| Polycystic Ovary
Syndrome (PCOS) |
 |
 The
following is a summary of an article by Dr. John Lee on this serious female
dysfunction due to hormonal imbalance. This was was published
in his medical letter dated July 1999.
All women should be made aware of this condition. Aside from what Dr.
Lee will be discussing, we know that PCOS
is associated with insulin resistance and Syndrome X, a condition afflicting
over 50 million Americans. One of the hallmarks of Syndrome X hyperinsulemia
caused by insulin resistance. Increase blood insulin causes the ovary to
secrete more androgen like testosterone, since it is quite insulin sensitive.
A New Epidemic
that Causes Infertility, Excess Hair, Acne and More
It is estimated that 10 to 20 percent
of women today have PCOS, and among young women, this figure
could be even higher, thus qualifying PCOS as an epidemic.
Doctors today have only 2 mainstream treatments for PCOS in their arsenal,
and neither is particularly successful. One treatment uses drugs like
birth control pills, hormone pills like androgens, androgens blockers, synthetic
estrogens or pills that inhibit hormone production like Lupron. The other
treatment is also drug-based, however this ones makes use of new drugs which
are meant for Type II diabetes, which lowers insulin resistance.
Dr. John Lee, the world's leading authority on natural progesterone,
has a new approach which is safer, simpler, less costly and more effective
method of treating PCOS. It targets the cause itself, and not just the symptoms.
What Is PCOS?
 PCOS
is a condition whereby there are multiple cysts found on the ovaries together
with other symptoms like anovulation (lack of ovulation) and menstrual abnormalities,
hirsutism (facial hair), male pattern baldness, acne, and often obesity.
These women may also at the same time have different degrees of insulin
resistance and therefore higher incidence of Type II diabetes, unfavorable
lipid patterns (usually high triglycerides), and a low bone density. Laboratory
tests often show higher than normal circulating androgens, especially testosterone.
PCOS takes place when the normal ovulation cycle of a woman is disrupted
or stopped, which thus creates an unbalance in the interrelationship
between her hormones, brain and ovaries. When in normal condition, the hypothalamus
regulates the hormone output of the ovaries and synchronizes the menstrual
cycle. At the end of the cycle, the hypothalamus secretes gonadotropin-releasing
hormone (GnRH), which stimulates the pituitary gland in the brain to release
follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones
will then in turn cause the production of estrogen and stimulate the maturation
of eggs in about 120 follicles.
The first follicle that ovulates will release its egg into the fallopian
tube and continue its journey to the uterus. Once inside the uterus, the
egg will quickly transform into a corpus luteum, which is a factory for
making progesterone, and raises progesterone's concentrations to 200 to
300 times higher than that of estradiol. This increase in progesterone will
then stimulate the uterus lining, thus putting it in its ripening phase
and at the same time, shuts down ovary production for the time being. If
fertilization does not take place, the corpus luteum will stop its elevated
production of both estrogen and progesterone. This will thus cause the uterine
lining to shed in the process known as menstruation. Then, in response to
low hormone levels, there is a rise in GnRH and the cycle starts all over
again.
PCOS happens when this cycle is disrupted due to unsuccessful ovulation.
This could take place via a myriad of reasons, e.g. the follicle migrates
to the outside of the ovary, but does not "pop" the egg and release
it. This follicle thus becomes a cyst and there will be no progesterone
production. This lack of progesterone is detected by the hypothalamus, which
continues to try to stimulate the ovary by increasing its production of
GnRH, which increases the pituitary production of FSH and LH. This stimulates
the ovary to make more estrogen and androgens, which stimulates more follicles
toward ovulation. If for some reason
these follicles are also unable to produce a mature egg which can secrete
the progesterone, the menstrual cycle is dominated by increased estrogen
and androgen production without progesterone. This hormonal imbalance is
the main reason behind PCOS.
Why Eggs Won't Pop and Progesterone Isn't Made
A. Xenobiotics
But what causes dysfunctional follicles that won't release eggs? One possible
reason is the exposure female embryos
to xenobiotics, environmental pollutants that chemically act
like estrogen on the developing baby's tissues. This is a phenomenon that
has been observed in wildlife studies.
When a female embryo develops in the womb, 500 to 800 thousand follicles
are created in the embryo, each enclosing an immature ovum. It has been
noted that the growth of these ovarian follicles is extremely sensitive
to the toxicity of environmental pollutants. When the mother is exposed
to these chemicals, she experiences no apparent damage. However the baby
is more vulnerable to these toxins, which may may damage its ovarian follicles
and make them dysfunctional. This will not
be apparent will the baby reaches puberty, where symptoms of incomplete
ovulation or insufficient progesterone production can be noted.
B. Lifestyle Factors that Cause Dysfunctional Follicles
 Besides
xenobiotics, other factors that can contribute to dysfunctional follicles
are lack of exercise, poor nutrition and
stress. Stress in itself can lead to anovulatory cycles by stimulating
high levels of cortisol production. Birth control pills shut down normal
ovary function, and sometimes it never recovers when the pills are stopped.
Our diets are full of petrochemical contaminants--also xenobiotics--that
derail normal metabolism. Drugs like Prozac impair the functioning of our
limbic brain, including the hypothalamus, which may affect the menstrual
cycle.
C. Diet
By far the biggest lifestyle contributor to PCOS is poor diet. Many young
women with PCOS eat a diet with too much
sugar and highly refined carbohydrates. These foods cause an
unhealthy rise in insulin levels. According to Jerilyn Prior, M.D., insulin
stimulates androgen receptors on the outside of the ovary, causing the typical
PCOS symptoms of excess hair (on the face, arms, legs), thin hair (on the
head), and acne. This will lead to obesity in the long run along with resistance
to insulin, which will further worsen the PCOS. The androgens also play
a role in blocking the release of the egg from the follicle.
Women, who were exposed to xenobiotics as babies in their mother's wombs,
will exacerbate the problem if their diets are high in sugary foods and
low in nutrition. Since this is exactly the type of diet favored by teens
and young women, it's easy to understand why there is so much PCOS in that
age group. Fifty years ago, the average person ate one pound of sugar
a year. Today the average teenager today eats one pound a week! Other
staples like pasta, white rice, or potato and corn chips also act on the
body much the same way as sugars do.
When the whole background of PCOS is taken into consideration, then it's
easy to see why the hormone-blocking and
insulin-lowering drugs don't work for very long. These approaches
merely treats the symptoms and not the underlying cause of PCOS. Improvement
is only temporary and both types of drugs have terribly unpleasant side
effects. By the same token, one can't just take progesterone, and you can't
just cut out the sugar. These usually need to work together in order to
produce the best results. Exercise and good nutrition are also very important
in maintaining hormone balance.
Treatment of PCOS
Dr. Lee recommends supplementation of normal physiologic doses of progesterone
to treat PCOS. PCOS occurs when the progesterone levels do not rise each
month as they are supposed to do during the luteal phase of the cycle. Natural
progesterone supplementation therefore should be the basis of PCOS treatment,
along with attention to stress, exercise, and nutrition.
It is recommended for PCOS patients to use 15
to 20 mg of progesterone cream daily from day 14 to day 28 of their menstrual
cycle. This dosage can be adjusted accordingly if the cycle is
longer or shorter than the usual. The first signs of the hormones balancing
out would be the disappearance of facial hair and acne. However, it will
take at least 6 months for the progesterone cream to take effect. This must
also be combined with proper diet and exercise.
Once the symptoms of PCOS fade, it is
possible to gradually reduce the dosage and to keep a lookout for PCOS symptoms.
If the symptoms reappear, the regular dosage should be restored and progress
monitored again. It would be most ideal for the patient to allow her body
to return to its normal hormonal patterns. However, some women with PCOS
may have too many damaged follicles and would always need some progesterone
supplementation to maintain the regular cycle.
Why Haven't Doctors Figured This Out?
There are several reasons why doctors don't recognize the role of progesterone
deficiency in PCOS. They may not be aware that the hypothalamus responds
not only to the rise and fall of estrogen, but also to the rise and fall
of progesterone. Since standard
tests usually indicate that a woman with PCOS has plenty of estrogen, and
she is still having periods, the doctor assumes she is still ovulating and
producing plenty of progesterone.
The odds of a woman having estrogen dominance
and progesterone deficiency rise to 50 percent in the female population
by age 35, yet doctors rarely measure progesterone concentrations.
They may fear giving progesterone because of all the side effects caused
by synthetic progestins, and may not be aware that natural
progesterone, unlike synthetic progestins, is remarkably free of side effects
when given in normal physiologic doses.
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