Polycystic Ovary Syndrome or PCOS is a hormonal imbalance that affects 5 to 10 percent of women of reproductive age across the world, and results in irregular or absent periods, acne, excess body hair and weight gain. It is also a major cause of infertility and yet is frequently misdiagnosed and often missed completely.

PCOS gets its name because under an ultrasound scan, the ovaries can look like a bunch of grapes, each one covered in what look like multiple cysts. In fact, these aren’t cysts at all, but are small, undeveloped follicles.

Symptoms

Not every woman with PCOS will get the same symptoms, but common signs to look out for include:

• Few or no periods
• Excess hair on the face or breasts or inside of the legs or around the nipples
• Acne
• Oily skin
• Scalp hair thinning or loss (male pattern baldness)
• Skin tags (known as acrochordons)
• Skin discolouration (known as acanthosis nigricans) where the skin looks ‘dirty’ on the arms, around the neck and under the breasts
• Mood swings
• Depression
• Lack of sex drive
• Weight gain especially around the middle of the body
• Difficulty in losing weight
• Cravings and binges
• Irregular or no ovulation
• Difficulty in becoming pregnant
• Recurrent miscarriages

PCOS creates a vicious cycle of hormone imbalances, which has huge knock-on effects throughout the rest of your body. With PCOS, the problem often starts with the ovaries, which are unable to produce the hormones they should, and in the correct proportions. But linked to this is the very common problem of insulin resistance. Women with PCOS very often have difficulties with blood sugar levels which can cause weight gain and the excess insulin can stimulate your ovaries to produce yet more testosterone. Half of all women with PCOS do not have any problems with their weight, yet they can still have higher insulin levels than normal.

How is Polycystic Ovary Syndrome diagnosed?

The most widely accepted criteria for the diagnosis of PCOS says that you should have two out of these three problems:

• Infrequent or no ovulation
• Signs (either physical appearance – hirsutism or acne – or blood tests) of high levels of male hormones
• Polycystic ovaries as seen on an ultrasound scan

The Seven Nutritional Steps to beat Polycystic Ovary Syndrome

Good nutrition is the foundation of your health and you should never underestimate how powerful it can be. It is the fuel that provides you with the energy to live your life and it gives your body the nutrients it needs to produce your hormones in the correct balance. The better the supply of those nutrients, the more healthily your body will function.

The fundamental aim of my nutritional approach to PCOS is to target a number of areas simultaneously so that you get the maximum effect in the minimum amount of time.

Here’s how:

1. Switch to unrefined carbohydrates (eaten with protein) and never go more than 3 hours without food to keep your blood sugar levels balanced
2. Eat oily fish and foods rich in Omega 3s to help your body to become more sensitive to insulin so it can overcome insulin resistance
3. Cut out all dairy products for 3 months to bring levels of male hormones under control
4. Eat more vegetables and pulses to which helps control male hormones
5. Cut right back on or cut out alcohol for 12 weeks to allow your liver function to improve
6. Cut down on caffeine to give your adrenal glands a rest
7. Cut down on saturated fats and eliminate trans fats to help control the potentially damaging inflammatory processes PCOS causes in the body

Best Supplements for PCOS

The use of certain vitamins and minerals can be extremely useful in helping to correct Polycystic Ovary Syndrome, along with a good diet.

Chromium

Chromium helps to encourage the formation of glucose tolerance factor (GTF), which is required to make insulin more efficient. A deficiency of chromium can lead to insulin resistance.  It also helps to control cravings and reduces hunger. Can help to reduce insulin resistance associated with PCOS

B vitamins

The B vitamins are very important in helping to control the symptoms of PCOS. Vitamin B2 helps to burn fat, sugar and protein into energy. B3 is a component of GTF which is released every time blood sugar rises, and vitamin B3 helps to keep the levels in balance. Vitamin B5 has been shown to help with weight loss and B6 is also important for maintaining hormone balance and, together with B2 and B3, is necessary for normal thyroid function.

Zinc

Zinc helps with PCOS as it plays a crucial role in the production of your reproductive hormones and also regulates your blood sugar.

Magnesium

Magnesium is an important mineral for dealing with PCOS because there is a strong link between magnesium levels and insulin resistance – the higher your magnesium levels the more sensitive you are likely to be to insulin.

Co-Enzyme Q10

Co-Q10 is a substance that your body produces in nearly every cell.  It helps to balance your blood sugar and lowering both glucose and insulin.

Alpha lipoic acid

This powerful antioxidant helps to regulate your blood sugar levels because it releases energy by burning glucose and it also helps to make you more insulin sensitive. It also has an effect on weight loss because if the glucose is being used for energy, your body releases less insulin and you then store less fat.

Omega 3 fatty acids

Omega 3 fatty acids taken in supplement form have been found to reduce testosterone levels in women with Polycystic Ovary Syndrome.

Amino Acids

Certain amino acids can be very helpful for PCOS as they can improve your insulin sensitivity and also can have an effect on weight loss.

N-Acetyl cysteine

In women with PCOS this amino acid helps reduce insulin levels and makes your body more sensitive to insulin. Study using NAC in women who were clomiphene resistant and had ovarian drilling.  After ovarian drilling, the women given NAC compared to a placebo showed a significantly higher increase in both ovulation and pregnancy rates and lower incidence of miscarriage.

Arginine

Arginine can be helpful in reversing insulin resistance. In one study, a combination of both arginine and N-acetyl cysteine were given to women with Polycystic Ovary Syndrome.  The two amino acids help to improve blood sugar and insulin control and also increased the number of menstrual cycles and ovulation with one women becoming pregnant on the second month.

Carnitine

Carnitine helps your body break down fat to release energy and can help improve insulin sensitivity.

Tyrosine

Tyrosine is helpful for women with PCOS who are overweight as it helps to suppress the appetite and burn off fat.

Glutamine

This amino acid is useful for helping with sugar cravings as it can be converted to sugar for energy and so takes away the need to eat something sweet.  It also helps to build and maintain muscle which is important for fat burning.

Branched Chain Amino Acids (BCAAs)

BCAAs include three amino acids leucine, isoleucine and valine. They are important in PCOS because they help to balance blood sugar and having good levels of these BCAAs can have a beneficial effect on your body weight

Inositol

A study used inositol (2,000mg) in combination with NAC (600mg), a significant increase in ovulation rates.

Having a good diet, regular exercise, controlling stress and taking key nutrients will help in getting your hormones back in balance and reducing the negative symptoms associated with PCOS.

More information can be found on www.naturalhealthpractice.com

Emma Cannon & Victoria Wells co-authors of FERTILE look What Causes PCOS.

It is thought that PCOS affects 1 in 10 women of reproductive age and it is something that I increasingly come across in clinic. Rather like IBS (irritable bowel syndrome) has been used to define any digestive disorder, PCOS seems to be used to define any ovaries that have the appearance of cysts.

Ovulatory problems are actually the biggest cause of infertility in the UK, despite the reporting in the media who tends to focus solely on age as the cause of infertility. This can often make younger women who may well have been trying to conceive since their 20’s frustrated and isolated. The main problems traditionally associated with PCOS are menstrual cycle disturbances, including irregular or absent periods, weight gain, excess hair growth and skin conditions. Increasingly though I see slim women who often have a history of over exercising and losing weight. PCOS is often a tricky condition to treat but we get good results from combining acupuncture with dietary advice.

In line with our ethos of integrated health we work collaboratively with a number of medical experts in this field and have many years of experience and success in supporting women with this condition.

Nutrition

Dietary advice for PCOS and insulin resistance aims to manage blood glucose and avoid insulin spikes. It is important to keep under control the insulin levels in your body through the type and timing of food consumed. The optimal diet for women with PCOS is unclear but women who follow a low glycemic index diet have better insulin sensitivity and this can help regulate menstrual function.

Insulin resistance in PCOS is independent of obesity (Attaran, 2010). Some lean women have insulin resistance but not all do. It is far less common in lean women with PCOS compared with obese women with PCOS but even without insulin resistance there may be impaired glucose tolerance.

Caloric balance and timing of meals

A study published in 2013 compared whether meal timing and calorie distribution influences insulin levels and androgen production in lean women with PCOS. The study compared a so-called breakfast diet (high caloric intake at breakfast, medium caloric intake at lunch and a low caloric intake at dinner) with a so-called dinner diet (low caloric intake at breakfast, medium caloric intake at lunch and a high caloric intake at dinner). The women on the breakfast diet had improved insulin sensitivity, lower androgens, and improved ovulation rates whereas there was no change in these parameters observed in the women on the dinner diet. Although a small study of 60 women it indicates that meal timing and distribution is a consideration for women with PCOS.

A study in 2010 looked at the beneficial effects of a high-protein, low-glycemic-load diet and concluded that increasing protein intake and lowering carbohydrate intake had a significant increase in insulin sensitivity in women with PCOS.

Dairy

Dairy may trigger insulin production and dairy contains insulin-like growth factor 1. Women with PCOS can have higher than normal levels of IGF-1 and may respond to small amounts of IGF-1 in the diet.

The ovaries are oversensitive to IGF-1 and this may stimulate the production of male hormones causing acne and hirsutism. When these PCOS symptoms are present following a dairy free diet may be recommended.

A Word about Sugar

I will never forget more than 25 years ago Professor Wu saying to me “sugar makes the ovaries cystic”; back then I did not have the experience to really understand the mechanism behind his words. But now all these years later I believe there is so much wisdom in this statement. My generation lived on a diet of chardonnay and Haribos in a bid to not eat fat! As we all know, this information turned out to be misguided a perfect recipe for causing hormonal imbalances and yes, cystic ovaries. Thankfully the message is getting out there and these days there is much more awareness around food; but skipping meals, drinking juices, excessive alcohol all disrupts the hormonal system and add to the problem.

And as Prof Wu would say “eat little and regularly, chew your food well, eat mostly food that grows from the earth, eat the majority of your food early in the day and most importantly eat with joy in your heart”

Recommended supplement programme

Supplements have the potential to support the diet to improve egg quality, correct nutrient deficiencies and improve overall health and may help improve symptoms of PCOS. In addition to good quality fertility multi-vitamin to support reproductive hormones and prepare for a healthy conception and pregnancy the following supplements are recommended:

Omega-3 fatty acids

Good sources of omega-3 fatty acids in the diet reduce and control inflammation, improve insulin sensitivity, promote beneficial prostaglandins and may improve egg quality. Omega 3 fish oil supplement may help women with PCOS with a beneficial effect on menstrual cyclicity and insulin resistance.

Vitamin D

Vitamin D deficiency is common in women with polycystic ovary syndrome (estimated 85% of women with PCOS may be vitamin D deficient). Vitamin D deficiency may exacerbate PCOS symptoms with observational studies suggesting vitamin D deficiency is associated with insulin resistance, ovulatory and menstrual irregularities, lower pregnancy success, hirsutism, hyperandrogenism, obesity and elevated cardiovascular disease risk factors.

Myo-inositol

Many women with PCOS have an inositol deficiency. Inositol is active in the cell to cell communication, important for the development and maturation of eggs and regulates hormone meditated functions including insulin pathway.

There is evidence that supplementing with myo-inositol may improve menstrual regularity, ovulation rate and improve insulin sensitivity and glucose tolerance.
Choose a brand providing myo-inositol, not D-chiro-inositol (that may worsen the quality of oocytes (egg cell).

Probiotic

A balanced microbiome is important for the health of your digestive system. It regulates the immune response and inflammation, produces vitamins, protects against bacteria that cause disease, controls appetite and helps maintain a healthy weight and supports emotional health.

There are many factors that influence our gut microbiome. It is largely genetic but also influenced by nutrition and lifestyle. Antibiotics and poor dietary choices can compromise the balance of the gut microbiome. The key to a gut-friendly diet is fibre and variety and good probiotic food sources. It only takes a few days of a low fibre diet for the microbe population in the gut to change and other factors affect it including stress and sleep deprivation. Avoid probiotic drinks that can have added sugar and artificial sweeteners.
Taking a probiotic supplement can help restore gut health problem and is helpful whilst gradually introducing probiotic foods into the diet and recommended when travelling or after a course of antibiotics to help repopulate the gut. I recommend taking a supplement for three months to help regulate bowel movement and increase beneficial bacteria to improve gut health.

Environmental hormone disrupters

I advise women with PCOS to reduce exposure to commonly used chemicals that are potential hormone disrupters. This includes BPA used in the manufacture of plastic including the lining of food tins and the plastic cups used to serve hot drinks.

The Mind and PCOS

Frustration, irritability and depression are all signs that the Qi energy of the body, in particular the Liver, is Stagnant and congested which may affect the release of an egg. Feelings of anguish or anxiety particularly affect the Heart energy, which may also delay ovulation since in Chinese Medicine theory the Heart is very much connected to our reproductive systems. So in any program that supports PCOS it is important to support yourself emotionally and reduce stress and anxiety.

I often say to patients “there are 2 kinds of stress, stress that we can not avoid and stress of our own making”. Stress of our own making is the stress that you need to reduce; this is actually the most damaging stress. Research demonstrates that when we worry about being stressed this causes more harm to the system than say the stress of getting to work or the stress caused by external influences. Acupuncture is the perfect tool to help you address these issues and reduce the impact of stress on the body/mind system.

Emma Cannon & Victoria Wells co-authors of FERTILE (Vermillion 2017)
www.emmacannon.co.uk

Fertility can be a mercurial beast, one that seems to bestow a baby on one person while denying it to another. One of the most common inhibitors to getting pregnant with PCOS also know as Polycystic Ovarian Syndrome and it is a health problem that has left many women snapping their pregnancy testing sticks with frustration. It can lead to weight gain, hairiness, skin blemishes and mood swings thanks to the tides of hormones surging through the body.

It can also be beaten.

Feeling upset with the cards that nature has dealt is only fair, but how about taking the deck and reshuffling it instead? Our 3 experts look at some of the PCOS myths and ways that will help fight the symptoms of PCOS without you having to take medications or undergo excessive tests and more invasive methods of getting pregnant.

Getting pregnant with PCOS 1 – Light

Problem skin is one of the unfortunate side-effects of PCOS and this really does have extraordinary power over how a woman feels about herself. Self-confidence can impact a woman’s fertility and ability to conceive. Research has found that a negative mental state such as depression can really affect the body, causing problems such as elevated prolactin levels or thyroid dysfunction. It can even result in the abnormal regulation of luteinising hormone which regulates ovulation.

“Acne has an impact on self-esteem and confidence and can cause permanent scarring,” says Dr Rakesh Patalay, consultant dermatologist. “It is a common symptom of PCOS, a condition that affects 5-10% of women and their fertility. Although the cause of PCOS is not fully understood, it does increase the production of male hormones which interfere with function of the ovaries and can result in acne, obesity and infertility.”

Dr Patalay worked on a research team with leading dermatologist Dr Tony Chu to develop a form of light therapy that can help women beat their problem skin. The visible blue light can kill P.acnes (propionibacterium acnes) by exciting the porphyr molecules that this type of acne produces in large amounts.

This causes them to release radicals into the bacteria which destroy them. A combination of blue and red light is an effective and gentle treatment for acne and has been used to develop a home light therapy called Lumie Clear. It was devised thanks to research gathered in the clinical trial by Dr Chu at Hammersmith Hospital who found it was far more effective than certain creams. “Lumie Clear is not on prescription, it’s effective and it’s safe, even for women who have fallen pregnant,” adds Patalay.

Light therapy is also a great way to boost self-esteem if your PCOS is affecting the way you feel about yourself and your appearance. It can help clear up the acne that comes with this condition and, by default, could help you to relax and feel confi dent which will tell your body that it’s time to get happy and possibly even fall pregnant.

PCOS Busted

Dawn Simpson developed acne in her early thirties thanks to PCOS and decided to try out light therapy to get rid of it. “I’d suffered acne intermittently as a teen, but then in my early thirties it reemerged on my face and back. It made me very self-conscious of my spots, especially the ones on my back,” says Dawn. The way she dressed, the way she felt about herself and her self-esteem were all affected by her problem skin. She couldn’t bring herself to wear strappy tops in summer; instead she covered herself up in the hope that one of the skincare treatments she was using would eventually start working.

“Initially I tried treating my skin with budget products from supermarkets and then, when they didn’t work, I tried some high-end ones,” says Dawn. “A few helped for a little while, but they soon stopped being effective.”

A visit to the GP and some tests later, Dawn found out she had PCOS. The Dr placed her onto a variety of acne treatments that included topical retinoids, benzoyl peroxide and antibiotics, but they were less than helpful.

“Nothing seemed to work and then I saw a tweet from a Lumie Clear user who said they were really happy with the results of the device so I decided to investigate for myself,” explains Dawn. “I started using it on a daily basis and soon saw improvements. I noticed a real difference in two weeks and the skin on my face looked and felt better, so much smoother and less inflamed.”

Dawn’s back cleared up, it started losing the redness, then the pain and spots began to fade. “Getting a diagnosis for my PCOS has been a long journey, but at least now I can use light therapy to clear up my acne,” she beams. “I am now fi nally looking forward to summer again and being able to wear my strappy tops!”

PCOS Buster Number 2 – Diet

Food is such an important part of life. It celebrates occasions, it inspires culinary delights and it brings families closer together. It can also really affect how badly a person suffers from PCOS. Unfortunately, high sugar and refined carbohydrate diets only make the PCOS symptoms worse and periods can even become far more painful and drawn out.

“By making a few simple alterations to your diet, you’ll not only be able to reduce the severity of symptoms such as acne, weight gain and hirsutism, but you should see your body easing back into a more normal way of functioning in just a matter of months,” says Dr Marilyn Glenville, PhD. “With luck it can be an end to all the complications you have had to endure with PCOS.”

Dr Glenville recommends a diet that switches to unrefined carbohydrates, oily fish and foods rich in omega 3 fats to encourage the body to become more sensitive to insulin. She also suggests cutting out all dairy foods for three months and eating more vegetables and pulses to improve SHBG protein levels which will help to bring the levels of male hormones under control.

“Never go more than three waking hours without food to keep your blood-sugar levels balanced and cut right back on, or cut out, alcohol for 12 weeks,” she adds. “Completely eliminate trans fats and cut down on saturated fats to counter the potentially damaging inflammatory processes PCOS causes in the body.”

Dr Glenville believes that by following her nutrition advice you can be well on your way to managing PCOS and possibly even reversing it.

“It may take time, but you will notice improvements in your weight, skin, hair and general health,” she says. “You might even start to ovulate once more as one of the most important changes of this natural approach is helping your body to start a normal, regular menstrual cycle. Research has shown that by the age of 35, women who have PCOS will have had as many successful pregnancies as those who don’t, even without fertility treatment.”

So, for anyone looking to beat PCOS, Dr Glenville has provided three super PCOS buster meals to help you kick it to the curb:

Breakfast: Porridge made with rolled oats and water with added nuts and raspberries
Lunch: Wholewheat pasta with nettle pesto
Supper: Poached salmon with cauliflower and spinach mash

Problem Busted

Michelle Thorne fell pregnant with her first child in the first month of trying and automatically assumed that the same would happen with her second. It was, in fact, the start of a long and difficult journey.

“After a year of trying I had a check-up with my Dr who said everything was fine!” she says. “A very long year later I gave in and sought the help of a fertility specialist who diagnosed my PCOS. While he was very reassuring, he did warn me that with PCOS and my advanced age – I had just turned 40 – I might be in for a bit of a journey.”

What Michelle didn’t know was that at that very appointment she was already pregnant, so early on that the Dr couldn’t even pick it up on the scan. “It was only two weeks later when he sent me for a blood test that we discovered I had fallen pregnant with what he called my ‘miracle baby’,” she smiles. “Given my PCOS and age he said that he very rarely saw such a positive outcome with no medical intervention.”

It was diet that forged the path to miraculous success. Michelle did plenty of research into what kind of a diet could help her to feel better and make her more fertile and set off to live the life of low sugar, low gluten and low dairy.

“I felt the results within about two weeks,” says Michelle. “My skin cleared, my energy levels picked up and my sugar levels were more balanced. I didn’t do anything fancy either, I made egg muffi ns for breakfast, ate a lot of salmon and salads for lunch and then meat or chicken with vegetables for dinner.”

When she craved pizza she had crackers with mozzarella and sliced tomato and she had loads of apples and fresh veggies around to snack on. One of her favourite recipes was sweet potato roasted in the oven with a teaspoon of butter and salt.
“The weight loss was lovely, 18 pounds, but what interested me the most was the change in my hormones,” concludes Michelle.

PCOS Buster Number 3 – Acupuncture

Some of the symptoms that are commonly associated with PCOS are enlarged and enraptured follicles, ovulatory dysfunction and very long cycles. In 75% of cases, women experience blood sugar abnormalities and it can sometimes lead to thyroid issues. What acupuncture does is seek to balance the hormonal chaos that’s caused by PCOS and to bring the cycle back into normal parameters. “One of the most common manifestations that I see are the symptoms of ‘Dampness and Phlegm’ – this term is used in Chinese medicine to describe accumulations in the body,” explains Jacqueline Hurst, acupuncture practitioner and counsellor at fertility-support.co.uk.

“Symptoms include tiredness and feeling sluggish after a meal, fibrocystic breasts, acne and being overweight. I also address stress levels with every treatment, helping the patient to relax and take time to concentrate on their own health and wellbeing.”

Hurst recommends that patients stimulate their pressure points when at home. To balance hormones, use the index finger to massage Spleen 6 which is found by placing the right hand on the inside side of the lower left leg. Rest your little finger on top of the ankle bone. There are a number of points that can be used, but these are best discussed with an acupuncturist to locate them properly.

“The benefits from acupuncture may take around 100 days or three cycles on a cellular level. However, many patients feel these much sooner,” says Hurst. “I provide weekly acupuncture treatments with the first one scheduled for the first day of a bleed so as to work with each stage of the cycle.”

Dietary changes and supplements are also highly recommended as part of an acupuncture routine with Hurst suggesting fi sh, a diet high in protein and nuts, beans and tofu. And her advice only serves to really underline the value of a good diet through the removal of sugar, trans fats, processed food and limited dairy.

“Shame, guilt and loss are very real emotions connected with fertility issues and I spend time with all my patients listening to their stories,” concludes Hurst. “I am also trained in Cognitive Behavioural Therapy that looks at understanding the behaviours that result from negative thoughts about yourself. This helps enormously with improving low self-esteem.”

Problem Busted

Susan Jones (name changed) spent a lot of time researching PCOS and reading about how acupuncture could stimulate the nervous system and help with the symptoms of the condition. She felt it was an affordable, non-time consuming treatment with the potential to help her relax and possibly even conceive.

“I suffered irregular, light periods and had been trying to fall pregnant for a really long time,” says Susan. “I had acne and symptoms were consistent with PCOS and looking back I can defi nitely identify times of anxiety and depression. I think these were linked to both the PCOS and the fertility issues we faced.”

Acupuncture was the golden ticket for Susan as she now has her gorgeous four-month-old son and many of her PCOS symptoms have subsided.

“When you think of acupuncture you tend to think of huge needles and pain!” she laughs. “This really wasn’t the case. I found my sessions relaxing and completely pain-free. I used to fall asleep on the bed and would look forward to my sessions all day. An expensive nap, but far from uncomfortable or painful.”

Susan cannot recommend acupuncture enough: “I found it helped with PCOS symptoms and made me feel like I was actually doing something constructive to overcome it.”