How can we use traditional Chinese medicine to understand and treat PCOS?
Polycystic Ovary Syndrome is one of the biggest mysteries and confusing health diagnoses women currently face. It is commonly used as a blanket term to describe hormonal issues a woman could be experiencing and you are typically prescribed prescriptions and then sent on your way. Whereas, in traditional Chinese medicine you are firstly focused on as an individual because a “one treatment fits all approach” is not an effective long-term solution. A traditional Chinese medicine practitioner will identify the pattern you are presenting with and then treat the pattern. I recently sat down with holistic health care practitioner Michelle Hansen on using traditional Chinese medicine to understand and treat PSOS. Through traditional Chinese medicine women with PCOS can eliminate their symptoms and bring their body back in balance through natural, healthy lifestyle regimens.
As Michelle says, “The challenges of modernity, environmental toxins, poor nutrition and medications are just some of the reasons women are facing challenges to our health like never before: It’s no wonder that women are suffering through menopause, hormonal and metabolic disorders such as PCOS, endometriosis and mood disorders are the “norm” and fertility is an issue. Clearly our current medical approach is limited and we need an alternative approach. Traditional Chinese Medicine is perfect for this niche.”
What is PCOS?
Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an excess amount of male sex hormones known as androgens. Androgens are usually present in women in small amounts. PCOS also describes the small fluid-filled sacs (cysts) that form in the ovaries. However, not every woman diagnosed with PCOS will develop these cysts. Five to ten percent of women of childbearing age have polycystic ovary syndrome and it can occur in girls as young as 11 years old. “It is a complex syndrome that includes problems with a woman’s menstrual cycle (length, intensity), her ability to have children, her hormone levels, and her appearance (excessive hair growth on the chin and cheeks, acne, weight gain),” says Michelle.
PCOS is generally diagnosed by a medical doctor after a thorough investigation of patient history, a physical examination, pelvic ultrasound and blood tests to check hormonal levels. As Michelle explains, “Ultrasounds are an effective diagnostic tool in PCOS because they can identify cysts on the ovaries. Typically, with PCOS, blood tests will show hyperandrogenism (high testosterone) and an elevated luteinizing hormone to follicle stimulating hormone ratio. Tests can also show high estrogen and low progesterone because estrogen dominance plays a significant role in PCOS and often correlates with low progesterone.”
While its name PCOS clearly indicates that ovulation is affected, the widespread effects of this hormone disease can show up in any part of the body system and affects your metabolism, skin, hair, mood, and sleep patterns. Practitioners of traditional Chinese medicine will detect, understand, and address each woman differently for her unique aspects and presentation. Traditional Chinese Medicine sees the body as a whole. The foods we eat, the thoughts and feelings we experience, the environments we surround ourselves with, and the lifestyle choices we make all dramatically impact the body. Even little changes and adjustments in these areas can produce dramatic changes in the body that influence the nervous, endocrine, immune, digestive, and metabolic systems.
Symptoms of PCOS
The symptoms of PCOS can vary from woman to woman, with some women suffering more than others. According to Michelle, symptoms can include any of the following:
*Infrequent, irregular or absent periods
*There can be no ovulation or irregular ovulation
*Hirsutism (excess hair growth) is a common symptom in PCOS due to the imbalanced hormonal profile. Women present with thick, dark hair on their face, neck, chest, tummy, lower back, buttocks or thighs.
*Acne (especially back and chest)
“PCOS affects your metabolism, heart health, blood sugar levels and overall creates imbalance in your hormones,” explains Michelle. “There is still plenty of debate around PCOS diagnosis within the medical community and not every woman will have all these symptoms. From a traditional Chinese medicine perspective, it is far more effective to focus on the patient’s clinical presentation and treat accordingly rather then focusing on having all the symptoms for a diagnosis. It is important to have a comprehensive view of each individual woman’s case.”
Conventional Treatment for PCOS
“Conventional treatments are not ideal for PCOS because they merely mask the symptoms and can actually cause worse problems later in life,” explains Michelle. The below three medications are commonly prescribed for PCOS:
Birth Control Pills
These are often prescribed to help with symptoms of PCOS but actually facilitate the need for fertility treatments if pregnancy later becomes a goal. PCOS often surfaces when women come off the pill because the pill has masked PCOS as many women have been on it since puberty. Secondly, the pill dysregulates one’s own hormones and affects liver function from a traditional Chinese medicine view, which, can induce PCOS symptoms. Birth control pills also can have intense side effects that often end up worsening symptoms of PCOS.
The medicine metformin is used to treat Type 2 diabetes. While it has also been found to help with PCOS symptoms, it isn’t approved for this use.
Fertility medications such as injections of gonadotropic are given to women with PCOS trying to get pregnant. “Lack of ovulation is usually the reason for fertility problems in women with PCOS,” explains Michelle.
What Causes PCOS?
The cause of PCOS is unknown but the main underlying problem is hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. High levels of these hormones affect the development and release of eggs during ovulation. Another cause of PCOS is insulin. Insulin is a hormone that controls the conversion of sugar, starches, and other food into energy for the body to store or use. Insulin resistance and inflammation are the major causes of PCOS symptoms. All of these could indicate metabolic syndrome which is a highly inflammatory state in the body.
PCOS with Metabolic Syndrome
“We do know that many women (not all) with PCOS have some degree of metabolic syndrome,” says Michelle. “Metabolic syndrome is directly related to obesity. Obesity in traditional Chinese medicine is related to what we call having "Damp and Phlegm" in the body. The treatment principle in traditional Chinese medicine is to clear damp and phlegm, and this starts with improving digestion and clearing stagnation.” This is done through treatment of the digestive system and closely working with the patient's diet and exercise routine. An inflamed, stressed, and inefficient digestive tract leads to problems of both assimilation and elimination. This directly impacts the supply of nutrients critical for proper function of our hormonal system. It can further significantly derail the body’s normal elimination process of hormones.
Metabolic Syndrome is defined as a cluster of conditions driven by insulin resistance that is the precursors to Type 2 diabetes and cardiovascular disease. The National Cholesterol Education Program states that Metabolic Syndrome is achieved by meeting three or more of these five criteria:
• Abdominal obesity (waist circumference larger than 88 cm in women)
• Hypertriglyceridemia (>1.69 mmol/litre)
• Low HDL (<1.04 mmol/litre in men and <1.29 mmol/litre in women)
• Hypertension (>130/85 mmHg)
• Elevated fasting glucose (>5.5 mmol/litre)
Importantly, like Diabetes type-2, metabolic syndrome is essentially a lifestyle disease due to poor eating habits and lack of exercise. In treating metabolic syndrome, the digestive system starts to move and function better, clearing damp from a traditional Chinese medicine point of view.
“In summary, being overweight is a damp pattern in traditional Chinese medicine, and if you have a metabolic disorder, you will be damp,” explains Michelle. “Dampness is an imbalance arising from having too much moisture/phlegm trapped in the body and is due in part to water retention but can be more than this. When food and drink is transformed into Qi (energy) the blood becomes congested and stagnant, and damp accumulates. Over time damp becomes more viscous and can transform into a thicker kind of dampness known as 'phlegm'. To be clear, if you want to lose weight in traditional Chinese medicine you must focus on draining damp and improving your digestive function will facilitate this weight loss. PCOS most often has a pattern of damp accumulation in traditional Chinese medicine. Achieving and maintaining a healthy weight is critical if your PCOS is driven by a metabolic dysfunction that is creating mayhem with your reproductive hormones.”
PCOS without Metabolic Syndrome
Michelle says, “More and more women today are presenting with PCOS who are not overweight and do not present with metabolic syndrome.” “They will have insulin resistance but are not overweight unlike the prevalent misconception. Most of the time, there are issues with the "Liver Qi flow" in traditional Chinese medicine. This is specifically liver Qi stagnation because when stagnation is present there will be inflammation. Gentle detoxification is beneficial, and the use of traditional Chinese herbal formulas will get the "liver qi flowing" and is very successful especially when combined with acupuncture. Like other hormonal disorders in working with the liver, the main focus is to support detoxification of estrogen, which reduces symptoms of estrogen dominance so it will not drive PCOS.”
Traditional Chinese Medicine Pattern Differentiations & Treatment
The main patterns of PCOS according to Michelle include imbalances of the:
Kidneys (includes the adrenal type of PCOS)
Liver (includes the inflammatory type of PCOS).
Digestive system (includes insulin resistance type of PCOS)
“It is usually a combination of the above patterns,” Michelle explains. “Women do not present in real life as most doctors learned in text books. PCOS is a disease that typically involves multiple organ systems and there is no one straightforward formula to heal it. Per traditional Chinese medicine, identify your pattern and treat accordingly.”
Treatment for PCOS
Acupuncture treatments are typically given once a week and sometimes more often, especially when there is pain before menstruation or mid-cycle. The duration of treatment with acupuncture and Chinese herbs depends on the duration of the disease, intensity of the symptoms, and the Chinese medicine diagnosis. Typically, at least three months of continuous treatment is required.
Moxibustion is a traditional Chinese medicine therapy which consists of burning dried mugwort on particular points on the body. Michelle says, “It is used to improve the flow of blood to injured parts of the body to bring relief and to help stimulate acupuncture points and balance the circulation of Qi. The burning of Chinese mug wort over specific points on the lower abdomen directly stimulates the blood flow within the pelvic bowl.” It's a preventative treatment; you use the Moxa Box or stick several times a week, ideally in the two weeks prior to your period (luteal phase).
Our bodies are made for movement and we need to move daily. Metabolic syndrome is an inflammatory disease and idling or excess sitting causes more inflammation. Regular exercise is a way to bring down blood sugar and regulate insulin quickly. Aim for a 30-minute walk per day then slowly start to build up to an hour.
A whole food, anti-inflammatory diet is one of the most effective ways in bringing hormones back into balance. A diet that focuses on whole foods and is void of all processed and packaged foods is ideal. This way of eating gives your body whole nutrients and provides it with the tools it needs to operate properly. Carbohydrates should be largely eliminated, especially high glycemic index foods (including sugar, alcohol), due to their effects on rapid increases in blood sugar levels and insulin. Eating a diet low in carbohydrates introduces fewer complex sugars into your body. This can keep your blood sugar level low so your pancreas doesn’t go into overdrive creating insulin. You should cut out all forms of refined sugar and carbohydrates which are white bread, pasta, white rice, rice cakes, most breakfast cereals, and all starchy, low-fiber foods. Also, avoid sweeteners, soda, fruit juice and any drinks that rapidly raise the blood sugar level, as PCOS is linked to Type 2 diabetes.
Instead, focus on consuming adequate protein combined with plant-based foods. Our bodies are designed to eat what we can catch (animal protein), pull off a tree and dig out the ground (plant food). It truly is this simple. When we break from our natural food supply, disease ensures. You cannot be overweight or have metabolic syndrome eating REAL food. Real food is never simultaneously high in fat and sugar like processed foods which is a deadly combination.
For PCOS, you should be eating primarily meat, fish, eggs, vegetables, fruits, nuts, seeds, herbs, and spices. To maximize nutrition and meet fiber needs aim to fill half your plate with veggies at each meal. Always, or when possible, stay away from sugar, dairy, artificial sweeteners, trans fats, grains, and legumes.
*PCOS has several causes based on the type of hormonal imbalance with which you’re dealing. Because of this your body will have different needs for different hormonal imbalances. Always work with a functional nutrition specialist to know your individualized need.
Supplements can be an effective way to speed up the healing process and support healthy hormones. A balanced hormonal system can create more reliable periods, glowing skin, healthy hair, and reduce PCOS symptoms. Below you will find the supplements Michelle and I find most beneficial for PCOS.
*Remember, you can’t substitute supplements for a poor diet and lifestyle. Supplements are meant to complement diet and lifestyle therapies and help support and speed up the healing process.
• Chromium: enhances the function of insulin. Helps insulin work more effectively, which can help maintain balanced hormones.
• Lipoic Acid: helps to lower insulin and glucose and help regulate menstrual cycles
• Zinc: helps eliminate extra testosterone
• Inositol: or vitamin B8, supports healthy blood sugar and ovarian health
• N-Acetyl-L-Carnitine (NAC): antioxidant and amino acid needed for overall endocrine health
• Vitamin D: helps improve fertility, improve mood and help symptoms of hyperandrogenism and improves insulin resistance
• Nigella (black Cumin): helps control insulin resistance and elevated blood sugar levels
• Cinnamon: regulates hormones and menstrual cycle, maintains healthy blood sugar and insulin levels
• DIM: reducing excess estrogen in the body and promotes hormonal balance
Per Michelle, “A registered Chinese medicine practitioner and Herbalist can properly assess and diagnose which symptoms need to be addressed first, and what is causing them. I strongly advise people against taking herbal formulas blindly, without proper dosage and professional diagnosis.”
“In traditional Chinese medicine, you are generally prescribed a larger dose of the herbs Bai Shao (Peony) and Gan Cao (Licorice) because these herbs help to clear excess testosterone,” explains Michelle. “These herbs are already part of the commonly used TCM formulas to correct hormonal imbalance - Xiao Yao San (Bupleurum and Dang Gui) and Dan Zhi Xiao Yao San (Bupleurum and Peony).”