Jeffrey Dach

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• Referral from November 22, 2014
  

  Tarna L. asked:

  Does anyone have any suggestions on PCOS - Polycystic Ovarian Syndrome treatment? I'm well informed on the physiology, but there isn't much info out there for natural treatment. Thanks!

  

  Keith N. replied:

  As I have no prior exposure to the issue of PCOS, I have researched the topic. The following has been extracted from http://www.drdach.com/PCOS.html I hope this helps. Please note that the article says that 10% of patients are incorrectly diagnosed with PCOS. Note also the warning about self-medication. ----------- What Causes PCOS ? The world’s greatest authority, Leon Speroff MD, says: “A question which has puzzled gynecologists and endocrinologists for many years is what causes polycystic ovaries. There is an answer which is appealing in its logic and clinical applicability. The characteristic polycystic ovary emerges when a state of anovulation persists for any length of time” (1) Clinical Gynecologic Endocrinology and Infertility by Leon Speroff MD p.493 According to Dr. Speroff, PCOS is the end result of not ovulating, (no progesterone production) for a long time (a few years), resulting in a vicious cycle which self perpetuates anovulation, causing increased testosterone production by the ovary. Insulin resistant diabetes and obesity aggravate the problem. As you might expect, PCOS is a major cause of infertility. Update 2014: The Cause of PCOS PCOS is explained as Hormone Receptor Defect Caused by Exposure to Hormone Disrupting Chemicals such as BPA. See this article: PCOS BPA Part 3 for more on this. Non Classical CAH About 10% of patients thought to have PCOS actually have an underlying genetic enzyme defect in adrenal steroid synthesis called Non-Classical CAH. This can be diagnosed with a Cortrosyn stimulation test, and a 21-OH genetic test called CAHDtex from Esoterix. If present, treatment is successful with low dose adrenal steroid tablets (cortef, dexamethasone, prednisone) which restores fertility and reverses the acne. (see below discussion on non-classical CAH). Oral Contraceptives for PCOS (BCP's) Birth control pills are a chemical form of castration, which prevent ovulation. Lack of ovulation is the primary defect in PCOS, so birth control pills merely perpetuate the primary defect. Birth control pills can restore regular bleeding periods, however, this is artificial, and aggravate the underlying PCOS problem rather than solve it. In addition, birth control pills are known to worsen insulin resistance and diabetes. (2) "PCOS may affect between 3.5 and 5.0 million young women in the United States, it arguably may be the most important general health issue affecting young women. BCP's (OCPs) are the traditional therapy for the chronic treatment of PCOS…… limited evidence raises the issue that BCP's (OCPs) may aggravate insulin resistance and exert other untoward metabolic actions that possibly enhance the long-term risk for diabetes and heart disease." JeriLynn Prior MD Says: “The fundamental problem with PCOS is not making progesterone for two weeks every cycle. This lack of progesterone leads to an imbalance in the ovary, causes the stimulation of higher male hormones and leads to the irregular periods and trouble getting pregnant. Progesterone is usually missing—replacing it therefore makes sense. “ John R Lee MD says: "I recommend supplementation of normal physiologic doses of progesterone to treat PCOS. If progesterone levels rise each month during the luteal phase of the cycle, as they are supposed to do, this maintains the normal synchronal pattern each month, and PCOS rarely, if ever, occurs. Natural progesterone should be the basis of PCOS treatment, along with attention to stress, exercise, and nutrition. If you have PCOS, you can use 15 to 20 mg of progesterone cream daily from day 14 to day 28 of your cycle. If you have a longer or a shorter cycle, adjust accordingly. The disappearance of facial hair and acne are usually obvious signs that hormones are becoming balanced, but to see these results, you'll need to give the treatment at least six months, in conjunction with proper diet and exercise." This is quoted from the The John R Lee Medical Letter 1999.(10) Self-Medication Not Recommended Some young women find out about progesterone on internet messenger boards, and then proceed on their own to buy it over-the-counter. The progesterone cream may successfully restores cycles in many cases. However, self - medication is not recommended. It is best to work with a knowledgeable physician. If you have PCOS and need a doctor to prescribe progesterone, you can find a knowledgeable physician on the ACAM or A4M doctor's directory.(65)(66) Always work closely with a knowledgeable physician. Can PCOS be Treated with Natural Progesterone? YES by Dr. Jerilynn Prior (3) "Progesterone talks back to the hypothalamic and pituitary (brain) hormones that control the ovaries and stops them from stimulating the ovaries to make too much testosterone." Dr Prior recognizes that the (BCP) pill, with its synthetic type of progesterone, does help women with PCOS to a certain degree. But her goal for PCOS patients is, "to return the brain/ovary system to a normal balance. The goal of the BCP Pill is the opposite - it must suppress the brain-ovary system to prevent pregnancy." To help her PCOS patients achieve a normal hormonal balance, she prescribes oral micronized progesterone (trade name Prometrium) which is a bio-identical hormone. Taking this natural progesterone for two weeks every month (called cyclic progesterone therapy) may help the brain to develop the normal cyclic rhythm that is missing in PCOS. Interestingly, Dr. Prior believes there is another benefit of cyclic progesterone therapy. She explains, "most doctors don't realize progesterone antagonizes and inhibits the enzyme (called 5-alpha reductase) that is needed to make testosterone into dihydrotestosterone. Dihydrotestosterone is the powerful male hormone that talks hair follicles into making coarse hair and too much oil that causes acne." ------------ Above quote is attributed to Jerilyn Prior MD Web Site.(3) --------------------

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