Needles & Nourishment: A Holistic Approach to PCOS
By Kari Pettersen
PCOS is a hormonal issue that affects the ovaries and menstrual cycles. According to the World Health Organization, polycystic ovary syndrome (PCOS) affects an estimated 6–13% of reproductive-aged women but up to 70% of affected women remain undiagnosed worldwide. Women need 2 of these 3 criteria to make a diagnosis of PCOS.
#1. High Androgens ( Testosterone) - Can have different levels and can decrease with age
#2. Long Cycles- Cycles are that are 35 days or longer
#3. Polycystic Ovaries on ultrasound
Often women will have insulin resistance with PCOS which will drive up inflammation and androgens in the body. Around 75% of women with PCOS will have insulin resistance. In addition to insulin resistance, women with PCOS have hormonal imbalance. Here are some hormonal imbalances that can show up
Women will have either low or high estrogen for longer because ovulation is delayed.
Inflammation and other factors can cause low egg quality thus creating low progesterone after ovulation, low progesterone in turn causes low LH hormone
Low LH hormone and high insulin create more androgens further decreasing ovulation at the level of the brain. This creates a feedback loop that keeps the PCOS cycle continuing.
These are some signs/ symptoms you may experience if you have PCOS
Hirsutism- hairs/ coarse hair on the body especially the chin
Acne along the jawline and cystic acne in adults
Hair loss in your 20’s that increases slowly and gradually- top of the scalp
Dandruff and oily scalp
Weight gain and issues with weight loss
Holistic Approach
The best way to approach PCOS is through a holistic approach. Lifestyle, diet, environmental factors and stress can all play a role in the feedback loop I explained earlier. Combining these changes with supplements and acupuncture is the best approach. Diet changes can have a huge impact on ovulation. This is because of 75 % of women with PCOS have high insulin. Eating a low glycemic, low carb diet can help balance blood glucose levels. Here is the best diet plan to follow if you fall into the category of high insulin. Here are some clinical signs of insulin resistance.
Belly fat
Fatigue
Craving for sugar and carbs
Skin tags
Dark skin patches
Diet
The best way to approach a diet is to make one that you can maintain long term. This includes
1.Whole food meals ( lean protein) 25 g per meal - protien helps build muscle and is highly satiating and will help you eat less.
2. Non starchy veg ( 2-3 cups/ meal)
3. Healthy fats ( 1/23 cup of nuts, seeds or avocado)
4. Controlled carbohydrates ( low GI or resistance starch is the best)
5. Minimize sugar and processed foods. If you have a hard time quitting sugar allow yourself to eat potatoes and rice because startch makes you feel full and can reduce cravings in the beginning. Once cravings are better you can reduce bread, potatoes and rice.
Exercise
This is one of the single best ways to improve insulin resistance. Exercise works in two ways. By improving glucose uptake into cells during exercise and building muscle improves insulin sensitivity while at rest. Just 12 weeks of strength training can improve insulin sensitivity by 24%
Here is my rule of thumb for starting an exercise program.
If you are just starting out start small. Try walking, climb some stairs and progress from there. Sometimes starting out to hard can be discouraging and stressful and taking small steps can make it more of a lifestyle, gradually building up to more intense workouts.
Sign up for a class. Some people find exercise easier in classes or with friends
Find something you enjoy. If you don’t love it then don’t do it. There are so many different types of exercise to choose from and if you enjoy it you are more likely to keep wanting to make it a lifestyle
Supplements
Supplements are aimed at helping with insulin resistance, reducing inflammation, reducing androgens and supporting egg quality. Please note that diet and exercise is better than any supplements and these are to be taken with lifestyle changes.
Here are some of my favorite supplements for PCOS
#1. Myo-Inositol & D-Chiro Inositol 40:1 ratio - this is my number one because it not only improves insulin resistance but it reduces androgens and can increase egg quality. This supplement can support regular ovulation.
#2.Vit D- Improves insulin sensitivity and promotes healthy maturation of ovarian follicles
#3. NAC & ALA- an antioxidant that can help with reducing inflammation, promoting and improving insulin sensitivity
#4. CO- Q10 - can help with egg quality if trying to conceive
#5. Zinc, Peony and Licorice- Can have anti androgen affects. It can reduce testosterone and help with making more regular cycles
Things to consider
Berberine- has done well in PCOS clinical trials outperforming metformin in two large studies. It can improve insulin sensitivity, is great for acne and can reduce anxiety; but do not take if you are pregnant or breastfeeding and consult with your doctor if you are taking any medications. Do not take more than 8 weeks in a row because it can disrupt your gut bacteria
Birth Control- can cause or worsen insulin resistance. One study found that 3 months on birth control worsened insulin resistance in PCOS.
Spironolactone- can suppress androgens and improve the symptoms of hirsutism and acne but it can also prevent healthy ovulation and alter the activity of the HPA axis. This is best avoided if you are trying to conceive or regulate your cycle. Stopping can sometimes result in worse acne
Acupuncture
Acupuncture is gaining popularity as a safe, natural and effective way to support women with PCOS. Here’s how it can help
Increase blood flow to ovaries thus supporting healthy ovarian function
Supports healthy estrogen activity
Support more regular menstrual cycles
Help reduce ovarian volume and the number of cysts
Support better blood sugar balacne by improving insulin sensitivity and lowering cortisol levels- this can assists with weight loss
Helps lower circulating androgens ( which can reduce symptoms like acne or excess hair growth)
Stimulates ovulation naturally
One study, a randomized sham- controlled trail involving 86 women with PCOS related infertility found that manual acupuncture combined with herbal medicine significantly improved both pregnancy and ovulation rates compared to a control group receiving sham acupuncture. 46. 34% of women in the acupuncture group became pregnant, versus 18. 42 % in the control group. The ovulation was higher in the acupuncture group ( 58.14%) compared to the control group ( 45.74)! The study also observed reductions in testosterone and luteinizing hormone, suggesting acupuncture can help balance hormones and support reproductive heath in women with PCOS.
Another interesting study by Stener- Victorian looked at women with PCOS who weren’t ovulating. After a few months of electroacupuncture, the number of ovulatory cycles jumped from 15% to 66%! They also found that acupuncture helps regulate the nervous system’s signals to the ovaries, improving blood flow and function.
An acupuncturist will work with the specific type of PCOS you may have and work with you to make a treatment plan tailored to you and your goals. Your supplement and treatment plan may vary from person to person.
Sources
Stener-Victorin, E., Waldenstrom, U., Tagnfors, U., Lundeberg, T., Lindstedt, G., and Janson, P.O. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2000; 79: 180–188
Wen Pen., Feng-Xing, L., Qiao Wang., Zou-Quin Haung., Yu Ming Yan., Ling Zhao., and Xue-Yong Shen, P.O. A randomized sham-controlled trial of manual acupuncture for infertile women with polycystic ovary syndrome. © 2022 Korea Institute of Oriental Medicine. Published by Elsevier B.V.
Briden, L. (2018). Period Repair Manual. Bolton, ON: Greenpeek Publishing.
McCulloch, F. (2024).Reproductive and Developmental Elements in PCOS: Optimizing Oocyte Quality and Beyond - Distance Education Retrieved from https://www.healthyseminars.com/product/how-effectively-treat-ovulatory-disorders-evidence-based-natural-medicine
Lyttleton, J. (2004). Treatment of Infertility with Chinese Medicine. Churchill Livingstone.