Treatments for Polycystic Ovary Syndrome (PCOS) are based on three main approaches:
- Weight loss
- Western medication or surgery
- Complementary therapies including supplements
(i) Weight loss
The chances of having PCOS increase if you’re overweight or obese, and the first line of treatment for many women with PCOS is weight loss as it can dramatically change hormone levels to not only improve fertility, but other health conditions including diabetes, hypertension and high cholesterol. Losing weight reduces the chances of these illnesses and triggers ovulation; in fact losing just 5% of body weight usually alters hormone balance enough to normalise ovulation and make natural pregnancy possible.i For women of 180lbs that’s just a 9lbs reduction, and a 10% weight loss reduces body fat by 30%, and nearly every woman ovulates then.
For many women (especially if overweight, but also many normal weight women) their PCOS is due to problems with sugar metabolism and insulin resistance, because high insulin levels stimulate the ovaries to produce testosterone. Genetics and the environment clearly contribute to PCOS and some people are more likely to be insulin resistant than others on the same diet, simply because their ancestors had adapted to low carb and sugar diets. Appreciating this really helps to understand how diet choices and exercise regimes affect us, and the good news is that when obese women with PCOS follow a 1200 kcal/day diet this happens:
- Three quarters lose 5% of their weight and a third lose 10%
- All reduce their BMI, body fat and waist and hip circumferences
- The ovaries significantly shrink in size, as do the number of cysts in them
- Two thirds of non-ovulating women resume normal cycles
- A third get pregnant when they lose at least 5% weight
Diet is a tricky subject, and best way to lose weight is usually by joining a support group, cutting calories (especially sugar) and taking regular exercise at the same time. The relationship between PCOS and high insulin levels makes a diabetic-type diet ideal, but also bear in mind that:
- Increasing protein in the diet reduces PCOS rates (we strongly advise vegetable protein)ii
- A high-fat diet contributes to PCOS (and insulin resistance) developingiii
- A low carb diet reduces PCOS (and insulin resistance)iv
- Losing weight by dieting is far more effective than taking metformin type drugs for obese and overweight women with insulin resistance and PCOSv
Drugs are often the first doctors suggest, with birth control pills offering hope of regular periods and less hair growth, however they stop you having a baby…! Women trying to conceive and wanting a medicated answer are best off seeing a reproductive endocrinologist for a proper evaluation and treatment, and what’s usually recommended is:
- Clomiphene citrate (clomid)vi is inexpensive and often successful, especially for younger women, but may be less appropriate for tired or older women as it thins the womb lining and this issue is more likely to affect them. It also carries a risk of ovarian hyper-stimulation syndrome (OHSS) and the side effects including hot flushes, mood swings, visual disturbances, breast tenderness, nausea and pelvic discomfort (natural alternatives to clomid, such as black cohosh avoid the side effects), and if clomid doesn’t do the trick, the options are then usually:
- Gonadotropins which are hormones that directly affect the ovaries (usually FSH) they’re expensive and increase the risk of multiple pregnancy and ovarian hyper-stimulation syndrome (OHSS), so a low-dose regimen with ultrasound monitoring is usually offeredvii
- Ovarian drilling involves laparoscopic surgery with 4-10 small follicles getting punctured, which often triggers normal ovulation or ovulation along with Clomid or FSH, however it also destroys ovarian tissue and reduces the ovarian reserve
- Metformin is often prescribed alongside clomid, the guidelines for metformin use in PCOS advise it’s restricted to women with glucose intolerance, there’s debate about its routine use for PCOS,viii and there are viable, healthy alternatives
(iii) Supplements and complementary treatments
There’s some REALLY exciting evidence on complementary and supplement use for treating PCOS:
Chinese medicine has been used in to raise fertility for centuries. Chinese herbal medicine is 3x more effective than clomid for live births, without the side effectsix and acupuncture can:
- Improve metabolic and hormonal systems long termx
- reduce androgens and acne
- promote ovulation and the frequency of periodsxi
i ‘Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet‘ P. G. Crosignani et al. Hum. Reprod. (2003) 18 (9): 1928-1932.
ii ‘Effects of increased dietary protein-to-carbohydrate ratios in women with polycystic ovary syndrome’ Lone B Sørensen, et al. Am J Clin Nutr January 2012 vol. 95 no. 1 39-48
iii ‘Obesity induced by high-fat diet promotes insulin resistance in the ovary’. Eliana H Akamine et al. J Endocrinol July 1, 2010 206 65-74
iv ‘Favorable metabolic effects of a eucaloric lower-carbohydrate diet in women with PCOS.’ Barbara A. Gower, et al. Clinical Endocrinology 2013.
v ‘Effect of Metformin compared with hypocaloric diet on serum C-reactive protein level and insulin resistance in obese and overweight women with polycystic ovary syndrome’ Fatemeh Esfahanian et al. Journal of Obstetrics and Gynaecology Research, Vol 39 Issue 4. DEC 2012. DOI: 10.1111/j.1447-0756.2012.02051.
vii ‘Ovulation induction in polycystic ovary syndrome’. Vause TD, Cheung AP, Sierra S, Claman P, Graham J, Guillemin JA, et al. J Obstet Gynaecol Can. May 2010;32(5):495-502.
vii American College of Obstetricians and Gynecologists. Polycystic ovary syndrome. Washington, DC: American College of Obstetricians and Gynecologists; 2009. ACOG practice bulletin; no. 108.
viii ‘Consensus on infertility treatment related to polycystic ovary syndrome.‘ Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Fertil Steril. 2008 Mar;89(3):505-22.
ix Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: A systematic review; Karin Ried, Keren Stuart. Complementary Therapies in Medicine (2011) 19, 319—331.
x‘Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence.’ Stener-Victorin E, Jedel E, Mannerås L. J Neuroendocrinol. 2008 Mar;20(3):290-8. Epub 2007 Nov 28.
xi ‘Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial’ Elizabeth Jedel, Fernand Labrie, Anders Odén, Göran Holm, Lars Nilsson, Per Olof, Elisabet Stener-Victorin. Am J Physiol Endocrinol Metab 300:E37-E45, 2011.
xii ‘D-Chiro-inositol and its significance in polycystic ovary syndrome: a systematic review.’ Galazis N, et al. Gynecol Endocrinol. 2011 Apr;27(4):256-62. doi: 10.3109/09513590.2010.538099. Epub 2010 Dec 10.
xiii “Effects of d-chiro-inositol in lean women with the polycystic ovary syndrome” Iuorno MJ et al. Endocr Pract. 2002 Nov-Dec;8(6):417-23.
xiv “Myoinositol as a Safe and Alternative Approach in the Treatment of Infertile PCOS Women: A German Observational StudyPedro-Antonio Regidor and Adolf Eduard Schindler International Journal of Endocrinology. Volume 2016 (2016), Article ID 9537632
xv Myoinositol as a Safe and Alternative Approach in the Treatment of Infertile PCOS Women: A German Observational StudyPedro-Antonio Regidor and Adolf Eduard Schindler International Journal of Endocrinology. Volume 2016 (2016), Article ID 9537632
xvi Treatment of hirsutism with myo-inositol: a prospective clinical study>” M Minozzi, G D Andrea, V Unfer Reproductive BioMedicine Online Volume 17, Issue 4, 2008, Pages 579-582
xvii “Ovulation induction with myo-inositol alone and in combination with clomiphene citrate in polycystic ovarian syndrome patients with insulin resistance”Zdravko Kamenov, Georgi Kolarov, Antoaneta Gateva, Gianfranco Carlomagno & Alessandro D. Genazzani Gynecological Endocrinology Vol. 31 , Iss. 2,2015
xviii Effects of myo-inositol supplementation on oocyte’s quality in PCOS patients: a double blind trial. Ciotta L et al. Eur Rev Med Pharmacol Sci. 2011 May;15(5):509-14.
xix Inositol supplement improves clinical pregnancy rate in infertile women undergoing ovulation induction for ICSI or IVF-ET. Zheng X et al. Medicine (Baltimore). 2017 Dec;96(49):e8842. doi: 10.1097/MD.0000000000008842.
xx Inositol supplement improves clinical pregnancy rate in infertile women undergoing ovulation induction for ICSI or IVF-ET. Zheng X et al. Medicine (Baltimore). 2017 Dec;96(49):e8842. doi: 10.1097/MD.0000000000008842.
xxi ‘Myo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial.’Papaleo E, Unfer V, Baillargeon JP, Fusi F, Occhi F, De Santis L. Fertil Steril. 2009 May;91(5):1750-4. doi: 10.1016/j.fertnstert.2008.01.088. Epub 2008 May 7.
xxii ‘Pretreatment with myo-inositol in non polycystic ovary syndrome patients undergoing multiple follicular stimulation for IVF: a pilot study.’ Lisi F, et al. Reprod Biol Endocrinol. 2012 Jul 23;10:52. doi: 10.1186/1477-7827-10-52.
xxiii ‘The Combined therapy myo-inositol plus D-Chiro-inositol, in a physiological ratio, reduces the cardiovascular risk by improving the lipid profile in PCOS patients.’ Minozzi M, Nordio M, Pajalich R. Eur Rev Med Pharmacol Sci. 2013 Feb;17(4):537-40.
xxiv “Ovulation induction with myo-inositol alone and in combination with clomiphene citrate in polycystic ovarian syndrome patients with insulin resistance”Zdravko Kamenov, Georgi Kolarov, Antoaneta Gateva, Gianfranco Carlomagno & Alessandro D. Genazzani Gynecological Endocrinology Vol. 31 , Iss. 2,2015
xxv “The effect of myoinositol supplementation on insulin resistance in patients with gestational diabetes.”Corrado F et al. Diabet Med. 2011 Aug;28(8):972-5. doi: 10.1111/j.1464-5491.2011.03284.x.
xxvi Myo-inositol may prevent gestational diabetes in PCOS women.D’Anna R. et al. Gynecol Endocrinol. 2012 Jun;28(6):440-2. doi: 10.3109/09513590.2011.633665.
xxvii Shahin AY, Mohammed SA: Adding the phytoestrogen Cimicifugae Racemosae to clomiphene induction cycles with timed intercourse in polycystic ovary syndrome improves cycle outcomes and pregnancy rates-a randomized trial. Gynecol Endocrinol. 2014, 30 (7): 505-510. 10.3109/09513590.2014.895983.
xxviii ‘Role of phyto-oestrogens in ovulation induction in women with polycystic ovarian syndrome’. Kamel HH. Eur J Obstet Gynecol Reprod Biol. May 2013;168(1):60-63.
xxix ‘Circulating markers of oxidative stress and polycystic ovary syndrome (PCOS): a systematic review and meta-analysis‘Mora Murri et al. Hum. Reprod. Update (2013)
xxx ‘A pilot study: effects of decreasing serum insulin with diazoxide on vitamin D levels in obese women with polycystic ovary syndrome.’Nestler JE, Reilly ER, Cheang KI, Bachmann LM, Downs RW Jr. Trans Am Clin Climatol Assoc. 2012;123:209-19; discussion 219-20.
xxxi ‘Vitamin D – roles in women’s reproductive health?’ Grundmann M, von Versen-Höynck F. Reprod Biol Endocrinol. 2011 Nov 2;9:146. doi: 10.1186/1477-7827-9-146.
xxxii ‘Plasma selenium levels in Turkish women with polycystic ovary syndrome. ’Coskun A, Arikan T, Kilinc M, Arikan DC, Ekerbiçer HC. Eur J Obstet Gynecol Reprod Biol. 2013 Mar 8. pii: S0301-2115(13)00064-X. doi: 0.1016/j.ejogrb.2013.01.021.
xxxiii ‘Altered Trace Mineral Milieu Might Play An Aetiological Role in the Pathogenesis of Polycystic Ovary Syndrome’Pratip Chakraborty et al. Biological Trace Element Research, April 2013, Volume 152, Issue 1, pp 9-15