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The PCOS Solution

Could this vitamin boost fertility during summer?

Saturday, July 15, 2017

As you probably know (if you paid attention during school geography lessons), folk living in the Northern American and European continents don’t get to enjoy as much sunlight as we do. They have bitterly cold winters where it’s dark even before the working day ends. No-one spends too much time outside from day to day, and when they do, as little skin as possible is exposed to the bitter weather. Researchers studying fertility of women in areas with these long winters have noticed an interesting trend: a spike in conception rates during summer. Coincidentally, this is when everyone gets more sun exposure. Blood tests confirmed that the vitamin D levels of women rose during summer and dipped during winter.  Could vitamin D be responsible for this boost in fertility rates?

Of all the nutrients, vitamin D is a curious one. We can get a little from food (greens, mushrooms, fish fat, cod liver oil) as vitamin D2, but mostly we soak it up through our skin as vitamin D3. It's a 'fat soluble' vitamin, so we can store some. Cholesterol carries the vitamin molecule through our liver and kidneys so each can play their part in converting vitamin D from UV radiation to become a powerfully active vitamin that is a major player in building bones. Researchers have learnt it isn’t just our bones that utilise vitamin D; cells on the ovaries, on the placenta and endometrium (lining of the uterus) also present receptors seeking vitamin D, indicating they need this vitamin to function properly.

Curiously, the research done so far around vitamin D and fertility is quite, well, “messy” (to use an unscientific term). There are plenty of studies, but each have utilised different supplement quantities  and with sometimes with not enough subjects to reach statistically sound conclusions. Review studies (where all the studies are assessed together) invariably comment that they can’t be sure, for sure, whether vitamin D affects fertility, because the science isn’t strong enough. But at the same time they point to those observations of women’s fertility in the far northern latitudes. 

So if you want to know, definitely, that vitamin D boosts fertility, you’ll have to wait while the science develops further. But in the meantime,  if your desire is to conceive a baby focus on conceiving consider how much sunlight you are exposed to, whether your workplace has windows, whether you get outside to exercise, and whether your vitamin D levels are sufficient for pregnancy. 

If you enjoyed this article you might also enjoy 'The Vitamin You Can Absorb Through Your Skin'

Like to look further? Consider these studies 

Azadi-Yazdi, M., Nadjarzadeh, A., Khosravi-Boroujeni, H., & Salehi-Abargouei, A. (2017). The Effect of Vitamin D Supplementation on the Androgenic Profile in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Clinical Trials. Hormone and metabolic research= Hormon-und Stoffwechselforschung= Hormones et metabolisme, 49(3), 174.

Fang, F., Ni, K., Cai, Y., Shang, J., Zhang, X., & Xiong, C. (2017). Effect of vitamin D supplementation on polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. Complementary Therapies in Clinical Practice, 26, 53-60.

He, C., Lin, Z., Robb, S. W., & Ezeamama, A. E. (2015). Serum Vitamin D Levels and Polycystic Ovary syndrome: A Systematic Review and Meta-Analysis. Nutrients, 7(6), 4555-4577. doi:10.3390/nu7064555

Irani, M., & Merhi, Z. (2014). Role of vitamin D in ovarian physiology and its implication in reproduction: a systematic review. Fertility and Sterility, 102(2), 460-468.e463. doi:

Muscogiuri, G., Altieri, B., de Angelis, C., Palomba, S., Pivonello, R., Colao, A., & Orio, F. (2017). Shedding new light on female fertility: The role of vitamin D. Reviews in Endocrine and Metabolic Disorders, 1-11. doi:10.1007/s11154-017-9407-2

Pergialiotis, V., Karampetsou, N., Panagopoulos, P., Trakakis, E., & Papantoniou, N. (2017). The effect of Vitamin D supplementation on hormonal and glycaemic profile of patients with PCOS: A meta‐analysis of randomised trials. International Journal of Clinical Practice.

Reis, G. V. O. P. D., Gontijo, N. A., Rodrigues, K. F., Alves, M. T., Ferreira, C. N., & Gomes, K. B. (2017). Vitamin D receptor polymorphisms and the polycystic ovary syndrome: A systematic review. Journal of Obstetrics and Gynaecology Research, 43(3), 436-446. doi:10.1111/jog.13250

Shahrokhi, S. Z., Ghaffari, F., & Kazerouni, F. (2016). Role of vitamin D in female Reproduction. Clinica Chimica Acta, 455, 33-38.

Skowrońska, P., Pastuszek, E., Kuczyński, W., Jaszczoł, M., Kuć, P., Jakiel, G., . . . Łukaszuk, K. (2016). The role of vitamin D in reproductive dysfunction in women–a systematic review. Ann Agric Environ Med, 23(4), 671-676.

Voulgaris, N., Papanastasiou, L., Piaditis, G., Angelousi, A., Kaltsas, G., Mastorakos, G., & Kassi, E. (2017). Vitamin D and aspects of female fertility. Hormones, 16(1), 5-21. doi:10.14310/horm.2002.1715

Xue, Y., Xu, P., Xue, K., Duan, X., Cao, J., Luan, T., . . . Gu, L. (2017). Effect of vitamin D on biochemical parameters in polycystic ovary syndrome women: a meta-analysis. Archives of Gynecology and Obstetrics, 295(2), 487-496. doi:10.1007/s00404-016-4247-y

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6 mistakes that block PCOS recovery

Monday, July 18, 2016

Serious about your PCOS treatment? Check that you aren't making any of these fundamental errors that can hinder your recovery:

Wishing your PCOS would just go away1. Wishing it would just go away

It’s a natural human tendency to do nothing, and sometimes this approach is actually exactly what you need to do. When a health problem emerges our first impulse is to wait and see if it goes away - and sometimes it does. That’s why when you visit your doctor with a health problem, he or she might prescribe nothing and ask you to come back in two weeks. They know that in some cases your symptoms may have emerged from sudden stress, a passing bug, or be something that will resolve itself in time. 

Bodies naturally and automatically work constantly to remain at certain set-points, called allostasis. For instance, if your temperature rises your body will start sweating to cause evaporation that cools you down again. Once your temperature has returned to normal, the sweating process is switched off. 

When you have a complex disorder like PCOS it’s tempting at first to wait to see if things get better. Your next period might be easier.  Maybe you’ll lose weight if you work out harder at the gym. Maybe making the final split from a dysfunctional relationship will change your mood for the better. Your head can start to recite a long list of justifications like this for doing nothing; even more so when life is busy. But when it comes to PCOS, the problem won’t go away on its own.

Hormones tend to fall out of balance in slow motion
, so it’s unlikely you’ll wake up one morning to find you’ve suddenly developed PCOS. One week passes, then another. Some good weeks, some awful weeks. You wish these problems would just go away, but they’re simply reflecting the growing imbalance in your hormones. The longer you put off taking action, the more dysfunctional your hormones are likely to become. The more amplified your symptoms become, the more treatment it will take to restore your hormonal health.

In the meantime, significant relationships can be permanently damaged by your sudden mood shifts, or you might lose your job because your boss is fed up with your mood swings impacting on your work. Your skin may become increasingly scarred from acne and now you have to shop for ‘plus size’ clothes. Your periods, if they happen at all, are more eventful each time with flooding, clots and pain. 

It's natural to feel overwhelmed at this point.

There’s no getting around it. You have a big job ahead of you to treat your PCOS and this is why having the right team around you can make a difference. PCOS is a ‘heterogeneous’ disorder, which means there are many possible contributors and many ways the symptoms can present. Like the causes, there are many changes needed to overcome the problems. At first this can seem overwhelming. You’ve visited several practitioners, both medical and alternative, and been given different explanations for the cause of your PCOS. You’ve been prodded, stuck with needles, had blood drawn, maybe had a glucose tolerance test done, or even been put under anaesthetic for exploratory surgery. By the time you get to the official diagnosis you’re probably emotionally exhausted. But after all that you then have to choose the best treatment for you from the smorgasbord available and make what seems like a multitude of changes to your diet and lifestyle. At this point you may feel like a rabbit in headlights, unsure which way to jump. It’s tempting to do nothing and wish it would all go away, but that won’t make you better. 

The way out of this sense of overwhelm
is to sit down with the practitioner you feel most comfortable with and, together, lay all the information on the table. Your practitioner is accustomed to sorting out what seems like a mountain of information and identifying patterns, then discerning the treatment needed to get results. A good practitioner will be happy to spend as much time as you need explaining what all your information means, and summarising it for you.

Take a deep breath and resolve to do whatever it takes to get your PCOS under control. Life will be more fun when you do!

Don't buy supplements without professional guidance2. Buying supplements without professional guidance

The internet is a wonderful, wonderful invention. We have all the world’s information at our fingertips. Unfortunately, we have the world’s dis-information at our fingertips too, and sometimes it’s hard to tell the difference. A multitude of diagnostic health sites are out there waiting for you to type in your symptoms and produce the instant answer. However, a common pattern emerges when you rely completely on the internet for your health care: Firstly, you could plug your symptom details into a medical diagnosis and ten minutes later you’re convinced what you have is fatal. Or, you get sucked into buying an expensive range of supplements from overseas, or you succumb to the emotive language of a web site promoting an extreme diet as the answer to all health problems. Despite these traps the internet also contains much reliable and credible information you can digest before you visit a practitioner for assistance. 

The reaction you can get from your health professional to your investigative work will vary. Some practitioners may be threatened by your initiative and dismiss your research efforts. If this happens, perhaps you should re-assess your relationship with your practitioner. A practitioner who is comfortable with your research, and the questions that come from it, will be interested to hear what you found. He or she will discuss with you how your research could fit into your treatment. This way your treatment becomes a collaboration, which is even more powerful than traditional practitioner-patient relationships and your results will be even better.

It’s important to become adept at critical analysis when you’re searching the internet for health information. Let’s say you type ‘PCOS treatment’ into the search engine. You’ll be offered several million options. How do you choose what site is worth visiting, what’s worth reading and what’s invalid? First, check the credentials of the web site. Is it a government agency? A PCOS support association? A health writer? An online store? The more reliable the source, the more reliable the information may be - but not always. If what you’re reading doesn’t make sense, just move on. There will be plenty of other sites providing more reliable information. 

Next, form an opinion on why the web site was created. Was it to genuinely provide information and guidance? (Government and association web sites often fall into this category). If there are products for sale, you can reliably conclude that the web site was created to sell you products, so move on. Be very wary if the language of the web site is emotional. Scientific facts and valid information can be presented in an interesting way without having to resort to emotive language that may  distort the facts. As you visit more sites you’ll develop a keen sense of what sounds right and which sites make you feel the web site isn’t for you.

Get a support team behind you for PCOS treatment3. Trying to fix this all by yourself

Solving a problem feels great. You can feel yourself glow with a sense of achievement. Like when something you’re cooking turns out perfectly, or you have a ‘good hair’ day or you make your budget stretch successfully. But when it comes to a complex problem like treating PCOS, you will get better results when you enlist the right help. If you work on this problem alone you have to learn all about PCOS, devise an effective treatment plan and monitor your progress. It’s going to take a lot of time, effort and possibly quite a few failed treatment experiments. Besides, if you go it alone you miss out on the emotional support of having a practitioner behind you. Becoming well informed about PCOS can give you a real sense of empowerment and knowing about PCOS and the treatments available may enable you to select the treatment approach that’s right for you. But while you’re doing that you need to engage the help of a practitioner who is experienced in treating PCOS who understands the human body and your symptoms.

Choice in PCOS treatment4. Not considering other treatments

There are many different treatments available for PCOS, all with the same aim - to get you back to your real self, and reduce the likelihood of developing long term chronic disorders from uncontrolled PCOS. Generally, there are two approaches to PCOS treatment: orthodox and alternative, and sometimes they can work together. When you talk to your doctor about your PCOS, they will think about what they know to help treat you effectively. This can include medication or surgery, but also diet and lifestyle considerations. 

When you talk to your naturopath they work from what they know as well.
It will be a different treatment from the doctor’s because naturopaths use some different tools. Instead of medications or surgery they will consider herbal remedies, homoeopathy and nutrients. Just like the doctor, they consider diet and lifestyle changes as an important part of your treatment.  Sometimes though, when you’ve chosen one style of treatment you can’t apply the other as well. For example, if you choose to utilise the oral contraceptive pill to manage your hormones, your naturopath will not be able to use some of their herbal remedies. If they did the two treatments could clash, bringing on unpleasant and possibly dangerous side effects.

What’s important to realise is that you have a choice about which treatment best suits you. When you’re sitting in a practitioner’s office it’s easy to feel intimidated, or that you have to go along with what they suggest. You don’t. There’s no need to make a decision about the type of PCOS treatment you want until you have the different treatment plans to consider. If you feel intimidated or pressured by your practitioner (whether orthodox or alternative) or feel they disapprove of the choice you make, it’s time to seek out a new practitioner. After all, your treatment is going to be a long term project. You want to feel comfortable and supported with every member of your health care team.

When you have chosen your preferred treatment (orthodox, alternative, or a combination), you can expect plenty of unsolicited advice from other people. Comments like “my sister’s friend’s cousin tried that and it didn’t work” or “that therapy doesn’t work” or “you’re being sucked into their system”. “My friend read on the internet about this great product that cured her”. Really unhelpful stuff and especially discouraging if you are feeling nervous about your choice of treatment anyway. The people who make these comments mean well but keep in mind that it’s your body and your decision about how you get better.

PCOS and sugar dont mix5. Refusing to change what you eat

Here’s one of the trade secrets: what naturopaths do to assess the motivation level of a client. When considering diet changes your practitioner may suggest you drop a particular food from your diet to see what effect this has on your health. If the response is “but I love my [insert name of food]” then your practitioner knows you have very little motivation to make real change in your diet and that your treatment progress will be hindered by your reluctance to change. It’s going to be tough, sure, but you’ll have good support backing you up.

Human bodies are incredibly resilient and adaptive. Consider that throughout the world there are many different countries with different diets that reflect their culture and geographic location. A Mediterranean meal looks different to a Japanese meal, or a central African meal, and western meals are different again. And yet our bodies manage to grow and thrive despite different food inputs.

Women with PCOS are more susceptible to the influence of certain nutritional components than the rest of the population. They generally don’t handle sugar well, or fast-release (high GI) carbohydrate foods like white bread. They need to check dietary fibre intake regularly. In practical terms, that means if you have PCOS and you’re eating mostly take-away, soft drinks and sweets, you can expect your body to develop unpleasant physical and psychological symptoms in return. But if you nourish your body with high quality protein, vegetables, fruit, legumes and nuts, you can expect your PCOS symptoms will recede. What you choose to put in your mouth makes a difference, but that doesn’t mean you can’t eat fun foods ever again.

Making changes to what you eat can be easier than you think and you don’t have to spend the rest of your life deprived of treats. After assessing how motivated you are for change and your food preferences your practitioner will design meal plans that move you closer to your goal of eradicating PCOS and its symptoms. If despite talking with your practitioner you’re still feeling resistant to changing what you eat, take time to ponder what you would gain from changing your diet and what you would lose. Then ask yourself if it’s worth the change.

PCOS fitness exercise6. Believing you don’t have to exercise

From time to time you’ll come across diets or supplements that promise amazing weight loss results without exercise. Indeed, they pledge to make you lose numbers on the scale without exercising but what will happen is exactly what you don’t want to happen. 

There are two types of weight loss: losing muscle and losing fat. Losing muscle is what sets you up to regain the weight, plus a little more, when you stop dieting. You want to lose fat instead, because muscle cells and fat cells behave differently and have different appetites. Muscle cells are active cells. They use energy 24/7, even when you’re not moving, and use even more energy when you are moving. The right amount of muscle cells gives you a toned, healthy look and keeps your metabolism ticking over nicely. Fat cells, however, behave differently. They’re lazy and don’t do much except store fat – rather like that cupboard under the stairs filled with stuff you haven’t looked at for years. Fat cells don’t use any energy, they just sit around. In excess, too many fat cells give you a blobby look. Worse, fat cells emit chemical messengers and hormones that perpetuate the fat accumulation cycle.

When you embark on one of these magic ‘no-exercise-needed’ diets, what you want to happen doesn’t always happen. Instead of reaching for the excess fat cells to make up the calorie deficit, your body will burn up muscle cells instead. The numbers on the scale will go down, certainly, but when you return to a normal diet, or go on a food splurge, the weight can bounce back on plus more. Your metabolism is now running slower because you have fewer muscle cells, so you don’t need as many calories to maintain your body. The extra fuel just gets shoved into fat cells, making you look flabby as well as fat.

This is why exercise is an important aspect of your treatment. It builds muscle cells and these speed up your metabolism, improve your sensitivity to insulin, and burn off stress hormones.

So - what has been holding YOU back in your PCOS treatment?

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PCOS Treatment When Results Don't Happen

Saturday, July 16, 2016
The journey to an official PCOS diagnosis is a long and arduous one, as you’ve probably noticed. On social media like Facebook and Twitter you’ve probably come across many frustrated, even angry women who are valiantly trying to access the appropriate help for their hormonal woes. The journey to diagnosis often goes like this:

At first there’s the suspicion that all might not be right with your hormones: Conception isn’t happening, or you have to constantly reach for the larger clothes sizes on the racks. Perhaps your skin isn’t responding to your rigorous care regime and facials; or hair is growing in the wrong places. Your energy levels soar and crash, and your mood is just as changeable. Clearly, something isn’t right and yet your practitioner doesn’t seem to share your drive to get some answers.

You see your doctor, then one or more specialists. You’re pricked with what seems like a thousand needles drawing blood for endless testing that doesn’t seem to provide a solid answer. You’ve sat in so many waiting rooms you’ve read every National Geographic published. Weeks pass, then months, and still no definitive answer to the question: “Do I have PCOS?” If fertility concerns are what led you to treatment, you can hear your biological clock ticking in the background.

So it’s not surprising that by the time the official diagnosis “PCOS” is stamped on your file, and your doctor has handed over the script for medication, it can seem like you’ve crossed the finish line of this arduous race. At last – you have treatment and now you’ll see results.

But for some women, frustratingly, results don’t happen. You’re still not conceiving, your skin problems and wayward hair growth remain stubbornly in place, as does your weight.  What’s going wrong?

If you find you’re in this situation I’d like to offer some points to consider that could uncover what’s holding back your progress:

1. You’re not exercising (enough). Movement is a key strategy to overcoming the insulin resistance that’s often underlying PCOS symptoms. You don’t have to train like you’re an Olympic athlete, but you’ll have to do more than a sedate walk around the block to get results.  This is the sticking point I see so many women make excuses about – so if you suspect that you’re not doing enough to get results you’re probably right. It might be time to schedule some regular training sessions with an accredited fitness trainer to assess whether your current training regime really is sufficient. 

2. You’re eating the kinds of food that promote fat accumulation. Like fitness, this is a tough one. PCOS produces moods that can drive you to seek out sugary, carbohydrate-rich foods to relieve your feelings. The emerging research promotes a moderately low (130g or less) daily intake of carbohydrates as the way to overcome insulin resistance and reduce weight – and yet some practitioners and their patients remain stuck on the high carbohydrate (130g +) approach which actually promotes insulin secretion.  If your blood glucose regulation isn’t improving on the diet your practitioner has suggested, it’s time to have a frank discussion with them or find a new practitioner who has embraced the new paradigms of nutrition.

3. You’re relying on medications and/or supplements to do the job for you. Medications and supplements are there to provide support while you address the underlying cause of your PCOS. We’re all attracted to the quick, easy fix. But if you really want results, you need to address the dysfunctional eating patterns, the sedentary lifestyle and the way you manage stress that’s led you into this problem. This is why attending to what you eat, how you move and stress management are regarded as front line therapies for PCOS by both naturopathic and medical practitioners.

Only you can decide whether you’re really doing enough work to make a difference; but it’s also possible that there’s another aspect to your PCOS management that’s actively pushing against your improvement: trying to do it all alone. You need a team behind you: Your medical practitioner and specialist, as well as your naturopathic practitioner, perhaps a fitness trainer too. Each member will contribute their expertise, cheer you on, and even call you out on your excuses that hold you back.

Tough love? Perhaps. But if you’re not getting the results you want, something has to change if you want change.

If you enjoyed this article you might also enjoy 'Empowering Your PCOS Diagnosis' here

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Is it PCOS or is it Hypothyroid?

Tuesday, April 19, 2016
Missing periods? Putting on weight that just won’t budge? You might think it’s PCOS but your practitioner wants to investigate hypothyroidism as well. That’s because many of the symptoms of PCOS and symptoms of hypothyroid match.  Here’s some of the confounding symptoms:

- Weight gain can come from deranged adipokines (messengers from your fat cells) or insulin resistance, or both, but weight gain can also happen because your thyroid isn’t passing on the right messages to your cells, to get active. How your energy goes during the day can be the clue; hypothyroid fatigue can be relentless from sun up to sun-down. Insulin resistance of PCOS can produce energy ‘slumps’ during the day, rather like an energy rollercoaster.

- Chronic low level inflammation is increasingly regarded as a fundamental cause of PCOS; however inflammation will interfere with thyroid production too.

- Your entire endocrine (hormone) system works together, like a symphony orchestra. The instruments aren’t just your ovaries but your adrenal glands, thyroid, pituitary, hypothalamus too. When one part of your endocrine system is affected, other glands are affected too. The key is to find out which one (or more) has the primary problem.

Your practitioner may order blood spot, urine or saliva tests – or all three – to establish how your endocrine system is communicating. You’ll probably get tests for anaemia, inflammation and cortisol (stress) too. If you have a practitioner who is exploring the possibility of hypothyroidism as well as PCOS then congratulations, you have found a thorough practitioner. 

If you enjoyed this article, you might also enjoy 'Empowering Your PCOS Diagnosis'

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The connection between PCOS and inflammation and what you can do

Sunday, April 17, 2016
Source click via MorgueFile

Knowledge about the underlying cause/s of PCOS is growing. Here’s what I’ve found from reviewing a few recent papers (listed at the end of this post)

- Inflammation is becoming recognised now as the dysfunction underlying insulin resistance. This may explain why PCOS happens in slim as well as overweight women.

- Although insulin resistance and obesity promote PCOS, it is proposed that perhaps the true underlying cause is inflammation.

- There’s a strong intertwining of cause and effect; fat cells stimulated by excess androgen promote inflammation, and inflammation promotes excess androgen production. They affect each other.

- The inflammation changes the function of the ovaries, disrupting the ovulation process (which utilises a controlled amount of inflammation to ovulate).

- C-reactive protein, a biochemical marker of inflammation, is greatly increased in women with PCOS regardless of BMI.

And now on to some practical steps: Here is what you can do:

Beyond the theory, this is what the scientists established in studying the effects of diet on ovary function in mice: Saturated fats (butter, coconut oil, red meat) and trans-fats (from processed foods), omega-6 oils (from modern foods) and sugary foods are believed to promote inflammation. Eating more omega-3 oils (from seafood for instance) can help restore the balance. 


And exercise, of course. That’s fundamental to overcoming PCOS, and one of its markers, insulin resistance.  But how much do you need to do? The Rich-Edwards et al paper crunched data from the Nurses Health Study (a large epidemiological study) and found that for every one hour of vigorous activity there is a 5% reduction in infertility, regardless of weight and diet. So, imagine what you could achieve with an hour of intense fitness training every day or so!

If you enjoyed this article, you might also enjoy 'Quenching The Fires of Inflammation'

Want to delve into the papers? Here they are. (The Boots paper includes a useful model)

Alanbay et al (2012) ‘A macrophage activation market chitotriosidase in women with PCOS: Does low-grade chronic inflammation in PCOS relate to PCOS itself or obesity?’ Arch Gynecol Obstet 286:1065-1071 DOI 10.1007/s00404-012-2425-0

Boots, C & Jungheim, E.S (2015) ‘Inflammation and Human Ovarian Follicular Dynamics’ Semin Reprod Med July 33(4) 270-275 doi: 10.1055/s-0035-1554928

Dhindsa G, Bhatia R, Dhindsa M, Bhatia V (2004) ‘Insulin Resistance Insulin Sensitization and Inflammation in Polycystic Ovarian Syndrome’ J Postgrad Med Vol 50 Issue 2

Dumitrescu, R et al ‘The Polycystic Ovary Syndrome: An update on metabolic and hormonal mechanisms’ Journal of Medicine and Life Vol 8 Issue 2 pp. 142-145 

González, F (2015) ‘Nutrient-induced inflammation in Polycystic Ovary Syndrome: Role in the development of Metabolic Aberration and Ovarian Dysfunction’ Seminars in Reproductive Medicine Vol 33(4) pp. 276-86 DOI 10.1055/2-0035-1554918

Kurt et al (2014) ‘The effect of obesity on inflammatory markers in patients with PCOS: a BMI-matched case-control study’ Arch Gynecol Obstet 290:315-319 DOI 10.1007/s00404-014-3199-3

Rich-Edwards et al (2002) ‘Physical activity, body mass index and ovulatory disorder infertility’ Epidemiology Vol 13 (2) pp. 184-90

Shorakae et al (2015) ‘The emerging role of chronic low-grade inflammation in the pathophysiology of polycystic ovary syndrome’ Seminars in Reproductive Medicine’ Vol 33(4) pp. 257-69 DOI 10.1055/s-0035-1556568

Spritzer et al (2015) ‘Adipose tissue dysfunction, adipokines, and low grade chronic inflammation in polycystic ovary syndrome’ Reproduction 149 R219-R227 DOI: 10.1530/REP-14-0435

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Seven clues you may have PCOS - and what to do next

Sunday, March 27, 2016
PCOS (or polycystic ovarian syndrome) is a widespread hormone condition that can steal your fertility, erode your self-esteem and increase your vulnerability to adult onset diabetes. Here are seven clues you may have PCOS, and what to do next.

1. Your periods are irregular, or completely absent; perhaps only every few months. This is the clue that often prompts women to seek help; because your periods should slip into a regular monthly-or-so rhythm within a year of starting.

2. You have thick male–pattern hair growing on your face and body. Hirsutism is the technical term for this self-esteem eroding symptom of PCOS. It’s caused by over-sensitivity to increased levels of androgen hormones.

3. You have intractable acne despite good skin care. Like hirsutism, acne diminishes your self-esteem, and is also caused by too much androgen (male) hormones in circulation.

4. You have had trouble conceiving a baby. Like infrequent periods, difficulty in conceiving can be the way many women discover they have PCOS. This can especially happen when you’ve come off the pill to try for a baby, because the dysfunction of your ovaries was masked by the pill’s artificial cycle.

5. You have to keep topping up with sugary or carbohydrate foods otherwise your energy slumps
, and it feels like immense sugar and carb cravings have control of you. Insulin resistance is a core trigger for PCOS and also a core focus for treatment. 

6. Your waist measurement is greater than 88cm and weight loss just doesn’t happen despite doing all the right things. The complex interplay between fat cells on your tummy, your ovaries, and the hormones they help produce can make weight really stick to you, unfairly.

7. Your moods aren’t the best – perhaps anxious or depressed, or experiencing mood swings. If the symptoms of PCOS weren’t enough to dampen your mood, then your insulin resistance can promote mood swings, and systemic inflammation can promote depression.

These are just some of the signs of PCOS. Your medical practitioner can ascertain the official diagnosis and offer medical treatment options. Your naturopath can also help, through natural remedies and by coaching you through the diet and lifestyle changes essential to successful treatment of PCOS. 

Ready to take the next step? Have a look at this article about how to empower your PCOS Diagnosis. 

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Empowering your PCOS Diagnosis: How Your Naturopath Can Help

Sunday, March 20, 2016
(This is part 2 of a 3-part article series on empowering your PCOS diagnosis. Access the first article here)

Why Naturopathy for PCOS?

A naturopath is a natural health practitioner who uses therapies like nutrition, herbs, homoeopathic remedies and counselling too, to help engage your body’s inherent self-healing abilities. Naturopaths are trained to assess and treat your physical and emotional well-being from a functional perspective: that is, where you are at now, what your particular goals are, what your body is doing and how your emotional health is.

Don’t already have a naturopath? Ask around your local area for recommendations. Phone prospective practitioners for a brief chat about how they work, so you can gauge whether you want to work with them. Look at their websites, and look for testimonials from other clients. Check their accreditation with the website of their professional association. If they’re properly qualified and comply with professional standards, they’ll be listed there.

Buyer Beware

In Australia there are no restrictions on who can call themselves a ‘naturopath’. Unfortunately, there are some people who say they are, but aren’t adequately qualified, which creates a situation of ‘buyer beware’ in natural therapies. You need a professional clinical naturopath who is accredited with one of the major professional associations – like the ATMS ( or ANTA ( 

Finally, in choosing a naturopath make sure you consult within a clinic. Some naturopaths (qualified or otherwise) work within pharmacies and health food stores. This situation doesn’t allow for a private consultation. In a retail situation the naturopath is employed to sell supplements. That’s their job. They have sales quotas to meet. It’s not their job to have a long discussion with you about the complex physical and emotional contributors to your health, they are employed to sell supplements, and sell you something they will. There’s no ongoing supportive relationship, no follow up. Instead, you need a clinical naturopath; one who can undertake a more extensive investigation, become part of your support team, and help you focus on the fundamentals of your diet and lifestyle as well as choose the right remedies to rebalance your hormones.

In the Consultation

Your first consultation with your naturopath will provide her with extensive information about your medical history, your current symptoms, what is happening in each of your body systems (including your digestion and your immunity as well as your hormones) and your usual diet. She will also enquire about your stress levels and overall emotional health to assess how your mood could be contributing. Expect to spend at least an hour in this consultation. 

Feel free to bring a support person with you, because like any consultation, it’s easy to feel tiny and insignificant in a practitioner’s office. A support person can take notes, keep an eye on how you’re going, and help you back out gracefully if she senses you’re feeling pressured. 

More diagnostic tests may be required by your naturopath, including a functional pathology test like salivary hormone. This reveals what hormones are actually within your tissue fluid. It can reveal the levels of all three types of estrogen, their balance with progesterone, your testosterone levels, DHEA and cortisol.

Having talked things over initally, your naturopath will propose a tentative treatment plan, and begin the process of negotiation with you. Your naturopath is looking for the fundamental underlying causes of your unwellness that provide clues on where to start treatment. And, what your particular goals are. And, how hard you’re prepared to work to reach your goals. Expect to be given homework and directives. For example, you might be asked to change what you eat for breakfast, because this will alter your blood glucose regulation. Or to do a certain amount of exercise X times per week. A follow up appointment is likely to be arranged before you leave the clinic.

Don’t Give Up Your Power

It’s really important that you feel comfortable talking with your naturopath, because if you don’t, it’s unlikely that you’ll comply with his directives; and that means no results for you. If you’re not comfortable with your practitioner, feel free to move on until you find the one that’s right for you. Each natural health practitioner has their own assessment process, their own favoured ways of treatment and their own ways of talking with clients. If you don’t agree with that practitioner’s assessment then say so, or move on.

The third article in this series is ‘Empowering Your Medical Treatment’

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Empowering your PCOS Diagnosis An Overview

Sunday, March 20, 2016

You think you have PCOS. You’ve done the internet searches and your symptoms seem to match. So it should be a simple process, surely: Visit your doctor, arrange some straightforward blood tests, and get their agreement that yes, it’s PCOS, so here’s the treatment. How hard could it be? Ah, if only it were that simple. But PCOS is a complex disorder with multiple causes that presents in a different way for each woman. And to complicate things, other disorders like hypothyroidism (slow thyroid) or Cushings Syndrome (an adrenal gland problem) can mimic some symptoms of PCOS. 

This can be a frustrating and confusing time. I’ve noticed a lot of women on social media forums, understandably annoyed, venting their feelings about the absence of a definitive diagnosis.  Lots of waiting rooms, lots of testing, sometimes invasive.  The delays in access to a diagnosis and treatment can be especially painful if you are trying to conceive a baby and one month follows another without an answer. 

In listening to and talking with many women over the years (as a clinical naturopath in Australia) it’s become apparent that not everyone knows how to get the best results from their access to health practitioners (orthodox or complementary). So, as well as pointing out two obstacles you may encounter on your PCOS journey, this article is all about helping you get to the treatment and results that you want more effectively, with greater speed and less frustration. 

Obstacle 1: PCOS Doesn’t Appear In a Standardised Form

There’s only minor agreement in science about what having PCOS really means; mostly because there’s no standard clinical presentation. For you, that means there’s no definitive diagnosis, so one practitioner may label you as having PCOS, but another may decide that you don’t fit the criteria. 

Why bother then with the frustration of many hours spent queuing in practitioner waiting rooms; the unpleasantness and pain of blood tests and physical examinations? Because your symptoms might not actually be PCOS after all; lots of other disorders have symptoms which resemble PCOS but are actually something else entirely. Your medical practitioners will sift through the evidence of your symptoms and your test results, so they can establish whether it’s really PCOS, which variety of PCOS you have, and what your treatment options are. Which treatment you choose, once you’re more informed, is up to you.

Obstacle 2: Time to Talk it Through

Since diet and lifestyle changes are regarded as essential aspects of PCOS treatment by both orthodox and complementary practitioners, it makes sense to start your journey to wellness with attention to what you eat and how you live, guided by a practitioner that’s got time to talk it over with you. That often takes a longer conversation than the brief time you have with a GP. And that’s where naturopathy can fit in to your treatment plan.

You don’t need to wait for the official PCOS diagnosis; you can be treated as an individual by your natural health practitioner and start the process of getting better right now. Natural health practitioners assess where you are right now and apply treatment based on your unique experience of your disorder. Attention to diet, lifestyle and emotional wellness while you’re waiting for the official diagnosis can help speed your progress towards healthier hormones.

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Empowering Your PCOS Diagnosis: The medical aspects

Sunday, March 20, 2016
By Imelenchon via MorgueFileThis is the third article in a series about empowering your PCOS diagnosis. Links to the first two articles are at the end of this blog post.

Why you need a GP as well as a naturopath

A visit to your general practitioner is highly recommended, even if you’ve already decided that you want only natural treatment for your PCOS. A medical practitioner can check that there’s nothing more sinister going on than PCOS, and arrange the tests that will enable you to measure your progress as you get better.

How To Find The Right GP For You

If you don’t already have a GP, look for one who specialises in women’s’ health – they’ll be more likely to have lots of experience with diagnosing PCOS. (Your naturopath may be able to identify suitably focused GPs in your area) If you’re keen to use natural therapies to rebalance your hormones, look for an ‘integrative’ medical centre (where doctors and naturopaths work side by side) or locate a doctor who practices in ‘functional’ medicine. The internet can be invaluable for your search, as can be reviews of associations like ACNEM ( which list integrative medical practitioners and their specific areas of interest. Often these medical practitioners will have a web site where you can get to know how they practice, and who they are as people. 

Pre-plan to Get More From Your Consultation

Before you go to that first appointment, whether it’s an integrative GP or not, make a list of the symptoms that are troubling you, and the dates of your menstrual cycle over the last year. Also take with you any prescription medications, self-prescribed medications or natural supplements that you’re taking. If you’re already seeing a naturopath, he or she can write a referral letter that gives your GP a head start. Expect this first appointment to be non-conclusive, and relatively brief compared to your naturopathic consultation; your GP will likely arrange some initial testing to rule out other disorders and ask you to return with this information before deciding whether to commence treatment and perhaps refer you to a specialist.

A good working relationship with your GP is vital. You need to feel assured that your GP cares, is acting in your best interests, and that you can tell her anything.  Although the government may be subsidising your consultations through Medicare, the practitioner is there to provide a service for you; so keep in mind that you are the customer. The atmosphere in a medical consultation can feel daunting; there is an immense imbalance of power. You’re in the practitioner’s personal space and you may feel very tiny, insignificant and unimportant. If you feel nervous, take a trusted friend or relative with you for support. They can also take notes – it’s difficult sometimes to remember all the details of a consultation and what you have to do next.

Take Notes, Keep Your Records

Part of being empowered with PCOS is taking control of your health; so request a copy of any blood test results, ultrasound reports, and specialist reports. You are legally entitled to a copy as the reports form part of your patient records. The results will prove immensely useful in years to come when you can refer to them again. Also, if you have to move to a new practitioner, he or she will be streets ahead because you have your medical ‘history’ with you. Start your own folder, or put the results in your PCOS Workbook.

If you decide to consult a naturopath, he or she may refer to these test results and specialist reports to help in choosing the right remedies, and to monitor your progress.

The Prodding, Poking and Testing

Your doctor may arrange some blood tests, and do a physical examination. She may ask you to have an ultrasound picture taken to check for cysts on your ovaries, or to check the thickness of your uterine lining. You may also meet with an endocrinologist (a medical hormone specialist) or a gynaecologist (a surgical specialist in female reproductive systems). The specialist may do more tests, ask more questions, and do a more extensive physical examination. Then she will explain the medical treatment options available for you.

If you consult with a specialist endocrinologist or gynaecologist, he will write a letter to your doctor outlining his findings, and you’ll need to meet with your doctor again to discuss the next step. If you weren’t happy with the specialist you consulted with, or you don’t want to go ahead with the treatment he suggests, say so. It’s your choice. 
If you want to investigate potential natural therapies and don’t already have a naturopath, let your doctor know. She may be able to suggest a naturopath who specialises in PCOS treatment.  If your doctor is already trained in naturopathy, lucky you! You’ll be able to discuss alternative treatments with her on the spot.

Medical or Natural Treatment? You Can Have Both

Just as with any practitioner, it’s important you feel comfortable and safe with your doctor and specialists. If you feel your concerns are dismissed or minimised, consider switching to a new doctor. Fortunately we’re moving out of the dark ages, when women’s hormonal problems were dismissed as unimportant, but some practitioners with out-of-date attitudes remain.

If your doctor is dismissive of the benefits of naturopathy, and you definitely want to incorporate natural treatment, it may be time to shop around for a more enlightened GP.  At the very least your naturopath can help you manage the lifestyle changes essential to management of PCOS (diet, exercise and emotional wellness) which are acknowledged as the pillars of successful PCOS treatment. If you decide to utilise prescription medication you can still utilise a naturopath for help with navigating the essential lifestyle treatment elements. 

The other two articles on Empowering your PCOS diagnosis are:

If you enjoyed these articles, why not download the free e-book “When Good Hormones Go Bad”

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Plastic and your hormones in PCOS

Wednesday, February 03, 2016

Take a look around you now, right where you are, and notice how many items around you contain plastic. The keyboard I’m typing this on is made of plastic, as is the standing desk converter. The printer, the plant pots, even the fan whirring in the corner. Although plastic is a helpfully versatile medium to create almost anything with, it’s not so helpful when it comes to our hormones.

Our modern environment is considerably polluted; every day our bodies come into contact with man-made chemicals that we’re just not designed to process and get rid of effectively; our genes haven’t evolved fast enough to handle them. Since we developed a love of plastic and its versatility over the last century and a half  our exposure has multiplied exponentially.Plastic and the pollution it creates is so prevalent that all you can do is minimise your exposure.

Manufacturers are now focused on creating safer plastics, but more research keeps emerging about how this man made substance causes us harm.

Bisphenol A (BPA) is a component of plastics. It’s useful for plastics manufacturers because it makes plastics more resilient and flexible, clearer, more resistant to heat. Since the first plastic items were invented during the 19th century our society has fallen in love with this versatile, light material. It’s now used extensively in food and drink packaging, medical devices, compact discs, epoxy-phenolic resins, in drinking water storage tanks, and in water pipes. It’s everywhere, and modern life seems impossible without plastic.

Although plastic is waterproof, the BPA within the plastic leaches easily into the contents of a food or drink container. Even more easily if the contents are acidic, have a high fat content, or are heated. BPA is then readily absorbed in your mouth, transferring across mucous membranes into the rich web of blood vessels that sit under your tongue. From there the molecules can travel through your body, escaping detection because at first glance your body thinks its a hormone molecule.

Eating and drinking is actually the major way we ingest BPA, but it isn’t the only way. You can absorb it through your skin, breathe it in too. When you consider that BPA is part of dental materials, contact lenses, thermal paper, and in many other objects, you get a sense of how pervasive it has become in our world. Once in your body BPA mimics estradiol, one of the estrogen hormones. So now your body thinks it has more estrogen in circulation than it planned for. 

Here’s what BPA does in various parts of your body. This list isn’t exhaustive; consider that many cells in your body possess oestrogen receptors. 

- When BPA molecules land on your ovaries, they stimulate the theca cells within them to produce more androgens.  The Androgens down-regulate the liver enzyme involved in clearing BPA from your body. So now you have more androgens in your system and less ability to break them down.

- Sex Hormone Binding Globulin (SHBG) is affected by BPA too. Remember that SHBG ‘mops up’ excess hormones in your system (like excess androgens). The BPA molecule attaches itself to SHBG; so again, excess hormones remain in circulation.

- There’s a compound your body produces, testosterone hydroxylase, that breaks down testosterone to keep levels in check. BPA inhibits the work of this enzyme, contributing to increased testosterone levels.

- Animal studies have shown BPA interferes with thyroid hormone production too. Perhaps this is why PCOS and hypothyroidism can occur together.

- Animal studies have also revealed that BPA alters the endometrial lining where a fertilised egg would normally attached.

- Because it mimics estrogen, BPA is suspected to contribute to early onset of puberty.

- BPA also interferes with your pancreas function, impairing blood glucose regulation. Considering that insulin resistance is a major underlying cause of PCOS, this is profound.

BPA has a half life of just over five hours, which means it’s constantly being broken down and excreted through urine. However the more you keep taking it in and the less functional your liver, the higher your BPA accumulation. So although BPA is not a cause of PCOS, it can certainly intensify it.

How does BPA get into your system? You can ingest it in contaminated food or water, absorb it through your skin or inhale it; but the main source of exposure is food or water contaminated through contact with BPA-containing plastic. You’ve probably noticed more and more plastic products promoted as ‘BPA-free’, and that’s certainly one way to reduce your exposure to this suspect toxin. 

That doesn’t mean that BPA is the only environmental toxin that could be affecting your hormones; just that BPA is the plastic toxin we know more about. In the meantime, it's a good idea to minimise your exposure to plastic wherever practical.

If you enjoyed this article, you might also enjoy 'adipokines the key to shifting your tubby tummy in PCOS'

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