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Acupuncture for PCOS

Acupuncture for PCOS

Polycystic Ovary Syndrome (PCOS) is a complex condition that is still, unfortunately, largely a mystery in women's health.  It is considered a syndrome, as opposed to a disease, as there are wide range of ways that PCOS can present itself.

PCOS

PCOS Symptoms

Symptoms of PCOS can include:

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  • Absent or irregular periods

  • Acne

  • Increase in body and facial hair, typically called hirsutism

  • An increase in weight

  • A greater risk of developing non-insulin depending diabetes

  • High blood pressure and an increase in the possibility of cardiovascular disease

  • Whilst not a sign of PCOS, understandably there is also a mental-emotional element to PCOS because of the symptoms that people are displaying.​  It can be very lonely, depressing, and scary to be told you have PCOS.  The fear of possibly not having children, or having to live with an excess of hair, weight gain, and/or acne can be detrimental to some people's mental health.

Diagnosing PCOS

If you suspect you have PCOS then the NICE guidelines for a diagnosis include:

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  • Signs and symptoms mentioned above including (but are not necessarily all)

    • hirsutism

    • acne

    • absent or irregular periods

    • weight gain

  • Blood tests for:

    • FSH

    • E2

    • LH

    • Testosterone (will be normal to high with PCOS)

    • Androgens (will be normal to high with PCOS)

    • SHBG (sex hormone binding globulin, will be normal to low in PCOS)

    • Prolactin (will be normal to high with PCOS)

    • TSH

    • Fasting insulin test

    • Ultrasound scan (although please note that the absence of cysts on the ovaries does not preclude a diagnosis of PCOS if all other signs and symptoms demonstrate it)

Polycystic Ovary Syndrome
PCOS

What "type" of PCOS do I have?

The criteria introduced by the Rotterdam Consensus in 2003 defined that PCOS should be diagnosed when it matched two out of the three criteria below:

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  1. Delayed ovulation or periods

  2. High androgenic hormones e.g testosterone

  3. Polycystic ovaries on an ultrasound

Phenotype A of PCOS

Defined by having all 3 criteria this type of polycystic ovary syndrome is categorised by:

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  • High androgens/androgenic signs

  • Irregular periods/delayed ovulation

  • Polycystic ovaries

Phenotype C of PCOS

In this phenotype, which is not considered "classic PCOS" the criteria is:

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  • High androgens/androgenic symptoms

  • Regular periods

  • Polycystic ovaries

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For this type it is important to to check Day 21 (or Day 7 post ovulation) progesterone levels to determine if true ovulation has taken place.

Phenotype B of PCOS

This phenotype of PCOS is similar to type A however the ovaries will not have cysts.

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Therefore criteria will be:

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  • High androgens/androgenic symptoms

  • Irregular periods/delayed ovulation

  • No cysts on ovaries

Phenotype D of PCOS

Many experts might not consider this phenotype but this would be characterised by:

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  • Normal androgens

  • Irregular periods/delayed ovulation

  • Polycystic ovaries

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PCOS Treatment

The NICE guidelines for the management and treatment of PCOS are as follows

Oral contraception for PCOS

NICE guidelines recommend a combined oral contraceptive (COC) pill, provided there are no contraindications 

Metformin for PCOS

The NICE guidelines recommend that GPs should consider seeking specialist advice before initiating metformin for women without diabetes.

  • Metformin (alone or in combination with oral contraceptives) may offer greater benefit in high metabolic risk groups, including those with diabetes risk factors, impaired glucose tolerance, or high-risk ethnic groups.

  • In addition to lifestyle measures, metformin should be considered in women with a body mass index (BMI) of  25kg/m2 or more for the management of weight and metabolic outcomes. 

  • In addition to lifestyle measures, metformin could be recommended for the treatment of weight, hormonal, and metabolic outcomes.

For prolonged amenorrhea

Prescribe a cyclical progestogen (such as medroxyprogesterone 10 mg daily for 14 days) to induce a withdrawal bleed, then refer for a transvaginal ultrasound to assess endometrial thickness.

For excess androgens

For acne: consider adding a topical retinoid, topical antibiotics, and/or oral antibiotics as appropriate. 

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For hirsutism: discuss methods of hair reduction and removal (such as shaving and waxing), as these will remain an important part of management.  Note that oral contraceptive pills are more effective for acne than for hirsutism.

Acupuncture for Polysystic Ovary Syndrome (PCOS)

Why is working with me, The Period Acupuncturist, so beneficial for your PCOS?  As your acupuncturist I evaluate your individual signs and symptoms of PCOS and I work with you, not only with my acupuncture needles and acupuncture points but also I am supporting and guiding you with expert knowledge to manage the following areas.​

01

Addressing Inflammation

In PCOS our physiological system of inflammation is disrupted leading to chronic low-grade inflammation.  I have a blog post here about the role of inflammation in PCOS, endometriosis and perimenopause.

02

Treat insulin resistance

Women with PCOS are more prone to insulin resistance.  High insulin levels aggravate your ovaries  causing them to produce more androgens​.

03

Balancing adrenals

The adrenals respond to stress.  They make hormones like cortisol and DHEA (androgen), which are already higher in women with PCOS.

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Increased cortisol also causes insulin resistance.

04

Treating excess androgens

As mentioned above, during times of stress our adrenals make cortisol and DHEA (androgens).  But there are other androgens such as testosterone, DHEA-S, Androstenedione and Dihydrotestosterone.   When these androgens are in excess it can lead to characteristics such as hirsuitism, acne, hair loss and change in body composition.

05

Address hormonal imbalances

The optimal communication between our sex hormones is disrupted with PCOS.  The miscommunication comes from overproduction of LH (Luteinising Hormone) which causes the ovary to create more testosterone, which inhibits ovulation.

06

Balance your thyroid

Research suggests that low thyroid function can aggravate the insulin resistance in PCOS. When thyroid dysfunction is combined with PCOS the chances of metabolic, hormonal and cardiovascular risks increase.

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Changes in thyroid function can also impact sex hormone-binding globulin (SHBG).  When SHBG is low, androgens can go into excess leading to more androgenic characteristics.

​I have written a blog post here about how acupuncture and Chinese medicine treats polycystic ovary syndrome (PCOS).  This blog post (it is a 4-minute read) looks at:

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  • What PCOS is in acupuncture and Chinese medicine

  • The evidence for using acupuncture in supporting your PCOS diagnosis

  • Free lifestyle advice based on your Chinese medicine diagnosis that you can start incorporating today.

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