Genetics and heredity are the usual suspects in this common hormonal disorder, which leads to abnormal menstrual cycles, enlarged ovaries and excessive hair growth. However, the new research indicates that exposure to bisphenol A (BPA), a chemical used in plastics and food-can linings, could be a significant environmental cause.
The researchers studied 71 women with PCOS and 100 women without the condition (the controls). They were split into groups matched by age and body composition, then their blood levels of BPA were measured. The results showed that women with PCOS had significantly higher levels of BPA compared with the controls.
In fact, blood levels of BPA were nearly 60-per-cent higher in lean women with PCOS and more than 30-per-cent higher in overweight women with the syndrome compared with the control group. Moreover, as BPA levels increased, so did concentrations of testos-terone (the male sex hormone) and androstenedione, a steroid hormone that is converted to testosterone. There was also a positive association between BPA levels and insulin resistance. High testosterone levels and insulin resistance are key characteristics of PCOS (J Clin Endocrinol Metab, 2011; 96: E480-4).
According to the researchers, the findings suggest that women with PCOS have difficulty clearing BPA from their system. "Excessive secretion of androgens, as seen in PCOS, interfere with BPA detoxification of the liver, leading to accumulation of blood levels of BPA," said study co-author Evanthia Diamanti-Kandarakis. However, the results could also mean that exposure to BPA might be an underlying cause of PCOS.
Indeed, BPA has a reputation for being a 'hormone disruptor', and a recent animal study found that female rats injected with BPA when they were newborns went on to develop PCOS-like hormonal abnormalities as adults. The rats exposed to BPA at the highest dosages showed large numbers of cysts on their ovaries as well as infertility (Environ Health Perspect, 2010; 118: 1217-22).
Although more research is needed to determine precisely what role BPA plays in PCOS, in the meantime, women with the condition are being advised to limit their exposure to the chemical. It might also be wise to minimize exposure to other hormone-disrupting chemicals in the environment, such as pesticides and the plastics chemicals phthalates.
Still, as we don't yet know whether reducing exposure to these chemicals will have any beneficial effects on actual symptoms of PCOS, here are some tried-and-tested ways to manage the condition.
- Maintain a healthy weight. If you are overweight, one of the most effective ways to alleviate classic PCOS symptoms is to lose weight. Although no one really understands the link between overweight and PCOS symptoms, it appears that overweight women, in general, have far lower levels of sex hormone-binding globulin (SHBG) in their blood. This deficiency can bring on higher levels of circulating testos-terone that, in turn, can cause many of the more disturbing symptoms of PCOS, such as facial hair. Research shows that even modest weight loss (as little as 5 per cent of the initial weight) can balance hormones, normalize menstrual cycles, and improve the likelihood of ovulation and pregnancy (Int J Womens Health, 2011; 3: 25-35).
- Try a low-glycaemic-index (GI) diet. Low-GI diets appear to help women with PCOS. Not only can they aid weight loss, but they may also improve insulin resistance, which is a major feature of PCOS. In one study, Australian researchers compared the effects of a low-GI diet with a conventional healthy diet (a reduced-calorie, low-fat, moderate-to-high-fibre diet) in overweight and obese women with PCOS. The results showed that insulin sensitivity and menstrual patterns improv-ed significantly more in the women who were following the low-GI diet (Am J Clin Nutr, 2010; 92: 83-92).
- Exercise. An increase in physical activity is often recommended for PCOS patients, although it's not known what the optimal type, duration or frequency is. A recent small study suggests that individualized aerobic training is beneficial by improving insulin sensitivity, as well as reducing the number of follicles on the surface of the ovaries (a high count is characteristic of PCOS). Interestingly, these changes were independent of changes in body weight (Fertil Steril, 2011; 95: 2696-9).
- Consider acupuncture. A review of the literature by researchers at the University of New South Wales in Sydney, Australia, concluded that "[a]cupuncture is a safe and effective treatment" for PCOS. Although they noted that higher-quality studies are needed, it appears that acu-puncture may help PCOS in a number of ways, such as by increasing blood flow to the ovaries, reducing the number of ovarian cysts, increasing insulin sensitivity and assisting in weight loss (Gynecol Endocrinol, 2010; 26: 473-8).
- Supplement your diet. Certain supplements appear to be useful for PCOS, so consult a qualified practitioner to check what's right for you. The following have shown promise in clinical trials:
- Inositol. This naturally occurring nutrient, unofficially referred to as 'vitamin B8', was tested in a randomized, double-blind, placebo-controlled trial, considered the 'gold standard' for scientific evaluation. A total of 136 women were given inositol (100 mg twice daily), while 147 were given a placebo. After 14 weeks, the inositol group showed signifi-cant improvement in ovulation frequency compared with the placebo group. Benefits were also seen in terms of weight loss and levels of HDL (good) cholesterol (Eur Rev Med Pharmacol Sci, 2003; 7: 151-9). A form of inositol called myo-inositol is also being trialled for PCOS. One study found that it reduced insulin and testosterone levels after three months, and improved acne and hirsutism after six months (Gynecol Endocrinol, 2009; 25: 508-13).
- B-complex vitamins. In a study of women with insulin-resistant PCOS receiving infertility treatment, those taking B vitamins had higher pregnancy rates compared with those taking the antidiabetic drug metformin (Fertil Steril, 2007; 88: 227-30).
- Chromium. A pilot study found that 200 mcg/day of this trace mineral improved insulin resistance in women with PCOS. However, it had no effect on menstrual cycles or hormone levels (Fertil Steril, 2005; 84: 1755-7).
- Alpha-lipoic acid. In a 16-week study of six lean, non-diabetic women with PCOS, this natural fatty acid (600 mg twice daily) improved insulin sensitivity by 13.5 per cent. Moreover, two women who were not taking oral contraception had an increased number of menstrual cycles (J Diabetes Sci Technol, 2010; 4: 359-64). However, better-quality studies are still needed.
- N-acetylcysteine (NAC). Studies suggest that this amino acid can improve insulin sensitivity and boost pregnancy rates in women with PCOS (Fertil Steril, 2002; 77: 1128-35; Fertil Steril, 2005; 83: 367-70).
- Vitamin D. Recent studies suggest that a deficiency in this vitamin could be involved in PCOS, and that supplemen-tation might be beneficial. In a pilot study published online ahead of print, a high dose (20,000 IU) of vitamin D given weekly for 24 weeks led to improvements in menstrual frequency and glucose metab-olism (J Endocrinol Invest, 2011, May 24). However, yet again, randomized controlled studies are still needed.
- Try herbs. Respected nutri-tionist and women's health writer Dr Marilyn Glenville recommends the following herbs for PCOS in her bookThe Natural Health Bible for Women (London: Duncan Baird Publishers, 2010). Consult a registered, experienced practi-tioner who can determine the best herbs and dosages for you.
- Agnus castus (Vitex agnus castus) is a good menstrual-cycle regulator.
- North American black cohosh (Cimicifuga racemosa) can help to suppress levels of luteinizing hormone (LH). High levels of LH are commonly found in women with PCOS and can contribute to symptoms.
- Saw palmetto (Serenoa repens) can reduce levels of androgens (male hormones), such as testosterone, in the system.
- Dandelion root (Taraxacum officinale) and milk thistle (Silybum marianum) can help to cleanse the liver and detoxify the body.
- Drink spearmint tea. Preliminary findings suggest that drinking spearmint herbal tea can reduce testosterone levels and possibly improve the excessive hair growth of PCOS. However, it may take quite some time (more than 30 days) to see any results (Phytother Res, 2010; 24: 186-8).
Factfile:Minimizing exposure to BPA
BPA is found in a variety of consumer goods, including food-can linings, and plastic food and drink packaging. It can leach into the product inside and end up in our bodies, where it can wreak havoc on our hormones. You can limit your exposure by:
- consuming fresh, unprocessed foods and avoiding canned goods as much as possible
- avoiding plastic food containers marked with the number '7' in the recycling logo (generally rigid, transparent containers)
- choosing glass rather that plastic or metal water bottles (metal bottles may be lined with BPA-containing plastic)
- avoiding the use of plastic containers in the microwave (use ceramic,glass or other microwavable dishware instead)
- using containers made of glass and stainless steel to store food in rather than plastic.
products whenever possible (see www.pollutioninpeople.org for more information).
WDDTY VOL. 22 NO. 5