The three main features of the condition are cysts that develop in the ovaries (polycystic ovaries), ovaries that do not regularly release eggs (ovulate) and high levels of “male hormones” called androgens. Polycystic ovaries contain a large number of harmless cysts up to 8mm in size. The cysts are under-developed sacs in which eggs develop. Often in PCOS, these sacs are unable to release an egg, meaning ovulation does not take place.
PCOS is a complicated metabolic disorder associated with inflammation and insulin resistance. Although insulin resistance is considered a major mediator of PCOS, it is not present in all cases. It is, however, relevant in up to 70% of women with PCOS.
Since insulin resistance will be a topic of other note insulin resistance is considered to be a major cause.
Oestrogen and Testosterone
Sex Hormone Binding Globulin (SHBG) is an important regulator of oestrogen balance in the body. High levels of SHBG are associated with an oestrogen-dominant environment. Lower levels of SHBG, which are more likely to be associated with a higher testosterone-to-oestrogen ratio, are often seen in those with PCOS. A diet high in processed refined foods, sugars and elevated insulin levels is commonly associated with a decline in the production of SHBG
In some cases of PCOS, ovulation is impeded due to higher levels of LH. The follicle-stimulating hormone (FSH) is the hormone responsible for the development of the egg and follicle, whereas LH triggers the release of the egg from the follicle.
Some ovaries are known to develop multiple cysts due to undeveloped follicles but not all will lead to symptoms or impact negatively on fertility. It is only when hormonal imbalance occurs that this is shown, which is why ultrasound scans of the ovaries alone are not conclusive for PCOS.
Hair-related symptoms associated with PCOS (excess hair growth on the body, facial hair and thinning of the hair on the scalp) are considered to be a result of increased circulating testosterone blood levels.
A hormonal cascade
The cascade of excess insulin, insulin resistance, hyperandrogenism and oestrogen dominance is self-perpetuating. Increased insulin from high blood glucose due to excessive carbohydrate intake and/or stress, leads to insulin resistance which increases androgen production but additionally promotes central obesity. Both high insulin and central obesity triggers excess androgens to be converted to Oesterone. This disrupts GnRH (gonadotrophin releasing hormone from the hypothalamus) and in turn affects the production of LH and FSH, leading to excess LH and insufficient levels of FSH. These imbalanced hormones further exacerbate androgen production leading to hirsutism, acne, and male hair distribution but also cessation of menses and anovulation and hence infertility.
Therefore, when considering interventions for PCOS ameliorating insulin excess and resistance must be considered.
Dietary interventions
Natural unrefined diets promote good blood sugar control and increase insulin sensitivity. It is important to consider low glycaemic load diets with fiber, healthy fats, and lean protein as they are essential for blood sugar regulation, reducing insulin levels and improving insulin sensitivity.
Including spices into your diet, such as cinnamon, may aid; this spice has long been considered supportive of blood sugar control. Garlic and onions have also been shown to be beneficial, although it may be important to look at more specific support. In fact, cinnamon has been found to be most myo-inositol of over 100 herbs/vegetables.
“Eleven meta-analyses results reveal that cinnamon supplementation significantly reduced serum levels of FPG, insulin, HOMA-IR, and HbA1c in T2D patients and in women with PCOS. For FPG and HbA1c, this reduction was the strongest in T2D participants”
Focusing on insulin resistance – Myo-inositol
Studies have identified myo-inositol (MI) as a useful intervention for PCOS due to its insulin sensitizing properties.
Inositol is a word that collectively refers to molecules with a similar structure, a collection of nine stereoisomers-MI is a specific stereoisomer. It will be covered under separate note.
Research
One observational study 3602 infertile women used MI and folic acid between 2 and 3 months in a dosage of 2 × 2000 mg MI + 2 × 200 μg folic acid per day. It was demonstrated that 70% of the patients had restored ovulation after the treatment. Furthermore, the achieved pregnancy rates are at least in a range equivalent to, or even superior to, those reported by the use of the insulin sensitizer metformin (a pregnancy rate of 14.4% in a cohort of 90 women and of 12.3% in a cohort of 75 women with PCOS were described). (1)
Studies show that MI leads to a decrease in LH and androgen levels, as well as a decrease in insulin resistance. Thus, MI is believed to be able to re-establish ovulatory menstrual cycles (especially in obese women with PCOS) but its effect on pregnancy rates is difficult to determine.
MI, at a dose of 4 g per day (2 g twice per day), three months prior to ovarian stimulation, is effective in normalizing ovarian function, improving oocyte and embryo quality in PCOS. However, further evaluations by large multicenter randomized controlled trials are needed to assess the clinical pregnancy and live birth rates in ART, because many published studies were heterogeneous. In addition, MI is a secure and cost-effective alternative in the treatment of PCOS, with no side effects observed in the standard dosage.(2)
Inositol in anxiety and depression
MI may indirectly support PCOS further by eliciting benefits to mood and anxiety disorders. Research suggests that MI may improve depressive and anxious conditions. The mechanism of this not fully understood, however, what is known is that inositol is used for the production of inositol triphosphate and diacylglycerol, important ‘second messengers’ allowing cell surface receptors for neurotransmitters, including serotonin, to affect intracellular processes.
The effect of PCOS on fertility and mood cannot be underestimated as disruption to normal reproductive function can be detrimental to mood, self-esteem and contribute to HPA dysfunction due to excess stress. These potential benefits to cognitive health are therefore supportive.
A general guide to further supplement support
A good quality multivitamin and mineral provides a balanced start to supporting health and reduces the risk of potential dietary led deficiencies through providing essential micronutrients needed for optimum health. Many of the nutrients important for carbohydrate metabolism, blood sugar balance and insulin regulation will be found in a well-balanced multi-formula that includes the B vitamins, vitamin D, zinc, and chromium.
Chromium
Chromium encourages the formation of glucose tolerance factor (GTF) which is a substance released by the liver and an important part of carbohydrate metabolism and the maintenance of normal glucose levels. When chromium levels are low in the body, GTF levels are also low, and the activity of insulin is blocked leaving elevated glucose levels in the blood. Note: if you are diabetic and on medication, you should speak with your doctor before taking chromium.
Magnesium
Low levels of magnesium are considered to be associated with a decreased level of insulin sensitivity.
Omega 3
Diets high in saturated fats and with a higher ratio of omega 6 to omega 3 are considered to increase triglycerides and have a detrimental impact on insulin resistance. Increasing intake of omega 3 from nuts, seeds and oily fish supports the healthier ratio of omega 3 to 6.
This is not a complete list of nutrients and herbs, which many consider beneficial in support of conditions such as blood sugar control, energy distribution and PCOS.
And now the notes on herbs are from our face book group:
Lot of herbs are researched to help and over the time we have placed several notes on those herbs in our face book group and they can easily be arranged.
1. Clinical studies with herbal medicine on polycystic ovary syndrome (PCOS) dt: 23/may/2022
2. PCOS (polycystic ovarian syndrome) and Tribulus Terrestris/Puncturevine herb. Dated: 6-dec-2023
3. POLYCYSTIC OVARIAN SYNDROME AND GENISTEIN 27-july -2023.
References
Regidor PA, Schindler AE. Myoinositol as a Safe and Alternative Approach in the Treatment of Infertile PCOS Women: A German Observational Study. Int J Endocrinol. 2016; 2016:9537632.
Merviel P, James P, Bouée S, Le Guillou M, Rince C, Nachtergaele C, Kerlan V. Impact of myo-inositol treatment in women with polycystic ovary syndrome in assisted reproductive technologies. Reprod Health. 2021 Jan 19;18(1):13. doi: 10.1186/s12978-021-01073-3. PMID: 33468143; PMCID: PMC7816413.