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This is an article I wrote for the newsletter "In Touch" produced by Verity, the polycystic ovaries self help group. I would recommend to any woman with PCOS that they join Verity, membership costs a mere £15 per year (£7 for concessions). The website is at www.verity-pcos.org.uk or e-mail veritymembs@aol.com
I have left in the editor's comments.
PCOS is
a poorly understood, complex, multifactorial syndrome involving both genetic and
environmental influences (a bit like life, really). It is the most common
endocrine abnormality in women of reproductive age. However, just because we
don't understand a condition doesn't mean that we can't treat it. Throughout
human history people have tried to explain disease with theories of differing
credibility, while treatment (until the modern era) has stayed pretty much the
same.
The
symptoms of PCOS can roughly be lumped into four main groups for convenience,
although they obviously all interact:
1.
Hormonal – lack of periods, irregular periods, painful periods, premenstrual
syndrome, infertility
2. Acne
3.
Hirsutism
4.
Metabolic – weight gain, insulin resistance, diabetes.
Women
with PCOS can vary from having only one of these symptoms mildly to having all
four severely, and this will affect the nature of the herbal treatment.
The aim
of herbal treatment is to enable the body to readjust the excess levels of
hormones to more 'normal' levels so that the menstrual cycle can occur in a
'normal' manner. In my experience, this often occurs very successfully, although
the further the body is from 'normal', the longer it may take, and the less the
likelihood of success eg women with irregular periods achieve a 28-day cycle
much faster and more successfully than women who are completely without periods.
As the
majority of my patients come to see me because they are trying to conceive or
want to regulate their periods, I tend to concentrate on the first category of
symptoms. I usually use a mixture of Chinese and traditional Western herbs:
Vitex
agnus castus (chasteberry) – I give this
separately, to be taken first thing in the morning, when it seems to be most
effective. There is some debate as to whether vitex is appropriate for PCOS, but
the majority of herbalists use it and find it effective. Reports from my
patients indicate that it can maintain menstrual regularity on its own once this
has been achieved with the other herbs, and it also reduces hair growth.
Angelica
sinensis (Chinese angelica/dong gui) and Paeonia
lactiflora (peony root/bai shao) – these two are often used together in
traditional Chinese medicine for the treatment of menstrual irregularity and
combine well with Glycyrrhiza glabra (liquorice root) – although this
should not be used medicinally if there is high blood pressure.
Other
herbs that might be used include:
Taraxacum
officinalis radix (dandelion root) –
Western herbal medicine places great emphasis on the liver and a PCOS formula
would often contain ‘hepatics’ or liver herbs. Examples are milk thistle,
barberry, schisandra berry and dandelion root. The latter is used to increase
bile flow and biliary excretion of conjugated hormones, and also to increase
production of sex hormone binding globulins (SHBGs), which basically ‘mop
up’ free testosterone in the body, thus reducing its effects, including acne
and hirsutism (see Jargon-buster box).
Cimicifuga
racemosa (black cohosh root) – recent
research has shown this herb contains three types of hormonally active compound,
one of which suppress luteinising hormone secretion after prolonged
administration.
Humulus
lupulus (hops) – this has an action
similar to black cohosh, but is used where stress and nervous tension accompany
PCOS.
Trifolium
pratense (red clover) – contains
phyto-oestrogens and also acts as an alterative (blood purifier), so is useful
where acne is a problem.
Hypericum
perforatum (St John's wort) – used where
depression, other than that of PMS, accompanies PCOS.
As
these both occur as a result of excess androgens I will discuss them together.
In PCOS there is an excess of testosterone produced in the follicles which is
converted to dihydrotestosterone in the target tissues by the enzyme
5-alpha-reductase, and it is this action that causes the acne and male-pattern
hair growth. The herb saw palmetto (Serenoa serrulata) has long been used
for blocking this conversion in the male prostate, and logically should be of
use in PCOS. However, actual experience is very variable, with some women
reporting improvements but others experiencing a worsening of the symptoms.
Another
indicated herb, or group of herbs, is Epilobii herba (E. angustifolium,
E. parviflorum, E. hirsutum), which has been used in Europe for prostate
problems. Recent research in Germany has shown that an infusion (ie a tea) can
inhibit the enzyme 5-alpha-reductase, so again logically this would be a good
herb to use, although so far it has not been used in PCOS long enough for there
to be any results either way (Ed’s note: I have used it with some success for
acne, and it actually tastes quite pleasant – a first for a herbal
treatment?!).
So try
either and see what happens. In my experience, if the menstrual cycle can be
regulated or initiated, then the acne will improve although not, for some
reason, the hair growth.
Metabolic
symptoms
These
are best controlled by a mixture of dietary change (eg the GI diet), lifestyle
change (eg lots of exercise) and supplementation. I normally recommend a
minimum of hemp seed oil (for the essential fatty acids it contains – see here)
and a B-vitamin complex. More might be required eg chromium, depending on the
person. Some herbalists also use herbs to regulate blood sugar and lipid levels;
examples are Gymnema sylvestre, an Indian plant known as the ‘sugar
destroyer’, Galega officinalis (goat's rue – NB guanidine,
the
active ingredient in goat's rue, was the inspiration for metformin)
and Trigonella foenum-graecum (fenugreek).
To sum up, I hope I have shown that although PCOS is poorly understood, herbs can successfully be used, alongside supplements, lifestyle and dietary change, to treat the symptoms and successfully manage the syndrome.
Jargon-buster: conjugated hormones and SHBGsSex
hormones are steroids ie fats and are therefore water insoluble – which
is why they need the sex hormone binding globulins or SHBGs (which are
water-soluble proteins) to move through the bloodstream. In order to get
rid of used or excess hormones the liver conjugates, or joins, them with
another molecule to make them water soluble. They are then excreted via
the bile duct into the gut. If they hang about in the gut too long these
conjugates are broken down by bacteria in the gut and the hormone
component is reabsorbed into the hepatic portal vein. This is known as
entero-hepatic recirculation. So by increasing bile flow you are helping
to both improve the clearance of excess hormones via the liver and reduce
the amount of entero-hepatic recirculation. Improved bowel function also
helps to reduce insulin levels. |
Copyright © Graham White, B. Sc. (Herb. Med), 2007.