Q-I am 36. I've always suffered from heavy periods, acne and facial hair. Fifteen years ago, my doctor diagnosed my problem as polycystic ovarian disease and put me on the Pill. Lately, my periods have taken over and sometimes go on for as long as three weeks; once this winter, I continued bleeding for nearly two months! I'm frightened that the Pill may be causing these side effects. Modern medicine doesn't seem to offer much help for women with my condition. Do you have any non drug solutions? TH, Stevenage.......
A-Although many women have enlarged ovaries with only partially developed follicles, in polycystic ovarian syndrome (PCOS), your hormonal household is in total disarray. Your body produces higher than normal levels of luteinising hormone (LH) and male hormone (testosterone), leading to infertility, overweight, mood swings, skin problems and excess body hair. PCOS can be a cause of miscarriage or infertility because your body produces a constant high level of LH rather than a surge of the hormone in mid month, as is ordinarily the case. As a consequence, your ovaries probably aren't releasing eggs. To complicate matters, many women with PCOS also have higher than normal levels of oestrogen and low levels of progesterone.
We asked our panel member Harald Gaier about your condition, and he suspects that undiagnosed endometriosis, possibly exacerbated by all those years on the Pill, is causing your endless bleeding.
Women with PCOS have problems controlling their weight; it's now thought that nearly two thirds of women with bulimia also have PCOS.
If you are overweight, one of the most effective ways to alleviate classic symptoms is to lose weight. Although no one really understands the link between overweight and PCOS symptoms, it does seem that overweight women in general appear to have far lower levels of sex hormone binding globulin (SHBG) in their blood. This deficiency can bring on higher levels of circulating testosterone which, in turn, can cause many of the most disturbing symptoms of PCOS, such as facial hair. Furthermore, oestrogen can be produced by fat cells, so overweight women have more circulating oestrogen in their bodies. Weight loss is also known to lower levels of insulin, which again can reduce the production of testosterone by the ovaries. Losing weight can also boost your fertility, which is often markedly reduced with this syndrome. It has been shown to normalise ovulation; in one study, 82 per cent of women who hadn't been ovulating improved (Clin Endocrinol, 1992; 36: 105-11); in another study, all but one woman with fertility problems went on to conceive after losing weight (Hum Reprod, 1995; 10: 2705-12). In one study which examined the relationship between overweight women with PCOS and fertility problems, once the overweight women went on a diet and lost weight, many of their hormonal problems normalised.
Besides weight, nutritional deficiencies may also bring on your condition. Women with PCOS tend to have poor blood sugar control (J Clin Endocrinol Metab, 1980; 50: 113-6) and high levels of insulin in the blood, often with insulin resistance (when cells require higher levels to respond to insulin) all conditions of the first stages of diabetes. Studies have shown that chromium supplements can help with glucose tolerance (Metabolism, 1992; 41: 768), so you may wish to take chromium supplements as part of your general nutritional supplementation. This should include an excellent multivitamin/mineral combination, plus extra zinc (a total of 30 mg per day) and essential fatty acids. Make sure you get adequate B vitamins, which help the liver in its central role of detoxifying hormones that will eventually be excreted from your body.
Saturated fats from dairy produce and red meat can also play a role since they can stimulate the body to produce too much oestrogen and produce prostaglandins, which can worsen endometriosis. Since you appear to have both endometriosis and PCOS, it might be wise to eliminate all red meat and dairy products to cut down on saturated fats. Eating red meat is also unwise because it slows down elimination, causing the body to reabsorb oestrogen compacted in the bowel.
A high fibre diet has recently been found to help with insulin control in diabetes (see News, page 9) and so presumably can help women with PCOS normalise insulin control. Marilyn Glenville says that fibre in grains and vegetables reduces oestrogen levels by 'shielding' oestrogens excreted in the bile, which prevents them from being reabsorbed back into the blood. You may also wish to change your diet to emphasise low fat vegetarian foods which also help speed up bowel transit time and eliminate old oestrogens in your bowel.
Minimise your exposure to endocrine disrupting chemicals (EDCs). These include all the so called 'oestrogen mimics' in pesticides, fertilisers, industrial pollutants such as dioxins and PCBs, and plastics such as phthalates. Make sure to eat organic food, cut down on exposure to these chemicals at home and at your workplace, and drink bottled water from glass rather than plastic.
Avoid refined carbohydrates and sugar which again can increase fat, increase your production of oestrogens and tamper with your insulin production. You may also wish to avoid caffeine (more than two cups of coffee a day have been linked to endometriosis; Am J Epidemiol, 1993; 137: 1353-60) and alcohol, which affects the health of the liver and diminishes its ability to detoxify waste hormones.
Exercise can also minimise body fat and raise levels of SHBG, which will counteract the effect of the high levels of testosterone. Exercise also lowers high levels of oestrogen; in one study, women who exercised for four hours a week more than halved their risk of breast cancer (J Natl Cancer Inst, 1994; 137: 18).
Besides dietary problems, constant stress could account for your condition. According to Colette Harris, author of the excellent PCOS: A Woman's Guide to Dealing with Polycystic Ovary Syndrome (Thorsons, 2000), stress triggers your stress hormones, or cortisol, which places your glucose stores on red alert for responding to the 'fight or flight' situation.
When excess amounts of these stress hormones are constantly released, you can develop Cushing's syndrome, which causes weight gain, mood swings, excess body hair, irregular periods, acne and
diabetes many of the same symptoms as PCOS. Furthermore, the artificially high levels of insulin in most women with PCOS tend to increase cortisol levels so that women with PCOS are flooded
with cortisol in times of stress.
Because stress will get to you more than most people, it is vital that you embark on a stress management programme. This can take the form of regular exercise, and also regular massage and aromatherapy, biofeedback, reflexology or meditation whichever suits you best.
It's also vital that you attempt to remove yourself from the source of stress. If your job is particularly stressful and gives you constant grief, consider getting a new job.
Doctors mainly tend to use the Pill to control symptoms of PCOS. According to Dr Adam Carey, Collette Harris's co-author, who runs the Centre for Nutritional Medicine and has a special interest in PCOS, the Pill only masks symptoms for a while and then tends to make the problem worse (as it may have done in aggravating your endometriosis).
"In the long term, [the Pill] would seem to be driving the process in an undesirable direction,"
he says. "The use of the Pill appears to make the user gradually more insulinresistant over a period of time. . . Increasing insulin resistance and the associated hyperinsulinaemia will gradually make symptoms worse. This may be why women who use the Pill for symptom relief often initially get very good results, but then, after a year or so, their symptoms return. Its important to have regular periods for the long term health of the uterus."
Naturopath Harald Gaier, who regularly treats patients with PCOS and endometriosis, finds that both conditions respond well to Agnolyt, made by Madaus AG in Cologne, Germany, a proprietary brand of the herb Agnus castus, which has a long history of regulating female hormones. The secret of this preparation's success appears to be that it makes a tincture from the fruit of A. castus rather than from other parts of the plant, as most formulations do. Taken over six to eight months, Agnolyt can stimulate the anterior pituitary gland, increase levels of progesterone, normalise other hormone levels and shrink cysts of the ovary.
In Gaier's experience, this regime will often resolve all the painful symptoms of PCOS and improve endometriosis as well as fibroids.
One important caveat. If you take too much of this herb, it can affect your mental state and make you depressed and negative. Harald often starts his patients on 30 drops once a day in the morning and reduces the dosage to 25 or even 20 drops if they complain that it is adversely affecting their moods. This is why, whenever possible, it is important to work with a qualified herbalist before embarking on this treatment. (For information about where to get hold of Agnolyt, see page 6).