Treatment Strategis for Specific Ailments
Poly-Cystic Ovarian Syndrome - definition and treatment |
Polycystic ovarian syndrome is a condition that is becoming more and more widespread. It is so common infact that, during my training in the University Clinic, one out of every five patients would present with this condition, or a complication of it (this does not represent its distribution nationwide). The term polycystic refers to the way in which the ovary appears during an ultrasound examination - covered in small cysts. However, these are not cysts infact, but ovarian follicles that have been unable to develop fully and rupture to release the egg within. This often occurs after an initial period of ovarian dysfunctions that are discussed later. The syndrome associated with polycystic ovaries usually presents with abnormal hormonal profile, abnormal cycle and duration, and menstrual complications. There can also be symptoms of hirsuitism (excessive, masculine hair growth), obesity, and sometimes a deepening of the voice. These symptoms arise as a result of increased ovarian androgens (male steroidal hormones, which are present in both sexes).
Insulin resistance
There have been many theories in circulation as to the cause of PCOS and its associated rise in ovarian androgens, but the most recent, and the one to have obtained a large amount of focus, is that of insulin resistance. Insulin resistance is a condition in which cells become progressively less responsive to the hormone insulin that is responsible for initiating glucose uptake by cells. This prevents tissues from being able to make adequate use of glucose in energy production. As a result more and more insulin is secreted in to the circulation in an attempt to restore proper function. This increased serum insulin leads to increased fat deposition, and prevents stored fat being used for energy production. It has been found that an increased serum insulin can increase the production of androgens within the ovary. The reason for this is not clear, but it is theorised that this may be due to either a direct stimulation of ovarian tissue, or the promotion of LH (lutenising hormone) secretion.
Ovarian dysfunction
In PCOS the ovary begins to function in an abnormal manner. There is a marked decrease in production of ovarian oestrogen, and as discussed above, an increased production of ovarian androgens. Within certain cells of the ovary, the male hormone testosterone is converted into oestrogen by an enzyme called aromatase. In women with PCOS, the activity of this enzyme is decreased. Therefore all male hormones produced are allowed to accumulate. It is the increased presence of male hormones, and decreased oestrogen that is the initiating factor in the improper development of ovarian follicles.
Nutritional approaches to treatment
The main area of this syndrome picture that can be greatly improved by nutritional intervention is that of insulin resistance. Carbohydrate foods with a low glycaemic index are useful to maintain a constant blood sugar level. This will reduce sugar cravings and prevent large insulin spikes that follow a high GI meal. The mineral chromium is vital in insulin resistance. It forms part of the body’s own ‘glucose tolerance factor’ a substance thats name speaks for itself. A minimum dose of 200mcg per day is necessary to increase the body’s ability to use insulin, and regain proper function. N acetyl cysteine is also a useful aid, as it has the ability to improve levels of circulating insulin.
Herbal approaches to treatment
Glycyrrhiza glabra (liquorice) has proven time and time again to be useful in the treatment of excessive androgens. It does this by having an inhibitory effect upon the enzyme 17-beta-hydroxysteroid dehydrogenase which converts androstenedione into testosterone. It is the constituent Glycyrrhitinic acid that instigates this effect.
Paeonia lactiflora (white peony) has the ability to stimulate the enzyme aromatase. As has been previously discussed, this enzyme converts testosterone into oestradiol. The monoterpene glycoside content of this herb is responsible for this effect.
Eleutherococus senticosus (Siberian ginseng) is a useful tool in the management of insulin resistance. It has the ability to maintain steady blood sugar levels and prevent significant drops. How this herb achieves this is not clearly undestood.
Asparagus racemosus (shatavari) contains a group of steroidal saponins that seem to have a regulatory activity on oestrogen and its production. The exact mode of this action is poorly understood.