By John Lee, MD

In the last 30 years, the occurrence of polycystic ovary syndrome (PCOS)   has risen to epidemic proportions. Research has shown that approximately 10 to 20 percent of women have the disease; my guess is that the number is probably higher.

The lifestyle of young women, i.e., lack of exercise, stress, poor diets high in sugar and highly processed carbohydrates work together to create a high incidence of the disease – something that on many levels can be prevented.  Fifty years ago, the average person age one pound of sugar a year. Today, the average teenager today eats one pound a week! Potato chips, corn chips, pasta and white rice are all highly refined carbohydrates that also act on the body much the same as sugars do.

But there is hope, and there are new treatments to consider.

First, what actually happens when PCOS is present?

PCOS is when multiple cysts are present on the ovaries, and there are accompanying effects such as anovulation (lack of ovulation) and menstrual abnormalities, hirsutism (facial hair), male-pattern baldness, acne, and often obesity. Women with PCOS may also experience insulin resistance and an increased incidence of Type II diabetes, unfavorable lipid patterns (usually high triglycerides), and low bone density. Laboratory tests often show higher than normal circulating androgens, especially testosterone.

When a woman doesn’t ovulate, there is a disruption in the normal, cyclical interrelationship among her hormones, brain and ovaries. Normally, the hypothalamus, a regulatory center in the brain, monitors the hormone output of the ovaries and synchronizes the normal menstrual cycle. When monthly bleeding ends, the hypothalamus secretes gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland in the brain to release follicle stimulating hormone (FSH) and luteinizing hormone (LH).  These hormones direct an ovary to start making estrogen (mostly estradiol), and stimulate the maturation of eggs in about 120 follicles.

The first follicle that ovulates, releasing its egg into the fallopian tube for a journey to the uterus, quickly changes into the corpus luteum, which is a factory for making progesterone, and raises progesterone’s concentrations to 200 to 300 times higher than that of estradiol. This huge surge of progesterone simultaneously puts the uterine lining in its secretory or ripening phase, and turns off further ovulation by either ovary.

If fertilization does not occur, the ovary stops its elevated production of both estrogen and progesterone. The sudden fall in the concentrations of these hormones causes shedding of the blood-rich uterine lining and bleeding (menstruation). Then, in response to low hormone levels, there is a rise in GnRH and the cycle starts all over again.

But what happens to this cycle if, for some reason, ovulation is unsuccessful? For example, if the follicle migrates to the outside of the ovary, but does not “pop” the egg and release it, the follicle becomes a cyst, and the normal progesterone surge does not occur. The lack of progesterone is detected by the hypothalamus, which continues to try to stimulate the ovary by increasing its production of GnRH, which increases the pituitary production of FSH and LH. This stimulates the ovary to make more estrogen and androgens, which stimulates more follicles toward ovulation. If these additional follicles are also unable to produce a matured ovum or make progesterone, the menstrual cycle is dominated by increased estrogen and androgen production without progesterone. This is the fundamental abnormality that creates PCOS.

Why Eggs Won’t Pop and Progesterone Isn’t Made

But what causes dysfunctional follicles that won’t release eggs?  From wildlife studies and my own observations, this is due to environmental pollutants, known as xenobiotics,  that works like estrogen on the developing baby’s tissues.

When a female embryo develops in the womb, 500 to 800 thousand follicles are created, each enclosing an immature ovum. Studies show that the creation of ovarian follicles during this embryo stage is exquisitely sensitive to the toxicity of xenobiotics. When the mother is exposed to these chemicals, she experiences no apparent damage. But the baby she is carrying is far more susceptible, and these chemicals may damage a female embryo’s ovarian follicles and make them dysfunctional; unable to complete ovulation or manufacture sufficient progesterone. This damage is not apparent until after puberty.

Lifestyle Factors that Cause Dysfunctional Follicles

A lack of exercise, poor nutrition/diet, and stress are the top three factors that contribute to PCOS.  Stress particularly because it can cause anovulatory cycles, and produce high levels of cortisol by the adrenal glands.  Birth control pills, a widely prescribed for young women, shut down normal ovary function, and even if discontinued, the ovaries’ return to proper functioning is not guaranteed.  Our diets are full of petrochemical contaminants — also xenobiotics — that have an adverse effect on  normal metabolism. Other popular drugs like Prozac can impair the functioning of our limbic brain, including the hypothalamus, which may affect the menstrual cycle.

The Diet Connection to PCOS

It cannot be emphasized enough that the biggest contributor to PCOS is poor diet. Young women with PCOS tend to eat food rich in sugar and carbohydrates which can cause an unhealthy rise in insulin levels. According to Jerilyn Prior, M.D., insulin stimulates androgen receptors on the outside of the ovary, causing the typical PCOS symptoms of excess hair (on the face, arms, legs), thin hair (on the head), and acne. Eventually, this type of diet will cause obesity, which will cause insulin resistance (the inability of the cells to take in insulin), which will aggravate the PCOS even more. The androgens also play a role in blocking the release of the egg from the follicle.

Women, who have a high number of dysfunctional follicles,to begin with, due to xenobiotic exposure in the womb, will have worse problems if their diets are high in sugary foods and low in nutrition. Since this is exactly the type of diet favored by teens and young women, it’s easy to understand why there is so much PCOS in that age group.

Treatments Widely Used, and Treatments that Work

There are two treatments for the disease that most physicians routinely prescribe, both of which treat the symptoms, and both of which are not particularly successful.

• Treatment one is a chemical castration, using birth control pills, androgens (male hormones), androgen blockers, synthetic estrogens, Lupron or similar drugs that block hormone production.

• Treatment two is prescribing the new oral drugs for Type II diabetes, which reduce insulin resistance.

A third approach is one that I have found to be safer, simpler, more effective, AND less expensive; an approach that treats the cause and not just the symptoms of PCOS.  By using a health therapeutic diet, supplements being vitamins, minerals, herbs, nutraceuticals, digestive support and stress reduction can go far for improving PCOS with natural treatments.

The John R. Lee, M.D. Medical Letter July 1999

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