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Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS)

What is PCOS?

PCOS is a multi-organ disease which results in small cysts on the outer layer of the ovaries with a concurrent hormonal imbalance – primariy:

–   Hormones that help regulate the normal development of eggs in the ovaries during each menstrual cycle In particular, too many androgens (male hormones) are produced.It is not well understood why or how the changes in the hormone levels occur, but these changes can result in:

✔ Infrequent or no ovulation - making it more difficult to conceive

✔ Interference with egg release androgens play a role in blocking egg release

✔ Higher than normal risk of miscarriage - associated with poorer egg quality; 

–    Higher INSULIN levels /INSULIN resistance - in a majority of women with PCOS


Normal vs. PCOS ovaries during the monthly cycle?

   With PCOS – alterations in hormonal pathways cause the ovaries to form a number of follicles on the outer layer (cortex) of the ovary. Follicles (egg-containing sacs within the ovaries) normally release one or more eggs during each menstrual cycle - called ovulation. In PCOS, the eggs in the follicles do not mature and are not released from the ovaries. Instead, they can form very small cysts in the ovary. The ovarian cortex thickens and the egg has difficulty breaking through.No single follicle becomes dominant and ovulation can't occur.

–    Normally - each month the ovaries start to ripen a number of follicles, which are actually cysts, tissue sacs filled with fluid and hormones (mostly estrogen). One or two of these follicles grow stronger than the others and produce and mature an egg. When ovulation is triggered by a surge in luteinizing hormone (LH), the egg in the dominant follicle is released into the fallopian tube en route to the uterus, where either it is fertilized within 24 hours, or it dies. The now empty egg sac becomes a corpus luteum producing large amounts of Progesterone(and smaller amounts of ESTRADIOL) to support the pregnancy. If implantation in the uterus does not occur within 2 weeks the corpus luteum dies and the uterine lining is shed, seen as menstrual bleeding.

Unlike larger ovarian cysts (follicles > ~ 2 cms),PCOS cysts do not cause pain and rupture,but because a woman with PCOS doesn't ovulate, hormonal cycles are disturbed causing high levels of estrogens and androgens (E.g.Testosterone and DHEA), yielding symptoms of estrogen and androgen excess.

Minimum criteria for PCOS diagnosis

NIH concensus, from 1990 conference:

–    Menstrual irregularity – due to infrequent or no ovulation (i.e. oligo- or anovulation); menstruation may be more or less frequent, and may range from very light to very heavy

–   Evidence of hyperandrogenism – E.g. hirsutism, acne, male pattern balding, high serum androgen; PCOS is the cause of > 70% of cases of androgen excess/secondary hirsutism

–    Exclusion of other disorders - such as congenital adrenal hyperplasia (CAH), androgen-secreting tumors, or hyperPROLACTINemia

Characteristics / Symptoms of PCOS?

Characteristics / Symptoms of PCOS include (some overlapping with hirsutism characteristics/symptoms):

–   Hyperandrogenism – including:

✔ Development of male sex characteristics (virilism) - decreased breast size, deepening voice, enlarged clitoris (rare), and hirsutism (increased hair on any of chest, abdomen, face, stomach, back, thumbs, toes, around the nipples)


✔  Male-pattern baldness - a thinning of hair on head


✔ Skin changes – Acne and dark/thick skin markings/creases around the armpits, groin, neck, and breasts due to INSULIN sensitivity; skin tags or tiny excess flaps of skin in armpits or neck area


–   Chronic


–   Changes secretion of pituitary gonadotrophins GROWTH HORMONE (GH) and ACTH – inefficient CORTISOL production results in rising levels of ACTH (stress-responsive hormone for stimulating adrenal CORTISOL production) which in turn induces overgrowth (hyperplasia) and over-activity of the steroid-producing cells of the adrenal cortex.

–    INSULIN resistance / Weight gain (usually around the waist) /Type 2 diabetes – it is possible that hyperinsulinemia can actually cause an increase in androgen and probably ovarian hormone production.

✔  The majority of patients with PCOS have INSULINresistance (IR) - associated with an increased risk of metabolic syndrome, type 2 diabetes and obesity; IR leads to high blood INSULIN levels and according to Jerilyn Prior, M.D., INSULIN stimulates androgen receptors on the outside of the ovary, causing the typical symptoms of hyperandrogenism (see above);

✔ INSULIN resistance has been linked to recurrent pregnancy loss – High INSULIN levels stimulate production of LH and Testosterone and excessive levels of INSULIN, LH and Testosterone are associated with poorer egg quality, thus increasing the risk of miscarriage.

✔  Androgens play a role in blocking the release of the egg from the follicle and producing cysts.

Insulin Resistance (IR)

✔ An unhealthy diet is a contributing factor of PCOS – Young women with PCOS tend to eat too much sugar and refined carbohydrates giving rise to IR with inherent unhealthy INSULIN levels.


 –   Characterized by an increased inflammatory state – with increased secretion of interleukins, chemokines, and adipokines.

–   Increased bone mineral density – despite decreased vitamin D levels.

–   Possible iodine deficiency – causing impaired thyroid function, is suggested as a factor in PCOS development. The ovary has the highest concentration of iodine, second only to the thyroid.Iodine also has a critical role in INSULIN function, which may explain the INSULIN resistance often seen in PCOS. An iodine loading test determines whether you are deficient by testing amount of iodine excreted in urine over 24 hours. If you don't excrete it, your body needed it and you are therefore iodine deficient.

Treatments for PCOS and prevention of related Miscarriage

There are two main approaches to dealing with PCOS:

(i) Normalize hormones to improve ovulation – particularly balance sex steroid hormones (i.e. estrogens, androgens, Progesterone/ many women with PCOS have high levels of Testosterone and low levels of Progesterone)


(ii) Normalize blood glucose levels.

Improve diet

–   LOWER sugar / refined carb intake / Fructose (including too much fruit or fruit juice)

–   Drink peppermint tea twice daily – to reduce your Testosterone levels (1 tsp in steeped in hot water for 5-10 minutes). This has been found more effective than medication.

Supplements / Drugs

–   Supplement folic acid – taking extra folic acid as much as a year before pregnancy has been shown to reduce miscarriage.

–   Metformin (Glucophage) - reported to reduce the rate of miscarriage in women with PCOS by controlling blood sugar levels.

–   Supplement DIM and/or use other methods to reduce body's estrogen levels - DIM aids in the breakdown of non-beneficial estrogen metabolites. Estrogen is a major culprit in many fertility issues faced by women today including PCOS.

DIM – Estrogen Blocker with anti-cancer benefits

Reduce Body's Estrogen levels

–   N-acetyl cysteine (NAC) - reported to ease PCOS symtoms.

Improve thyroid activity – which is associated with ovarian cysts, and can eliminate them by lowering estrogen levels and causing the ovaries to produce more Progesterone. This is best accomplished by a couple of different ways:

–   By thyroid hormone supplementation – using dessicated porcine thyroid gland containing a natural mix of thyroid hormones, not ineffective synthetic forms – see Thyroid Replacement Hormones)

–    However, this author has concluded that the better choice is via iodine supplementation – Dr. Jorge D. Flechas, a renowned author and expert in iodine supplementation, writes that iodine deficiency in the ovaries may cause the ovaries to develop cysts, nodules and scar tissue and has patients who have successfully eliminated ovarian cysts by taking a daily 50mg dose of a specific combination of iodine and iodide (E.g. Lugol's solution or Iodoral®) for 2-3 months. Orthoiodosupplementation in a Primary Care Practice

Iodine –The universal medicine

Directly supplement a physiological dose of Progesterone Dr. John Lee (author of “What your doctor may not tell you about Premenopause”, and a pioneer of Progesteronesupplementation for hormonal imbalance) said that natural Progesteroneadministered on specific days of the menstrual month for two to three cycles, will almost routinely cause disappearance of ovarian cysts, by suppressing normal FSH (follicle-stimulating hormone), LH (luteinizing hormone), and estrogen production and giving the ovary time to heal. To see details of Progesteronetherapy, which for a women is best delivered via the vaginal route using suppositories:


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