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Polycystic Ovarian Syndrome, or PCOS, has also been known by the name
Stein-Leventhal Syndrome, and includes a multi system presentation,
having its effects on the skin, hair, body weight, endocrine system,
and reproductive system. It is said to affect up to ten percent of
women of reproductive age, and up to ninety percent of woman with
irregular menstrual cycles.
PCOS was first recognized as a medical disease or syndrome in the West
in 1845 in France. Its most distinctive sign is the pathologic
appearance of sclerocystic changes on the larger than average ovaries,
which appeared to have a thick, shiny, white coating overlying many
rows of cysts on the surface of the ovary. These ovarian changes give
PCOS its name. In 1990 a National Institute of Health conference
decided the two most consistent elements which comprise the disorder of
PCOS include elevated androgenic hormones and chronic lack of
ovulation. Yet PCOS has a multitude of other symptoms as well,
including obesity, acne, facial hair and increased body hair, and
thinning of the hair on the head.
Most of the symptoms of PCOS are caused by the state of the ovary. The
capsule of the ovary is thickened and waxy. Multiple small cysts exist
inside the ovary which are not the same as active follicles, but have
been arrested in their development. These cysts and the connective
tissue surrounding them, the stroma, produce male hormones called
androgens. Testosterone is very similar in chemical composition to
estrogen, but it causes the male type effects so often seen in PCOS.
The brain detects circulating levels of sex hormone, and inhibits
ovulation accordingly.
Luteinizing hormone is often elevated higher than FSH in a woman with
PCOS, and remains elevated throughout the cycle. LH stimulates the
cells of the ovary to produce androgens, which block follicular
development, causing the follicles to degenerate. This process is
thought to be a result of an altered feedback mechanism within the
hypothalamic - pituitary - ovarian axis, and makes ovulation unlikely.
Impaired glucose tolerance and insulin abnormalities are also a factor
in many cases of PCOS, and have to do with another endocrine gland, the
pancreas. Insulin resistance affects ovulation by producing higher
amounts of circulating insulin, which stimulates the activity of
enzymes which help to manufacture androgens in the ovary. High insulin
levels further may cause overstimulation of androgen receptors, leading
to follicular atresia of developing eggs.
The etiology of this disease remains unknown. Doctors and scientists
have been unable to pinpoint the actual causative factor, and thus have
been unable to treat it effectively. Woman with PCOS are at risk for
other health hazards like disorders in lipid metabolism, obesity and
its health concerns, vascular disease and cancer.
So, how does PCOS affect fertility? By affecting the ability to
ovulate. Less estrogen is produced, but more LH and testosterone. This
affects not only the quality of the follicle, but also the state of the
endometrium. As a result, menstrual cycles become more erratic and less
predictable. Women with PCOS will often very long cycles and very heavy
bleeding; or amenorrhea, or anovulation with scanty bleeding. (Each
presentation, by the way, is addressed using different treatment
protocols with Oriental Medicine.) When an egg is released, it is often
released later in the cycle, and it is of poorer quality because of the
surroundings in which it has been developing. Remember that follicular
development is a process that takes approximately one hundred days
within the ovary. Eggs are meant to develop in an estrogen and
progesterone rich environment, not in an androgenic setting.
Women diagnosed with polycystic ovarian syndrome historically do not
respond positively to Western assisted reproductive techniques
including in-vitro procedures; nor do they respond well to clomid
alone, or any hormonal manipulation which does not address the state of
the ovary's endocrine milleau over the previous three or more months of
development. If they do become pregnant, they are at higher risk of
miscarriage, again presumably because of the health of the egg and
therefore the developing embryo.
Chinese medicine seeks to redress the entire hormonal milleau.
Polycystic Ovarian Syndrome - The Traditional Eastern View
In Traditional Chinese Medicine, Polycystic Ovarian Syndrome is seen as
a heterogenous disorder, consisting of quite a few possible pattern
discriminations. They are broken down into two main subcategories:
Vacuity
- Kidney yang vacuity
- Kidney yin vacuity
- Spleen qi vacuity
Repletion
- Phlegm dampness
- Liver depression/depressive heat
- Blood stasis
They all have manifestations in the way in which the body ovulates,
however. Most women with PCOS ovulate later in the cycle, if at all.
Going back to the diagnostic checklist, you may categorize yourself
into any combination of the diagnostic categories. Treatment will be
based upon these differentiations.
Treatment
Treatment must first and foremost be based upon your individual
diagnostic pattern. Follow the dietery guidelines for PCOS (below). Do
the following exercise to increase blood flow to the ovaries:
Femoral Massage -
[This exercises increases the blood flow to the pelvic organs, providing more nourishment to the uterus and ovaries.]
Compress (or have your partner compress) the large artery just beneath
the crease in your groin between your thigh and lower abdomen. This is
the femoral artery, which comes from the iliac artery. The iliac artery
gives off branches which supply blood flow to the uterus, fallopian
tubes and ovary. (The ovary has an additional blood supply which
branches off the same arterial section that supplies the kidneys.) When
the flow has ceased and you feel the pulsation end at your finger tips,
hold for 30-45 seconds. The blood is now backing up and increasing the
pressure gradient in the iliac arteries and forcing more blood into the
pelvic arteries, flooding the pelvic organs with more blood. When the
hold is released, you should feel a sensation of warmth rushing down
your leg as the blood supply returns to the lower extremity. Perform
the femoral massage three times, twice daily.
NOTE: Do not perform this exercise if you are pregnant. If you have
high blood pressure, heart disease or circulatory problems including
aneurisms, varicose veins, phlebitis, thrombosis, or a history of
strokes or detached retinas, do not practice these techniques. If you
have diabetes or similar disorder which affects the circulation, but
can perform normal exercises and daily routines, practice on one side
at a time and repeat on the opposite side. Perform the femoral massage
three times on each side, twice daily if possible.
If you will be l supplementing with herbs, include Gleditsia during the
first half of your menstrual cycle, before ovulation. Gleditsia is
categorized as a phlegm resolving medicinal in Chinese Medicine, and is
known to dissolve the waxy capsule around the ovaries, and it promotes
ovulation. Leonurus Fruit is a blood quickening medicinal with an
inherent effect of encouraging ovulation in those who have any element
of blood stasis. Women with ovulatory pain have blood stasis on
ovulation.
Anovulatory women should begin to notice signs of ovulation after a
couple months of treatment. Women with belated ovulation will often
notice that their ovulation comes earlier and earlier in the cycle
until they ovulate normally on cycle day fourteen.
Most women with PCOS also have endocrine abnormalities which are affected by diet.
Dietary Therapy
If you are overweight, this condition responds much better to weight
loss. Fat cells store estrogen, and there is usually relatively too
much circulating estrogen and LH in women with PCOS. The liver
metabolizes these hormones, so a healthy functioning liver is mandatory
for proper therapeutic effect. Include dietary sources of the B
vitamins, which keep the liver healthy.
Because of the insulin resistance and impaired glucose metabolism found
in PCOS, it is very important to modify dietary intake if you have this
condition.
Insulin is a hormone secreted by the beta cells of the pancrease and is
designed to maintain the blood glucose level within a certain range.
Insulin stores glucose in the form of fat. Insulin resistance means
that the body's response to insulin in various tissues is impaired.
Hence, the pancreas secretes more insulin. When the body fails to
respond to insulin, glucose intolerance and diabetes and its many
complications may become the eventual result.
The best natural management for insulin resistance and impaired glucose
metabolism is to lower the level of sugar intake from the diet, and
eliminate the ingestion of any food substance that the body can
utilizes as simple sugar.
-
Cut out all forms of refined sugar
- Cut out all forms of refined carbohydrates. The body immediately turns
these into sugar. This includes white bread, pasta, potatoes, white
rice, most breakfast cereals, rice cakes, popcorn, or any starchy, low
fiber food.
- Do not adhere to the fertility diets that advocate massive yam
consumption. This can actually delay or prevent ovulation if you have
PCOS.
- Avoid soda, fruit juice, and any drink which rapidly raises the blood sugar level.
- Consume adequate amounts of protein, either in vegetarian form or in
the form of lean meat which has not been treated hormonally.
- Eat as many fresh vegetables as you wish.
- Eat only complex, whole grains.
- Eat fruits like berries which are not too sweet.
- Avoid milk and dairy products which tend to exacerbate the condition of internal dampness.
- Eliminate alcohol and caffeine.
- Increase your dietary fiber intake.
- Exercise.
A Swedish/Italian controlled study from the Biology of Reproduction
Journal, (date): involved inducing a state of poly cystic ovaries in
rats, with injections of estradiol valerate. Increased activity of the
sympathetic nervous system resulted, followed by increased
concentrations of nerve growth factor in ovaries, and the adrenal
glands. Within 60 days the rats developed polycystic ovariess. The
control group received no therapy and maintained features of PCOS.
Those treated with acupuncture showed a reduction in the hyperactivity
of the ovarian peripheral sympathetic nerve fibers, reduction of the
increased nerve growth factor concentrations within the ovaries to
normal and reduced the weight of the poly cystic ovaries. This group of
doctors then set out with the aim of reproducing similar results in
women with PCOS. The study concluded, "We have shown that repeated
electroacupuncture treatments restore regular ovulations in the
anovulatory women with PCOS. In addition, acupuncture influenced
neruoendocrine and endocrine parameters indicative of PCOS, such as
LH/FSH ratios, mean testosterone concentrations, and beta-endorphin
concentrations, which reduced significantly."
This study illustrates the hormonal origin of this disease process, and
the fact that it can be induced artificially. The induction of this
hormonal trauma produces a physiologic state of stress which raises the
activity of the sympathetic nervous system, producing a disease
syndrome. Acupuncture treatments were effective at resolving this
pathologic process because it reduces the level of hypersympathetic
nervous system response, relaxing the whole neuroendocrine system.
About the Author
Randine Lewis, MSOM, L.Ac., Ph.D., a licensed acupuncturist and
herbalist, has studied both Eastern and Western medicine. After
suffering from "infertility" herself, she earned her graduate and
post-graduate degrees in Acupuncture and Oriental Medicine, always
focusing on fertility enhancement. In addition to resolving her own
fertility issues, she has helped thousands of women throughout the
world - with natural, health enhancing methods. She lectures, and
publishes articles for RESOLVE, the American Infertility Association,
and medical organizations, and is a medical expert on numerous online
fertility boards.
Dr. Lewis authored "The Infertility Cure, the Ancient Chinese Wellness
Program for Getting Pregnant and Having Healthy Babies", and has
appeared on multipe radio and television shows throughout the country,
all featuring her successes in helping women conceive with Traditional
Chinese Medicine.
She now offers her phenomenal treatment methods, combined with the
mind-body medical program for overcoming infertility in her fertility
enhancing retreats, which take place in Austin, Texas at The Crossings
in 2006. Each retreatant receives a thorough Eastern medical
evaluation, and dietary, nutritional and herbal plans based upon this
individual diagnosis.
For details regarding retreats or Dr. Lewis' speaking availability, please visit www.thefertilesoul.com or call 713-869-8842.
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