Hormonal Balance and PCOS

PCOS, or polycystic ovary syndrome, is a hormonal disorder that affects a growing number of women. Despite the name, it doesn’t actually stem from a problem with your ovaries. In fact, PCOS is due to an imbalance of the endocrine system that may be reflected by changes in the ovaries.

Insulin resistance is the imbalance that starts the entire cascade, but inflammation may be the true trigger of PCOS.  

This metabolic disorder can contribute to hormonal imbalances that further worsen PCOS symptoms. Having elevated testosterone is one common symptom in PCOS. While it is healthy for women to have some testosterone, excess levels of testosterone can create problems, like causing you to lose hair on your head or grow it on the face or nipples. Moreover, an imbalance in hormones like progesterone or estrogen can also lead to changes in your menstrual cycle.

Many people who might have PCOS report a group of symptoms including: high levels of androgens like DHEA or testosterone, irregular cycles, mood swings and or polycystic appearing ovaries on ultrasound. Patients may also complain of cystic acne or unwanted hair on face, chest, or abdomen. Insulin resistance is common, often presenting as an apple body shape with more weight around the waistline. The ovaries may be enlarged and contain multiple small cysts. Lack of regular ovulation leads to absent or irregular periods and can cause subfertility (problems getting pregnant).

Many have been given a diagnosis of PCOS and not feel like they have been offered many solutions. The standard treatment of birth control pills masks the symptoms of the condition, but do nothing to restore underlying hormonal balance. Metformin, a drug usually prescribed for diabetics, addresses the insulin resistance, but many people want to avoid a prescription if there are alternatives. While genetics can be a predisposing factor for PCOS, there are plenty of lifestyle changes that can decrease inflammation, thereby improving hormonal health.

It is also important to consider the fact that hormones are interconnected, and an excess or deficiency of one, affects everything else. For example:

1. Thyroid- Thyroid disorders, especially Hashimoto’s thyroiditis, are observed significantly more often in patients with polycystic ovary syndrome (PCOS) than in the general population. Some people want thyroid optimization, but are not eligible for a prescription. Fortunately, there are supplements that support the thyroid, available without a prescription.
2. Melatonin- Melatonin is your sleep hormone. In PCOS your monthly clock is “off”, so if your daily clock is also disrupted, this may be connected. Melatonin is also important for the health of your ovaries.
3. Progesterone– sometimes low progesterone is a problem and is needed to balance the system. When your progesterone is low, your estrogen can overwhelm the system, and low progesterone affects the function of your thyroid.
4. Saw Palmetto- is used as an anti-androgen and is used to block 5-alpha-reductase activity which affects levels of dihydrotesteosterone (DHT). This herb helps in reducing hirsutism and excess facial and body hair.
5. Chasteberry/Vitex- sometimes low progesterone is a problem and is needed to balance the system
6. Pomegranate- are considered a symbol of fertility in some countries. They have a positive effect on hormone balance and insulin levels. 
7. Resveratrol- is found in the skin of grapes, red wine, and peanuts has shown encouraging results for helping restore hormone balance.
8. Ashwagandha- it is an adaptogen that helps fight stress by reducing cortisol levels. It has a thyroid stimulating effect that can prove helpful for under-active thyroid glands commonly associated with PCOS
9. Spearmint– Based on the results of a 2017 animal study, spearmint essential oil reduces weight, testosterone levels, and ovarian cysts.
10. Green Tea- decreases inflammation and cortisol, and also improves insulin sensitivity. Click here to find my favorite. It is very mild and non-bitter, and blends with my favorite vitality oils.
11. Reishi mushroom- can lower cortisol levels and inflammation, which disrupt other hormones.

When I suggest supplements to patients, I have labs, so it is easier to decide which of these supplements would best align the hormones. These are examples of combination supplements made of the above supplements:

1. Femigen– contains Black Cohosh, wild yam, American ginseng, licorice, fennel, and sage. These come up often in regards to studies for PCOS, and they are all together in this supplement.
2. PowerGize– contains Ashwagandha, Fenugreek, Tribulus, and Cassia which have been studied for PCOS
3. Prostate Health– contains Saw Palmetto and Fennel, I suggest this product to people concerned about hair thinning
4. Thyromin– contains iodine, thyroid powder, and spearmint for thyroid support
5. Privita– Contains Ginger, Chamomile, Pomegranate, Reishi, and Resveratrol which have all been studied, and I often recommend this for estrogen dominant women.
6. Immupro– Contains reishi mushroom and melatonin.

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Additional Reading:

Kowalczyk K, Franik G, Kowalczyk D, Pluta D, Blukacz Ł, Madej P. Thyroid disorders in polycystic ovary syndrome. Eur Rev Med Pharmacol Sci. 2017;21(2):346-360.

Simon SL, McWhirter L, Diniz Behn C, et al. Morning Circadian Misalignment Is Associated With Insulin Resistance in Girls With Obesity and Polycystic Ovarian Syndrome. J Clin Endocrinol Metab. 2019;104(8):3525-3534. doi:10.1210/jc.2018-02385

Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytother Res. 2010;24(2):186-188.

Sadeghi Ataabadi M, Alaee S, Bagheri MJ, Bahmanpoor S. Role of Essential Oil of Mentha Spicata (Spearmint) in Addressing Reverse Hormonal and Folliculogenesis Disturbances in a Polycystic Ovarian Syndrome in a Rat Model. Adv Pharm Bull. 2017;7(4):651-654. doi:10.15171/apb.2017.078

Jung JH, Park HT, Kim T, et al. Therapeutic effect of korean red ginseng extract on infertility caused by polycystic ovaries. J Ginseng Res. 2011;35(2):250-255. doi:10.5142/jgr.2011.35.2.250

Saiyed A, Jahan N, Makbul SAA, Ansari M, Bano H, Habib SH. Effect of combination of Withania somnifera Dunal and Tribulus terrestris Linn on letrozole induced polycystic ovarian syndrome in rats. Integr Med Res. 2016;5(4):293-300. doi:10.1016/j.imr.2016.10.002

Arentz S, Smith CA, Abbott J, Fahey P, Cheema BS, Bensoussan A. Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial. Phytother Res. 2017;31(9):1330-1340. doi:10.1002/ptr.5858

Arentz S, Abbott JA, Smith CA, Bensoussan A. Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings. BMC Complement Altern Med. 2014;14:511. Published 2014 Dec 18. doi:10.1186/1472-6882-14-511

Grant P, Ramasamy S. An update on plant derived anti-androgens. Int J Endocrinol Metab. 2012;10(2):497-502. doi:10.5812/ijem.3644

Banaszewska B, Wrotyńska-Barczyńska J, Spaczynski RZ, Pawelczyk L, Duleba AJ. Effects of Resveratrol on Polycystic Ovary Syndrome: A Double-blind, Randomized, Placebo-controlled Trial. J Clin Endocrinol Metab. 2016;101(11):4322-4328. doi:10.1210/jc.2016-1858

Gaberšček S, Zaletel K, Schwetz V, Pieber T, Obermayer-Pietsch B, Lerchbaum E. Mechanisms in endocrinology: thyroid and polycystic ovary syndrome. Eur J Endocrinol. 2015;172(1):R9-R21.

Swaroop A, Jaipuriar AS, Gupta SK, et al. Efficacy of a Novel Fenugreek Seed Extract (Trigonella foenum-graecum, Furocyst) in Polycystic Ovary Syndrome (PCOS). Int J Med Sci. 2015;12(10):825-831. Published 2015 Oct 3. doi:10.7150/ijms.13024

Li X, Feng Y, Lin JF, Billig H, Shao R. Endometrial progesterone resistance and PCOS. J Biomed Sci. 2014;21(1):2. Published 2014 Jan 9. doi:10.1186/1423-0127-21-2

Tagliaferri V, Romualdi D, Scarinci E, et al. Melatonin Treatment May Be Able to Restore Menstrual Cyclicity in Women With PCOS: A Pilot Study. Reprod Sci. 2018;25(2):269-275. doi:10.1177/1933719117711262

Esmaeilinezhad Z, Barati-Boldaji R, Brett NR, et al. The effect of synbiotics pomegranate juice on cardiovascular risk factors in PCOS patients: a randomized, triple-blinded, controlled trial. J Endocrinol Invest. 2020;43(4):539-548. doi:10.1007/s40618-019-01139-x

Ghafurniyan H, Azarnia M, Nabiuni M, Karimzadeh L. The Effect of Green Tea Extract on Reproductive Improvement in Estradiol Valerate-Induced Polycystic Ovarian Syndrome in Rat. Iran J Pharm Res. 2015;14(4):1215-1233.