PCOS – Androgen Excess

I’m a naturopathic physician, but I’m also a woman who had a hormonal imbalance called Polycystic Ovarian Syndrome, and who comes from a family of women with PCOS. I’ve spent decades learning about this hormonal imbalance and treating women who have it. If women want to really turn PCOS around there are strategies that can improve symptoms, improve fertility, and set them up for better mental and physical health long term. There have been three major breakthroughs in our understanding of PCOS that have come about since I was diagnosed 30 years ago. Naturopathic physicians are leading the way to find real solutions to this issue, which is the number one cause of infertility in North America. 

Firstly, I have to say that the name Polycystic Ovarian Syndrome is a lousy name.  Women with PCOS don’t even have to have cysts on their ovaries to get a diagnosis! A better name being proposed by experts in the field is Anovulatory Androgen Excess, meaning that these women have too many of the “male” hormones, or androgens, which can hijack the menstrual cycle so that it slows or stops, and ovulation is less likely. There are also receptors for androgens in the skin, which can result in acne and excess hair growth on the face and body. Lesser-known symptoms of PCOS are anxiety, depression, brain fog and increased risk for cardiovascular disease and certain cancers.

Secondly, there are several different types of women that can have these symptoms which we call PCOS, depending on what’s driving the issues. In women who may be slim and have inherited the issue the root of the problem is in the pituitary gland.  These women tend to have normal blood sugar metabolism. In contrast, for some women, PCOS is very closely related to adult-onset or type 2 diabetes in that they have high insulin levels which drive up testosterone.  The good news for these women is that normalizing body weight, eating a low-carb diet, and having regular exercise can make a real difference in their hormones. 

The third breakthrough is that we’ve expanded the ideas around treating PCOS. It used to be that the only treatment was oral contraceptives.  Yes, “the pill” can help control some symptoms.  But it does nothing to restore fertility, reverse dark hair growth or teach women how to balance their hormones in a real and lasting way.  My goal in working with women with PCOS is to engage them in a program that can do all those things and set them up for good long-term health.   Firstly, I run blood tests to dig deeply into their hormones and blood sugar to see which type of PCOS they may have. Then we create an individualized program with diet, exercise, and stress management at its core.  There are also herbs and natural medicines shown in clinical studies to balance hormones, reduce symptoms and help fertility.  There are times when pharmaceuticals can help, especially when excess dark hair growth is the issue. When women with PCOS go off “the pill”, their symptoms come back. But with these other medications, the positive effects can remain after the pills have been stopped. I am so grateful that a naturopathic physician helped me get a handle on my PCOS 30 years ago and I have learned so much in helping my own daughter and many other women manage their PCOS with the help of our modern understanding of this complex condition. 

5 Things to Know about Infertility

More and more couples are starting families later in life and thus the number of people experiencing infertility has gone up significantly over the last two decades. People can have trouble having their first child, but equally heartbreaking is the inability to conceive or carry a second or third child. Naturopathic physicians are in a unique position to help couples uncover the cause of their infertility and enhance their health to increase the chances of becoming and staying pregnant. Depending on the cause, treatment strategies can incorporate healthy options like lifestyle changes and natural medicines to enhance male and female fertility. There are five things you should consider if you are trying to conceive. 

 

  1. Don’t wait to get help.  Medical workup for infertility usually begins after a year of unsuccessfully “trying.” But for women who are over 35 it is recommended to start investigations after 6 months, or sooner if they are approaching 40. Anyone with very irregular cycles shouldn’t wait at all. With my patients, I usually start with a thorough history and physical exam to look for clues. Then I recommend comprehensive lab work to look for the cause. Gynecologists can do imaging to help find anatomical issues. 


  1. Don’t forget the guy. Almost half the time, infertility is due to the “male factor”. Semen analysis can identify issues. For male infertility, once we rule out anatomical problems, there are science-backed lifestyle factors and natural medicines to improve sperm quality and quantity. For instance, the herb Ashwagandha was shown in a placebo-controlled study to increase sperm count by 167% and to increase sperm motility by 57% in three months.

  2. If a woman isn’t cycling regularly, she may not be ovulating, or may not be able to support a pregnancy. Hormone imbalance can be caused by many issues, including excess stress, weight loss, over-exercising, toxin exposure and more. In addition, PCOS is a pituitary disorder that causes excess androgens (“male” hormones). Menstruation can be less frequent or non-existent and ovulation is sporadic. Naturopathic medicine has excellent strategies to address these types of hormone issues safely and effectively. For instance, Chaste tree helps balance the pituitary gland while N-acetyl cysteine can safely enhance ovulation. Most conventional medicines for PCOS and irregular menstruation are contraindicated in pregnancy, so they are not helpful for women trying to conceive. 



  1. Heavy or painful periods can be a clue. Endometriosis can cause very painful periods and can affect fertility. Fibroid tumours are a common cause of heavy periods and can affect conception or increase miscarriages. Naturopathic physicians seek to address the underlying causes of these issues in safe ways (see my blog article and video about endometriosis). 


  1. Remember to check for autoimmune conditions.  Low thyroid can affect other hormones, anti-sperm antibodies can prevent conception, and autoimmune blood clotting disorders like anti-phospholipid syndrome can be a cause of recurrent miscarriages. 

For couples who want to take an active role in enhancing their fertility, there are ways to narrow down any issues and use safe naturopathic strategies to get on track. There’s nothing more satisfying as a doctor than helping a couple to get pregnant, and providing them adjunctive naturopathic medical care during pregnancy and beyond.