PCOS (Polycystic Ovarian Syndrome): East Meets West
Written by Rachel Muich, L.Ac, MSTCM and originally posted on www.firewoodacupuncture.com.
Polycystic Ovarian Syndrome, or PCOS, has troubled the minds of health professionals for years. Sadly, there are no real clear answers to most of the questions health care practitioners have simply because it’s a relatively new disorder. There have been many arguments and great puzzlement over what constitutes a PCOS diagnosis throughout the last couple of decades. What’s even more puzzling is that it can present with a combination of symptoms or the complete absence of common symptoms altogether.
Simply put, PCOS can be described as a hormone disorder. However, the steps to diagnose it are more involved. Common symptoms include:
weight gain
infertility
loss of menstrual cycles and anovulatory cycles
acne
hirsutism (hair growth on the face/back/chest)
head hair loss, male-pattern baldness
polycystic ovaries seen on ultrasound
PCOS has become a “catch all” diagnosis for doctors who just don’t understand why women aren’t ovulating, menstruating, or are dealing with irregularities within their cycle.
Traditional Chinese Medicine Approach
As practitioners of Chinese Medicine, we are constantly looking for patterns in the body. Your symptoms are signal fires guiding us to the root cause of your imbalance, and it’s our job to find that root imbalance to provide relief or reversal or symptoms.
You may be experiencing hot flashes at night, gas and bloating after meals, extreme fatigue, or emotional imbalance. These things may seem unrelated to your menstrual cycle, but oftentimes, especially with hormonal disorders, there are several things going on at one time, so it’s important we always have a clear picture of your lifestyle and presenting symptoms of any organ system.
Acupuncture treatments and herbal medicine therapy are cumulative. It takes a long time to develop menstrual irregularities and it will take a while to correct….but it can be corrected. Eastern medicine offers a patient-centered approach meaning, YOU have to do the work and you guide your own recovery. I like to think of acupuncturists as the bumpers on a bowling lane. We can guide you back on track when you start to go off the rails, but you’re in charge of your potential to heal and you’re guiding your recovery. We’re giving you some tools.
Common Patterns
According to Giovanni Maciocia, “PCOS may correspond to several gynecological diseases: Infertility, scanty periods, no periods, flooding and trickling, irregular periods…[and] the main patterns appearing in PCOS are as follows: Damp-Phlegm, Kidney Deficiency, Blood Stasis, Damp-Heat in the Liver Channel, Blood Deficiency, and Liver-Fire…the two most important patterns in PCOS are Damp-Phlegm in the Uterus and a Kidney Deficiency.” (Maciocia, 2011, p. 896-897).
What do all of those patterns mean? For the purposes of this post, I’m going to focus on the two main patterns as outlined by Maciocia, with the first being Damp-Phlegm in the Uterus. Damp or Phlegm can be loosely linked to excess, sticky fluids like mucus build-up, invading pathogens that cause sickness and inflammation, excessive vaginal discharge or a build up of excess ear wax, or skin tags, cysts, eczema, and other skin growths. Dampness can form due to malabsorption of essential nutrients for hormone production due to digestive imbalances, poor circulation or poor blood flow to the uterus, or toxicity from environmental factors. “Damp-Phlegm obstructs the uterus and ovaries and it has two effects: on the one hand, it interferes with normal hormonal function in the ovaries and, on the other hand, it obstructs the Uterus preventing implantation of the ovum. The ovarian cysts are due to Damp-Phlegm” (Maciocia, 2011, p. 897).
This could explain weight gain in the middle, which is a common symptom as are constant vaginal discharge and the formation of cysts on the ovaries. The main symptoms of Damp-Phlegm include scanty periods, no periods, obesity, excessive hair, feeling of oppression in the chest, abdominal masses, excessive vaginal discharge with a swollen, sticky tongue. (Maciocia, 2011). Here we will need to resolve Damp-Phlegm, move Qi, and soften masses.
The second main pattern is Kidney Deficiency, which may be of Yin or Yang but more often the latter. “[T]he deep hormonal imbalance points to a Kidney deficiency and an imbalance of the Governing, Directing, and Penetrating Vessels (Du, Ren, and Chong Mai). We could see the hyperandrogegism and the disruption of the estrogen metabolism of PCOS as a reflection of the imbalance between the Governing Vessel (controlling androgens in women) and the Directing Vessel (controlling estrogen). If there is Blood Stasis and/or Blood Deficiency, then the Penetrating Vessel is also involved. The Kidney, therefore, is the root in PCOS” (Maciocia, 2011, p. 897). This is a very fancy way of saying, your HPA Axis (hypo-pituitary-adrenal axis) is stressed out or you are dealing with the effects of trauma or emotional stress which has led to a deficiency in the energetics of your Kidney meridian. This does not mean your Kidneys are diseased, but rather, there are a lack of resources circulating to or through your Kidneys and that deficiency needs to be rectified.
Interestingly, the Kidney pattern is always combined with either Dampness or Blood Stasis where Kidney Yin and/or Kidney Yang play roles separately. Maciocia explains that there are dozens of combined patterns like this, but that the combination of Damp, Phlegm, Kidney Yin, Kidney Yang, and Blood Stasis are seen most often clinically.
An example of the symptoms for Damp-Phlegm, Kidney Yin Deficiency, and Blood Stasis would be obesity, hirsutism, excessive vaginal discharge, feeling of fullness and heaviness of the abdomen, irregular periods, scanty periods, amenorrhea (no cycles), painful periods with dark, clotted blood, abdominal pain, backache, dizziness, tinnitus (ringing in the ears), night sweating, feeling of heat in the evening, tiredness, and low spirits. (Maciocia, 2011). This type of disorder is best treated alongside the phases of the reproductive cycle, meaning, weekly treatments would entail specific point prescriptions and herbal remedies. It’s important to remember that first, we must invigorate the blood, eliminate stasis by driving blood flow to the uterus, and lastly, resolve Dampness or Phlegm build-up. All of the combined patterns are to be treated in phases just as the pattern I described above.
Herbal Medicine
Chinese herbal therapies help support the balancing of the meridians that directly relate to blood flow to the uterus. These are the Liver, Kidney, and Spleen channels.
—> The Liver stores Blood and is in charge of the smooth flow of energy in the body, which includes proper detoxing and recycling of essential fluids.
—> The Kidneys filter Blood and are our body’s internal engine, pumping out fuel to other stressed out organs when necessary and eliminating toxic loads and other waste passed down from the Liver.
—> The Spleen transforms and transports Blood and other fluids in the body, including nutrients extracted from food and drink. This fluid metabolism is important during all phases of the menstrual cycle.
These organs are also responsible for detoxification of high levels of androgens and estrogens. Your Kidneys, specifically, facilitate a reduction in cortisol levels (stress hormones). We can prescribe formulas to assist with any organ system dysregulation like poor sleep, a weak or compromised digestive tract, or poor circulation to your ovaries and uterus.
Lastly, education can NEVER be discounted. Acupuncture appointments will include detailed recommendations on how to eat in a way that supports healthy hormone levels, which often include slight modifications during each week of your cycle; and lifestyle adjustments you can make in order to find your natural rhythm again.
Western Approach
Criteria to obtain a PCOS diagnosis using bloodwork or other lab work are as follows:
In 1990, the NIH, the National Institute of Health posited “[PCOS] requires three criteria:
1. Delayed ovulation or periods, known as oligoovulation.
2. Excess androgens, such as testosterone or DHEA, causing acne, hirsutism, male pattern hair loss, or high androgens on a woman’s bloodwork.
3. Other conditions that would create a similar syndrome would have to be excluded.”
This is just one view, however. According to Fiona McCulloch, N.D., author of 8 Steps to Reverse Your PCOS, there are four main phenotypes of PCOS, that were outlined by Rotterdam—a 2003 meeting in Rotterdam, Netherlands, and sponsored by the top reproductive medicine groups: ESHRE (European) and ASRM (American). At this meeting, a new set of criteria was determined. The three criteria included:
“1. Delayed ovulation or menstrual cycles (anovulation);
2. Hyperandrogenism/high androgenic hormones like testosterone;
3. Polycystic ovaries on ultrasound.” (“Diagnostic criteria for polycystic ovary syndrome: comparison between Rotterdam 2003 and NIH,” 1990).
The 4 phenotypes are as follows:
Type A - hyperandrogenic, anovulation, and polycystic ovaries
Type B - hyperandrogenic and anovulation
Type C - Hyperandrogenism and polycystic ovaries
Type D - anovulation and polycystic ovaries (McCulloch, 2016, p. 9)
These criteria and types of PCOS are the most widely-accepted to date, though, as this syndrome progresses, these could morph or be eliminated all together as research and varying presentations continue to surface.
Causes
The exact cause of PCOS is unknown as every female presents with a different set of patterns or signs and symptoms, however, according to hormone.org, “PCOS seems to be inherited. Female relatives or children of patients with PCOS are at increased risk for having PCOS. Environmental risk factors, including low birth weight, rapid weight gain in infancy, early pubic hair and puberty development, childhood obesity, excess adult weight, exposure to harmful chemicals like glyphosate and unhealthy lifestyle factors, like exposure to EMFs or other endocrine disruptors, are also important and may interact with genes to lead to PCOS (called epigenetics)” (“Polycystic Ovary Syndrome,” 2018). There is no way to know how or why this develops, not yet anyway.
Western Treatment
There are dozens of approaches to this syndrome. More often than not, upon a diagnosis of PCOS, a woman may be given birth control pills, as they have proven to “balance” the hormones in an artificial way by suppressing symptoms for the duration the pill is administered. In addition, the medication, Metformin, which is mainly used to treat type 2 diabetes, may be prescribed because of its abilities to balance insulin levels. According to the NCBI:
“Insulin resistance appears to be the fundamental common pathway to disease amongst women with PCOS. Women with PCOS have normal insulin molecules and the insulin receptor on cells appears to be normal. However it appears to be a post-receptor deficit, in relation to the downstream cellular effects of what happens after insulin binds to the insulin receptor, meaning that the molecular cascade of intracellular events has a level of impairment, leading to a post-receptor ‘intracellular’ resistance to insulin. Since there is relative insulin resistance, women with PCOS produce higher levels of insulin than they otherwise would have. These increased circulating levels of insulin have direct effects on the ovaries, and the increased insulin levels also release other factors—notably insulin-like growth factor 1 (IGF-1) from the liver—which, in turn, exerts an effect on the ovary. The impact of higher levels of insulin and IGF-1 on the ovary is for the ovary to release higher levels of testosterone. All of these hormones—including insulin, IGF-1 and testosterone—prevent the growth of ovarian follicles through to ovulation, leading to an accumulation of small ovarian follicles less than 10 mm diameter that do not progress through to ovulation (“Metformin Use in Women with Polycystic Ovary Syndrome,” 2014).”
Still though, the importance of diet cannot be understated here. While there is currently no gold standard diet for patients with PCOS, it’s incredibly important to follow an anti-inflammatory regimen and to regulate your blood sugar to combat insulin-resistance since sufferers of this syndrome are already prone to inflammation and insulin-sensitivity. Your relationship with food is incredibly important in order to manage this syndrome.
In Dr. McCulloch’s book, she lists eight areas that require attention and care in order to reverse your PCOS, or to successfully maintain the syndrome throughout life, to a point where it causes you very little discomfort or concern of developing secondary diseases, like cardiovascular disease, diabetes, or cancer.
The eight areas of concern are as follows:
Inflammation
Insulin Resistance
Androgen Excess
Hormone Balance/Ovulation
Adrenal
Thyroid
Environmental Factors
Nutrition and Diet
She states, “You may need to spend more time on one step, particularly if you have a significant factor in that area, whereas you may not need to spend as much time with other steps. Another consideration is that when you work on the underlying causes, like inflammation and insulin resistance, you may see problems resolve in some of the other areas before you get there.” (McCulloch, 2016, p. 5). Helpful supplements like N-acetyl cysteine (NAC), Curcumin, Probiotics, or Omega-3 fatty acids have shown to help women fight inflammation, heal the gut, and promote healthy insulin levels.
So where does that leave us?
Like most disorders, PCOS has mainly been treated with a Western approach, and with some success. Most women don’t pursue an aggressive form of treatment until they are ready to get pregnant, though they should. Education is especially paramount in teens who are diagnosed with PCOS so their ability to minimize or fight the symptoms later in life is stronger. The four phenotypes Dr. McCulloch outlined are helpful in determining your level of PCOS and she stresses that if you have type A or B, with diligence and a deeper understanding of the syndrome, you can be pushed into the type C or D category, which have milder and more manageable symptoms.
In recent years, a turn to Eastern and alternative healing has flooded the Western world in terms of treating women with infertility and menstrual irregularities, and there has been great success. With PCOS being a relatively new disorder, however, it’s difficult to determine what approach is best; but, like most disorders, it is important, especially in reproductive disorders, to determine the root cause and not simply suppress the symptoms with artificial medications. That type of branch approach has proven to cause greater difficulty down the road for those women with a PCOS diagnosis.
My Story and Ongoing Journey with PCOS:
I had the quintessential midwestern upbringing with loving parents, two older siblings, and a strong family bond. We played sports, we took vacations, and we celebrated each other at every turn, which often included eating ice cream, a fridge in the basement filled with every type of soda you could imagine, pizza every Friday night, grandparents who spoiled us with cinnamon rolls every weekend and if that didn’t happen, we got donuts and watched early morning cartoons. Are you seeing a theme here? Food is a midwestern love language. And we are all fluent.
After spending the better part of my 20s in and out of doctor’s offices, I was finally diagnosed with PCOS—Polycystic Ovarian Syndrome. What on earth was that?
Here’s what I knew: I started my period at a very young age, 10 years old. My periods were never regular. I was put on the birth control pill at 15 years old. I stayed on the pill until I was 26 years old. My period did not return for 6 months, and when it did, it came back with a vengeance. And then my period cycles started to get longer……and longer……and longer…..until they just stopped coming entirely.
Here’s what I was being told by doctors: Your only hope is synthetic hormones. You’re not ovulating at all which means you’re not fertile and if you don’t take hormones, you’ll become sterile. Your risk of getting ovarian cancer just increased by 40% due to this diagnosis. Your diet has no bearing whatsoever on your reproductive health.
Here’s what I think about it (after a decade of self-guided research and connecting with my own body): Your diet absolutely plays a role in your reproductive health. Furthermore, your diet as a child plays a role in reproductive health. Now more than ever, we are being fed high fructose corn syrup, GMO foods, processed foods, and fast foods loaded with salt and preservatives. Our body learns how to process things at a young age and certain genetic triggers get turned on and off when you feed it an unnatural diet. All of those sweet treats, access to soda, eating vegetables from cans, and not focusing on an organic base diet contribute to the type of reproductive frustrations we, as women, share across the globe. In fact, more and more studies are coming out that speak to egg quality specifically and how to eat according to where you are in your cycle, especially during ovulation to increase chances of fertilization (if you are trying to get pregnant).
Why Eastern medicine really shines with reproductive health: All of this begins with education. Had I not spent so much time trying to figure out what was really going on, I might still be on the pill. I might be living my life in fear thinking that I’m going to get ovarian cancer. I might have just accepted that “doctor knows best,” when, in actuality, I know more about my own body than a complete stranger, despite their years of study and subsequent degrees. And that is the real gift of eastern healing—a deeper knowing of yourself and the confidence to sit in the driver’s seat of your own wellness.
References:
Diagnostic criteria for polycystic ovary syndrome: comparison between Rotterdam 2003 and NIH (1990). Retrieved from: https://www.fertstert.org/article/S0015-0282(06)04683-8/fulltext
Maciocia, Giovanni (2011). Obstetrics and Gynecology in Chinese Medicine. Great Britain, England: Churchill, Livingstone, Elsevier.
McCulloch, Fiona, N.D. (2016). 8 Steps to Reverse Your PCOS. Austin, TX: Greenleaf Book Group Press.
Metformin use in women with Polycystic Ovary Syndrome. (2014). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200666/
Polycystic Ovary Syndrome (PCOS). (2018). Retrieved from: https://www.hormone.org/diseases-and-conditions/polycystic-ovary-syndrome