Though fertility and reproductive health are not immediate concerns for all women of reproductive age, polycystic ovarian syndrome (PCOS) has signs and symptoms that affect several of the other systems in the body. Laypeople and patients often categorize PCOS as a reproductive disorder and, though it can affect fertility, PCOS is actually an endocrine disorder.1 The endocrine system controls hormone secretion and basic metabolism. Endocrine disorders occur if the body does not respond to hormones appropriately. While the most common endocrine disease is diabetes, PCOS affects 5 to 10 percent of women of reproductive age.
PCOS and Insulin Resistance
There is a strong link between PCOS and insulin resistance, similar to the pathology of diabetes. In individuals who are insulin resistant, the body does not respond appropriately to the hormone insulin, so the liver, muscle, and fat cells cannot properly absorb glucose from the blood. Then the body produces excessive levels of insulin. In PCOS, the excess insulin leads to excess production of androgenic hormones by the ovaries, thereby disrupting ovulation and leading to infertility. Insulin resistance is often associated with obesity, particularly midsection obesity.2
Endocrine disorders like PCOS can also be associated with risk factors for cardiovascular disease like obesity, and high blood pressure, and inflammation. A 2015 study found that women with PCOS were likelier to experience more nonobstetric hospital admissions, including diabetes, obesity, hypertension, asthma, stress, and depression, than were women without PCOS.3 Other research has found that women with PCOS are more likely to have insulin resistance – indeed, insulin resistance was found in 95 percent of overweight women with PCOS and in 75 percent of normal weight women with PCOS.4
PCOS is notoriously difficult to diagnose, in part because the cause of it is unknown. Symptoms of PCOS can include weight gain, especially around the midsection, excess hair growth, and cystic acne. However, a diagnosis of PCOS requires elevated levels of androgenic hormones like testosterone, irregular or nonexistent periods, and/or twelve or more follicular cysts on the ovaries, though there is no one way to definitively diagnose the condition.5-6 Its genetic component means that the pathology of PCOS is different in each woman.
Treating and Managing PCOS
Conventional, alternative, any lifestyle medicine can all play a role in managing PCOS. While the evidence for lifestyle medicine is strong, including maintaining a healthy weight and consuming an anti-inflammatory diet, Chinese medicine and acupuncture have also been found to play a role in PCOS management.
As with other endocrine conditions like diabetes, taking a lifestyle medicine approach by improving nutrition can have dramatic effects on endocrine function and insulin resistance. Over six to seven months, a study was conducted in which 24 women with PCOS were placed on a low-fat diet of 1000 calories per day.7 At the beginning of the study, all of the women had obesity and menstrual disturbances, 12 of the women experienced infertility, and 19 had excessive hair growth, each of which is a common symptom of PCOS. Over the course of the study, 13 of the participants lost more than five percent of their body weight. Those women had improvements in hormonal balance, reduction in fasting serum insulin levels, improvements in insulin response, more regular menstruation, and reduction in excessive hair growth.
Chinese Medicine Therapies for PCOS
A review of the physiological effect of complementary and alternative therapies to manage PCOS describes the function of acupuncture, Chinese herbs, and dietary supplements when it comes to managing PCOS.8 For example, acupuncture can improve hormone balance to reduce the menstrual irregularity that can accompany PCOS. Acupuncture modulates the somatic and autonomic nervous system, thereby influencing the endocrine system. Indeed, a literature review of four studies on the effect of acupuncture on PCOS found that the therapy might result in positive outcomes.9 Acupuncture was found to increase β-endorphin levels up to 24 hours and may have regulatory effect on the hormones follicle-stimulating hormone (FSH), luteinizing hormone (LH), and androgen.
While some limited research exists on the function of herbal medicines and dietary supplements for PCOS, the evidence on their effectiveness is limited as well.
A meta-analysis of four randomized controlled trials included 344 subfertile women who had PCOS.10 The quality of the evidence included in the meta-analysis was poor because all of the interventions were different. One dietary supplement regimen including Chinese herbs improved the pregnancy rate of the women enrolled in that regimen, but there was no evidence that any other PCOS-related health outcome improved, including ovulation.
Research indicates that lifestyle medicine is the most effective method for managing PCOS. PCOS is more than a reproductive health issue or an irritation involving appearance. It is a complex endocrine disorder that may affect up to 10 percent of reproductive-aged women, so additional research into causes and development of the condition is required.