Polycystic Ovary Syndrome PCOS
34 Case Studies
42 Member Stories
2274 Research

 Despite being the most common hormonal disorder in women, PCOS is often underdiagnosed. A thorough Functional Medicine physical examination can assist in an accurate diagnosis, as acanthosis nigricans and hirsutism are common physical findings in patients with PCOS.

What is PCOS?

Do you face infertility and menstrual irregularities so often that it is affecting your quality of life? Are you among those women who lack awareness of PCOS? Well, PCOS or polycystic ovarian syndrome, is a group of symptoms resulting from hormonal imbalance. PCOS can be devastating, but you are not to blame for this, and you can follow certain steps that can bring you relief from this situation. It's the number one cause of infertility where  5-10% of women of childbearing age have PCOS.

The exact pathophysiology behind PCOS still remains unclear and is known to be associated with various neuroendocrine defects, impaired ovarian steroidogenesis, thyroid , and genetic factors, Insulin resistance, obesity, and increased cortisol metabolism-related adrenal hyperandrogenism. Increased androgen levels and insulin are thought to be two main key factors involved in its pathogenesis. 

PCOS is a complex endocrine and metabolic condition.  Although estimates vary because of different standards for analysis, it possibly affects up to 15-20 % of women.  Despite being the most common hormone disorder in reproductive-age ladies, it's underdiagnosed.  Patients with PCOS don't all seek care and aren't aware that their symptoms can be managed. A recent survey revealed that two-thirds of PCOS patients are unsatisfied with their experience of diagnosis, and only 15 percent were happy with the information and materials that they received.  Nearly half of the girls saw over three clinicians before a diagnosis was obtained.PCOS includes significant health risks, so early identification can reduce long-term health consequences.  Frequent comorbidities include infertility, hypertension, type 2 diabetes, depression, anxiety, sleep apnea, menstrual irregularities, and much more.  

In one study, 42 percent of women with PCOS had irritable bowel syndrome (IBS), and these patients had higher BMI and higher body fat percentages.  Insulin resistance is found in 50-70percent of guys with PCOS.  Women with PCOS are also more likely to have depression or anxiety, even in comparison with controls with the same BMI. In a primary care clinic, patients with PCOS are typical.  One estimate found that in the US, some 500,000 patient visits annually are related to PCOS.

See: Birth Control Pills Side Effects & Alternatives

How does Functional Medicine help PCOS?

Functional Medicine provides tools to diagnose and treat these patients effectively. A thorough Functional Medicine physical examination can assist in an accurate diagnosis, as acanthosis nigricans and hirsutism are common physical findings in these patients. A recent Cochrane review concluded that lifestyle interventions" may enhance the free androgen index, weight, and BMI in women with PCOS."  Lifestyle modifications are crucial to assist patients with PCOS to alleviate symptoms and reduce ongoing health risks.  As an example, a plant-based diet (without energy restriction), lifestyle education, and aerobic exercise decreased PCOS symptoms in a cohort of 30 women over 16 weeks over the therapeutic lifestyle changes cardioprotective diet, though both groups showed improvements throughout the study. Accurate analysis followed by multimodal interventions can't just help patients in the short term, but also improve health in the long run.

PCOS treatment requires multi-modal management, since its a complex metabolic disorder, and the conventional treatment available focuses on treating the symptoms rather than identifying and treating the root cause of the disease. This is why many women with PCOS tend to find relief from the stubborn symptoms of PCOS through various PCOS integrative medicine approach. The PCOS functional medicine focuses on every aspect of the individual, be it dietary modification, stress management, nutraceuticals, naturopathy or exercise. A combination of functional medicine approaches may help improve the health of female reproductive organs and treat various health complications like hormonal imbalance, polycystic ovarian syndrome (PCOS), infertility and various other related problems. 

Functional medicine is a systems biology-based approach to health.  It is available as a PCOS treatment option, which when followed can help get rid of all the ailments of the body, not just PCOS. Functional medicine fights the root cause of the disease and improves and relieves from the ailment.some of the functional medicine approaches for PCOS are listed below

1.    Reduce Stress

Chronic stress is a condition of modern-day living that has been associated with the pathogenesis of many diseases including PCOS. Stress can cause increased levels of cortisol, via increased sympathetic activity and decreased serotonin levels in the central nervous system. Thus, affecting metabolic homeostasis and giving rise to clinical symptoms in PCOS patients. Real stress reduction procedures must be followed in order to manage the symptoms of PCOS. Stress can be managed by practicing relaxation techniques like yoga, meditation, exercise or even a minute few minutes’ walks can help. It is also recommended that doing short activities throughout the day can be more beneficial than doing the exercise once a week.

2. Take Supplements

Providing sufficient nutrients and energy for growth and reproduction can play a central role in the regulation of ovarian follicle growth. The optimal nutrient composition must be maintained for regulating proper nutrition-associated signaling pathways in conditions like PCOS. some of the supplements that help in PCOS are mentioned below:

Vitamin Supplements-

Vitamin-A- Retinol an important derivative of Vitamin A is known to be involved in various signaling pathways of reproduction, embryogenesis, steroid metabolism, oocyte nuclear maturation, cell proliferation, and differentiation. Research has shown that abnormal retinoid signaling can contribute to the pathogenesis of PCOS. Hence, a precise amount of Vitamin A or retinol should be maintained.

Vitamin-D and PCOS-  It is an essential component that plays a significant role in PCOS. Decreased levels of vitamin D are known to be associated with PCOS. Supplements like Vitamin D3 play a physiologic role in ovarian follicular development during reproduction and luteinization via altering anti-müllerian hormone (AMH) signaling. Vitamin D3 supplement can help improve menstrual frequency and also inhibits inflammatory progress in the pathogenesis of PCOS.

B group vitamins- It has been observed that homocysteine levels are elevated in women suffering from PCOS which increases the risk of reproductive symptoms in PCOS. During this, B group supplements like Vitamin B6, B12, and folic acid can effectively manage the increasing role of homocysteine (Hcy) levels in PCOS. 

Inositol- Derivatives of Inositol like Myo-inositol and d-chiro-inositol acts as a second messenger various signaling pathways and thus it also helps regulate thyroid-stimulating hormone, follicle-stimulating hormone (FSH) and insulin which are involved in the pathogenesis of PCOS.Inositol supplements can help improve insulin levels, lower testosterone, promotes cell morphogenesis, oocyte maturation, oogenesis, and recovery of reproductive abnormalities.

Vitamin E is known to be a potent antioxidant that acts as a free radical scavenger and regulates the balance between antioxidant and oxidant systems. Vitamin E helps improve endometrial thickness in women with unexplained infertility and improve androgen levels in women suffering from PCOS.

Vitamin like supplements

Bioflavonoids- these compounds have potent antioxidant, antidiabetic, anti-inflammatory, and antiestrogenic, properties and play a significant role in PCOS. Bioflavonoids help improve ovarian and uterine morphological appearances, LH levels, and reduce testosterone levels in PCOS.

L-carnitine-  L-carnitine fights oxidative stress, and promotes glucose metabolism. It is an essential component that provides thicker endometrium, higher pregnancy rates, and improved lipid profiles in PCOS conditions.


Mineral supplements

Calcium- Calcium is an essential micronutrient and is involved in egg activity, oocyte maturation, the progression of follicular development, and regulation of cell division in mammalian oocytes. Furthermore, Calcium deficiency could be related to the risk of obesity because the insulin signaling pathway is Calcium-dependent

Chromium- Levels of chromium is considerably low in women suffering from PCOS. Chromium is an essential nutrient that is known to improve the symptoms of oligo/amenorrhea, decrease the levels of free testosterone that can be beneficial in PCOS. 

Selenium-   Women with PCOS have insufficient selenium levels, which lead to increased androgen levels including LH and total testosterone. Selenium rich diet or supplements can help improve the levels of testosterone.

Other supplements

Probiotics - It has been found through various researches that PCOS emerge from two pathologic conditions which include a chronic state of inflammation and Insulin Resistance.  Both conditions are known to be associated with the dysbiosis of gut microbiota. In such cases, consumption of probiotics can have beneficial effects on metabolism, especially under inflammatory conditions like PCOS.

Phytomedicine- Licorice, Flaxseeds. Saw palmetto is known to reduce testosterone levels by its anti-androgen effects. Milk thistle- improves ovulation, Dandelion root- vitamins and minerals great for skin and improves acne. 

3. Manage your Weight-

PCOS is often associated with weight gain due to insulin resistance. Insulin resistance is a condition where your cells become resistant to take up the glucose from your blood and convert it into energy. This builds up visceral fat into the body which is inherently insulin resistant, inflammatory and causes estrogen production. The increased estrogen levels suppress the release of luteinizing hormone and follicle-stimulating hormone from the brain, which is essential to get a menstrual cycle. Managing weight in PCOS can be an effective way to manage various symptoms of PCOS. Women suffering from PCOS should cut down their carbs intake, and daily calorie intake. Foods that are rich in protein, fiber, and healthy fats must be considered. Probiotics and fermented food can also make you feel satisfied and help tackle PCOS.

4. Lifestyle modification and exercise

Recent research indicates modifying lifestyle factors, like psychosocial stressors, alcohol consumption, and smoking is crucial in the long-term treatment of PCOS and might also reduce the extent of impaired glucose tolerance. Performing exercise regularly has many benefits in treating PCOS. It helps you reduce excess weight and build muscle mass, prevents insulin resistance, lower testosterone/androgen levels in the body.

See: Autoimmune Paleo Diet or AIP Diet

Scientific studies in Functional Medicine for PCOS

Efficacy of combination therapy of inositols, antioxidants , and vitamins in obese and non-obese women with polycystic ovary syndrome: an observational study.1.

The study was carried out on  54 women who were qualifying  the Rotterdam criteria for PCOS. This clinical study aimed to evaluate the efficacy of various supplements like inositols, antioxidants , and vitamins in obese and non-obese women with polycystic ovary syndrome. The duration of the treatment was 12 weeks, where all the women included in the study were asked to consume one tablet of Trazer F ForteTM. Each tablet has a combination of inositols, N-Acetyl Cysteine, Biotin, Lycopene, Chromium picolinate,  Folic Acid and  Vitamin D. parameters like body weight, menstrual cyclicity, and hirsutism data were evaluated at  baseline and after 12 weeks. A significant improvement was observed in  all the women with no side effects.

Outcome: Good

Vitamin D and probiotic co-supplementation affect mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome.2.

The study included 60 subjects diagnosed with PCOS aged between 18–40 years. The patients were randomly allocated into two groups, each group containing 30 individuals, where one group received 50,000 IU of vitamin D every 2 weeks along with probiotics 8 × 109 CFU/day. The other group received a placebo treatment. The treatment lasted for 12 weeks after which parameters related to depression, anxiety and stress scale scores were evaluated along with  high-sensitivity C-reactive protein (hs-CRP), antioxidant capacity total glutathione (GSH) levels, and malondialdehyde (MDA) levels.

The results showed that Vitamin D and probiotic co-supplementation was associated with a significant reduction in total testosterone levels, beneficial effects on mental health parameters, hirsutism, hs-CRP, plasma GSH , and MDA levels.

See: Heal from PCOD with the Help of Panchakarma Treatment

Summary

Functional medicine is a therapeutic system of medicine based on systems biology that believes in treating a patient ailment by following a natural pathway. The functional medicine approach for PCOS is safe to use, affordable, effective, and easy to reach. It helps balance the hormonal imbalance that occurs in PCOS through various factors that help nourish the reproductive system of a female by detoxifying, cleansing and boosting fertility. Hence, a wide number of patients suffering from PCOS are opting for a functional medicine approach.


See: Keto diet benefits for weight loss, diabetes & PCOS

References

1. Advani K, Batra M, Tajpuriya S, Gupta R, Saraswat A, Nagar HD, Makwana L, Kshirsagar S, Kaul P, Kumar Ghosh A, 2. Pradhan S, Mehta A, Jaiswal A, Nakhate KT, Kamdi S. Efficacy of combination therapy of inositols, antioxidants , and vitamins in obese and non-obese women with polycystic ovary syndrome: an observational study.1.J Obstet Gynaecol. 2019 Jul 24:1-6.

2. Ostadmohammadi V, Jamilian M, Bahmani F, Asemi Z. Vitamin D and probiotic co-supplementation affect mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome. J Ovarian Res. 2019 Jan 21;12(1):5. 

3. Susan Arentz, Caroline A. Smith, Jason Abbott, and Alan Bensoussan. Nutritional supplements and herbal medicines for women with polycystic ovary syndrome; a systematic review and meta-analysis. BMC Complement Altern Med. 2017; 17: 500.

4. https://www.onemedical.com/blog/get-well/pcos-treatment

 10.5001/omj.2018.88

5. https://www.ifm.org/news-insights/womhorm-pcos/

6. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013;6(1):1-13. doi:10.2147/CLEP.S37559

7. Sirmans SM, Parish RC, Blake S, Wang X. Epidemiology and comorbidities of polycystic ovary syndrome in an indigent population. J Investig Med. 2014;62(6):868-874. doi:10.1097/01.JIM.0000446834.90599.5d

8. Ding T, Hardiman PJ, Petersen I, Wang FF, Qu F, Baio G. The prevalence of polycystic ovary syndrome in reproductive-aged women of different ethnicity: a systematic review and meta-analysis. Oncotarget. 2017;8(56):96351-96358. doi:10.18632/oncotarget.19180

9. Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2017;102(2):604-612. doi:10.1210/jc.2016-2963

10. Mathur R, Ko A, Hwang LJ, Low K, Azziz R, Pimentel M. Polycystic ovary syndrome is associated with an increased prevalence of irritable bowel syndrome. Dig Dis Sci. 2010;55(4):1085-1089. doi:10.1007/s10620-009-0890-5

11. Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2017;32(5):1075-1091. doi:10.1093/humrep/dex044


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