POLYCYSTIC OVARY SYNDROME/STEIN – LEVENTHAL SYNDROME (PCOS)
PCOS can be termed as chronic anovulation triggered by insufficient oestrogen feedback to the hypothalamus pituitary system. Current figures suggest that it affects 1 in 10 women, with a frightening estimated figure of up to 33% of women affected in the UK. Typical onset is 25/35 years of age and there is often a mother or sister with the same problem.
Its presentation is bilateral polycystic ovaries with the ovaries swollen up to 2 to 5 times their normal size. An ultrasound image would show swollen ovaries with a thick shiny white coating and multiple rows of cysts on the surface of the ovaries that only grow to half or less the normal size. In a normal ovulation phase, up to 20 eggs start out and usually only 1 ruptures when fully mature to start its journey through the fallopian tubes. However with PCOS, hormone levels are not sufficent and the oocytes in the follicles fail to mature, resulting in no follicle rupturing to release an egg. These immature follicles (5 to 8mm max)produce a lot of oestrogen and some testosterone which results in FSH being cut off too early and lutenizing hormone being secreted. These hormone levels ultimately indicate the level at which the period will be affected. So menstrual disorders can include, ammenorhea, oligomenorrhea, dysfunctional bleeding, infertility, coupled with hirsuitism sometimes and obesity alongside biomedical irregularities like elevated testosterone and lutenizing hormone. The other signs and symptoms are deepening of the voice, decreased breast size, acne, high prolactin levels and alopecia.A 2008 study suggests that mental health issues are much worse than originally thought for the PCOS sufferer. For example they tend to present with higher rates of clinically relevant anxiety and depression, resulting in a higher dependance on anti depressants and anxiolytic drugs. There is also a high likelihood of high insulin levels or insulin resistance in adipose tissues and skeletal muscles. which can also contribute to the unusually high levels of depressive symptoms. Hyperinsulinaemia can result in the ovaries overproducing androgens and increase levels of testosterone. These androgens are the main contributory factor of the syndrome clinically and endocrinological.
The PCOS patient needs to be aware of her condition and always monitor her body weight primarily througn exercise and diet. Overweight women have been shown to have lower levels of sex hormone-binding globulin(SHBG) in their blood leading to higher levels of circulating testosterone which can then cause distressing symptoms of PCOS like hirsuitism(excessive hair growth) A weight loss of even just 5-10% can balance hormones,aid her ovulation and increase her chances of a successful pregnancy.(Int J women’s Health, 2011;3:25-35) It can also reduce her susceptability to developing type2 diabetes, cardiovascular problems or endometrial cancer. The exercise aspect is essential for helping to maintain the weight but it can also help normalize insulin levels.
In short besides the visual aspect of obesity the effects of obesity in a PCOS sufferer increases the likelihood of metabolic disturbances, reproductive disturbances and if pregnancy is achieved it increases pregnancy complications.
When attending a Western Physician the woman is generally treated with medication such as:
* Clomid to promote ovulation. * Gonal-F or Pergonal (gonadotropins). * Human chorionic Gonadotropin (hCG). * Gluchophage, Metformin or Actos to control insulin resistance.( Metformin can cause you to become deficient in vitamin B12. If you decide to supplement, use methylcobalamin, the active form of B12. What they generally sell in the drug stores is cyanocobalamin and it doesn’t work.)
* Steroids to balance the androgen hormonal effects, which, over the long term, can damage the liver and puts a woman at risk of osteopenia.
Acupuncture is gaining critical recognition at helping this condition. From a TCM perspective swollen ovaries indicate water accumulating to transform into damp phlegm. The root cause is kidney deficiency and more often kidney essence\kidney yang deficiency. When kidney yang is weak it fails to transform and ascend fluids in the lower jiao resulting in accumulation of damp phlegm. This allows cysts to form and the deficient kidney yang then leads to menstrual irregularities, ammennorhea and infertility. The kidney yang deficiency is usually coupled with phlegm damp,/ liver qi stagnation,\ blood stasis, \kidney yin deficiency \ spleen qi deficiency.
So it is a mixed excess / deficiency pattern. Excess; phlegm damp\liver qi stagnation \blood stasis. Deficiency; Kidney yang def/ kidney yin def\spleen qi def.
If Acupuncture and chinese herbs are incorporated into treatment and If the BMI is reduced to a healthy level and insulin sensitivity is improved ,Ovulation can be increased by up to 90% and in fertility cases, pregnancy can be achieved in over 75% of PCOS women. However , if pregnancy occurs and the obesity is not rectified a live birth achievement is 3% in comparison to the weight loss group of 67%, as unfortunately the syndrome makes them more prone to miscarriage.(Statistics quote;Jane Littleton). More western clinical studies used Electro acupuncture(EA) on rats with PCOS. This study by Stenor-Victorin proved thatStenor-Victorin, proving that EA inhibits the hyperactivity of the sympathetic nervous system. ((2000 Stener-Victorin, E., Lundeberg, T., Waldenstrom, U., Manni, L., Aloe, L., Gunnarsson, S., et al. (2000). Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biology of Reproduction, 63, 1497-1503.) )
Another study by Chen showed that acupuncture normalized dysfunction of the hypothalamus- pituitary- ovarian (HPO) axis, and that EA may promote the activity of the body and senses sensitive mechanisms normalizing GnRH, LH, and estrogen levels. (1997 Chen, B. Y. (1997).Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis. Acupuncture & Electro-therapeutics Resources. International Journal, 22(2), 97-108.)
From my own point of view as a practitioner working with PCOS,I believe that Acupuncture and particularly EA has the ability to affect the Sympathetic Nervous System(SNS). It is well documented that PCOS sufferers have a higher sympathetic nervous system than other women. So the Acupuncture Points located between L2 and T2 can affect the nerve fibers of the SNS affecting a wide range of functions including the ovaries, the endocrine system and the liver to mention a few. In other words Acupuncture has the power to regulate the SNS and help calm it down achieving a sense of homeostasis in the body.This in turn regulates blood and hormonal levels and increases blood flow to the ovaries thus stimulating the reproductive system into action. It has also in my own opinion and experience helped support the mental/emotional wellbeing of the sufferer. I also recommend herbs that can help resolve the waxy lining around the ovaries, stimulate ovulation, resolve cysts while helping to increase insulin sensitivity while supporting the whole body according to the woman’s presentation and TCM diagnosis. Alongside the above I believe in encouraging the lady to take some time out, evaluate the levels of stress in her life and try to support a weight loss program or even refer to a nutritionist for expert nutritional advice. On that note, I believe at all stages of the sufferers life and most importantly they have no negative side effects.