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...
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...
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 ......
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.
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.
The medications used to treat PCO's include...
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.
The following ranges are for normal levels... FSH levels (generally low in PCO)
LH levels (often high in PCO)
Progesterone (generally low in PCO)
Oestradiol (normal, high or low in PCO)
Testosterone (often high in PCO)
Biol Trace Elem Res. 2013 Apr;152(1):9-15
Altered trace mineral milieu might play an aetiological role in the pathogenesis of polycystic ovary syndrome
Eur Rev Med Pharmacol Sci. 2013 Feb;17(4):537-40
The Combined therapy myo-inositol plus D-Chiro-inositol, in a physiological ratio, reduces the cardiovascular risk by improving the lipid profile in PCOS patients
Gynecol Endocrinol. 2013 Apr;29(4):375-9
Endocrine and clinical effects of myo-inositol administration in polycystic ovary syndrome. A randomized study
Eur Rev Med Pharmacol Sci. 2011 Oct;15(10):1212-4
Bye-bye chiro-inositol - myo-inositol: true progress in the treatment of polycystic ovary syndrome and ovulation induction
Gynecol Endocrinol. 2012 Jul;28(7):509-15
Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials
Minerva Ginecol. 2012 Dec;64(6):531-8
Evaluation of the treatment with D-chiroi-nositol on levels of oxidative stress in pcos patients
J Ovarian Res. 2012 May 15;5(1):14
Does ovary need D-chiro-inositol?
NIH Thursday, May 24, 2012
Progestin treatment for polycystic ovarian syndrome may reduce pregnancy chances
Clin Endocrinol (Oxf). 2012 May 10
Vitamin D in the etiology and management of polycystic ovary syndrome
Eur Rev Med Pharmacol Sci. 2012 May;16(5):575-81
The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone
Eur Rev Med Pharmacol Sci. 2011 Apr;15(4):452-7
Myo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial
Am J Clin Nutr 2011
Higher Protein Diet Helpful in PCOS
Fertil Steril. 2011;96:1128-1133
Metformin in Polycystic Ovarian Syndrome and Infertility
Gynecol Endocrinol. 2010 Apr;26(4):275-80
Insulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women
J Steroid Biochem Mol Biol. 2010 Oct;122(1-3):42-52
Insulin and hyperandrogenism in women with polycystic ovary syndrome
Human Reproduction 2009 24(11):2924-2930
Thyroid-stimulating hormone is associated with insulin resistance independently of body mass index and age in women with polycystic ovary syndrome
Gynecol Endocrinol. 2009 Aug;25(8):508-13
Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome>
Fertil Steril. 2009 Jul;92(1):328-43
Melatonin and the ovary: physiological and pathophysiological implications
Rev Obstet Gynecol. 2009 Fall;2(4):232-9
Polycystic ovary syndrome: a major unrecognized cardiovascular risk factor in women
Gynecol Endocrinol. 2008 Mar;24(3):139-44
Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome
Med Hypotheses. 2007;68(3):480-3
Polycystic ovary syndrome in men: Stein-Leventhal syndrome revisited
Endocr Pract. 2002 Nov-Dec;8(6):417-23.
Effects of d-chiro-inositol in lean women with the polycystic ovary syndrome
Biol Reprod. 1993 Oct;49(4):647-52
Pathologic effect of estradiol on the hypothalamus
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
Advances in Experimental Medicine and Biology 2009, Volume 643, Pages 353-358
Taurine Supplementation and Pancreatic Remodeling
Diabetes. 2008 Oct;57(10):2619-25
Baseline Serum 25-Hydroxy Vitamin D Is Predictive of Future Glycemic Status and Insulin Resistance
Diabetologia Issue Volume 51, Number 1 / January, 2008
Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: the Pune Maternal Nutrition Study
Early Human Development Volume 83, Issue 10, October 2007, Pages 693-696
Neonatal taurine administration modifies metabolic programming in male mice
Human Reproduction 2007 22(12):3264 Calcium homeostasis and anovulatory infertility
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
Clinical Chemistry 51: 1691-1697, 2005 Serum Parathyroid Hormone Concentrations Are Increased in Women with Polycystic Ovary Syndrome
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 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
Am Fam Physician. 2004 Jan 15;69(2):264-266
Use of Metformin Is a Cause of Vitamin B12 Deficiency
Am Fam Physician. 2003 Mar 1;67(5):979-986
Vitamin B12 deficiency
Clinical Diabetes October 2003 vol. 21 no. 4 186-187
Glucose, Advanced Glycation End Products, and Diabetes Complications: What Is New and What Works
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
Steroids. 1999 Jun;64(6):430-5 Vitamin D and calcium dysregulation in the polycystic ovarian 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.