It all starts with follicle stimulating hormone (FSH) and luteinizing hormone (LH). FHS helps the eggs mature and follicles grow till one is mature enough to be released in ovulation. Luteinizing hormone, on the other hand, is what triggers the release of the egg once it’s ready to go.
In people who don’t have PCOS, the ratio of luteinizing hormone (LH) to follicle stimulating hormone (FSH) is around 1:1. In PCOS, LH to FSH ratio is closer to 3:1. When that happens, follicles try to mature, but then the relatively high level of LH interrupts them in the middle of their growth and they never end up getting big enough to be released.
PCOS is one of the most common causes of infertility in the US. But don't lose hope! For most people PCOS is totally treatable. Read on to find out more...
So… what treatments do we have for PCOS?
A common macronutrient ratio is 20% of calories from carbs to 30% calories from protein and 50% calories from fat, or something close to that (25:25:50, 20:20:60, etc). Remember - those numbers are a percentage of calories, not volume or weight. For example, one ounce of rice has 37 calories, while the exact same amount of coconut oil (by volume) has 245 calories.
The type and quality of these foods matters a lot - we’re talking about healthy carbs, like organic fruit and starchy vegetables, healthy proteins like fish and hormone-free meats, healthy fats such as coconut oil, olive oil, and grass-fed animal fats.
All of that extra care and money that goes into buying clean foods can make a big impact on your body’s overall ability to regulate your hormones. In addition, keeping your liver happy (which is the organ that takes the brunt of the burden to detox all the junk we are exposed to in our environments and food) may help your hormone regulation, as it’s where many of your hormones are broken down so that your body can get rid of them.
- Fish oil. In a 2013 study on the effects of omega-3 supplementation on PCOS, people with PCOS who took 3000mg of fish oil for 2 months had significant reductions in their serum testosterone levels. Several of them even started having regular periods!
- Inositol: there are two main forms of inositol: myo-inositol and d-chiro inositol. When you buy inositol in the store, the type is often not specified - which is an issue for certain conditions but not a big deal for PCOS because both forms help increase fertility and regulate hormones. The main difference is how much you have to take (the dose for d-chiro-inositol is around 900-1200mg while the dose for myo-inositol is closer to 4000mg).
Inositol has been shown to reduce testosterone, DHEA-S and LH in people with PCOS, increase ovulation rates and fertilization rates, and may even help prevent certain birth defects. Check out this article for more information on the science of inositol for PCOS.
- In the naturopathic world, we also like to use CoQ10 and Melatonin to reduce oxidative stress. This helps increase the quality of the eggs (which is often reduced in PCOS).
If you are interested in getting any of these supplements from a high-quality supplier (and at a 10% discount!) check out my online medicinary here.
- Vitex agnus-castus (Chase tree berry): This herb works by regulating the release of LH and FSH in the pituitary. It’s the classic PCOS herb and has been used for infertility and menstrual irregularity for centuries.
- Angelica sinensis (Dong Quai root): This herb helps blood flow to the pelvis and can be useful for people who don’t menstruate regularly (or at all) because of PCOS.
- Serenoa repens (Saw Palmetto berry): This is mainly used to keep the endometrium a healthy thickness. In PCOS the endometrium can become hyperplastic (too thick), which can affect implantation.
Again, these herbs may not be safe in pregnancy or certain specific medical conditions so please seek the guidance of a qualified health care practitioner.
Because PCOS interrupts or prevents ovulation, all of the standard medications to stimulate ovulation are used to help with PCOS-related infertility. The main medications currently in use for this are:
- Clomid: This is a type of medication called a SERM: a selective estrogen receptor modulator. It works (in a round-about way) by increasing follicle stimulating hormone (FSH). That helps move that 3:1 LH to FSH imbalance closer to a 1:1 balance. That 1:1 ratio is just what’s needed to let one of the follicles to grow to full size and be released.
- Femara (aka letrozole): Femara is an aromatase inhibitor. It’s a different type of medication from Clomid, but it has a similar result: it triggers your body to release more FSH, thus bringing your LH to FSH ratio back into balance.
- FSH hormone injections: This is pretty self-explanatory - just adding some FSH to get that LH:FSH ratio closer to 1:1