By Hayley Stobbs CNC, R.Ac. | Acupuncture Victoria BC

Polycystic ovarian syndrome (PCOS) is a common hormone disorder that affects women of reproductive age. Its characteristic pathology relates to the development of multiple small fluid-filled follicles on the ovaries. This occurs when ovulation, the release of an egg from an ovarian follicle, ceases to occur for multiple cycles. This disruption is the cause and effect of disharmony in the normal, cyclical interconnection between the brain, hormones, and ovaries.

PCOS is more complex than the name presents as it often involves varying degrees of endocrine, cardiovascular, metabolic, and/or mental-emotional co-conditions. The following post focuses on PCOS awareness as a syndrome through a pathophysiology overview followed by the explanation of how acupuncture works as an effective treatment method.

Underlying Causes of PCOS

Genetic predisposition
Insulin resistance (1)
Chronic low-grade inflammation (food sensitivities/allergies, environmental, stress)
Lack of regular menstruation after ceasing birth control pill use (2)
Adrenal dysregulation
Hypothyroidism (3, 4)
Environmental (chemicals, toxins, pollutants, iatrogenic)
Circadian rhythm disruption (5)

Common Signs & Symptoms of PCOS

Long-standing menstrual abnormalities including irregular periods, lack of menstruation, severe menstrual cramping, or prolonged or heavy bleeding.
Signs of high testosterone including excessive hair growth (ie. on the face, abdomen, chest, arms, etc.), acne, and male pattern baldness.
Fertility issues including inability to conceive and miscarriage in the first trimester (6).
- NOTE: PCOS accounts for 75% of anovulatory infertility (7) and infertility affects 40% of women with PCOS (8). Infertility is defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.
Insulin resistance (IR) which can present as darkening of the skin at the nape of the neck and under the arms (acanthosis nigricans), high BMI, high cholesterol, high blood sugar and/or high blood pressure (9)
- NOTE: IR affects 65 – 70% of women with PCOS, 1/2-2/3 of whom are overweight or obese (10).
Mental health disorders including depression, anxiety, bipolar disorder, and binge eating disorder.

How is PCOS Diagnosed?

PCOS diagnosis must include two of the following, based on the Rotterdam criteria (11):

Ultrasound confirming the presence of multiple ovarian cysts.
Hyperandrogenism: high androgens on lab work (ie. testosterone), or clinical signs of high androgens.
Menstrual dysfunction including anovulation, oligo-ovulation, amenorrhea, or oligomennorrhea.

PCOS is associated with multiple conditions, therefore regular testing should include:

Fasting insulin and glucose levels
Full thyroid panel
Total testosterone and free
DHEA
LH and prolactin
Cholesterol
Blood pressure
Inflammatory markers: CRP ESR
Food sensitivities/allergies

PCOS Treatment & Management

Conventional management options include: oral contraceptives, metformin, clomiphene, gonadotropin therapy, progestin, assisted reproductive technology (ie. IUI or IVF), and weight regulation.

Alternative or complementary options include: acupuncture and bodywork, whole foods or low carbohydrate nutrition therapy, weight loss, lifestyle counselling, botanical medicine, natural progesterone therapy, and nutritional supplementation.

What is PCOS According to Chinese Medicine?

PCOS is a western diagnosis that was developed according to biomedical perspectives and standards. A registered acupuncturist learns about modern western illnesses, yet focuses on each individual’s unique pattern of symptoms in relation to a specific traditional Chinese medicine (TCM) diagnosis. Syndrome differentiation comes to fruition by comprehensively differentiating all areas of the patient’s life in relation to the disharmony, which includes environmental, diet, and lifestyle observation and questioning, in addition to whole body, tongue and pulse analysis, and palpation. This information guides the practitioner towards making an acupuncture prescription and treatment plan, which addresses the mind, body, and spirit. PCOS may reflect any one or more of the following TCM diagnosis patterns: spleen qi deficiency, phlegm-damp or damp, kidney deficiency, blood stasis, liver qi stagnation, blood deficiency, and Ren-Chong Mai disharmony.

Acupuncture as an Effective Treatment Option for PCOS

Acupuncture treatments work with the patient’s innate regulatory ability to harmonize any number of unique PCOS patterns through balancing the communication network between the brain, hormones, and ovaries. Specifically, it is an effective treatment option for regulating menstruation and ovulation (12), insulin sensitivity (13), inflammation and immune function, mood and stress response (14, 15), detoxification, and weight loss (16). Acupuncture is thus able to target a number of root causes and manifestations. The recommended treatment frequency includes 2 treatments per week for the first 2 weeks, followed by 1 treatment per week for 3 – 6 months. In addition to needling an acupuncturist will implement bodywork along with diet and lifestyle counselling into the overall treatment plan. After symptoms dissipate it is recommended to keep up with one treatment per month to prevent re-occurrence.

References

(1) (8) Marshall, John C., and Andrea Dunaif. “All Women With PCOS Should Be Treated For Insulin Resistance.” Fertility and Sterility 97.1 (2012): 18–22. PMC. Web. 6 May 2017.

(2) Evanthia Diamanti-Kandarakis, Jean-Patrice Baillargeon, Maria J. Iuorno, Daniela J. Jakubowicz, John E. Nestler. “A Modern Medical Quandary: Polycystic Ovary Syndrome, Insulin Resistance, and Oral Contraceptive Pills.” J Clin Endocrinol Metab 2003; 88 (5): 1927-1932. doi: 10.1210/jc.2002-021528

(3) Singla, Rajiv et al. “Thyroid Disorders and Polycystic Ovary Syndrome: An Emerging Relationship.” Indian Journal of Endocrinology and Metabolism 19.1 (2015): 25–29. PMC. Web. 6 May 2017.

(4) Kloss, Jacqueline D. et al. “Sleep, Sleep Disturbance and Fertility in Women.” Sleep medicine reviews 22 (2015): 78–87. PMC. Web. 8 May 2017.

(5) Selix, Michael., and Menaker, Michael. “Circadian Clocks in Mammalian Reproductive Physiology: Effects of the “Other” Biological Clock on Fertility.” Discovery Med 11(59): 273-281, April 2011.

(6) Sheehan, Michael T. “Polycystic Ovarian Syndrome: Diagnosis and Management.” Clinical Medicine and Research 2.1 (2004): 13–27.

(7) Sheehan, Michael T. “Polycystic Ovarian Syndrome: Diagnosis and Management.” Clinical Medicine and Research 2.1 (2004): 13–27.

(8) Sirmans, Susan M, and Kristen A Pate. “Epidemiology, Diagnosis, and Management of Polycystic Ovary Syndrome.” Clinical Epidemiology 6 (2014): 1–13. PMC. Web. 2 May 2017.

(9) Sheehan, Michael T. “Polycystic Ovarian Syndrome: Diagnosis and Management.” Clinical Medicine and Research 2.1 (2004): 13–27.

(10) Martinez B, Peplow PV. “Treatment of insulin resistance by acupuncture: a review of human and animal studies.” Acupuncture in Medicine 2016;34:310-319.

(11) Sirmans, Susan M, and Kristen A Pate. “Epidemiology, Diagnosis, and Management of Polycystic Ovary Syndrome.” Clinical Epidemiology 6 (2014): 1–13. PMC. Web. 2 May 2017.

(12) Johansson, Julia, and Elisabet Stener-Victorin. “Polycystic Ovary Syndrome: Effect and Mechanisms of Acupuncture for Ovulation Induction.” Evidence-based Complementary and Alternative Medicine : eCAM 2013 (2013): 762615. PMC. Web. 7 May 2017.

(13) Li, Juan et al. “Acupuncture Treatment for Insulin Sensitivity of Women with Polycystic Ovary Syndrome and Insulin Resistance: A Study Protocol for a Randomized Controlled Trial.” Trials 18 (2017): 115. PMC. Web. 7 May 2017.

(14) Sniezek, David P., and Imran J. Siddiqui. “Acupuncture for Treating Anxiety and Depression in Women: A Clinical Systematic Review.” Medical Acupuncture 25.3 (2013): 164–172. PMC. Web. 6 May 2017.

(15) Rui Ma, Shujun Xu, Xiuyun Wen,Qian Wu,Yanan Wu, et al. (2014) “Acupuncture for Generalized Anxiety Disorder: A Systematic Review.” J Psychol Psychother 4:155. doi:10.4172/2161-0487.1000155

(16) Ismail, Laila Ahmed Abou et al. “Effect of Acupuncture on Body Weight Reduction and Inflammatory Mediators in Egyptian Obese Patients.” Open Access Macedonian Journal of Medical Sciences 3.1 (2015): 85–90. PMC. Web. 4 May 2017.

(17) Badawy, Ahmed, and Abubaker Elnashar. “Treatment Options for Polycystic Ovary Syndrome.” International Journal of Women’s Health 3 (2011): 25–35. PMC. Web. 7 May 2017.

(18) Cochrane, Suzanne et al. “Acupuncture and Women’s Health: An Overview of the Role of Acupuncture and Its Clinical Management in Women’s Reproductive Health.” International Journal of Women’s Health 6 (2014): 313–325. PMC. Web. 13 May 2017.

(19) http://www.pcosaa.org/pcos-overview/

(20) http://www.mayoclinic.org/diseases-conditions/pcos/basics/definition/con-20028841

(21) https://chriskresser.com/adrenal-pcos-surprising-ways-stress-affects-your-hormones/