What is PCOS?
In each menstrual cycle, follicles grow on the ovaries. Eggs develop within those follicles, one of which will reach maturity faster than the others and be released into the fallopian tubes. This is “ovulation”. The remaining follicles will degenerate.In the case of polycystic ovaries, however, the ovaries are larger than normal, and there are a series of undeveloped follicles that appear in clumps, somewhat like a bunch of grapes. Polycystic ovaries are not especially troublesome and may not even affect your fertility.
However, when the cysts cause a hormonal imbalance, a pattern of symptoms may develop. This pattern of symptoms is called a syndrome. These symptoms are the difference between suffering from polycystic ovary syndrome and from polycystic ovaries.
So you can have polycystic ovaries without having PCOS. However, nearly all women with PCOS will have polycystic ovaries. Polycystic Ovary Syndrome is the name given to a metabolic condition in which a woman will have polycystic ovaries, along with a certain pattern of other symptoms that reflect imbalances in reproductive and other hormones.
Acne is a common symptom of polycystic ovary syndrome. It is an inflammatory skin disorder that involves interactions between hormones, hair, sebaceous (oil-secreting) glands and bacteria.
Women with PCOS are susceptible, possibly due in part to excess levels of androgens (male sex hormones) in the skin. Teenagers are also susceptible around the onset of puberty due to an increase in the production of androgens. This androgen, a metabolite of testosterone, is called DHT.
It is thought that DHT stimulates the production of oil, which eventually can lead to clogged glands or pores. Clogged pores can no longer release oil and allow bacteria to grow and multiply in the follicle, leading to inflammation.
Enzymes from this bacteria breakdown triglycerides in the sebum (oil) to form “free fatty acids” that further irritate the follicular wall. Rupture of the follicle, accompanied by the release of free fatty acids, bacterial products and keratin, results in an abscess that heals with scars in severe cases.
Treatment Options for Acne:
Conventional Treatment of Acne
- Oral or topical tretinoin or isotretinoin. Oral tretinoin should only be prescribed by a physician who thoroughly understands its adverse effects. Pregnancy testing is important prior to beginning tretinoin therapy and at monthly intervals, due to the risk of severe fetal abnormalities that can occur if pregnancy results while taking this drug. Its acts by unplugging acne follicles and bringing acne pimples (comedones) to the surface. This is why tretinoin makes acne look worse in the first few weeks of treatment.
- Over-the-counter topical preparations containing benzoyl peroxide, which is an anti-bacterial agent.
- Over-the-counter topical preparations containing sulfur, which is a keratolytic (peeling agent) and also helps suppress the growth of bacteria.
- Topical agents containing azelaic acid. Azelaic acid exerts an antibacterial effect.
- It is also keratolytic and has a therapeutically positive effect on the formation of comedones (blackheads, whiteheads).
- In severe cases, the antibiotics tetracycline or minocycline may be used.
- Antibiotics are anti-bacterial agents.
- Increased exposure to sunlight or ultraviolet light (such as tanning beds).
- The ClearLight system, which uses a narrow-band, high-intensity light known as blue light to attack the bacteria in pimples. Available from some dermatologists.
- In the case of women with PCOS and acne, physicians will typically prescribe spironolactone and birth control pills. Some birth control pills contain lower levels of androgens and should, at least theoretically, provide better acne control.
Natural Treatment of Acne
- Avoid using drugs that may cause acne.
- Avoid exposure to oil or grease.
- Use hypoallergenic cosmetics and soaps if available.
- Wash the affected areas thoroughly twice daily, or more if needed, to remove excess oils.
- Wash pillowcases and sheets regularly in chemical-free (no added colors or fragrances) detergents.
- Get adequate sun exposure.
- Eliminate refined carbohydrates and sugars from the diet.
- Avoid eating foods containing trans fatty acids (such as milk, milk products, margarine, shortening), partially hydrogenated vegetable oils, and fried foods.
- Zinc (50-75 mg daily): Zinc decreases the conversion of testosterone to its active form (DHT), thus reducing the stimulatory effects on oil glands. Other important functions of zinc include wound healing, immune system activity, tissue regeneration, and control of inflammation. In a study published in the British Journal of Dermatology, zinc was found to be equally as effective as oral antibiotic therapy in the treatment of acne. Results may take up to twelve weeks for results to occur.
- Vitamin A (25,000-50,000 IU daily – if you are not pregnant or planning on becoming pregnant): Vitamin A has been shown to reduce sebum production and the build-up of keratin in the follicle. The dosages required for this effect are relatively high (300,000-400,000 IU daily for up to six months) and potentially toxic. If you use a micellized (water soluble) form of vitamin A, you may be able to mitigate the toxicity somewhat. You may be able to take less vitamin A if you’re also taking other nutrients such as zinc and vitamin E. For sexually active women of childbearing age, do not take more than 5,000 IU daily unless an effective form of birth control is being used, or unless you are under the supervision of a physician.
- Vitamin B6 (50-100 mg daily): Plays a role in the normal metabolism of steroid hormones. Vitamin B6 deficiency in rats has been shown to cause an increased uptake and sensitivity to testosterone.
- Pantothenic acid (2.5 grams four times daily for a period of two weeks): Plays a role in fat metabolism and has been shown to be of value in the treatment of acne at high doses.
- Vitamin E (400 IU daily): Is vital to the functioning of vitamin A and the activity of selenium. During a vitamin E deficiency, blood levels of vitamin A stay low regardless of the amount of vitamin A consumed. However, when vitamin E is added to the diet, blood levels of vitamin A will normalize.
- Selenium (100-200 mcg daily): This antioxidant trace mineral functions in the enzyme glutathione peroxidase. Selenium is important for preventing the inflammation associated with acne. Individuals suffering from acne have been shown to have reduced levels of glutathione peroxidase. Following treatment with selenium and vitamin E, glutathione peroxidase levels significantly increase, while the severity of acne typically decreases.
- Essential fatty acids (EFAs): These fats have the ability to reduce inflammation and may be of benefit in treating acne. One tablespoon of either fish oil or • flaxseed oil may be helpful. Consumption of cold water fish like salmon and • mackerel are other good sources of anti-inflammatory fats. You can also in • convenient capsules.
- Tea tree oil (10-15% preparation): A 1990 study compared the topical use of tea tree oil (5% preparation) to benzyl peroxide (5% preparation) in the treatment of common acne. Although the tea tree oil took longer to work and was less potent in action, it had far fewer side effects and was thus considered to be more effective overall. Tea tree oil should not be applied to broken skin or to areas affected by rashes.
- Azelaic acid (apply cream to affected areas twice daily for at least four weeks): This naturally occurring acid has been shown to have antibiotic activity against acne bacteria. Studies using a 20 percent azelaic acid cream have shown that it produces results equal to those achieved with benzyl peroxide, Retin-A or oral tetracycline in the treatment of many different types of acne. Given its low incidence of side effects and allergic reaction, azelaic acid may be a safe alternative to many conventional drug therapies. However, you may find it irritating to the skin.
Note: Your genetic predisposition and health status is unique to you. If you have PCOS and acne, a treatment that works for you may not work for someone else, and vice-versa. Therefore, you will have to do some experimentation to find the right combination of diet, lifestyle, supplements and medications that will diminish your acne and other symptoms of PCOS.
Pre-eclampsia is a dangerous complication of pregnancy, involving high blood pressure, protein traces in the urine and edema (abnormal fluid accumulation in parts of the body). It is one of the most dangerous complications that can occur during pregnancy and is a major cause of both maternal and child death during pregnancy and immediately after birth. Macrosomia is the term for a newborn with an excessive birth weight. Factors associated with fetal macrosomia include gestational diabetes and Diabetes Mellitus, demonstrating once again a link to hormonal disorder.
The first symptoms may be vaginal bleeding or discharge, sometimes accompanied by abdominal pain or backache. Vaginal bleeding in early pregnancy is called “threatened miscarriage”, but doesn’t necessarily develop into an actual miscarriage. Many women will go on to have a normal pregnancy.
Additional early signs are that you may notice that pregnancy symptoms such as nausea or sore breasts disappear, whether or not there is bleeding. Or, you may not have any bleeding or any other sign that something is wrong, but discover that your pregnancy has ended only during a routine antenatal scan. This is called a “missed miscarriage” or “delayed miscarriage”.
Another but less common symptom is severe and sharp or one-sided abdominal pain. In this case, you may have an ectopic pregnancy, which develops outside of your womb. Anytime you have severe abdominal pain, contact your physician immediately or go to the nearest emergency room.
How Common Is Miscarriage?
Estimates of the incidence of miscarriage vary, because women have miscarriages without even knowing that they are pregnant. However, some health authorities estimate that one pregnancy in four ends in miscarriage, mostly in the first 12 weeks of pregnancy.
The miscarriage rate appears to be higher for women with polycystic ovarian syndrome (PCOS). Some studies suggest that the rate could be 45% or more.
Causes of Miscarriage
There are multiple possible causes of miscarriage. Although not all the possible causes have been identified, the main causes are thought to be:
Perhaps half of all early miscarriages occur because of chance chromosomal abnormalities. Chromosomes carry the genes that hold the keys to your baby’s traits. Most chromosomal abnormalities result from a defective egg or sperm, which produces an embryo with the wrong number of chromosomes or a chromosomal defect. These embryos often fail to thrive and the pregnancy miscarries.
German measles or an infection accompanied by a very high fever may lead to miscarriage. Women with a bacterial vaginal infection have a significantly greater risk of miscarriage in the second trimester of pregnancy.
Some women may have an inherited tendency to produce immune system antibodies that cause an excessive tendency to form blood clots, which can block circulation to the developing fetus. Women with these blood coagulation disorders have more miscarriages and pregnancy problems than other women.
If your cervix (neck of the uterus) is weak, it may start to open as the uterus becomes heavier in later pregnancy and this could lead to later miscarriage. An irregular-shaped uterus may not allow enough room for your baby to grow. Large fibroids in your uterus may cause miscarriage in later pregnancy.
More than two alcoholic drinks a day may increase risk of miscarriage. Smoking is a clear risk for miscarriage, premature birth, and low birth weight.
Some studies have suggested that coffee or caffeine may increase rates of miscarriage.
What you eat can also affect your pregnancy outcome. One recent study has shown that women with low folic acid levels were 50% more likely to have a miscarriage than women with high levels. Folic acid is a B vitamin found most commonly in leafy green vegetables. Low zinc has also been associated with miscarriage. These studies imply that a poor-quality diet may be a contributor to miscarriage.
Eating a diet a low-fiber diet that is also high in refined carbohydrates and other processed foods will disturb your hormonal balance and could contribute to a higher risk of miscarriage. In particular, you want to avoid sweets and refined flour products, since these foods cause excessive increases in insulin.
Chemical compounds are everywhere in our food, water and air. Every person is a “bioaccumulator” of these chemicals. Some of these chemicals are hormone mimics or hormone disrupters. Others are just plain toxic. Women with high blood levels of a class of chemicals called “organochlorine compounds”, have problems with infertility, stillbirths, and miscarriages.
There’s no question that you have environmental chemicals in your fat tissue. The only question is what concentrations of chemicals do you have, and what effect are they having?
Women with hormonal irregularities may find it harder to conceive and when they do, they appear more likely to miscarry. A dominant feature of women with polycystic ovary syndrome (PCOS) is that they are likely to have multiple hormonal imbalances — some are too high while others are too low.
Luteal phase defect.
The luteal phase is the second half of the period, the time between ovulation and onset of the next menses. A luteal phase defect is essentially a failure of the uterine lining to be in the right phase of development at the right time, thus preventing implantation of the fertilized egg, or making the embryo’s attachment to the uterus precarious.
A luteal phase defect may occur at several points during a menstrual cycle. It’s thought that most luteal phase defects originate in the follicular phase of your cycle, before ovulation.
During the follicular phase, your body may not produce enough FSH (follicle stimulating hormone), or your ovaries have a weak response to FSH. The consequence is inadequate follicle development. After the follicle releases its egg, it converts itself into a different structure called the corpus luteum.
The corpus luteum produces the progesterone needed to thicken the lining of your uterus and stimulate development of additional blood vessels, which provide a place for your embryo to attach and to grow.
However, poor follicle formation will lead to a poor quality corpus luteum, and thus the corpus luteum is less likely to secrete the amount of progesterone required to ensure that the uterus can support the development of your embryo.
A luteal phase defect may also be caused by excessive levels of LH (luteinizing hormone) too early in the menstrual cycle, or an improperly timed LH surge.
LH (luteinizing hormone) hypersecretion.
Some women with PCOS have elevated LH during the follicular phase (first half of the cycle), which prematurely sends a signal to the egg that it is about to be released from its follicle. The egg then prematurely disconnects from its supporting cumulus cells, which causes the egg to pause in its maturation process.
It is thought that this interruption in the normal maturation process may result in abnormal chromosomes in the egg, which would then substantially increase the probability of a miscarriage.
Of course, other hormonal imbalances besides FSH and LH may be involved.
Women who miscarry appear to have higher levels of testosterone and DHEA than women with continuing pregnancies.
Women who miscarry may tend to have higher prolactin and androgen levels during the follicular phase of their menstrual cycle.
Insulin and insulin resistance.
Some women with the polycystic ovarian syndrome have insulin resistance, where an excessive amount of insulin is required to control blood sugar levels. High insulin levels stimulate further production of LH and testosterone. Excessive levels of insulin, LH and testosterone are associated with poorer egg quality, thus increasing the risk of miscarriage. Insulin resistance has been linked to recurrent pregnancy loss.
As you can begin to see, the risk of miscarriage may be increased by a complex, interacting web of hormones that are out of balance.
An ultrasound scan is the most reliable way of diagnosing miscarriage, but a pregnancy test (blood or urine) and clinical examination are also ways to establish what has happened
As you can begin to see, the risk of miscarriage may be increased by a complex, interacting web of hormones that are out of balance.
There is no effective treatment to stop an early miscarriage that is already happening. However, once it is inevitable, there may be choices about managing it.
Unless you have miscarried completely, you may be offered a minor operation (a D&C). You can usually able to go home within a few hours. You may be asked if you would prefer to let nature take its course and wait for the pregnancy to spontaneously end.
Prevention – Natural Therapies
We believe that the best “treatment” for miscarriage is prevention. By prevention, we mean getting much healthier and attempting to get your hormones into balance before you plan to become pregnant. Here are some steps you can take:
1. Healthy diet
A HEALTHY diet means eating foods that are whole, fresh, and organic. Minimize consumption of refined, processed or fabricated foods. Minimize fast foods. Emphasize vegetables, fruits, nuts, seeds and legumes. Preferred animal proteins are fish and poultry. What you eat has a profound effect on your hormones.
2. Exercise and be physically active.
Exercise helps you to lose weight and balance your insulin and testosterone levels.
3. Clean up your insides.
Consider a physician-supervised cleansing diet or other procedures designed to remove any accumulated toxic material from your body. Naturopathic physicians specialize in safe, effective detoxification protocols.
You’ve probably been exposed to all sorts of petrochemicals, heavy metals and other contaminants over your lifetime. Bear in mind that some of these substances can reside in your body for a long time, and some of them act as hormone mimics or disrupters. Most of the chemicals you’ve been exposed to have not been evaluated for their effect on fertility and pregnancy. Some of them may influence your risk of miscarriage.
Other accumulated but undesirable materials may include pathogenic microorganisms, inflammatory food particles, or various byproducts of normal metabolism.
To further explore the issue of removing toxic substances from your body, consult with a licensed naturopathic or other qualified physician.
4. Clean up your environment.
Do what you can to remove toxic materials from your personal and work environment. Environmental pollution and workplace exposure to chemicals adversely affects your fertility and your health.
5. Find ways to deal with stress.
Chronic stress increases cortisol, which is a stress-response hormone. Elevated cortisol is associated with insulin resistance and increased abdominal fat. Obesity appears to be a risk factor for miscarriage.
6. Use nutritional supplements.
Food surveys conducted by the U.S. Dept. of Agriculture and other agencies consistently show that Americans consume a diet that is deficient in essential nutrients. Therefore, nutritional supplementation is indicated. Supplementation should contribute to your overall health, help you to balance your hormones, and to have a healthier baby if you become pregnant.
For example, studies have suggested that vitamin E may reduce the risk of miscarriage.
7. Consider herbal medicines.
Herbal medicines have been used for centuries to aid reproduction. For example, black haw root and false unicorn root may help to reduce miscarriage risk. However, we do not recommend that you self-prescribe herbal medicines. You will get better results if you consult with a licensed naturopathic physician or other certified health practitioner who is trained in herbal medicine.
8. Work with a qualified physician.
Your primary goal is to balance your hormones so that you’ll be more likely to have a successful pregnancy. You will need a doctor to help you with this endeavor.
Find a doctor who
- Understands all of the options available for bringing you into a state of hormonal balance, including natural therapies.
- Is willing to do an in-depth assessment of your health and hormonal status.
- Will spend the time needed to answer your questions and educate you regarding what you need to do.