. In a study published in Iran Journal of Reproductive Medicine, overweight women with PCOS were randomized to receive omega-3 (3grams per day) or a placebo for 8 weeks. Testosterone concentration was significantly lower in the omega-3 group compared with placebo, after supplementation. After the trial, the percentage of regular menstruation in the omega-3 group was more than the placebo group (47.2% vs. 22.9%).
Fish, in particular, cold water fish, are rich sources of omega-3 fatty acids. Examples of these types of fish include salmon, tuna, and trout.
Tea
Studies have shown drinking tea (hot or iced) may help improve PCOS symptoms. Spearmint tea, for example, has been shown to have anti-androgen effects in PCOS and can reduce hirsutism
Marjoram herb is reputed for its ability to restore hormonal balance and to regulate the menstrual cycle. A study published in the Journal of Human Nutrition and Diet investigated the effects of marjoram tea on the hormonal profile of women with PCOS. Women who were assigned to receive marjoram tea twice a day for one month were found to improve insulin sensitivity and reduce the levels of adrenal androgens compared to a placebo tea.
Red Reishi Mushrooms
Flaxseed
Flaxseed has been shown to reduce androgen levels in men with prostate cancer. In a case study involving a 31-year old woman with PCOS, flaxseed supplementation (30 g/day) reduced total and free testosterone. The patient also reported a decrease in hirsutism at the completion of the study period.8 Further research of flaxseed supplementation on hormonal levels in women with PCOS are warranted.
Supplements to Decrease Testosterone Naturally
DIM 120mg
Calcium D Glucarate 200mg
Spearmint tea 2 cups per day
Black Cohosh 40mg BID
Saw Palmetto 160mg BID
Chaste Tree (Vitex) 20-40mg per day
Probiotic containing Bifidobacterium lactis
GOAL SETTING AND ACHIEVING HEALTH GOALS
Tools for Achieving an Attainable Goal
Step 1. What is my goal? long, medium, and short term
Must contain 3 elements
concrete, well-defined
specific time frame
realistic
Step 2. What are the mini-steps I will need to accomplish my goal? i.e. I will walk an extra 500 steps a day (what time of day?) I will eat home cooked healthy meals at least 4 nights/week
consider barriers and how you will overcome them
Include deadlines if multi-step process
Step 3. How will I measure my progress?
mobile monitoring device?
adding to and checking off personal to-do list?
Step 4. How will I hold myself accountable?
Will I track my own progress to make sure I remain on track?
Will I utilize a health coach or personal trainer?
POYNOR HEALTH PCOS Program
Initial in office evaluation with physician
Physical examination
Laboratory testing including metabolic, hormone, vitamin and micronuturient testing.
Ultrasound imaging
Follow-up tele health with physician at 2 weeks post initial evaluation
Review laboratory values
Establish health goals
Formulate plan for allopathic and integrative treatments
Medication discussion and presciption if opted for
Supplement discussion and presciption
Nutrition approaches
Lifestlye approaches
Exercise
Sleep
Stress management
Review tracking of symptoms and measurement of outcomes
Additional integrative testing will be reviewed
Initial visit with health coach
Establish nutrition and lifestyle goals
Symptom assessment
Establish nutrition and lifestyle plan
Functional foods to add
Anti inflammatory goods
Meal planning
GI system support
Exercise plan
Stress management
Environmental toxin exposure reduction
Sleep support
Targeted supplement support based on lab review, physician and nutrition assessment
Followup physician tele health check in at 6 weeks
Review symptom tracking
Evaluation of plan and modifications
Followup physician tele health check 3 months
Outcomes analysis
Follow-up physician in office at 6 months
Evaluation of outcomes based on goals
Evaluate previous 6 months
Establish ongoing plan for next 6 months
Ongoing nutrition and lifestyle interventions with health coach
Telehealth appointment every 2 weeks for 3 months then reassessment for frequency
Meal planning
Exercise evaluation
Stress management
Sleep support
Environmental toxin exposure reduction
Weekly check ins with evaluation of outcomes based on goals
Additional Resources
Availability for additional telehealth and office visits as required
Monthly chat concerning PCOS with physician and support