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

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PCOS is a condition that is rising alarmingly all over the world.

It is the most prevalent reproductive problem in young girls and women, affecting up to 10% in the 15 to 50 age group. Although reaching almost 25% if women with mild cystic ovaries and ovaries damaged by the contraceptive pill are included.

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.

Symptoms vary and include some or all of the following...

  • oligomenorrhoea (absent or infrequent periods) or amenorrhea (no menstrual period). The normal cycle length is between 21 to 35 days. But in women with PCO the cycle length can vary from every 6 weeks, to only 1 to 8 periods a year, to none at all. Other symptoms include include lengthy bleeding episodes, scant or heavy periods, or frequent spotting. Ovulation would be infrequent or not at all, leading to a drop in progesterone levels
  • enlarged ovaries (usually 1.5 to 3 times larger than normal) with a few to many follicles arrested in growth, commonly called...
  • cysts (fluid-filled sacs), giving the classic "string of pearls" appearance to ovaries with many cysts. PCOS is difficult to diagnose without the presence of some cysts or ovarian enlargement. Often the underlying cause is inflammation, which would not be picked by the radiographer. Cystic ovaries can lead to...
  • chronic pelvic pain - although the exact cause of this pain isn't known, inflammation is the most likely cause. It is considered chronic when it has been noted for greater than six months. But follicles arrested in growth cannot ovulate, which leads to...
  • anovulation (lack of ovulation), which is relatively common as the follicles mature only occasionally, this leads to...
  • low progesterone levels, as it's only after ovulation that the follicle, now called the corpus luteum, produces progesterone. But low progesterone levels lead to...
  • high levels of luteinising hormone (LH) as the pituitary is trying to stimulate ovulation. High LH suppresses follicle stimulating hormone (FSH) so this leads to arrested follicle growth in the next cycle. But LH also stimulates the thecal cells in the ovary to produce androgens which leads to...
  • high androgens (hyperandrogenism), particularly high testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS), leading to excess facial and body hair, male pattern baldness, deepening of the voice, weight problems including obesity and a smaller hip to waist ratio, acne, oily skin, dandruff, suppression of ovarian function, leading to anovulation which leads to...
  • infertility (the inability to get pregnant within six to 12 months of unprotected intercourse, depending on age) and low progesterone levels
  • high blood glucose level is occasionally found, leading to...
  • high insulin, this leads to...
  • high androgens, anovulation and low progesterone
  • A prolonged high insulin level leads to...
  • insulin resistance, a condition where the body's use of insulin is inefficient, which in turn can lead to weight gain/obesity, blood glucose problems, acanthosis nigricans (a sign of insulin resistance, these are dark brown, 'velvety' patches found on the neck, armpits, groin, vulva and other areas), skin tags (acrochordons), high androgens, high triglycerides, elevated LDL and reduced HDL cholesterol levels. But this leads to a greater susceptibility to...
  • heart disease, which is often associated with...
  • hypertension (high blood pressure) and...
  • high homocysteine, which is caused by a lack of vitamins B2, 6, 12, folic acid and zinc. But a lack of zinc can lead to...
  • acne and a suppressed progesterone level. But heart disease, insulin resistance and malfunctioning ovaries are caused by...
  • oxidative stress, which in turn is caused by...
  • a lack of antioxidants, which includes zinc, selenium, arginine, N-acetyl cysteine, glutathione, and in particular Vitamin D. But oxidative stress is also caused by...
  • high sugar intake and foods which convert to sugar, these are the most oxidizing foods we can eat. It causes glycation, which releases free radicals, damaging cells in the process and leading to...
  • inflammation

Natural treatment

  • Above all have a vitamin D test done, and take a minimum of 5000 IU's per day, bringing the level in the blood to 50ng/ml (125nmol/L) or above. A lack of vitamin D is found in PCO, with many authorities believing it could be the main contributing factor. A lack also leads to hyperparathyroidism which is often present in PCO. High levels of parathyroid hormone suppresses thyroid activity, leading to a higher than normal TSH level. The year round level of vitamin D should be 50ng/ml (125nmol/L) or higher
  • A lack of vitamin D reduces the benefits of progesterone
  • 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 and stabilizing glucose levels. Studies have shown this restores gonadal function
  • Take the antioxidant amino acids L-arginine and N-acetyl cysteine, studies have shown these restore gonadal function.
  • The amino acids L-glutamine and L-glycine are very helpful. The brain can use them in place of glucose for energy, so they stop all binging, tiredness, cravings for sugary foods and alcohol. Glutamine also 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. These two amino acids are also two of the three precursors to glutathione, which apart from vitamin D, is the most important antioxidant the body makes. The third amino precursor is cysteine, which is essential to take
  • MCT oil (medium chain triglyceride) is another 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

Reduce androgen levels - use progesterone to suppress these and avoid all food which converts to glucose, to reduce insulin, which causes androgens to rise.

Reduce insulin levels - eat organic protein (with no growth hormones), avoid all starchy carbs such as the grains and legumes, sweet/starchy fruit and root vegetables, eating only the non-starchy leaves, shoots, sprouts, non sweet fruits and fruit vegetables etc.

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)
  • 100mg zinc for 3 months, then reduce slowly to the normal daily dose of 15mg. This will also help the acne if present.

It could take a while for things to sort themselves out, so have patience. Researchers have found it takes from four to six months for the ovaries to start functioning correctly.

If inflammation is found, (a CRP test can be done to find this, see below under 'Tests'), it should be reversed. This will prevent the suppression of ovarian function, allowing the ovaries to start functioning normally.

Insulin resistance is not always found in PCO, but if it is, it must be reversed. This will lower insulin levels, which in turn lowers androgen levels.

Insulin resistance can be present from birth. If a diet with an excess of folic acid and a deficiency of vitamin B12 and the amino acid taurine is eaten by the mother while pregnant, the child will be affected. Neither B12 nor taurine is found in plants. A lack of vitamin D while pregnant can lead to insulin resistance in the child too.

Insufficient vitamin D is now thought to be the principal cause of oxidative stress and insulin resistance. For more information on vitamin D levels, testing etc see ......

Vitamin D Council
GrassrootsHealth
Birmingham Hospital
Vitamin D Links

Blood levels should be 70-100ng/ml or 175-250nmol/L and not the 30ng/ml or 75nmol/L most labs and doctors regard as adequate. The minimum daily dose should be 5000iu's per day, although the latest research indicates it should be 10,000iu's per day, see here.

Additional information

Progesterone

Apply 150-250mg of progesterone per day. The higher dose might be needed.

It should 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. For more information please see this web page on how to use progesterone.

If symptoms are severe, please consider using the progesterone daily, through any bleeding that might occur. Do this for at least 3 months, before following the cycle once again. A scan will confirm if the cysts are being absorbed back into the body.

If after the 3 months the scan confirms the cysts are going, a cycle can be started using the progesterone following a 28 day cycle. This should prevent any further cysts developing and hopefully initiate ovulation. It's essential to take the necessary antioxidants too. Progesterone alone won't be sufficient.

If there is a cycle, but with spotting before a full period, between 200-250mg of progesterone 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, too soon, to support the endometrium.

Stress drops progesterone levels sharply so symptoms come back. Increase the amount used if stress should occur.

Before using progesterone it's essential to first read the page on Oestrogen Dominance.

Please see here for more information on Nutrition and Diet.

Medical treatment

The medications used to treat PCO's include...

  • birth control pills
  • spironolactone
  • flutamide
  • 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.

The birth control pill contains progestins (synthetic progesterone) and oestrogen, which not only stops ovulation, but reduces the level of natural progesterone in a woman, plus the many adverse side affects it has. For more on this please see the web page on Contraceptives.

Contraceptives also increase insulin resistance.

If insulin resistance is present glycophage (Metformin) or one of the thiazolidinedione medications is given. Glycophage reduces vitamin B12 levels, which could cause homocysteine to rise.

Standard tests for PCO include...

  • Abdominal ultrasound
  • Abdominal MRI
  • Biopsy of the ovary
  • Estrogen levels
  • Fasting glucose and insulin levels
  • FSH levels
  • Laparoscopy
  • LH levels
  • Male hormone (testosterone) levels
  • Urine 17-ketosteroids
  • Vaginal ultrasound

(Medline)

The following ranges are for normal levels... FSH levels (generally low in PCO)
  • During puberty: 0.3-10.0 IU/L
  • Women who are menstruating: 3.5-3.0 IU/L or 5-20 mIU/ml
  • TEXT

(Medline FSH)

LH levels (often high in PCO)
  • Adult female: 5 to 25 IU/L (levels peak around the middle of the menstrual cycle)

(Medline LH)

Progesterone (generally low in PCO)
  • Serum 10 ng/ml
  • Saliva 0.2 ng/ml

(Medline Progesterone)

Oestradiol (normal, high or low in PCO)

  • Serum 30 to 400 pg/mL
  • Saliva 2 pg/ml

(Medline Oestradiol)

Testosterone (often high in PCO)

  • Serum 3 - 9.5 ng/ml
  • Saliva 0.1 ng/ml

(Medline Testosterone)

Further recommended tests...

  • Vitamin D (low) (essential test). The test should be done for 25-hydroxyvitamin D, also called calcidiol. The following list gives an indication of levels of vitamin D found in the blood (Vitamin D Council):
    • Sufficient 50-100ng/ml or 124.80-249.60nmol/L
    • Hypovitaminosis less than 30ng/ml or 75 nmol/L
    • Deficiency less than 25ng/ml or 62.4nmol/L

  • CRP (increased levels) (essential test). The level of CRP rises when there is inflammation throughout the body, normally none should be found. Levels if found, vary from <1.0mg/L to >3.0mg/L (Medline CRP)

  • Parathyroid hormone (often increased). Normal values are 10-55 pg/mL
    (Medline Parathyroid hormone)

  • Homocysteine (increased levels) 0.54-2.3 mg/L (4-17 micromoles per liter (mcmol/L) (WebMD)

  • DHEA-sulfate (increased levels) (normal values for serum can differ with age) (Medline DHEA-S)
    • Ages 18 - 19: 145 - 395 ug/dL
    • Ages 20 - 29: 65 - 380 ug/dL
    • Ages 30 - 39: 45 - 270 ug/dL
    • Ages 40 - 49: 32 - 240 ug/dL

  • TSH (levels sometimes increased). Normal values are 0.4 - 4.0 mIU/L (Medline TSH)

  • Glucose test (levels sometimes increased) (Medline Glucose)
    • Normal levels are up to 100 milligrams per deciliter (mg/dL)
    • Persons with levels between 100 and 126 mg/dL may have impaired fasting glucose or insulin resistance
    • Diabetes is diagnosed when fasting blood glucose levels are 126 mg/dL or higher

  • Insulin resistance (sometimes observed). (Medline Insulin resistance) (Lab Tests Online - Understanding insulin resistance) There is no single test for IR, but the following are often tested...
    • blood pressure equal to or higher than 130/85 mmHg
    • fasting blood sugar (glucose) equal to or higher than 100 mg/dL
    • elevated insulin levels
    • elevated CRP - a marker for inflammation
    • large waist circumference - 35 inches (87.5cm) or more
    • low HDL cholesterol - Under 50 mg/dL
    • triglycerides equal to or higher than 150 mg/dL

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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.



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