Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

Understanding PCOS
Be careful about reading health books. You may die of a misprint. ~Mark Twain I felt like a freak in high school, Pam told the group. I was overweight. My skin was always breaking out. But the worst part was that I had to shave twice a day or someone would see that I was growing a beard. I was so afraid people would think I was not a real woman. Everyone in the room nodded. While each of us had different symptoms, the feelings Pam expressed were familiar to us all. We had come together for a monthly PCOS meeting. For many of us, the experience of talking openly about our symptoms was as good as any treatment. Feeling normal for the first time, we were able to freely talk about how PCOS affected us emotionally and physically. The emotional effects of PCOS often start in the teenage years when girls begin to experience weight problems, excess facial or body hair, debilitating periods, acne, or other effects of PCOS. The journey to a diagnosis is often long and painful. Kathy explained, I was exhausted from the search for answers. I went from doctor to doctor for eight years in a desperate search for answers. I started to think it really was all in my head! Doctors often overlook the symptoms of PCOS or dismiss the severity of its effects on a womans emotional and physical wellbeing. Some doctors even blame women for their weight problems and accuse them of not following instructions or of having no self control. For many the diagnosis is both a relief and a shock. Often the diagnosis is made as part of an infertility workup. Diagnosis brings a name for the problem, but too often the diagnosis is not followed with information about what PCOS is and how to minimize its effects. The doctors werent interested in solving the problem, Lisa said. They just told me to take birth control pills to treat the acne and start my periods. I had to do my own research, since I couldnt find a doctor who would listen. Getting healthy requires taking charge of your well-being. There is no recognized cure for PCOS, yet many women have found ways to dramatically improve their health and wellbeing. With diligence and the right treatment some women experience complete remission of symptoms. You may choose to work solely with natural, non-invasive methods or you may choose to use alternative healing as a supplement to treatments offered by your doctor. Whatever path you choose, you are in control of your health. You can choose to provide the optimum environment for healing or you can choose to continue in unhealthy patterns. The more you know about your body and PCOS, the smoother the road to wellness will be. It is extremely important that you consult with a doctor and do your own research. Learn all you can about any drug, herb, or supplement you take. Prescription drugs can have many side effects and can even cause death. Before taking any drug you should read the 1

Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

Physicians Desk Reference listing for that drug. Most pharmacists are happy to let you read this or you can find it at the library. Know what you are taking, no matter what the source. Be very careful about drug interactions. Even herbs can have dangerous drug interactions.

What are the typical treatments?

At one time PCOS was treated almost exclusively with replacement hormones or birth control pills. In recent years the discovery of the link between PCOS and insulin resistance has lead to the use of insulin-sensitizing drugs such as metformin (Glucophage). Doctors may also prescribe cholesterol-lowering drugs, drugs to lower androgen levels, creams to reduce facial hair, antibiotics for acne, and other symptom-specific drugs. Surgical treatments include ovarian drilling in which the ovaries are either drilled several times with a laser to puncture the toughened outer coating and reduce cysts, or wedge resection in which a small section of the ovary is removed and the remainder stitched back together. Both are known to be effective in inducing ovulation for a short time, but within a year most women are right back where they started from. These treatments temporarily lower testosterone, but soon the underlying endocrine problems that created the cysts will cause them to return. Doctors may also choose to deflate or remove larger fluid filled cysts that are causing pain or are in danger of rupturing. These larger cysts may or may not return. Diet and exercise are also recommended by most doctors as a way to sensitize the body to insulin and reduce weight. These two keys are vital to reducing PCOS symptoms. However, which diet is the right diet is still quite controversial. For overweight women with PCOS some doctors may prescribe weight loss drugs or even gastric bypass surgery. A gastric bypass removes part of the stomach so that it becomes impossible to overeat. For some women this solves the weight problem, but the risks are high and the surgery can also result in vitamin deficiencies and other side effectsin some cases it can cause death. Again, I am not opposed to using conventional medical care as needed. However, I see many women suffering from cures that lead to side effects worse than the original symptoms. Whatever method you choose, please do your research so you know the risks. The wonderful thing about alternative methods is that for most the risks are very low.

What is PCOS?
Polycystic ovarian syndrome (PCOS) is a collection of symptoms that is not yet welldefined by medical science. This is part of the reason many women go from doctor to doctor for years before they get an appropriate diagnosis. Many doctors do not keep up with the latest research about PCOS and they do not understand that PCOS is much more than a fertility or reproductive problem. PCOS is often called a diagnosis of exclusion. In other words, PCOS is what is left when you rule out everything else. Women who suffer from PCOS are much more likely to also have heart problems, high cholesterol, diabetes, high blood pressure, fatigue, autoimmune disorders such as thyroid 2

Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

disease and other health problems related to obesity, high cholesterol levels, certain cancers, and insulin resistance. To make it more confusing, not all women with PCOS have cysts on their ovaries, many are not overweight, and some are able to have children without intervention because they ovulate occasionally. Diagnosing PCOS is not easy, but as they say I know it when I see it. The following are just some of the symptoms that may be associated with PCOS. Most women will have a few of the symptoms; rarely someone has all of them. Symptoms of PCOS can include: Irregular periods or no periods Painful or unusually heavy or light periods Irregular or absent ovulation Hirsutism (hair on face, stomach, thighs, arms, breasts, etc.) Alopecia (thinning hair or male pattern baldness) High blood pressure Infertility Obesity (especially around the stomach) Difficulty losing weight Insulin resistance or hypoglycemia Fatigue Depression or SAD (seasonal affective disorder) Mood swings Acne Ovarian cysts Skin tags Acanthosis nigricans (dark skin patches, often found on the nape of the neck, groin, under breasts) High cholesterol levels Decreased sex drive Excess "male" hormones, such as androgens, DHEAS, or testosterone Decreased breast size Enlarged clitoris (rare) Enlarged ovaries Enlarged uterus

The medical community even disagrees about the name for this syndrome. Once called Stein-Leventhal Syndrome, PCOS is also known as polycystic ovary disease. Some say it should be called hyperandrogenic anovulation. This simply means that there are too many male hormones (androgens) and that ovulation is not occurring. But even this name leaves out the fact that many women with PCOS do ovulate, although not as often as normal. Here is the explanation offered by Samuel S. Thatcher M.D., Ph.D., in his book PCOS: The Hidden Epidemic. 3

Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

"The earlier term, disease, is not quite correct. A disease is a specific and constant set of symptoms and physical findings.... The term disease now has been abandoned in describing PCOS in favor of the term syndrome, which is defined as a grouping of symptoms, including both physical and laboratory findings.... In an attempt to more clearly define PCOS, the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) cosponsored the 2003 Rotterdam polycystic ovary syndrome (PCOS) consensus workshop group to revise the 1990 National Institutes of Health (NIH) guidelines for diagnosis and management of PCOS. The Rotterdam panel concluded that PCOS encompasses more types of ovarian dysfunction than those included in the original criteria defined by NIH in 1990. The Rotterdam criteria require two of three symptoms for a formal diagnosis of PCOS: irregular or absent ovulation, elevated levels of androgens, and/or one or two enlarged ovaries containing at least 12 cysts each. Other syndromes with similar symptoms, such as androgen-secreting tumors or Cushing's syndrome, must be ruled out. According to the Rotterdam group women with PCOS should be evaluated for metabolic syndrome by measuring abdominal obesity, triglycerides, high-density lipoproteins (HDL), high blood pressure, and fasting and two-hour glucose tolerance. PCOS symptoms are similar to some other disorders. Your doctor should rule out congenital adrenal hyperplasia, Cushing's syndrome, and androgen-secreting tumors. Tests should likely also be done for estradiol, follicle-stimulating hormone (FSH), and prolactin levels. Hirsutism is considered to be the best clinical marker of hyperandrogenism, although different degrees of hirsutism should be expected based on ethnicity. Women of Asian, Native American and some other ethnic groups may have less body hair than women of Western European heritage even with equally elevated androgens. Free testosterone levels or the free testosterone index are the best measures of hyperandrogenism. However, not all women with PCOS have elevated circulating androgen levels. Insulin resistance can occur in up to 50% of patients with PCOS, so the Rotterdam group recommends oral glucose tolerance tests for all PCOS patients. LH levels are frequently elevated in women with PCOS, especially when compared with FSH. LH/FSH ratios can be elevated in up to 95% of women with PCOS if women with recent ovulation are excluded. A 1999 article in the Journal of Clinical Endocrinology and Metabolism detailed a study showing that the risk of glucose intolerance was 2.76 times higher in women with PCOS. The study also indicated that many women with PCOS will meet the criteria for diabetes based on oral glucose tolerance tests but would not be diagnosed only by results of fasting glucose tests. Women with PCOS are at increased risk for diabetes. This risk is higher for those who are anovulatory (not ovulating). Despite the increased cholesterol and metabolic disorders,

Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

PCOS has not been proven to increase risk of cardiovascular disease, endometrial cancer, or death. Dr. Thatcher gives these statistics: 20-30% of all women have PCO changes evident on ultrasound 5-10% of all women have elevated androgens and chronic anovulation 90% plus of PCO patients show PCO on ultrasound 40-60% of PCOS patients have weight/obesity problems 60-90% of PCOS patients have skin and or hair problems 40-80% of those with PCOS have fertility impairment 40% of those with PCOS develop type 2 diabetes by age 40

This last point is downright scary. All women with PCOS need to take extra good care of themselves and work to get lifestyle issues such as diet and exercise under control as quickly as possible. Diabetes is preventable in many cases. Even when it is not preventable, diabetics who learn to manage their disease have much longer and healthier lives and are less likely to become insulin-dependent. What causes PCOS? There are a number of theories about what causes PCOS. The most commonly held theory right now is that insulin resistance is at the root of PCOS. While it is true that many women control their PCOS symptoms by controlling insulin resistance, many other women with PCOS do not have insulin resistance and have no symptom improvement from the standard insulin medications or diet and exercise treatment. There is a lot of evidence now that PCOS might actually be a result of chronic internal inflammation. Studies are now showing that inflammation may be the root cause of heart disease, diabetes and PCOS. This inflammation is caused by diet, stress and other causes. Other theories include: An underlying neuroendocrine defect that causes high luteinizing hormone (LH) levels. One recent study University of Virginia study confirmed that provoking high LH levels lead to PCOS symptoms. A defect in androgen production that results in excessive ovarian androgen production. A problem with cortisol metabolism leading to enhanced adrenal androgen production.

The pituitary gland secretes luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In the ovary LH controls the production of female hormones (estrogen and progesterone) and FSH controls the development and release of eggs. The pituitary gland releases LH and FSH in pulses in response to gonadotropin releasing hormone (GnRH) released by the brain. Levels of LH and FSH typically vary throughout the menstrual cycle. Research at the University of Virginia indicates that differences in the pattern of GnRH pulses from the brain affect LH and FSH secretion. Rapid GnRH pulses lead to more LH 5

Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

secretion and slow GnRH pulses lead to more FSH secretion. Estrogen and progesterone from the ovary regulate how frequently the brain produces pulses of GnRH, and also the amount of GnRH secreted per pulse. After normal ovulation the estrogen and progesterone levels change, signaling the brain to slow GnRH pulses. This feedback is further disrupted in PCOS when normal ovulation does not occur. Studies indicate that this normal slowing of GnRH allows for FSH secretion during menstruation, which leads to proper egg development in the next cycle. If these GnRH pulses are not slowed down, University of Virginia researchers suggest, FSH production is diminished. The University of Virginia Center for Research in Reproduction website offers this view, Studies have shown that GnRH secretion in patients with PCOS is relatively fast, and that it does not slow down very well in response to estrogen and progesterone. We believe that this helps to explain why PCOS patients frequently do not ovulate. Women with PCOS often have high levels of LH secretion. High levels of LH contribute to the high levels of androgens (male hormones such as testosterone), and this along with low levels of FSH contributes to poor egg development and an inability to ovulate. A lack of ovulation also leads to relative deficiencies of progesterone production by the ovary, which often leads to absence of menstrual periods. More information can be found at www.healthsystem.virginia.edu/internet/crr/patientinfo.cfm. Researchers are now considering the possibility that PCOS is not one disease but several diseases that have similar symptoms. There is a lot of evidence in favor of this theory. One indication of this is that some women with PCOS are thin while others constantly battle the weight gain typical of insulin resistance. This theory may also explain why some women have great results from a particular treatment such as the herb vitex while others have no improvement or even a worsening of symptoms. An excellent review of the potential causes of PCOS, entitled The Pathophysiology of Polycystic Ovary Syndrome was published in the medical journal Clinical Endocrinology (Tsilchorozidou et al, 60(1):1-17, 2004). It can be found at www.medscape.com. What is insulin resistance? Current research, and much of conventional and natural treatment, seems to be focusing on the idea that PCOS is caused by insulin resistance. It is possible that PCOS is caused by a defect in the action of insulin or in the way insulin is produced. There appears to be a genetic component and many women with PCOS can point to members of their family who are clearly insulin resistant, have diabetes, or are infertile. There is a link between obesity, male pattern hair loss and PCOS. However, obesity is unlikely to be the cause of PCOS. Many women develop the signs of PCOS before they gain weight. Losing weight can improve the symptoms but weight loss is not a cure. The hormone insulin is secreted by the pancreas. Insulin helps the cells use blood sugar (glucose) by binding with receptors on the cells. Just as a key unlocks a door, insulin unlocks the cells and allows glucose to pass into the cell from the blood. The cell then uses glucose for energy. Liver and muscle cells also store glucose for future use as glycogen. 6

Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

When the cells do not respond to a normal amount of insulin they are said to be insulin resistant. The pancreas must then create more insulin to unlock the cells. About one in three people with insulin resistance develop high blood sugar or diabetes type 2. Excitotoxins We know insulin resistance is part of the how, but there is another theory about why PCOS develops. Endocrine disruptors, or excitotoxins, are chemicals that are known to interfere with the production or use of hormones in the body. These chemicals are found in our air, water, food, and cosmetics. Pesticides, chemical dyes, aspartame, monosodium glutamate (MSG) and many other chemicals have been shown to interrupt the endocrine (hormone production) system. Most of these chemicals have only been used since just before World War II. Where our mothers and grandmothers may have had a tendency towards PCOS symptoms, their exposure to these chemicals began much later in life. We are hit with full-blown PCOS because our bodies have been swimming in these chemicals since conception. I address this issue in much greater detail in the chapter on toxins. You can learn more about these chemicals and their effect on our bodies by reading Its My Ovaries, Stupid! by Elizabeth Lee Vliet, MD.

Diagnosis- What tests do I need?

Symptoms may lead you or your doctor to suspect PCOS, but for an accurate diagnosis it is important to have a variety of tests run. PCOS is a complicated endocrine disorder that affects your whole body. Depending on your symptoms, your doctor may order an ultrasound to check for ovarian cysts or uterine problems such as fibroids or a thickened lining. Polycystic ovaries are defined as those found on ultrasound to contain 12 or more follicles measuring 2 to 9 mm in diameter and/or have an increased volume of 10 mL or greater. Only one ovary meeting these criteria is necessary to meet the definition of polycystic ovaries. Blood tests can measure hormone levels and check for high cholesterol levels. A family history and a personal medical history can offer further insight. These blood tests are often ordered: Androstenedione Cholesterol (HDL, LDL and triglycerides) Cortisol Dehydroepiandrosterone sulfate (DHEAS) Estrogen Glucose and Insulin Follicle stimulating hormone (FSH) Luteinizing hormone (LH) Progesterone 7

Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

Prolactin Complete thyroid panel (TSH, T3, T4, antibodies) Total and free testosterone

Androstenedione (ANDRO) ANDRO is produced by the ovaries and adrenal glands. High levels of ANDRO can affect estrogen and testosterone levels. Normal levels are between 0.73.1 ng/ml. This steroid is most likely to be elevated in women with PCOS, however, knowing it is high will rarely impact treatment decisions so your doctor may not measure this. The Rotterdam group does not recommend testing for ANDRO. Cholesterol Cholesterol is a fatty substance your body uses to form cell membranes and certain hormones. Under normal conditions your body uses enzymes to turn cholesterol into other hormones. When your body does not process cholesterol well or creates too much cholesterol your cholesterol levels can become dangerously high. A high cholesterol level is considered greater than 200. Your doctor should also look at your LDL (low-density lipoprotein), HDL (high-density lipoprotein), and triglyceride levels. The ratio between LDL and HDL is important. HDL is considered good cholesterol; it seems to help protect your arteries. LDL is considered bad cholesterol; too much and it can start to stick to your artery walls, leading to heart disease. Your triglyceride levels can also indicate future health problems! My doctor explained that my very high triglyceride level could cause my pancreas to shut down over time, throwing me into full-blown diabetes. This was a major motivating factor for me to change my health! Cortisol Cortisol is not measured as a routine part of PCOS evaluations. Low cortisol levels can lead to Addisons disease which looks nothing like PCOS. However, high levels of cortisol can lead to Cushings disease which can mimic PCOS. Measurement requires one of two tests. The first test is a 24 hour urine collection from which the total amount of cortisol is determined. The second test involves taking a dose of dexamethasone at night and drawing blood in the morning. There is some argument as to which test is more reliable. DHEA-S DHEA-S or dehydroepiandrosterone is another male hormone or androgen that all women have. DHEA-S is produced in the adrenal gland. Normally women have DHEA-S levels between 35-430 ug/dl. Most women with PCOS tend to have DHEA-S levels greater than 200 ug/dl. The Rotterdam group does not recommend testing DHEA-S levels. Estrogen All estrogens are made from androgens, therefore androgens are vital to womens reproductive health. There are three forms of estrogen: estriol, estradiol, and estrone. Estriol is produced in the placenta during pregnancy. Estradiol is the most potent estrogen and is produced mostly by developing follicles in the ovary. Estradiol can be used to measure 8

Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

effectiveness of infertility treatment and to detect estrogen deficiency where there are menstruation problems. Estrone is a byproduct of the removal of estradiol from circulation. Estrone is weaker than estradiol and can be produced in the liver, muscles, fat, and other tissues. Estrogen and progesterone work together to promote monthly cycles and menstruation. Women with PCOS usually have normal levels of estrogen, between 25-75 pg/ml. Women with PCOS tend to be estrogen dominant meaning that they produce more estrogen than progesterone or that their progesterone levels are very low in relation to their estrogen levels. One reason weight loss improves fertility is that it decreases the amount of estrone created in the body. If you have abnormal estrogen levels, or you have an estrogen-dependent cancer, you may wish to avoid foods and herbs that have estrogenic activity. Estrogenic herbs include alfalfa, anise, hops, fennel, black cohosh, milk thistle, clover, red clover, Don Quai, licorice, ginseng, royal jelly, peony, nettle, sage, fenugreek, evening primrose oil, burdock, chamomiles, rhubarb. While foods tend to have a milder effect, you may wish to avoid eating too much of any of these foods: dates, garlic, pomegranate, apple, soybeans and soy products, chick peas, cherry, cow peas, green beans, red beans, split peas, flaxseed, raspberries, carrots, and squash. Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) LH and FSH are the two gonadotropins produced by the pituitary gland that cause the ovary to develop and release a mature egg. Levels vary throughout the cycle. At the beginning of the cycle, LH and FSH levels are usually between 5-20 mlU/ml. For most women LH and FSH are about equal during the early part of their cycle. Twenty-four hours before ovulation there is an LH surge causing LH levels to rise to 25-40 mlU/ml. Once the egg is released by the ovary, the LH levels go back down. While many women with PCOS still have LH and FSH within the 5-20 mlU/ml range, their LH level is often two or three times that of the FSH level. For example, a woman with PCOS may have an LH level of 18 mlU/ml and a FSH level of about 6 mlU/ml (both levels still fall within the normal range of 5-20 mlU/ml). This elevated LH to FSH ratio may disrupt ovulation. If LH levels are elevated in the early part of the cycle then PCOS should be suspected. FSH levels rise as the body approaches menopause. It is important to check FSH levels to rule out premature menopause, premature ovarian decline, or other problems that could impact your health. Insulin and Glucose Numerous studies indicate that PCOS is affected by insulin resistance. Insulin resistance is a diabetes-like condition in which your cells stop responding to normal levels of glucose (blood sugar). Your body produces more insulin causing an insulin spike. The excess insulin encourages your body to store the blood sugar away as fat. You may feel hungry soon after a starchy or sugary meal because your body quickly converts the starch or sugar into glucose causing an insulin spike, leaving your blood sugar levels lower then they should be. 9

Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

You may feel shaky, dizzy, nauseated or have a headache if your blood sugar levels drop too low. Even if your levels remain in the normal zone you may have symptoms of low blood sugar if your levels drop too quickly. Your doctor may test your fasting glucose and insulin levels or ask for a fasting glucose tolerance test (GTT). The Rotterdam group recommends that all women with PCOS have a glucose tolerance test to check both insulin and glucose levels. The GTT is more effective if you eat a lot of carbs in the few days prior to the test. You may be insulin resistant even though these tests come out within the normal range. Symptoms may develop when there is a significant change in your insulin or blood glucose levels throughout the day, even if they stay within the normal range. I tested within the normal range for years before the condition got bad enough to show up as abnormal on a test, despite the fact that I had the classic signs of insulin resistance: weight gain around middle, thinning hair, hypoglycemia, and a very difficult time losing any weight. Progesterone After ovulation occurs, the follicle develops into a small progesterone factory called the corpus luteum. Progesterone prepares the uterine lining for implantation of an embryo. Progesterone levels are checked about 7 days after ovulation is thought to have occurred. If the progesterone level is high (usually greater than 14 ng/ml) this means that an egg was released from the ovary. Low progesterone levels may indicate no egg was released. It is important to be sure that ovulation is actually occurring and progesterone levels are a good indication. Women with PCOS may have signs of ovulation but the egg may not actually be released. Prolactin Prolactin is a pituitary hormone that helps women produce milk when nursing. While prolactin levels are usually normal in women with PCOS, it is important to check for high prolactin levels in order to rule out a pituitary tumor or other problems that might cause PCOS-related symptoms. Prolactin levels are generally less than 25 ng/ml. Some women with PCOS have elevated prolactin levels, typically 25-40 ng/ml. Testosterone All women have testosterone in their bodies. Your doctor may order tests to measure your total testosterone and free testosterone. Total testosterone tests measure the total amount of all testosterone, including the free testosterone, in your body. The typical range for total testosterone is 6.0-86 ng/dl. Free testosterone is unbound and active in your body. Free testosterone usually ranges from 0.7-3.6 pg/ml. Women with PCOS often have an increased level of both total testosterone and free testosterone. Slight increases in testosterone can suppress normal menstruation and ovulation. Thyroid hormones and antibodies A recent study by Dr. Onno E. Janssen of the University of Essen (Germany) showed that women with PCOS are three times more likely to have autoimmune thyroiditis than other women. Dr. Janssen found that 27 percent of women with PCOS had elevated thyroid 10

Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

antibodies compared with only eight percent in the control group. If you suffer from fatigue, hair loss, irregular periods and other symptoms of low thyroid you should ask your doctor about having your thyroid hormones and thyroid antibodies checked. In his presentation at the American Thyroid Association 2003 annual meeting Dr. Janssen said, "All patients with PCOS should be screened for autoimmune thyroiditis, even without evidence of overt thyroid dysfunction. Thyroid stimulating hormone (TSH) is the most common level checked. However, TSH levels that are normal can occur even when there is an underlying thyroid problem. Worse, many doctors are not aware that the American Thyroid Association (ATA) has changed their recommendations for TSH levels. The new normal is between 0.3-3.04 instead of the old range of 0.5-5.0. Also presenting at the 2003 ATA conference, Elizabeth N. Pearce, MD, an instructor of medicine at Boston Medical Center and Boston University School of Medicine in Boston, detailed the results of her recent study on cholesterol and thyroid disease. The study found that people with mildly high blood levels TSH may also have elevated blood cholesterol levels. Getting your thyroid levels checked is extremely important before trying to conceive. If you have a thyroid problem and you become pregnant you should have your thyroid levels checked frequently because pregnancy changes your thyroid levels rapidly. Uncontrolled thyroid disease during pregnancy can lead to brain damage and other health effects in babies. Understanding Hormone Levels Hormone levels can vary widely, even in healthy women. Each lab determines their own normal range. This can make it very confusing when the lab says your levels are normal and they fall outside the average accepted by other labs. It is important to remember that with all women, hormone levels can very greatly. If your doctor is not well versed in PCOS they might not understand that small differences can make a huge impact on your symptoms. One doctor I saw insisted that since my estrogen and testosterone levels were within the normal range that I did not even have PCOS! Be especially aware of differences in your testosterone, LH, FSH, and estradiol levels. If your doctor insists that you dont have PCOS yet your FSH/LH levels are not equal, your LH level is much higher than your FSH, your levels are low, or your testosterone level is >40 ng/ml you may need to see a specialist.

What are the conventional treatments?

Conventional doctors have treated PCOS with birth control pills for decades. More recent treatments include using insulin sensitizing drugs such as metformin. In either case these treatments are covering up symptoms, not treating the cause of the illness. I have nothing against using these methods if they work and if you dont have worse side effects from using them. If you choose to use these methods there are a few things you should 11

Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

know about them. Please do not stop taking any medication without consulting your physician. Abruptly stopping some drugs can cause serious health problems. Metformin Metformin and other insulin sensitizing drugs are a fairly new treatment for PCOS. Many women have great success with weight loss, increased fertility and effectiveness of clomiphene citrate, and other benefits of these drugs. Metformin has been shown to decrease the risk of miscarriage and gestational diabetes if taken during pregnancy. However, many women have serious side effects such as diarrhea, stomach cramps, nausea and vomiting. For some women these effects go away as the body adjusts, for others it is an ongoing problem. If you decide to take metformin you should be aware that 10-30% of metformin users show decreased vitamin B12 absorption. The stomach creates a substance called intrinsic factor that makes it possible for B12 to be absorbed. Vitamin B12 is required for the proper growth and function of every cell in your body as well as for DNA replication. Decreased B12 is linked to cardiovascular disease. In one study this lack of intrinsic factor continued after the use of metformin stopped. Increased intake of calcium may counteract this problem (Bauman et al, Diabetes Care. 2000;13(9):1227-1231). Metformin raises homocysteine levels. Women with PCOS already tend to have elevated homocysteine. An elevated level of homocysteine in the blood means that your metabolic processes are not working properly. High levels of homocysteine are associated with coronary artery disease, heart attack, chronic fatigue, fibromyalgia, cognitive impairment, and cervical cancer. Vitamin B12, vitamin B6 and folic acid are responsible for metabolizing homocysteine. When metformin reduces absorption of vitamin B12, you lose one of the nutrients needed to metabolize homocysteine and thus increase your risk of cardiovascular problems. Pre-eclampsia (high blood pressure and edema) can cause serious complications in pregnancy. A study at the Center for Perinatal Studies at Swedish Medical Center in Seattle, Washington, indicated that a second trimester elevation of homocysteine was associated with a tripled risk of pre-eclampsia. The Dept. of Obstetrics and Gynecology, Nijmegen, The Netherlands, concluded, upon review of a number of studies, that elevated homocysteine is a risk factor for recurrent early miscarriage. Liver and kidney function should be assessed before starting metformin and reevaluated annually while taking metformin. Metformin alters your liver function and causes your kidneys to work harder. Some women report an increase in hair loss while taking metformin, although no studies have confirmed this link.

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Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

A tiny percentage of people who take metformin will develop lactic acidosis. Lactic acid is produced naturally in your body as a result of metabolism. However, if it builds up faster than the body can eliminate it, then it can become toxic. Those at greatest risk include those with diabetes, kidney or liver disease, multiple medications, dehydration, or severe chronic stress. Symptoms include rapid deep breathing, a slow, irregular pulse, feeling weak, muscle pain, sleepiness, and a sense of feeling very sick. If you suspect lactic acidosis, go to the emergency room immediately. According to the Diabetes Prevention Program, a major clinical trial conducted by the United States National Institutes of Health (NIH), exercise and diet changes were 38% more effective than metformin in preventing diabetes in those with already elevated glucose levels. The researchers divided 3,234 people with elevated blood glucose but no diabetes into 3 groups. The first group received metformin alone with no diet or lifestyle changes. The second group received only diet and lifestyle education and support (no metformin). The third group received a placebo and no diet or lifestyle support. After 2.8 years, the placebo group had a diabetes rate of 11%. For those taking metformin, diabetes developed in 7.8%. Those who changed their diets and lifestyle had the best results with only 4.8% developing diabetes. If you take metformin, you should ask your doctor about taking a good quality multiple vitamin and mineral supplement, calcium, magnesium, a high-quality B-complex, and vitamin D. A holistic approach to PCOS treatment offers greater effectiveness than metformin alone. It is also cheaper, offers other benefits such as reduced cancer risk, and is less expensive than metformin. There are no adverse side effects to a healthy lifestyle. Lowering stress, improving your diet, getting enough exercise, and getting the right nutrition can make your whole life better. I know I prefer the benefits of a healthy lifestyle over the side effects of medication. Birth control pills Birth control pills (BCP) and other hormone therapies vary widely in their specific levels of estrogens and progestins (progestin is not the same as natural progesterone). Different brands can have very different effects on your body and your nutrient levels. Some brands use synthetic hormones and others use hormones from horse urine or from precursors found in plants such as wild yam. Birth control pills can cause rapid weight gain, mood swings, depression, and fluid retention. Many women with PCOS use Yasmin or Diane 35 to regulate their cycles. If your doctor believes that birth control pills are the best answer for your needs, be sure that you are on the appropriate type of pill. Some pills do reduce acne and help with PMS symptoms. Women who have heavy or painful periods may find some relief on BCP. Birth control pills can cause folic acid depletion and increase the risk of cervical dysplasia and vascular thrombosis, and stroke. 13

Excerpt of Alternative PCOS Solutions 2004 Julie Renee Holland All Rights Reserved

Many B-vitamins are depleted by birth control pills, so nutritionists recommend a Bcomplex supplement. Vitamin C levels are lowered by BCP because they disrupt the metabolism of ascorbic acid. Insufficient intake of vitamin C is linked with an increased risk of cervical dysplasia. On the other hand, some nutrients are increased by BCP. Copper levels increase as estrogen levels increase. Elevated copper is associated with an increased risk of death from cardiovascular disease. Copper and zinc tend to be antagonistic, so an elevated copper level will result in a lower zinc level. Using BCP can increase iron levels. Too much iron can be as dangerous as too little. Iron testing may be appropriate in long term users. You can read more about PCOS in my book Alternative PCOS Solutions or sign up for my newsletter at www.pcoscoach.com. You have permission to share this report as long as you make no changes to it.

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