PCOS: Therapeutic options

It  is not always necessary to treat PCOS straight away. If a woman does not suffer, is lean and without insulin resistance, no immediate action is required. Overweight women, on the other hand, are at risk of developing metabolic syndrome. In addition to that, studies have shown that shedding endometrium at least once a year may contribute to low cancer-risk.

Prior to treatment
…it is recommendable to have thyroid function checked. Quite frequently thyroid hypofunction can cause symptoms similar to PCOS. If this is the case, symptoms may vanish quickly once thyroid function has been restored.

Treatment options

Weight loss
Due to a close association of carbohydrate metabolism, amount of adipose tissue and PCOS, weight loss should be the first step for every PCOS patient who is overweight. Good news: even moderate weight loss of only 5 % can result in marked amelioration!
Calculating from a body weight of 80 kg, this makes 4 kg – that is achievable! The reward: more beautiful skin, less facial hair, more regular cycles.
A typical western diet rich in highly processed carbohydrates (sugar, white flour, etc), yet only little fibre and micronutrients, is a main factor leading to insulin resistance and excess weight.
Instead, vegetables and fruits, high-quality proteins, fiber and moderate amounts of complex carbohydrates (e.g. whole-grain products, legumes, oil seeds) should make the basis of everyday nutrition. Additional support of weight loss programs can come from orthomolecular support with carnitine.
A study from 2013 summarizes the effects of a diet like this:
“Decreasing insulin levels via a suitable diet is an attractive non-pharmaceutical therapeutic option for women with PCOS, whose elevated insulin levels stimulate testosterone synthesis, adding to PCOS symptoms.“

The contraceptive pill
If the primary aim of the patient is to reduce facial hair growth and acne, taking a contraceptive pill often presents as a suitable approach. The doctor will choose a pill depending on its progesterone content, counteracting the effect of male hormones.

Metformin, a drug also used in diabetes treatment, is also effective in reducing insulin resistance which affects approximately 60 % of PCOS patients. It helps to optimize insulin action, thus diminishing insulin resistance and production of androgens. Lipid metabolism benefits as well.
However, in many countries metformin has not been formally recognised as treatment option for PCOS and not every patient tolerates the treatment very well. Then, certain micronutrients present as an interesting alternative (see below).

Bowel cleanse
It is well documented that rats with PCOS exhibit changes in enteric flora and that restoring it to normal can improve PCOS symptoms. Consequently the scientists Tremellen and Pearce postulated in the magazine Medical Hypotheses (2012), that a disturbance of gut flora may be among the triggers for PCOS.
To date, there is no definite prove of effectiveness, however, natural health practitioners have promoted bowel cleanse for quite some time already.

Orthomolecular therapy
Due to the close association of metabolism and PCOS, nutritional interventions are frequently successful.

Inositol has gained a lot of attention due to many studies in recent years. Insulin needs it in order to exert its effects in target cells. According to research, inositols are as effective in treating insulin resistance as metformin, yet free from any side effects. When planning for pregnancy, experts advice to take both isoforms of inositol, myo-inositol and D-chiro-inositol, respectively, in their physiological ratio. While myo-inositol is particularly important for mediation of insulin action on sugar metabolism, D-chiro-inositol is particularly important for ovary function.

Omega-3-fatty acids
Lipids play an important role in the orthomolecular therapy of PCOS as well. They modulate the activity of hormone receptors and expression of certain genes involved in excessive weight gain and insulin resistance. PCOS patients should therefore make sure they take up enough omega-3-fatty acids with their diets. Good sources include fatty sea-fish, walnuts and linseeds and their oils.
Simultaneously it is advisable not to consume too many omega-6-fatty acids, as these can partly counteract the beneficial effects of omega-3-fatty acids.

Chromium is well known for its positive effects on blood sugar and insulin levels. Unfortunately, stress and high carbohydrate consumption can increase its demand considerably, which is why supplementation in PCOS can be helpful.

Vitamin D
According to a German nutritional survey from 2008, up to 91 % of women do not reach the nutritional reference values for vitamin D. Obviously, this is a problem for PCOS patients, as vitamin D is well known to positively impact insulin resistance. Patients who want to become mothers should also know that a healthy vitamin D status is important for conception and pregnancy.
Therefore, PCOS patients are recommended to have their vitamin D status checked regularly and supplement this vitamin, if needed.

If all of this sounds just a bit too complicated for you, the dietary supplement Fertilovit®F PCOS by Gonadosan Distribution GmbH offers a medically sensible combination of micronutrients for PCOS patients and is also suitable if you are planning for pregnancy due to a high content of folic acid.

About the author

Dr. rer. nat. Birgit Wogatzky

For many years now, biologist and nutritionist Dr Birgit Wogatzky, has been focusing on the special needs of fertility patients. For the readers of this blog, she sums up interesting novel information and developments from current research projects regarding lifestyle and nutrition of fertility patients.


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