Can progesterone help recovery from Polycystic Ovarian Syndrome (PCOS)?

I think a third of all the emails I get are from women who have PCOS. Its a condition that is rising alarmingly all over the world.

Progesterone levels are always low in PCO, as ovulation occurs very infrequently or not at all. Many authorities believe insulin resistance (IR) causes it. IR causes insulin to rise, which in turn causes androgens to rise. This is what causes the main symptoms of PCOS. By reversing IR it has been found that androgen levels drop, the symptoms disappear and ovulation resumes.

I also believe all the oestrogen now found in our environment, in the food we eat, our drinks, the air we breathe and in most of the skin care products we rub on ourselves are involved too.

Progesterone is certainly needed to help reverse PCOS as its normally very low in those suffering the condition. Progesterone also helps to regulate the cycle.

It could take a while for things to sort themselves out, so have patience. Researchers have found it takes three and a half months to reverse insulin resistance.

I have put together a plan of action and listed research papers with web links to aid further...

PCO is the most prevalent reproductive problem in young girls and women, affecting between 5 to 10%.

Women with PCOS have...

Insulin resistance, which in turn leads to weight gain, blood sugar problems, high triglycerides and high androgens

A high blood sugar level leads to high insulin

High insulin leads to high androgens

High androgens lead to excess hair, weight problems, acne, suppression of ovarian function, leading to anovulation

High triglycerides in turn lead to heart disease

Progesterone levels are very low, as ovulation does not take place, so only half the cycle is being completed

Often high cortisol and high homocysteine levels are found

If the stress hormones cortisol and adrenaline rise, neurotransmitters and hormones drop

They also have high levels of 5-alpha reductase, this converts oestrogen to androgens. Progesterone inhibits 5 alpha reductase

A possible high level of luteinising hormone

If insulin resistance is reversed insulin levels drop, this in turn lowers androgen levels, which in turn prevents the suppression of ovarian function, allowing the ovaries to start functioning normally. Two studies have found that the B vitamin inositol helped control insulin resistance.

Women are normally given The Pill to prevent ovulation and Metformin, a diabetic drug, to bring the sugar level down.

The Pill contains synthetic progesterone and oestrogen, which also stops ovulation, but it also reduces the level of natural progesterone in a woman, plus the many adverse side affects it has. Synthetic progesterone or progestins increase insulin resistance.

It is imperative that the insulin resistance is reversed before ovarian function returns to normal.

Plan of action

Reduce insulin levels - eat organic protein (with no growth hormones), avoid all starchy carbs, including fruit, eating only the non-starchy leaves, shoots, sprouts etc
Reduce androgen levels - use progesterone to suppress these and avoid all food which converts to glucose (as above), to reduce insulin, which causes androgens to rise
Use between 150-250mg/day progesterone, this helps stabilise blood sugar and suppresses androgen production. It also helps to correct ovarian malfunction
Take the B vitamin inositol, this aids in reversing insulin resistance
The amino acid L-glutamine is very helpful. The brain can use it in place of glucose for energy, so it stops all binging, tiredness, cravings for sugary foods and alcohol, it heals the lining of the gut, it boosts the immune system and is the most abundant amino acid in the muscles, so helping with muscle weakness
Take the probiotics Lactobacilus acidophilus and Bifidobacteria bifidum/lactis with at least ten billion bacteria per dose
Check homocysteine levels. As this can be a contributing factor, a blood test should be done. If higher than 6 then it is essential to take the following nutrients to bring it down:
- 150mg B2 - riboflavin
- 75mg B6 - pyrodoxine
- 1000mg B12 - cyanocobalamin
- 1200mcg folic acid
- 3000mg TMG-tri-methyl glycine (anhydrous)
- 20mg zinc
Take the amino acids L-arginine and N-acetyl cysteine, these restore gonadal function
MCT oil (medium chain triglyceride) is an excellent source of energy which is not converted to fat, but can be used directly by the cells for energy, take 5-60ml/day. It's extracted from coconut oil and comprises 60% caprylic acid, which kills candida, and 40% capric acid

Additional information

Progesterone

Apply 150-250mg of progesterone per day (4.5-7.5ml Natpro cream). The higher dose might be needed.

It must only be used at ovulation, for the last 14 days of the cycle, taking day 1 as the first day of bleeding.

Cycles can be very erratic or non-existent in PCO, if this is the case use a 28 day cycle to begin with, until the natural cycle exerts itself. This would mean using the cream from day 15 to 28.

Some authorities advise using the cream every day without a break to prevent any eggs from growing and maturing, as they only result in more cysts. If this route is followed use half the dose given above for the first two to three months, a scan will confirm if the cysts are being absorbed back into the body.

After the two to three months of using the cream every day, a cycle can be started using the progesterone from day 15. This should prevent any further cysts developing and hopefully initiate ovulation.

If there is a cycle, but with spotting before a full period, between 200-250mg of progesterone (6-7.5ml of Natpro cream) will be needed during the last 14 days, to prevent the spotting. The spotting is a sign that the progesterone level is dropping too low to support the endometrium.

Nutrients

The nutrients given below are to be taken daily in the appropriate proportions. They all assist in...

the insulin response
reverse insulin resistance
prevent tiredness and weight gain
lower triglycerides
assist in the energy transfer within the mitochondria
cleansing the liver

The amino acids:

L-arginine
L-carnitine (N-acetyl-L)
L-cysteine (N-Acetyl-L)
L-glutamine
L-glycine
L-isoleucine
L-leucine
L-taurine
L-valine

The minerals:

chromium
selenium
zinc

The vitamins:

B1
B2
B3
B5
B6
B12
biotin
choline
folic acid
inositol
vitamin D3 (cholecalciferol)

Other essential nutrients:

ALA (alpha lipoic acid)
CoQ10
D-Ribose
milk thistle
purified phylosilicate clay

The above list presents a rather daunting picture when it comes to buying each individual nutrient and then measuring and mixing them.

Because of this I have put together a formulation for your convenience should you be interested in following through with this program.

I call it the 'Energy Boost' formula.

To find out more, including a detailed description of the functions of each ingredient please click here

Diet

The Metabolic Typing Diet is an excellent means of obtaining lasting health. The diet is the product of many years of detailed research and looks at the many ways the body metabolises food. It is based on the obvious but hitherto little understood fact that each individual has a unique metabolism.

'Metabolic Typing', as the name suggests, is an analytical process that defines each individual's unique nutritional requirements by determining how they metabolise food and categorising a person according to their needs.

If you really want to pursue this path as fully as possible I cannot recommend strongly enough that you seek out a qualified Metabolic Typing practitioner for a consultation and hair analysis. The hair analysis will give you insights into who you are as a physical being that will likely revolutionize your views on health in general and nutrition in particular.

To find a qualified practioner go to the source...

William L. Wolcott, the founder of The Healthexcel System of Metabolic Typing and author of The Metabolic Typing Diet (Doubleday, 2000)

...this link will take you (in a new window) directly to Healthexcel's online directory of Metabolic Typing practitioners which lists (at time of writing) several hundred in 25 countries.

Small frequent meals are often a help for blood sugar imbalances. After a large meal there is a temporary drop in the level of progesterone, due to an increased metabolic clearance rate of that hormone, so symptoms can become worse for a while.

Food should be natural, unprocessed and if possible organic and include both protein and fibre, particularly the gel forming fibre such as apple pectin, guar gum and oat bran as these have been shown to stabilise blood sugar.

As a substitute for sugar use xylitol, erythritol or stevia. Stevia is a natural extract from the plant Stevia rebaudiana, a member of the daisy family, native to Paraguay. The extract is 200-300 times sweeter than sugar, but has none of the drawbacks and does not affect blood sugar in any way. The fresh or dried leaves are easier to use and taste better. Xylitol or erythritol are sugar alcohols, which look and taste like sugar, but are metabolized by the body at a much slower rate, they have respectively 2.4 and 0.0 calories per gram. A beneficial effect is their ability to reduce pathogenic bacteria and to act as a prebiotic for the good bacteria. A drawback is the high cost. If used in large quantities they can cause flatulence and have a laxative affect.

Avoid...

sugar
all forms of processed foods containing sugar
refined grains, particularly wheat
carbonated drinks, including the 'diet' drinks
biscuits
cakes
white breads
canned foods
sauces
sweets
large meals
all forms of artificial oestrogen
oxidised fats, i.e. margarine, refined oils, saturated fats and fried foods, in particular fried animal protein
non organic milk
stimulants such as coffee, black tea

Read all labels on containers, especially those for food and cosmetics. Look for natural alternatives to body care products, many contain high levels of endocrine disruptors and carcinogens.

Processed food contains preservatives, colourants, flavourants, sweeteners, especially avoid aspartame, known to cause lupus and epilepsy.

Avoid fluoride, long term exposure causes brittle bones. Use natural alternatives to household cleaners, which are some of the most toxic chemicals we regularly come into contact with.

Avoid golf courses, especially when fertilising or spraying, a higher level of chemicals are used on them than on farms.

Here are the research papers I mentioned above...

Eur J Endocrinol. 2009 Oct;161(4):575-82. Epub 2009 Jul 23.
Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome

Endocrine Abstracts (2009)
Prolonged treatment with N-acetylcysteine and L-arginine restores gonadal function in patients with PCO syndrome

Med Hypotheses. 2009 Jun;72(6):647-51
Poor vitamin D status may contribute to high risk for insulin resistance, obesity, and cardiovascular disease in Asian Indians

The Rockefeller University - Newswire Tuesday, May 19, 2009
Pilot study to examine link between vitamin D and insulin resistance

Diabetes. 2008 Oct;57(10):2619-25
Baseline Serum 25-Hydroxy Vitamin D Is Predictive of Future Glycemic Status and Insulin Resistance

Eur Rev Med Pharmacol Sci 2007; 11 (5) : 347-354
Randomized, double blind placebo-controlled trial: effects of Myo-inositol on ovarian function and metabolic factors in women with PCOS

The Journal of Clinical Endocrinology & Metabolism 2007, Vol. 92, No. 7 2726-2733
Insulin and Insulin-Like Growth Factor Stimulation of Vascular Endothelial Growth Factor Production by Luteinized Granulosa Cells: Comparison between Polycystic Ovarian Syndrome (PCOS) and Non-PCOS Women

Exp Clin Endocrinol Diabetes. 2006 Nov;114(10):577-83
Low serum 25-hydroxyvitamin D concentrations are associated with insulin resistance and obesity in women with polycystic ovary syndrome

European Journal of Endocrinology, 2006 Vol 154, Issue 1, 141-145
Metabolic syndrome in polycystic ovary syndrome (PCOS): lower prevalence in southern Italy than in the USA and the influence of criteria for the diagnosis of PCOS

The Anatomical Record 2005 Volume 231, Issue 2 , Pages 185 - 192
Changes in ovarian morphology and serum hormones in the rat after treatment with dehydroepiandrosterone

American Journal of Clinical Nutrition, Vol. 79, No. 5, 820-825, May 2004
Hypovitaminosis D is associated with insulin resistance and ß cell dysfunction

The Journal of Clinical Endocrinology & Metabolism 2004, Vol. 89, No. 5 2160-2165
Increased C-Reactive Protein Levels in the Polycystic Ovary Syndrome: A Marker of Cardiovascular Disease

Clin Endocrinol 60(5):560-567, 2004,
“Plasma Homocysteine in Polycystic Ovary Syndrome: Does it Correlate With Insulin Resistance and Ethnicity?”

Int J Mol Med. 2004 Aug;14(2):207-15.
Induction of polycystic ovary by testosterone in immature female rats: Modulation of apoptosis and attenuation of glucose/insulin ratio

STEROIDS Volume 69, Issues 11-12 , October-November 2004, Pages 763-766
Licorice reduces serum testosterone in healthy women

J Intern Med. 2003 Nov;254(5):455-463.
“Effects of short-term treatment with metformin on serum concentrations of homocysteine, folate and vitamin B12 in type 2 diabetes mellitus: a randomized, placebo-controlled trial.”

J Clin Endocrinol Metab. 2003 Dec;88(12):5907-13.
'Altered cortisol metabolism in polycystic ovary syndrome: insulin enhances 5alpha-reduction but not the elevated adrenal steroid production rates.'

Human Reproduction, Vol. 17, No. 6, 1459-1463, June 2002
Luteal phase progesterone excretion in ovulatory women with polycystic ovaries

Gynecologic and Obstetric Investigation and Vol. 53, No. 3, 2002
The Plasma Homocysteine Levels Are Increased in Polycystic Ovary Syndrome

Human Reproduction, Vol. 16, No. 10, 2061-2065, October 2001
Effects of androstenedione, insulin and luteinizing hormone on steroidogenesis in human granulosa luteal cells.

Prim. Care Update Ob Gyns 2001 Jan;8(1):12-17
“The low-carbohydrate diet in primary care OB/GYN.”

The Journal of Clinical Endocrinology & Metabolism 2001, Vol. 86, No. 6 2453-2455
Low Grade Chronic Inflammation in Women with Polycystic Ovarian Syndrome

New England Journal of Medicine , 340(17), 1999, pages 1314-1320.
'Ovulatory and Metabolic Effects of D-Chiro-Inositol in the Polycystic Ovary Syndrome'

Gynecol Endocrinol. 1998 Feb;12(1):29-34.
Effects of estradiol and an aromatase inhibitor on progesterone production in human cultured luteal cells.

Archives of Environmental Contamination and Toxicology
Volume 3, Number 4 / December, 1975: 479-490
Prolonged ingestion of commercial DDT and PCB; effects on progesterone levels and reproduction in the mature female rat.

Further information

PCOS is generally considered a syndrome rather than a disease, because it manifests through a group of signs and symptoms that can occur in any combination, rather than having one known cause.

Other names for Polycystic Ovary Syndrome are Stein-Leventhal Syndrome, hyperandrogenic chronic anovulation, functional ovarian hyperandrogenism, and Polycystic Ovary Disease.

The exact cause of PCOS is unknown, although some authorities believe insulin resistance to play a major role.

The medications used to treat PCO's include birth control pills, spironolactone, flutamide, and clomiphene citrate. Treatment with clomiphene induces the pituitary gland to produce more FSH, which in turn stimulates maturity and release of the eggs. Although one study found a high level of bioactive FSH in PCO granulosa cells which failed to effect maturity of an egg. If insulin resistance is present metformin or one of the thiazolidinedione medications is given.

Women with PCOS may have some of the following symptoms...

Amenorrhea (no menstrual period)
infrequent menses, and/or oligomenorrhea (irregular bleeding) - Cycles are often greater than six weeks in length, with eight or fewer periods in a year. Irregular bleeding may include lengthy bleeding episodes, scant or heavy periods, or frequent spotting
Oligo or anovulation (infrequent or absent ovulation) - While women with PCOS produce follicles - which are fluid-filled sacs on the ovary that contain an egg - the follicles often do not mature. It is these immature follicles that create the cysts. With the absence of ovulation no progesterone is made
Hyperandrogenism - Increased serum levels of male hormones. Specifically, testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS)
Infertility - Infertility is the inability to get pregnant within six to 12 months of unprotected intercourse, depending on age. With PCOS, infertility is usually due to ovulatory dysfunction
Cystic ovaries - Classic PCOS ovaries have a "string of pearls" or "pearl necklace" appearance with many cysts (fluid-filled sacs). It is difficult to diagnose PCOS without the presence of some cysts or ovarian enlargement, but sometimes more subtle alterations may not have been recorded, or are not recognized as abnormal by the ultrasonographer
Enlarged ovaries - Polycystic ovaries are usually 1.5 to 3 times larger than normal
Chronic pelvic pain - The exact cause of this pain isn't known, but it may be due to enlarged ovaries leading to pelvic crowding. It is considered chronic when it has been noted for greater than six months
Obesity or weight gain - Commonly a woman with PCOS will have what is called an apple figure where excess weight is concentrated heavily in the abdomen, similar to the way men often gain weight, with comparatively narrower arms and legs. The hip:waist ratio is smaller than on a pear-shaped woman - meaning there is less difference between hip and waist measurements. It should be noted that most, but not all, women with PCOS are overweight
Insulin resistance, hyperinsulinemia, and diabetes - Insulin resistance is a condition where the body's use of insulin is inefficient. It is usually accompanied by compensatory hyperinsulinemia - an over-production of insulin. Both conditions often occur with normal glucose levels, and may be a precursor to diabetes, in which glucose intolerance is further decreased and blood glucose levels may also be elevated
Dyslipidemia (lipid abnormalities) - Some women with PCOS have elevated LDL and reduced HDL cholesterol levels, as well as high triglycerides.
Hypertension (high blood pressure) - Blood pressure readings over 140/90.
Hirsutism (excess hair) - Excess hair growth such as on the face, chest, abdomen, thumbs, or toes
Alopecia (male-pattern baldness or thinning hair) - The balding is more common on the top of the head than at the temples
Acne/Oily Skin/Seborrhea - Oil production is stimulated by overproduction of androgens. Seborrhea is dandruff - flaking skin on the scalp caused by excess oil
Acanthosis nigricans (dark patches of skin, tan to dark brown/black) - Most commonly on the back of the neck, but also in skin creases under arms, breasts, and between thighs, occasionally on the hands, elbows and knees. The darkened skin is usually velvety or rough to the touch
Acrochordons (skin tags) - Tiny flaps (tags) of skin that usually cause no symptoms unless irritated by rubbing
FSH levels are either low or normal
LH levels are generally high
Androgen (testosterone) levels are high
Estrogen (principally estrone and estradiol) levels can be high or low
Progesterone levels are lower than normal

Medline information

Wikipedia

Lab Tests on Line

Fertility Plus (showing hormone levels)

How to best absorb progesterone

A good skin cream (such as Natpro) is the most user friendly of all the ways progesterone can be taken. Oral progesterone is a waste as 80-90% is destroyed in the digestive system and liver. Injections are inconvenient and painful. Buccal drops or pills are very bitter and suppositories are not much fun!

The cream can be applied anywhere... in the vagina or nose for dryness, on piles or painful, achy or itchy areas. Its the best thing for burns and wonderful on the face and elsewhere.

All the successful studies done on progesterone use between 100mg to 200mg per day. This equates to 3ml to 6ml of Natpro per day. Some authorities suggest as high as 400-600mg/day. Orally administered forms need 5 to 10 times as much to compensate for the digestive losses. The cream is best applied twice a day, to keep levels up.