Polycystic Ovarian Syndrome and Ovarian Cysts
More and more I am seeing young girls in their teens and 20’s with ovarian cyst or even full blown PCOS. While the cause of PCOS is unknown, there do appear to be connections with family history, insulin resistance and lifestyle or environment. Personally I think it’s happening more than ever due to the barrage of oestrogenic or hormone modulating chemicals that have flooded our environment over the last 50 or so years. It is also likely that chemicals that your mothers and grandmothers were exposed to have contributed. Another big contributor is most certainly stress. So what is PCOS?
The common symptoms of PCOS are:
· No periods or periods that are irregular, infrequent or heavy
· Immature ovarian eggs that do not ovulate
· Multiple cysts on the ovaries
· Difficulty becoming pregnant
· Excess facial and or body hair (hirsutism)
· Acne on the face and or body
· Scalp hair loss
· Darkened skin patches (acanthosis nigricans)
· Mood changes
· Depression
· Anxiety
· Possible insulin resistance
Although some women with PCOS have regular periods, high levels of androgens and also the hormone insulin can disrupt the monthly cycle of ovulation (when eggs are released) and menstruation.
If you have PCOS, your periods may be 'irregular' or stop altogether. In some girls PCOS is a cause of periods failing to commence. The average menstrual cycle is 28 days with one ovulation, but anywhere between 21 and 35 days is considered 'normal'. An 'irregular' period cycle is defined as either:
Eight or less menstrual cycles per year. Menstrual cycles longer than 35 days.
As menstrual cycles lengthen, ovulation may stop entirely or only occur occasionally. Some women with PCOS also experience heavier or lighter bleeding during their cycle.
The hormone insulin is thought to be an important part of the development of PCOS. Insulin is needed in the body for control of blood sugar, and 'insulin resistance' is thought to be a key part of the development of PCOS. Insulin resistance means that some parts of the body are 'resistant' to insulin, meaning that more insulin than usual is needed to keep blood sugar in the normal range. This means that insulin levels are often high or the body doesn't respond normally to insulin. This in turn can affect the function of the ovaries, including hormone and egg production. So, insulin resistance should always be tested for.
The standard medical approach is to use the Oral Contraceptive Pill to essentially mask your hormonal problem. This can be helpful in some women as they may get symptom relief but for many, who can’t tolerate the OCP or don’t want the risk they are left stranded. Also masking your hormones is not resolving the underlying issue and that’s the key to good hormonal health. Metformin is also often used to help with insulin resistance however this is not ideal as there are some side effects.
Herbal Medicine has much to offer in PCOS:
There are different types of cyst and this may also change the treatment options in Complementary Medicine. The most likely is a Benign cyst which has just built up due to a disturbance in the normal processes of ovulation – which to me means your hormone triggers are not adequate enough to trigger full ovulation. A naturopath could certainly address this but you may need to come off the Oral Contraceptive Pill (OCP).
There are many types of benign cysts:
Serous and mucinous cystadenomas, Fibromas, Dermoid Cysts (teratomas) and Brenner tumours.
The first type is the one that can get very big and are sometimes attached to the ovary by a stem which can twist and cause the cyst to burst. Complete torsion (when the ovary containing the cyst twists and cuts off it’s own blood supply) can cause extreme pain and vomiting. These cysts rarely reabsorb by themselves and surgery is recommended particularly if over 5 cm.
Ovarian cancer is rare and ovarian cysts can be borderline – neither benign or malignant so this would have to be considered by your GP. One in every three ovarian cysts which occur from 45 yrs. onward are cancerous. Hormone markers are often produced by ovarian cancers and these can be used as diagnostic aids.
Other types of Cysts are Physiological cysts (also called simple cysts or functional cysts) and there are two types: Follicular and Luteal cysts.
Follicular cysts are formed due to failed ovulation and occur because the mature follicle fails to release its ovum and continues to grow, forming a cyst. In most cases they are small and cause few symptoms.
Luteal cysts develop in the second phase of the menstrual cycle after the corpus luteum has formed. If large enough they can cause dull pain on the side. They usually reabsorb eventually. Occasionally luteal cysts rupture and pain is mild however large blood-filled cysts can be associated with quite a degree of pain. Luteal cysts often disappear after one cycle.
Naturopathically the option would be to prescribe certain herbs that work on breaking down cysts in the body, improving the lymphatic system, that support micro-circulation to the ovary, that support the immune response and improve liver clearance of hormones. However really getting into proper naturopathic treatment would mean coming off the pill and using ovarian tonics and hormonal modulating herbs.
In some cases, I would do a salivary hormone test to see how your testosterone, estrogen and progesterone levels are as this can give us a baseline to work from and tell us a lot about how bad your hormonal imbalance is. It is also important to test your DHEA which is an adrenal hormone. If DHEA is elevated it can mean that your PCOS has developed due to too much stress and this is an area we need to treat. In fact, stress causes PCOS in 20% of cases. Another test to consider would be could do a LH/FSH ratio to see if there are any abnormalities with the pituitary hormones – your GP would normally take care of this. Please bear in mind that if you need to have surgery on a cyst, the hormonal abnormalities that led to it are usually still there and need to be addressed.
Herbal Medicine is universally about treating the underlying cause, not masking the symptoms. I would choose specific hormone modulating herbs to support healthy ovulation, improve the health of the ovaries, normalize hormonal levels and clear cysts.
There are three specific herbs for treating ovarian cysts
1. Chaste Tree
This herb is for up-regulating progesterone (often decreasing for women in their 40’s) and often lacking when you don’t get complete ovulation – you see it is the Corpus Luteum (really think of this as the tissue left behind in the ovary) that secretes a lot of the progesterone we need once the egg has been released from the ovary.
The actions of Vitex are that it is a Hypothalamic- pituitary-ovarian regulator – so it is regulating all the hormone signals that support normal female physiology.
It is also commonly used for female acne.
One of Vitex’s specific indications is female acne and ovarian cysts. It is really effective however it needs to be dispensed and monitored by a Naturopath or Herbalist who knows when, what dose is right for you and how long to use it for.
2. Peony
Peony is also a pituitary – ovarian regulator and what we call Ovarian Tonic . It is used for a wide range of female repro conditions because of this including Ovarian cysts. Peony has traditionally always used for ovarian dysfunction together with Licorice. Again this herb should only be used by a qualified Naturopath or Herbalist who can assess your situation.
3. Licorice together with Peony have been clinically trailed to prove their efficacy in reducing testosterone production from the ovaries and to improve ovulation. The combination of Licorice and Peony has been used in TCM for centuries and now used extensively in western herbal medicine for ovarian cysts and PCOS. The combination alters the Luteinising Hormone vs Follicle Stimulating Hormone ratio that is abnormal in PCOS and this is what is starting to become irregular if you are developing cysts.
Licorice is call and ADRENAL TONIC – it helps our body to regulate the amount of stress hormones including cortisol, produced by your adrenals. High stress is exactly what can lead you into hormonal abnormalities as you are always siphoning off your hormonal pre-cursor DHEA to make stress hormones instead of using them to produce healthy levels of Progesterone which protect you from developing ovarian cysts and other female hormone problems. Progesterone protects us from the negative effects of Oestrogen. Progesterone is also rapidly declining in your 40’s and me are more susceptible to hormonal problems. It can be helpful to understand the symptoms you may get if your progesterone is getting low in relation to your oestrogen levels:
Symptoms of Progesterone deficiency (and therefore often relative Oestrogen excess) include:
· Premenstrual breast swelling
· Painful periods (Dysmenorrhea)
· Premenstrual Bloating
· Endometriosis
· Ovarian Cysts
· Uterine fibroids
· Infertility
· Breast and Endometrial cancer
· Premenstrual irritability
· Anxiety
· Cystic breasts
· Mastalgia (sore breasts)
· Menorrhagia
Licorice and Peony in combination has been shown to reduce testosterone levels and improve the oestradiol to testosterone ratio after 4 weeks of taking.
There are many ways a Naturopath can help you with female hormonal problems such as ovarian cysts right up to full blown PCOS and I have just given you a taste. In my opinion Herbal Medicine has many answers that far surpass what the pharmaceutical industry has to offer. Women’s bodies work amazingly well with herbal medicine. I hope you found this article helpful and if you are worried or you think you have some of the issues, I have described above please book an appointment with me to discuss.
Article by Lucy Frew Naturopath BHS Comp Med. Adv Dip Nat. Dip Nut. ATMS 14588
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