Over the past few years I have noticed a rise in women coming to the YinOva Center for acupuncture and herbal medicine to treat polycystic ovary syndrome or PCOS. These women usually have irregular periods or in many cases no periods and are looking to regulate their cycles in a natural way.

What is PCOS?

Polycystic Ovary Syndrome (abbreviated PCOS or PCO), also known clinically as Stein-Leventhal syndrome, is an endocrine disorder that affects approximately one in ten women. PCOS affects all races and nationalities and is the most common hormonal disorder among women of reproductive age.

The principal features of PCOS are lack of regular ovulation and/or menstruation, weight gain and excessive amounts or the effects of androgenic hormones. While the causes are unknown, insulin resistance, obesity and diabetes are all strongly correlated with PCOS. There is also a strong genetic component. One of the main clinical signs of PCOS is the observation of numerous follicles in the periphery ovaries, often referred to as having the appearance of a “string of pearls”. Interestingly polycystic women ovulate much more frequently when they are underweight which might be an evolutionary trick to keep the population going in times of famine.

Symptoms of Typical PCOS:

• Oligomenorrhea (irregular menstruation), amenorrhea (no menstruation)
• Hirsutism (excessive body hair)
• Dyspareunia-pain during intercourse
• Acne
• Dark patches of skin
• LH: FSH ratio 2:1 instead of 1:1
• Insulin resistance
• Prolonged PMS

If you have read Jill’s book you would identify this pattern with Waterlogged, Tired and/or Stuck. Usually when I treat classical PCOS I immediately reduce all sugary foods and simple carbohydrates. Women are much more likely to ovulate with a reduction in weight, just a 5% reduction can help tremendously. Additionally I strengthen the Spleen and Kidneys and provide herbs to induce ovulation by reducing dampness and phlegm.

How Typical Ovulation Works:

At about cycle day three Follicle Stimulating Hormone (FSH) is released from the brain that sends a message to the ovaries to grow an egg. Many eggs “hear” the message and grow in response to the hormone. As the eggs grow they secrete estrogen. The bigger the egg, the more estrogen it secretes. Once one egg gets large enough and secretes a high enough level of estrogen it turns off the FSH. This prevents the body from releasing too many eggs in one cycle. At this point Lutenizing Hormone (LH) is secreted and the egg ruptures from the follicle causing ovulation. The corpus luteum that surrounds the egg begins to secrete progesterone and more estrogen.

PCOS and Anovulation:

Women with PCOS usually have a cluster of cysts in the ovaries as detected by transvaginal ultrasound in addition to a set of symptoms. This little cluster of eggs secretes enough estrogen to tell the body to turn off the follicle stimulating hormone but they are not large enough to ovulate. This creates a stalemate between the ovaries and the brain and no ovulation occurs. In this situation there is an abundance of estrogen and testosterone floating around the system but very low levels of progesterone.

“New PCOS”

Lately I have seen a rise in women diagnosed with PCOS as determined by cysts on their ovaries but they do not have the aforementioned symptoms. Interestingly this group presents entirely differently from the original PCOS group that I have both studied and treated extensively.

This “new” group appears entirely different. These women tend to be very thin (not anorexic thin, as low leptin and fat levels can also inhibit ovulation), just typical “New York thin” if you will. Another remarkable factor is long-term birth control pill usage. I usually discover that the women had regular cycles before going on the birth control pill but after taking the pill for 10-18 years consecutively they are having difficulty ovulating after stopping the pill.

Commonly observed new PCOS:

• Observable cysts on the ovaries
• Long term birth control pill usage
• Prolonged PMS
• Digestive complaints like reflux, IBS
• Post-nasal drip
• Light or no flow on the BCP
• Anxiety
• Poor sleep

I find myself tapping my pencil about this on a weekly basis… Did the birth control pill have the effect on the ovaries or was the condition already present but masked due to years of anovulatory cycles? Have the ovaries been trying to ovulate for 10+ years?

The findings seem to suggest that there is a link between the birth control pill and polycystic ovaries in cases where the hormone levels are normal and there are metabolic issues such as sensitivity to glucose.

Traditional Chinese Medicine and Typical PCOS:

As always we treat conditions based upon the symptoms in addition to information gleaned from ultrasounds and lab work. This “New group” is already thin and in our medicine, I find them to be Blood Deficient, Yin Deficient and Stagnant aka Pale Type, Dry Type and Stuck Type. Treatment is geared towards nourishing and moving Qi and Nourishing Blood and Yin.

Typical solutions are providing an herbal formula to help regulate progesterone and estrogen levels. Vitex Chastetree is a singular herb that I prescribe to take daily. I also do a lot of acupuncture points and herbs to clear stagnation and help rid the body of the excess estrogen floating around. Another good way to do this is by adding Probiotics to make sure the colon is clearing out excess estrogen.

I have had a lot of success helping women resume ovulatory cycles. Depending on the severity of the condition it can take a 3-12 months to regulate a cycle. If you are looking to get pregnant quickly, PCOS responds very well to Assisted Reproductive Technology and can be a effective way to get things moving. We do however suggest three months of treatment to help adjust the hormone levels in the body so the eggs that are stimulated are more hormonally balanced.

Several recent studies have explored the use of acupuncture to treat polycystic ovary syndrome with encouraging results. We see quite a number of women who are suffering from PCOS at the YinOva Center and have found that a combination of acupuncture and Chinese herbs can be really helpful.

PCOS is a complex endocrine and metabolic syndrome that affects 5% – 10% of women of reproductive age and is characterized by small ovarian cysts, irregular menstrual cycles, abnormal hair growth, acne, and metabolic problems leading to weight gain. The cysts associated with PCOS cause a hormone imbalance that means that sufferers have increased male sex hormones. This can disturb ovulation and lead to infertility. Women who suffer from PCOS also have a higher risk of developing hypertension and diabetes and are at an increased risk of heart disease.

A study at Goteborg University in Sweden showed that electro-acupuncture may help some women with PCOS to ovulate. Electro-acupuncture was developed in China as an alternative to manipulating acupuncture needles by hand. It involves the application of a pulsating electrical current to acupuncture needles as a means of stimulating the acupuncture points, .

During the study, one group of women with polycystic ovary syndrome received acupuncture regularly for four months. A second group of women were provided with heart rate monitors and instructed to exercise at least three times a week. A control group was informed about the importance of exercise and a healthy diet, but was given no other specific instructions.

The study showed that activity in the sympathetic nervous system was lower in the women who received acupuncture and in those who took regular exercise than it was in the control group. The acupuncture treatment brought further benefits. “Those who received acupuncture found that their menstruation became more normal. We could also see that their levels of testosterone became significantly lower, and this is an important observation, since elevated testosterone levels are closely connected with the increased activity in the sympathetic nervous system of women”, says Elisabet Stener‑Victorin the lead researcher. 38% of women who received the electro-acupuncture experienced regular ovulation. However, the electro-acupuncture was not effective in the more severe cases (obese, highest waist-to-hip ratio, and highest testosterone and insulin individuals).

What causes PCOS remains a mystery, but we do know that PCOS sufferers have a higher sympathetic nervous system (SNS) activity than other women so it may be that the acupuncture is calming the SNS and thus leading to a reduction in symptoms.

In Chinese medicine PCOS is usually attributed to Kidney Yang Deficiency (poor metabolism) and Damp Accumulation (fluid filled cysts) and has been treated for hundreds of years using a combination of herbs and acupuncture. Some herbs such as zao jiao ci (Spina Gleditsiae Sinensis) have the ability to dissolve the waxy coat around the ovarian cysts and at the YinOva Center we use them as part of a larger formula to reduce cysts. Other herbs such as bu gu zhi (psoralea) and xian mao (circuligo) help metabolic slowdown and insulin resistance and at the YinOva Center we usually combine them with herbs that calm an overactive system such as huang jing (polygonatum) and herbs that balance hormones such as dang gui (tangkuei).

In our book Making Babies we give the following advice to PCOS sufferers

• Lose weight if you need to. Studies have shown that losing just 10% of your body weight can result in normal ovulation in women with PCOS
• Cut down on animal fats and increase essential fatty acids
• Eat a wide range of fruits, vegetables and low fat protein such as chicken, fish and beans.
• Balance your blood sugar by limiting your carbohydrate intake. Don’t cut out carbs altogether, though, as that can lower serotonin levels and leave you feeling depressed. Instead eat healthy carbs such as whole grains.
• Take N-acetyl cysteine (NAC) to help reduce circulating testosterone, cholesterol, plasma triglycerides, low density lipoproteins and insulin.
• Get plenty of anti-oxident nutrients from foods and supplements. They fight inflammation which can exacerbate PCOS.
• Get regular exercise to increase your metabolism. Aim for a half hour of brisk walking a day.
• Practice stress management. Stress stimulates the production of more hormones, including testosterone, which makes PCOS worse. Try yoga meditation or a warm bath.
• See an acupuncturist for help restoring ovulation.
• See an herbalist about creating a formula that reduces cysts and balances hormones.
• Allow at least three months of treatment before trying to conceive. Follicles exposed to excess androgens will be of poor quality and lead to higher risk of miscarriage.