Five to ten percent of women of childbearing age have polycystic ovary syndrome, also known as PCOS. It can occur in girls as young as 11 years old.
In approximately 75% of cases where young women have problems with menstruation due to late puberty, PCOS is often diagnosed. Irregular, infrequent or absent periods, or periods with heavy flow and unbearable pain, are all variations of the problem. Sometimes PCOS presents itself much later in life when a woman of childbearing age stops using contraceptive pills and finds herself having very long cycles or no cycles at all, and is unable to conceive.
Symptoms of PCOS
Polycystic ovary syndrome (PCOS) 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, baldness).
Women with PCOS often have ovaries that contain many small cysts, of a size seldom exceeding 0.5 cm.
The symptoms of PCOS can vary from woman to woman, with some women suffering more than others. Symptoms can include any of the following:
• Infertility due to lack of ovulation (PCOS is the most common cause of infertility); Anxiety; Depression
• Menstrual irregularities: irregular or absent menses;
• Heavy menstruation (especially if periods are late);
• Painful menstruation or pain during ovulation, bleeding in the middle of a cycle;
• Pelvic pain (distention, heaviness, stabbing pain);
• Physical changes (often occurring at a later stage but not always): increased hair growth on the face, chest, stomach, back, thumbs or toes, weight gain around the waist, an inability to lose weight despite physical exercise, acne, dandruff, thinning hair (looking like male baldness);
• Multiple cysts on the ovaries diagnosed by ultrasound.
What Causes PCOS?
The cause of PCOS is unknown, but most experts think that several factors, including genetics, could play a role. One main underlying problem with PCOS 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. Researchers also think that insulin may be linked to PCOS. Insulin is a hormone that controls the conversion of sugar, starches, and other food into energy for the body to use or store.
PCOS is generally diagnosed by a medical doctor after a thorough investigation of patient history, a physical and/or pelvic examination, pelvic ultrasound and endometrial lining thickness and blood tests to check hormonal levels. PCOS cysts need to be differentiated from functional cysts, which resolve on their own and require no treatment.
The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.
In women with PCOS, the ovary doesn’t produce all of the hormones an egg needs in order to fully mature. The follicles may start to grow and build up fluid, but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone, progesterone, is not produced. Without progesterone, a woman’s menstrual cycle is irregular or absent altogether. PCOS is a cause of infertility, as the eggs are not released and ovulation occurs irregularly or not at all.
Conventional Treatment for PCOS
• Birth control pills – are sometimes recommended for women who don’t want to get pregnant (this approach does not really treat PCOS; it merely masks the symptoms and may facilitate the need for fertility treatments if pregnancy later becomes a goal).
• Diabetes medications – The medicine metformin (Glucophage) is used to treat Type 2 diabetes. It has also been found to help with PCOS symptoms, though it isn’t approved for this use.
• Fertility medications (clomifene-clomid, serophene, injections of Gonadotropins) for women trying to get pregnant. Lack of ovulation is usually the reason for fertility problems in women with PCOS.
Traditional Chinese Medicine for PCOS
Chinese medicine has studied polycystic ovaries since ancient times. There are many ancient and modern text books which mention abdominal masses (ie polycystic ovaries), along with scanty menstruation and absent or delayed menstruation.
According to Traditional Chinese Medicine theory, organs involved with PCOS include the Spleen, Kidney and Liver, with a subsequent disharmony of Chong and Ren channels / meridians.
In my Traditional Chinese Medicine practice, the condition known as PCOS has become a very common diagnosis. I see young women diagnosed with PCOS who are quite thin, have no facial or body hair growth, and suffer from very painful menstruation that is relieved by the application of hot pads. These women tend to feel more chilly, especially around the time of their periods.
Other women, also diagnosed with PCOS, have very irregular periods occurring only 4 or 5 times a year, but with a heavy and debilitating flow. They most often come to me for help because they have been trying unsuccessfully to get pregnant for a couple of years. Some mature women come because of persistent, painful acne and later find out they have PCOS.
Chinese medicine views PCOS as a complex combination of different patterns. Ovarian cysts are seen and treated as an accumulation of ‘phlegm damp’ in the uterus, enlarging the ovaries. This pattern is often accompanied by blood stagnation that is responsible for painful menstruation (stabbing pain) and dark, scanty, thick blood.
At the root of the disease is a kidney deficiency (hormonal imbalance), and a spleen qi deficiency (digestive problems) which causes accumulation of dampness. Very often a liver qi stagnation, worsened by years of stress or frustration, is added to the mix.
To effect complete recovery from PCOS, Chinese medicine uses herbs and acupuncture to regulate menstrual cycles, improve digestion, dissolve cysts, promote ovulation, improve egg quality, support conception and prevent a miscarriage when a pregnancy is achieved.
Pattern Differentiations and Treatment
Deficiency of Spleen Qi and Kidney Yang, Accumulation of Phlegm and Damp – Women suffering from this pattern have very long menstrual cycles (more than 35 days between periods which occur only 4 or 5 times a year), scanty bleeding that can alternate with flooding periods, which contain stringy tissue or mucus, or watery blood. Or they have no periods at all and come for fertility treatments. Such women also have a tendency to put on weight easily, feel bloated, don’t like cold weather and tire easily. Their appetite is not necessarily strong but they crave pastries and carbs, especially after meals. They can have chronic yeast infections, or chronic vaginal discharge. The tongue shows swollen and enlarged, with teethmarks on the sides, and is sometimes covered by a thick white coat.
In North America, despite cold winters, the overconsumption of large quantities of ice cream (with its high sugar and fat content), milk-shakes, cream cheese and other dairy products impact the digestive system from a young age. This accumulation of toxins in the body manifests as damp phlegm that blocks proper channel circulation in the abdomen, where the toxins tend to accumulate (think belly fat).
Treatment aims at strengthening the digestive system, removing dampness, and dissolving phlegm (removing cysts) with herbal supplements that include Gui zhi (cinnamon), Tu si zi, Du zhong, fu ling, Cang zhu, etc.
Gui zhi (cinnamon bark) is very good at warming the uterus and promoting blood circulation in the uterus, especially for women who have painful periods that are relieved with the application of hot compresses or hot pads. In many cases I like to add the herbs Lu lu tong and Ze lan to promote circulation in the abdomen. Lu lu Tong is used to unblock clogged tubes and dissolve phlegm. Fu ling and Cang zhu help the digestive system deal with excessive dampness and also promote urination, while Tu si Zi and Du zhong tonify the kidneys.
Liver Qi Stagnation and Blood Stasis – Enduring stress, depression or anxiety may lead to liver qi stagnation. This eventually impairs proper circulation of the blood, since qi makes blood circulate in the liver as well as in the ren and chong channels that traverse and connect with the uterus.
Another common cause of blood stagnation in the uterus is the invasion of cold. Cold causes contraction and prevents proper blood circulation. The liver channel begins at the big toe and travels up the leg, encircling the genitals. Coldness can easily enter the body through the feet and invade the uterus via the liver channel. This is one of the reasons why we advise women not to swim during their menstrual periods, when the uterus is particularly open and vulnerable, and to keep their feet, legs, abdomen and lower back warm.
Long term liver qi stagnation can also transform into heat, causing severe PMS symptoms: feelings of heat, restlessness and irritability, headaches, distended breast or abdomen, irregular periods and particularly heavy and clotty periods (when heat has transformed into blood stasis).
We use herbs that promote qi and blood circulation in the uterus, reduce clotting, reduce pain and distention, calm emotions and remove heat.
Formulas such as chai hu shu gan san or Dan zhi xiao yao san can be used with modifications. Ge xia zhu yu tang, with added herbs, can also be used if blood stasis is particularly strong.
With this pattern, the pulse is often wiry (feeling like a wire hitting the finger), and the tongue is reddish with redder sides. Sometimes you can see purplish spots on the sides of the tongue, indicating blood stasis.
Phlegm, kidney yang deficiency, spleen qi deficiency, liver qi stagnation, blood stasis (with either heat or cold symptoms) and finally, some possible blood and yin deficiency, can all combine as symptoms.
Acupuncture 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.
i) Young women should have regular moderate exercise in the sun. Around the time of menstruation, exercise should be reduced.
ii) Relax and avoid strong emotions, especially around menstruation time.
iii) Avoid cold environments, foods and beverages (cheese, dairy products especially ice creams and milkshakes). On cold days during menstruation, use a hot water bottle and place it on the abdomen. Do not swim while menstruating.
iv) Cut out all forms of refined sugar and carbohydrates: white bread, pasta, white rice, rice cakes, most breakfast cereals, and all starchy, low-fibre foods.
Avoid sweeteners, soda, fruit juice and any drinks that rapidly raise the blood sugar level, as PCOS is linked to Type 2 diabetes.
v) It is important to record day one of your menstrual cycle, the duration, condition of the blood (quality, amount, colour). If you suffer from delayed periods or period pain, it is recommended you address this in the early stages in order to avoid polycystic ovaries.