Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome (PCOS), is a complex complaint that usually presents with multiple ovarian follicles as well as hormonal and metabolic abnormalities and irregularities in ovulation and menstruation.

Women with PCOS might experience one or all of these symptoms:

1. 90% of women with PCOS experience irregular menstrual cycles. Approximately 50% will not menstruate, whilst 30% will have abnormal bleeding patterns.
2. PCOS is the most common cause of ovulatory failure (menstrual bleeding does not necessarily indicate ovulation).  Approximately 75% of women with PCOS develop infertility.
3. Between 50-70% of women with PCOS are estimated to have insulin resistance – irrespective of body weight.
4. Approximately 40% are overweight.
5. 60 % have excess/ male pattern body hair (hirsutism).
6. A rare symptom is the development of a deeper voice and changes in body shape.

What causes PCOS?

The generally held view is that PCOS is caused by an excess of androgen production in the ovary. Androgens can exert masculinising effects, but usually circulate in small amounts in the blood of all women without causing any problems. There are a number of theories regarding the cause of androgen excess. Lately consensus is building on the role of insulin resistance and glucose intolerance. The hypothalamic-pituitary unit and adrenal gland are also involved. PCOS may also be inherited; around 40% of women in families with PCOS have the condition, though not all develop symptoms.

Herbal treatment of Polycystic Ovarian Syndrome

The first goal of herbal treatment for women with PCOS is to reduce and treat the consequences of excess androgen levels. Whilst each prescription will be individual to each patient’s needs and constitution the following three herbs (which have demonstrated an ability to reduce androgen levels) are often included:

• A herb with anti-androgen action related to inhibition of androgen receptor binding.
• A herb which has demonstrated an ability to inhibit enzyme 17B- hydroxysteroid dehydrogenase which converts androstenedione to testosterone in the ovary & hair follicle (thereby reducing male pattern hair growth).
• A herb which contains a monoterpene glycoside which is thought to act upon an enzyme in the ovary to promote the synthesis of oestradiol from testosterone thereby reducing the production of androgens.

Diet changes targeted at reducing the bioavailability of androgens are also useful. Phyto-oestrogens (plant based foods) and fibre increase levels of Sex Hormone Binding Globulin (SHBG) which binds to androgens, rendering them less biologically active.

The prescription is then amended to focus attention on the underlying cause i.e. improving insulin resistance.

Dietary changes including consumption of low GI foods and a specific eating pattern are essential at this stage. Several herbs have demonstrated an ability to reduce insulin resistance e.g. one herb contains guanidine, the drug Metformin (used to treat adult type 2 diabetes) is a synthetic guanidine.

Please note
Making a diagnosis of PCOS is complicated because the combination of symptoms is not unique to PCOS. Women who have other endocrine disorders may develop similar symptoms. Blood tests to evaluate hormone levels are normally required.