No. 1 Cause of Infertility? Polycystic Ovarian Syndrome (PCOS)

May 7, 2018
PCOS symptoms - Dr. Axe

This “silent disorder” is one of the most common hormonal disorders in women. It’s closely associated with infertility and can create a heavy emotional burden on those who suffer with it, on top of its many symptoms and related physical problems. This disorder is called polycystic ovarian syndrome, or polycystic ovary syndrome (PCOS), which affects anywhere from 6 percent to 21 percent of women of childbearing age. (1)

More people are becoming aware of this disorder and what PCOS symptoms look like, although it’s been a relatively under-diagnosed condition for a long time. Up to 72 percent of those with PCOS experience infertility, contrasted with the 16 percent of non-PCOS women who have those issues. (1) Meanwhile, it’s associated with an increased risk for developing type 2 diabetes, mood disorders, endometrial cancer, fatty liver, sleep apnea, high blood sugar, high cholesterol, high blood pressure, metabolic syndrome and heart disease. (2)

The good news is there are many natural ways to treat PCOS symptoms, and it starts with doing everything you can to balance hormones naturally. Read on to raise your PCOS awareness and find about ways to reverse the symptoms of PCOS naturally.


What Is Polycystic Ovarian Syndrome (PCOS)?

PCOS is one of the most common hormonal imbalances affecting women today and is often characterized by insulin resistance. The endocrine system is very complex; while PCOS has been recognized and diagnosed for over 75 years and is now considered the leading form of endocrine disruption in women of reproductive age, there’s still a lot to learn about how exactly this hormonal imbalance occurs in different women and how it can most effectively be reversed.

Alarmingly, estimates show that somewhere between 6 percent to 21 percent of women of childbearing age are affected by PCOS. However, less than 50 percent of women are properly diagnosed. This means millions have no idea what’s causing their underlying symptoms. (3, 1) Since it’s considered to be the major cause of female infertility, this is a big deal! (4)

PCOS can develop for a number of different reasons, and symptoms can vary a lot from woman to woman, although it is generally accepted that insulin resistance plays “an intrinsic role” in the development of the disease. (5) Currently, there is no known “cure” for polycystic ovary syndrome, although the underlying hormonal causes are believed to be mostly reversible, and many women find effective ways to lower their symptoms without the use of medications.

While PCOS symptoms can come and go depending on fluctuations in someone’s lifestyle, insulin resistance affects 50–70 percent of all women with polycystic ovarian syndrome. (6) And when left untreated, this can increase the risk for metabolic syndrome, hypertension, dyslipidemia (high cholesterol and/or triglycerides) and diabetes down the road.


PCOS Signs & Symptoms 

There are several PCOS symptoms common among woman dealing with hormonal issues. Sometimes, the ovaries will form what’s called a “functional ovarian cyst.” A sac forms on the surface of an ovary around a maturing egg. Usually, the sac goes away once the egg is released. If the egg isn’t released or the sac closes around the egg and fills with fluid, it becomes a functional cyst. The term “polycystic” literally means that a woman’s ovaries have multiple small cysts on them.

Normally, the ovaries release a small amount of male sex hormones (called androgens), but in women with PCOS, the ovaries start making slightly more androgens, which is the reason for masculine symptoms like extra facial and body hair and male pattern baldness.

Classically, physicians have looked for multiple cysts on the ovaries (described as looking like a “string of pearls” when performing an ultrasound), but not every woman diagnosed with polycystic ovarian syndrome has visible cysts on her ovaries. (7)

Another sign of PCOS is what’s known as “androgen excess,” or too many male hormones (androgens) produced in the body. This can lead to symptoms like acne, abnormal hair growth and mood issues. It’s estimated that over 80 percent of women who have androgen excess, as diagnosed by a physician, have PCOS. (3)

Common polycystic ovary syndrome symptoms include:

  • Partial or total infertility (related to and affected by many other symptoms, like insulin resistance, menstrual cycle disruption, weight problems, high male hormone levels and low sex drive)
  • Oligomenorrhea (irregular periods) or amenorrhea (missing periods)
  • Weight gain and/or trouble losing weight
  • Acne
  • Insulin resistance (related to an increased risk for diabetes)
  • High male hormone levels, particularly testosterone
  • Hirsutism (excessive hair growth, including in places women don’t usually grow hair, such as on the face and abdomen)
  • Male pattern baldness or thinning hair
  • Fatigue
  • Changes in mood
  • Low sex drive (libido)

Causes & Risk Factors of PCOS

While the exact cause of PCOS is somewhat unclear, there are a few theories on how it develops. These are probably not a “one-size-fits-all” answer, but rather interact with each other to initiate the development of this disease. The main causes and risk factors are thought to include:

  • Altered action of the luteinizing hormone (LH) (8, 9)
  • Insulin resistance (10)
  • A genetic predisposition to hyperandrogenism (this may be reflected diagnostically by subclinically high levels of androgens) (11, 12)
  • Family history of PCOS (13)
  • Smoking
  • Excessive alcohol consumption
  • Sedentary lifestyle (14)
  • Epilepsy and/or use of valproic acid to treat epilepsy
  • Type 1, type 2 and gestational diabetes (it’s unclear if diabetes leads to PCOS, or if this occurs in reverse order, but both are probably true)
  • High birth weight (particularly when born to an obese mother)
  • Premature puberty
  • Acanthosis nigricans (a skin disorder)
  • Metabolic syndrome (3)

It’s been commonly thought that obesity is a risk factor for PCOS. However, clinicians seem to agree, based on recent research, that while losing weight is one major way to naturally treat polycystic ovarian syndrome, the weight itself probably isn’t a direct cause. It may bring on symptoms faster, though. (3) A high percentage of PCOS patients deal with weight gain at some point, but we now know that there are plenty of women who are normal weight, or even underweight, who also develop hormonal disruptions that lead to polycystic ovarian syndrome. PCOS patients come in all shapes and sizes, and their histories can be very diverse, which makes treating this condition even more complicated.

A 2017 study led by the University of Birmingham revealed that a class of androgens, known as 11-oxygenated C19 steroids, contributes significantly to androgen excess in women with PCOS, while previous research has primarily focused on one androgen: testosterone. (15)

PCOS was also thought to be more hereditary than it actually is. While twin studies have indicated there is a strong genetic component to developing polycystic ovaries, other information points to only up to a 32 percent chance of immediate relatives also having the condition. (16, 13)


Diagnosing Polycystic Ovarian Syndrome

There’s actually some controversy surrounding the criteria used to determine a PCOS diagnosis and even how to label the condition. In fact, some polycystic ovarian syndrome experts have questioned whether or not changes to polycystic ovarian syndrome criteria have led to an over-diagnosis of the condition among reproductive-age women. In addition, as noted previously, treatment options can vary.

Multiple criteria for diagnosing polycystic ovarian syndrome exist, all of which require different combinations of the following three symptoms for a positive diagnosis: (17)

1. Androgen Excess

As I’ve stated, an excess of androgens is commonly caused by PCOS (or vice-versa). These include testosterone, androstenedione, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEA-S). These levels are sometimes sub-clinical (not obvious on a blood test) in PCOS patients, but typically need to show up at significant levels for a doctor to include it for a diagnosis.

2. Ovulatory Dysfunction

One of the most well-known effects of PCOS is problem with ovulation. This can manifest as oligomenorrhea (irregular periods) or amenorrhea (missing periods). Many women with PCOS experience abnormally heavy, short or long menstrual cycles, which also falls under the heading of ovulatory dysfunction.

3. Polycystic Ovaries

This may seem obvious, but not every diagnostic criteria actually requires a definitive discovery of polycystic ovaries, as they claim that the possibility of polycystic ovaries based on the first two criteria is enough for the syndrome to manifest itself. However, many women with PCOS multiple ovarian cysts that can be identified on a vaginal ultrasound. I’ve heard personal reports from women whose ultrasound technicians pointed out their ovaries were partially and even completely obstructed on ultrasound by the large number of ovarian cysts they had.

Depending on what doctor you see, they may use different criteria to diagnose you. The three basic options include: (17)

  • National Institute of Health Criteria (1990): Patient must have both androgen excess and irregular periods
  • Rotterdam Criteria (2003): Patient must have any two of the above three symptoms
  • Androgen Excess and PCOS Society (2009): Patient must have androgen excess plus either ovulatory dysfunction OR polycystic ovaries

According to The Endocrine Society, Rotterdam criteria is the best option for diagnosis. Some clinicians estimate that this may nearly double the number of PCOS diagnoses from either of the other two methods.

The guidelines for the Rotterdam criteria note that excess androgen is a key factor in presentation of the condition in adolescents. (18)


Conventional Treatment of PCOS

According to the American Family of Family Physicians, treatment for PCOS should be “individualized,” meaning it matters how old you are, how severe your symptoms are and whether or not you’re trying to get pregnant for a physician to advise a treatment plan. (17)

They also recommend patients be tested for blood pressure levels, lipid levels (for cholesterol, triglycerides, etc.), glucose tolerance, depression and sleep apnea.

Depending on whether or not you want to get pregnant, conventional medicine dictates one of the following treatment plans:

If You’re Trying to Get Pregnant

For women interested in re-starting ovulation for the purposes of pregnancy, conventional treatment methods include:

For Fertility: Clomiphene (an estrogen-modulating drug) or letrozole (a hormone-based chemotherapy)

For Insulin Resistance: Metformin (an anti-diabetic medication)

For Obesity (if applicable): Lifestyle modification (no specific instructions, generally an instruction to lose weight and be more active)

For Hirsutism (abnormal hair growth): Electrolysis and light-based therapies

For Acne: Topical antibiotics or antiseptics like benzoyl peroxide

If You’re Not Trying to Get Pregnant

For Irregular Periods: Hormonal contraception like an IUD (intrauterine device) or birth control pills plus metformin

For Insulin Resistance: Metformin

For Obesity (if applicable): Lifestyle modification

For Hirsutism: Hormonal contraception (with or without antiandrogen therapy), spironalactone monotherapy, electrolysis, light-based therapies, eflornithine or finasteriside (the last two of which are prescription medications) along with metformin

For Acne: Hormonal contraception, topical antibiotic or antiseptic creams (including tretinoin and adapalene, which shouldn’t be used by those trying to get pregnant) and spironalactone (a high blood pressure/heart failure medication)

Research has shown that metformin is most effective when prescribed in conjunction with lifestyle changes, such as dietary changes and weight management. (19) However, there is controversy around using metformin to treat PCOS and a lack of long-term studies to prove its efficacy. In addition, it can cause many side effects. (20)


9 Natural Remedies for PCOS Symptoms

PCOS is a complex condition, and the road to resolving the hormonal imbalances that cause it are not the same for every woman. Practitioners, and women with polycystic ovarian syndrome, both agree that there isn’t a “one size fits all” approach that balances hormones best. Kate Kordsmeier of Root + Revel recounted her personal experience in reversing PCOS naturally without medications in a guest post.

Diet isn’t everything, and other lifestyle factors — especially stress, but also things like meal timing and level of exercise — all play an important role in a woman’s reproductive system. While it might seem complicated, the best options for moving forward for women with different types of polycystic ovarian syndrome all fall within the same general categories, focusing on all aspects of health: mainly, eating a balanced diet, maintaining an appropriate body weight and eliminating as much physical and psychological stress as possible.

Here are some of the most well-researched natural remedies for PCOS symptoms.

1. Give Your Diet a Makeover

The Standard American Diet (SAD — how appropriate!) offers little in the way of nutrition, particularly for women with PCOS who are often insulin resistant. While the standard recommendation for obese women has been to eat a low-fat and/or low glycemic index diet, these may not actually be beneficial for those with polycystic ovarian syndrome.

For instance, did you know that a diet high in healthy fats and low in carbohydrates can actually result in more weight loss? In morbidly obese subjects (both men and women, not directly those with PCOS), this type of diet led to over doubled weight loss when compared to a low-fat diet, stunning researchers in a 2003 clinical trial. (21)

This type of diet is known as a keto diet, or ketogenic diet. Originally developed for children with epilepsy by researchers at Johns Hopkins Medical Center, this diet focuses on drastically reducing carbohydrate intake, getting the majority of your calories from healthy fats and some from protein. This diet induces a process called ketosis in which your liver begins producing ketones for you to metabolize as energy, rather than burning glucose. When you’re in ketosis, your body burns fat more quickly. This diet has also been heralded as a remedy for brain fog and is currently the focus of a great deal of research surrounding mental health and disorders.

There are multiple benefits of the ketogenic diet for PCOS. For one, women with PCOS are at a higher risk for depression, so the mental health benefits of keto may help offset some of that risk. For another, doing keto is often a fast, safe and effective way to lose a lot of weight in a short amount of time, which is associated with an improvement in fertility and other PCOS symptoms. Third, this diet causes your body to utilize ketones, not glucose, which means it’s a powerfully potent remedy for insulin resistance, which is also associated with fertility issues. (22)

Reducing carbohydrate intake has already been shown to improve insulin sensitivity in women with PCOS. (23) Two clinical trials have been completed testing the effectiveness of keto for PCOS, finding very positive results in both weight loss and increased insulin sensitivity. (24, 25)

Another dietary model that may work those with PCOS is an anti-inflammatory diet. Naturally anti-inflammatory foods include vegetables, fruits, grass-fed/pasture-raised meats, wild-caught fish (like salmon), nuts/seeds (like chia, flax, hemp, almonds and walnuts) and unrefined oils/fats (including coconut oil, olive oil and avocado). This type of diet seems to reduce some of the metabolic symptoms of PCOS and results in weight loss. (26)

In general, any lifestyle-modifying diet that effectively allows a patient with PCOS to lose weight is going to have some benefit in restoring fertility and improving other symptoms of the condition, even when you lose only five to 10 percent of your total body weight. (27, 28, 29, 30)

2. Get Enough Rest 

Sleep is crucial for cell regeneration, hormone production, stress control and even weight management. In fact, sleep deprivation can have the same negative effects on health and hormones as a lack of activity and a poor diet can. Women with PCOS are more likely to have sleep disturbances, and at least one study has found that this may due to an overproduction of melatonin. (31, 32)

According to a large cross-sectional study, PCOS sufferers who get less sleep are at more risk for mental issues and insulin resistance. (33) These women are also more likely to develop obstructive sleep apnea. (34)

Consistently going without enough sleep increases stress hormones in the body, including cortisol, and changes levels of hormones that control your weight and appetite, including insulin and ghrelin. The more stressed you are, the more sleep you likely need — but the general recommendation that works well for most people is aiming for seven to nine hours each night. Some women with polycystic ovary syndrome may need upwards of nine hours consistently.

3. Exercise in an Appropriate Way

If you have a predisposition to developing hormonal imbalances, keep in mind there’s a fine line between too little activity and too much. Generally speaking, women’s bodies are more susceptible to hormonal changes when exercise is increased beyond healthy levels. For example, “female athlete triad” is a condition that can contribute to PCOS. It’s caused by too much exercise coupled with a restrictive diet and too few calories. Female athletes also can be more susceptible to irregular periods, according to multiple studies. (35)

However, there are many benefits of exercise to consider beyond this one condition. While those with polycystic ovarian syndrome might not be able to lose weight through exercise as easily as others, there is evidence that, no matter the type of exercise you choose, exercising with PCOS might improve fertility markers, insulin resistance, inflammation and weight. (36, 37, 38, 39)

4. Avoid Exposure to Endocrine Disruptors

Endocrine disruptors are chemicals that interfere with the production, release, transport, metabolism or elimination of the body’s natural hormones. Women with hormonal disorders like PCOS are very sensitive to this type of interference, and high levels of endocrine disruptors such as bisphenol A may have an impact on the androgens in their bloodstream. (40) Endocrine disruptors in plastics (BPA, DEHP and DBP) might even influence the epigenetics of people with reproductive disease and obesity to make it more likely that people pass the disorders to their children. (41)

In all, the endocrine disruptors that affect PCOS seem to include: (42)

5. Supplement with Inositol

One particularly significant natural method of treating PCOS is inositol, a sugar alcohol chemical compound found in fruits, beans, grains and nuts (although it is not always bioavailable in these foods if presented with phytates). In nutrition, inositol is present in the highest levels in cantaloupe and oranges.

Most sources investigate inositol in supplement form, although the specifics can get a little tricky as there are two types of inositol: myo-inositol and D-chiro-inositol. However, the research seems to support that inositol can greatly improve PCOS symptoms. Multiple studies have shown that supplementation may improve insulin resistance, decrease male hormones in the bloodstream, and lower blood pressure and high triglycerides. The recommended dosage for naturally treating polycystic ovarian syndrome is a 40:1 ratio of myo-inositol to D-chiro-inositol, typically 2000:50 grams or 4000:100 grams. (43, 44, 45, 46)

Most notably, inositol seems to promote ovulation, which, in turn, may support fertility. In one study, only 6 percent of control group participants experienced menstrual cycles versus 86 percent in the inositol group, results that seem to be supported by follow-up research. (47)

Using inositol supplements and eating foods high in this nutrient may also help combat some of the mental risks involved with PCOS, since inositol has been found to combat these in several human studies. Examples of this include:

6. Try Acupuncture

While many might be skeptical, there is evidence that acupuncture may function as a very useful complementary treatment for women with PCOS. A review in 2011 of four human clinical trials of acupuncture for PCOS found that:

Acupuncture therapy may have a role in PCOS by: increasing of blood flow to the ovaries, reducing of ovarian volume and the number of ovarian cysts, controlling hyperglycaemia through increasing insulin sensitivity and decreasing blood glucose and insulin levels, reducing cortisol levels and assisting in weight loss and anorexia. (55)

Another acupuncture option that shows promise is electro-acupuncture. Also published in 2011, a report from the Osher Center for Integrative Medicine in Sweden discovered that combining electro-acupuncture (EA) with exercise resulted in improved sex hormone levels, menstrual frequency and hyperandrogenism. EA alone outperformed exercise in this clinical trial. (56)

7. Get More Vitamin D

Between 67–85 percent of women with polycystic ovary syndrome are thought to be deficient in vitamin D. (57, 58) While this deficiency isn’t a direct cause of the syndrome, it can contribute to many of the symptoms of PCOS like insulin sensitivity, obesity, low luteinizing hormone (LH) levels, high triglycerides and infertility. (59, 58) Some sources suggest that people may have a faulty vitamin D receptor, leading to conditions like PCOS and diabetes. (60)

Adding vitamin D to a daily routine has been observed to improve insulin sensitivity, increase weight loss success, slow the formation of ovarian cysts, regulate periods, minimize inflammation, reduce oxidative stress, lower cholesterol, lower high triglycerides and reduce androgens in the bloodstream. (61, 62, 63, 64)

Vitamin D has been studied in these cases both on its own and along with calcium or evening primrose oil. (62, 64)

8. Other PCOS Supplements

There are a number of supplements, in addition to inositol and vitamin D, that can greatly improve markers of PCOS. Many sources suggest that it may be beneficial to experiment with which of these work best for you (preferably under the supervision of your healthcare provider, of course).

Other supplements that have been studied and seem to be effective for polycystic ovary syndrome include:

9. Visit a Chiropractor

While evidence on this topic is somewhat limited, there are several case study reports in which care from a chiropractor led to an improvement in menstruation and fertility. Some of these subjects had definitively been diagnosed with PCOS, while others had not (but still had some symptoms of polycystic ovarian syndrome). (75, 76, 77, 78) In all cases, the chiropractor reporting the case suggested this shows a need for well-designed clinical trials to see if these results can be duplicated.


Precautions

Polycystic ovary syndrome is complex and not every woman will respond the same to every type of treatment. As with any new supplement, dietary or exercise regimen, check in with your healthcare provider before starting (and don’t try to take yourself off of medications you take without supervision).

Some supplements for PCOS may imitate the impact of metformin, so it’s important to ask about medicinal interactions for this or any other medications you take before adding supplements to your routine that may impact insulin function.

In addition, certain mineral supplements, like zinc, shouldn’t be taken in large doses over extremely long periods of time. Always read instructions and precautions for individual supplements, and take only the recommended dosages.


Key Points About PCOS

Polycystic ovarian syndrome is a very prevalent disorder that is responsible for a large portion of the female infertility in our modern world. However, there are many options for potentially managing and/or reversing this condition by natural means.

The three main features of PCOS include an excess of male hormones, irregular or absent periods and ovarian cysts. Symptoms and/or risk factors affected by PCOS are insulin resistance, high lipid levels (triglycerides and cholesterol), mental disorders like depression, diabetes, acne and hirsutism (male-patterned hair loss and growth).

While not every natural solution will work in the same way for every woman with PCOS, there are many natural remedies for PCOS that may work effectively. Nine examples of these are to:

  1. Give your diet a makeover (with a keto or anti-inflammatory diet)
  2. Get enough rest
  3. Exercise in an appropriate way
  4. Avoid exposure to endocrine disruptors
  5. Supplement with inositol
  6. Try acupuncture
  7. Get more vitamin D
  8. Try other PCOS supplements (magnesium, zinc, calcium, omega-3s, chromium, N-acetylcysteine and folic acid)
  9. Visit a chiropractor

Read Next: Get Your Cortisol Levels Under Control & Turn Down Stress


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