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.