Many female patients seek care from us for menstrual irregularities, skin issues like acne, or weight management concerns and often times PCOS, or polycystic ovary syndrome, is behind their symptoms. In more recent years the medical community has worked towards a diagnostic standard for PCOS, but there isn’t yet an accepted standard for treatment, particularly because PCOS can affect each woman so differently. Given the potential for adverse reactions from conventional medication currently used in the management of PCOS, this blogs aim is to highlight some of the latest research on natural treatments that carry less side-effect risk. But are they as effective?
PCOS In Context
Excerpt from the International Evidence-Based Guideline For The Assessment & Management Of Polycystic Ovary Syndrome 2018:
“Polycystic ovary syndrome (PCOS) is a significant public health issue with reproductive, metabolic and psychological features. It is one of the most common conditions in reproductive-aged women, affecting 8-13% of reproductive-aged women with up to 70% of affected women remaining undiagnosed. Women with PCOS present with diverse features including psychological (anxiety, depression, body image), reproductive (irregular menstrual cycles, hirsutism, acne, hair loss, infertility and pregnancy complications) and metabolic features (insulin resistance (IR), metabolic syndrome, pre-diabetes, type 2 diabetes (DM2) and cardiovascular risk factors).
Diagnosis and treatment of PCOS remain controversial, with challenges defining individual components within the diagnostic criteria, significant clinical heterogeneity generating a range of phenotypes with or without obesity, ethnic differences and variation in clinical features across the life course. These factors contribute to variation in diagnosis and care across geographical regions and health professional groups. This culminates in delayed diagnosis, poor diagnosis experience and dissatisfaction with care reported by women internationally. (Teede et. al. 2018).”
Why Should We Consider Natural Support?
With respect to currently accepted pharmacological treatments for PCOS, although relatively safe, combined oral contraceptive pills (COCPs) have absolute and relative contraindications and risks in the general population that need consideration by health professionals and women. The increased risk of vascular events such as DVT or stroke are reason enough to consider other therapies. The gastrointestinal side effects related to anti-androgen and insulin sensitizing medications such as metformin, and more serious adverse effects related to glitazones, further suggest the need for alternative interventions to manage the clinical features of PCOS (Teede et. al, 2018).
Management of PCOS is vital as it has been shown to be associated with increased risks of insulin resistance, metabolic syndrome, and type 2 diabetes, all of which have long-term consequences. Moreover, increased insulin resistance and compensatory hyper-insulinemia play a key role in the pathogenesis of PCOS itself. Metformin is an oral anti-diabetic drug used to regulate insulin resistance by suppressing glucose production in the liver. A recent study examined the efficacy of metformin compared to n-acetyl cystine (NAC) on the clinical, metabolic and hormonal profile in women with PCOS and found that after 24 weeks of treatment, both the group given metformin 500mg three times daily and the group given NAC 600mg three times daily showed a significant reduction in both fasting glucose and fasting insulin. Additionally, the group receiving the NAC showed a significant reduction in waist circumference, waist-to-hip ratio and BMI, as well as a significant reduction in total testosterone. The authors of the study concluded that “NAC improves the clinical features, biochemical markers of insulin resistance, hormonal levels, anovulation and consequently the long-term health status of women with PCOS through inhibition of oxidative stress and improvement of peripheral insulin more effectively when compared with metformin. Due to the lack of adverse effects, NAC can be regarded as an appropriate substitute for insulin-reducing medications in the treatment of PCOS patients” (Chandil et. al, 2019).
PCOS is the most common cause of anovulation in reproductive-aged women, often leading to abnormal uterine bleeding, associated anemia, endometrial hyperplasia/cancer and sub-fertility. Given all these serious consequences, “there is a critical need to establish therapeutic strategies for ovarian dysfunction observed in women with PCOS and to improve ovarian health in this patient population (Merhi Z, 2019).” Current studies suggest that advanced glycation end products (AGEs) are mediators of ovarian dysfunction, and that these pro-inflammatory molecules are elevated in the serum and ovarian tissues of women with PCOS. It has also been shown that women with PCOS have low serum levels of vitamin D and therefore that supplementation with vitamin D “might alleviate the detrimental effects of AGEs on women with PCOS. (Merhi Z, 2019)”. Con
A recent study in 2019 demonstrated a significant body weight reduction, decreases in fT, FSH, LH and insulin levels, as well as significant increase of serum SHBG concentrations in their patients receiving a combined therapy of one tablet that contained 550 mg of inositol (myo-inositol (MI) and D-chiro-inositol (DCI) in a ratio of 10:1) twice a day for 6 months. Serum glucose levels during OGTT decreased after 6 months of treatment and skin conditions (acne) improved after only three months of treatment (Januszewski et. al, 2019). Another study compared inositol to metformin with respect to glycemic control and lipid profiles in women with PCOS and found that inositol supplementation, compared with metformin, significantly reduced fasting plasma glucose, serum insulin levels, serum triglycerides and VLDL-cholesterol levels (Shokrpour, et, al, 2019). The most current systematic review as discussed in the 2018 international evidence-based guideline, also suggests ovulation rate and menstrual cycles appear to improve with inositol in women with PCOS. Furthermore, some data also suggest inositol may be effective in decreasing risk for gestational diabetes. They do note however that the literature is still limited, many key questions remain and that more research should be prioritized (Teede et. al, 2018).
If you have one or more of the following symptoms: irregular menstrual cycles, weight gain, acne, hair loss, increased facial hair growth, cysts on your ovaries, history of ruptured ovarian cyst, abnormal insulin or hormone tests or fertility issues you may have PCOS. To get properly evaluated or if you already have been diagnosed with PCOS and would like to learn more about how you can manage your symptoms and prevent long-term health consequences book your initial consultation with myself or another trusted health care provider.
Dr. Alaina Overton, ND
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Chandil N, Pande S, Sarkar Sen S, Gupta D. Comparison of Metformin and N Acetylcysteine on Clinical, Metabolic Parameter and Hormonal Profile in Women with Polycystic Ovarian Syndrome. The journal of obstetrics and gynecology of india. 2019. 69 (1); 77-81.
Januszewski M, Issat T, Jakimiuk A, Santor-Zaczynska M, Jakimiuk A. Metabolic and hormonal effects of a combined Myo-inositol and d-chiro-inositol therapy on patients with polycystic ovary syndrome (PCOS). Gynekol Pol. 2019. 90 (1) 7-10.
Merhi Z. Crosstalk between advanced glycation end products and vitamin D: A compelling paradigm for the treatment of ovarian dysfunction in PCOS. Molecular and cellular endocrinology. 2019. 479 (5); 20-26.
Shokrpour M, Foroozanfard F, Ebrahimi F, Vahedpoor Z, Aghadavod E, Ghaderi A & Asemi Z. Comparison of myo-inositol and metformin on glycemic control, lipid profiles, and gene expression related to insulin and lipid metabolism in women with polycystic ovary syndrome: a randomized controlled clinical trial. Gynecological endocrinology. 2019. //doi-org.ezproxy.library.ubc.ca/10.1080/09513590.2018.1540570.
Teede H, Misso M, Costello M, Dokras A, et. al. International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018. Monash University, Melbourne Australia 2018.
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