PCOS - Navigating Polycystic Ovary Syndrome Correctly

Interview with alternative practitioner Iris Lemke

Polycystic ovary syndrome , or PCOS for short, is the most common hormonal disorder in women of childbearing age. Due to a predominance of male sex hormones such as testosterone, the symptoms manifest themselves in absent menstrual bleeding or very long menstrual cycles, fertility problems, weight gain, depressive moods, as well as increased body and facial hair, acne, and hair loss. Blood tests often show an elevated androgen index and elevated testosterone. The generally masculine appearance also causes many women to suffer psychologically. The symptoms do not all have to occur at the same time or be particularly severe, but at least two of the criteria indicate “polycystic ovaries,” i.e. cysts on the eggs that do not fully mature in the ovaries, meaning ovulation does not occur.

In recent years, the number of affected individuals has increased significantly. In an expert interview with Iris Lemke, a Berlin-based alternative practitioner specializing in women's health and fertility, the PCOS expert reports a drastic increase in her patients' symptoms. Approximately 5 to 12% of women across Germany are affected, although she notes "more like 10%, and the trend is rising" in her practice.

So, what exactly is PCOS? How does this endocrine disorder develop? How can PCOS be treated holistically and sustainably? This article presents possible causes and proven treatment approaches to help the imbalanced hormonal system navigate back into balance. A holistic approach that includes stress reduction, stabilizing blood sugar levels, dietary changes, and mental and emotional techniques provides a solid foundation for a balanced life and greater well-being – every day.

What is PCOS?

Characteristic of the cysts seen on imaging techniques are the ovaries ( Latin: ovaria ), which resemble a string of pearls. The follicles in the ovaries, which are visibly not fully mature, are prevented from ovulating due to hormonal dysregulation. Normally, ovulation is triggered every 28 days by a rise in the hormones FSH, LH, and estrogen. A lack of ovulation leads to a missed menstrual period, since only the egg located in the fallopian tube, known as the corpus luteum, ensures that the uterine lining is built up through the production of progesterone. If the egg remains unfertilized, it is shed during menstruation.

What are possible causes of PCOS?

• Stress and overload of the adrenal glands

According to Iris Lemke, a naturopathic practitioner and women's health, hormone, and fertility specialist practicing in Berlin and Wandlitz, the causes are still not fully understood and clarified. However, she consistently observes a significantly increased level of stress, even among young girls. Women have to and want to achieve a lot, have to "stand up for themselves" from an early age. Achieving good grades, pursuing a job, leisure activities, a harmonious relationship with their partner and family, fulfilling their desire to have children, and achieving personal and professional fulfillment.

One of the most serious stressors is elevated or highly fluctuating blood sugar levels caused by either skipping meals or eating foods with a high glycemic index, which includes more than just sugary sweets. Irregular sleep, too few breaks in the fresh air and relaxation in nature, extremely increased activity and competitive sports, as well as intestinal imbalances and detoxification disorders are also stressors.

Persistently elevated stress levels result in constant production of the stress hormones adrenaline and noradrenaline in the adrenal glands, which also produce hormones related to the female menstrual cycle. If the pituitary-adrenal axis, the stress-regulating axis between the pituitary gland in the brain and the adrenal glands, is continuously challenged, disruptions in sex hormone regulation can occur. This occurs via a hormone system known as the pituitary-gonadal axis between the brain, adrenal glands, and ovaries, and controls the complex regulation of sex hormones, the menstrual cycle, egg maturation, ovulation, and possibly pregnancy.

The body can only facilitate egg maturation and ovulation if the system signals sufficient energy resources, which theoretically guarantee a healthy pregnancy. However, if the body is constantly exposed to new stimuli and to-dos instead of regular rest periods, the reproductive hormone system automatically receives the signal that, due to stress, it does not have sufficient capacity to develop new life. The survival of one's own system takes priority over reproduction, an ancient survival instinct.

In addition, stress can cause the balance of male and female hormones to shift to such an extent that androgens, i.e. the male sex hormones such as testosterone, gain the upper hand and estrogen does not have sufficient influence to trigger egg maturation and ovulation.

• Increased testosterone

Testosterone and estrogen are synthesized from the same basic molecule, the prohormone DHEA. DHEA is converted by enzymes first into testosterone and then into estradiol. Estradiol is an important estrogen, while testosterone is a male sex hormone. For various reasons, a DHEA deficiency can occur, resulting in less testosterone and estrogen being produced overall. Furthermore, the conversion of testosterone to estradiol can be disrupted, resulting in a predominance of testosterone over estrogen, which in turn provides a breeding ground for the characteristics of PCOS. Elevated testosterone causes increased hair growth on the body and face, e.g., beard growth, hair on the belly button and around the nipples. It can lead to acne and cause the hair loss and high forehead that are more characteristic of men.

• Inhibin, insulin and obesity

Inhibin is a hormone produced in the ovaries. It inhibits the release of follicle-stimulating hormone (FSH) from the pituitary gland and, during a regular menstrual cycle, ensures that not all follicles mature fully at the same time, but rather only one or two eggs are released. PCOS can cause impaired inhibin levels, leading to imbalances in the interaction of the hormones that regulate the menstrual cycle.

In addition, the elevated androgen levels in PCOS stimulate the growth of ovarian follicles. This leads to increased inhibin production, thus inhibiting FSH and inhibiting follicle maturation, which leads to the cysts characteristic of PCOS. Consequently, the disturbed inhibin-FSH balance contributes to irregular ovulation and menstrual cycles.

People with PCOS also often exhibit insulin resistance, meaning their cells respond less to insulin. Reduced insulin sensitivity can be caused by factors including obesity, hormonal imbalances, or a diet high in sugar and carbohydrates. Reduced insulin sensitivity can lead to higher insulin levels in the bloodstream, contributing to the overproduction of androgens in the ovaries, which in turn stimulates the production of inhibin and thus the development of the ovarian cysts typical of PCOS. According to Iris Lemke, approximately 50% of the PCOS women in her practice have detectable insulin resistance in their blood count and are overweight.

Treating PCOS, navigating holistically

First and foremost, if you are diagnosed with PCOS, you should seek medical support from a gynecologist or alternative practitioner, rather than attempting to change your diet and take medications on your own. In any case, it's important to combine a multi-component treatment plan, which often involves drastic lifestyle changes at the beginning.

• Nutrition: Stabilize blood sugar & support with nutritional supplements

The first step in the treatment plan for PCOS is a change in diet. "Sugar, gluten-containing baked goods and pasta, alcohol, and often dairy products must be avoided during the healing phase ," says Iris Lemke. "This is initially frightening for many, but the body noticeably thanks them after just a few weeks of perseverance, and initial successes motivate patients to continue."

A balanced and, above all, regular diet means avoiding blood sugar spikes after eating and lows caused by skipping meals. Ideally, each meal should provide the body with only what it needs to maintain balance. Whole foods, plenty of vegetables, lean protein from fish, legumes, and healthy fats should be the main components of the diet. Sugar, alcohol, gluten, dairy products, and processed foods should be avoided. The Mediterranean diet, rich in antioxidants, healthy proteins, and fats, is an excellent example. Foods and meals with a low glycemic index (GI) are particularly important for stabilizing blood sugar levels and counteracting insulin resistance. Anything that cannot be absorbed through diet, or is possibly deficient, should be obtained through suitable dietary supplements and vitamin preparations. Vitamin B6, for example, is important for supporting hormone regulation, nerves, psyche, energy metabolism, and the immune system. There are also many proven plant substances that should be used in consultation with your treating therapist.

Consulting a nutritionist or your doctor when creating your meal plan and administering appropriate supplements not only guarantees a customized treatment plan, but also creates the motivation to stick with it, as you don't have to do everything on your own.

• Exercise and physical activity

Regular exercise helps improve insulin sensitivity, control weight, and reduce stress. A combination of cardio or jogging, strength training, and relaxation exercises like yoga or meditation is ideal. It's important that it's fun, as this makes it easier to stick with it and integrate the new routines into your daily life sustainably and with a sense of achievement.

• Cultivate stress reduction and mental health

A PCOS diagnosis often brings with it depressive moods and psychological symptoms, as well as fatigue and anxiety. Reducing psychological stress is another key aspect of successful PCOS treatment. It can be beneficial to seek professional psychological counseling and cultivate additional stress management techniques and mindfulness in everyday life, to boost self-esteem, take breaks, and re-teach the body what relaxation and letting go feel like, and above all, that it has permission to do so. Wonderful tools include extensive, deeply relaxing massages, meditation, or even support groups for sharing and establishing emotional well-being. Healthy and restful sleep is also essential for hormone regulation and therefore also for the treatment of PCOS. Effective stress management techniques such as breathing techniques, progressive muscle relaxation, and time management can help reduce stress levels and have a lasting positive effect on hormone balance.

• Community - Exchange with like-minded people

Talking openly about your own suffering and sharing with like-minded people and close relatives is another important pillar of PCOS healing. This signals to the body that it is understood and taken seriously. There are numerous online communities dedicated to the increasingly common topic of PCOS, where people face challenges together, support each other, and offer encouragement. Experiences, tips, strategies, and support promote a sense of belonging, motivation, and emotional security.

PCOS and Patience - Are You Nourishing Your Body?

Endocrine disorders usually develop gradually and cannot be permanently resolved overnight. We would like to remind you that your body needs time to return to its original balance. Trust it and give it trust by acting according to its needs and nourishing it. This doesn't mean feeding it constantly, but rather putting your own well-being first. Don't skip meals, don't overeat, don't let your blood sugar skyrocket, support yourself with suitable supplements and nutrients in consultation with your gynecologist or alternative practitioner, say 'hit' to bosses and family in good time to avoid stress, take breaks, exercise daily in the fresh air, socialize with people in a stable community, and get enough sleep. Hormones love stability and reliability.

Sources:

Gu Y, Zhou G, Zhou F, Wu Q, Ma C, Zhang Y, Ding J, Hua K. Life Modifications and PCOS: Old Story But New Tales. Front Endocrinol (Lausanne). 2022 Apr 13;13:808898. doi: 10.3389/fendo.2022.808898. PMID: 35498415; PMCID: PMC9045543.

https://www.msdmanuals.com/en-us/home/women's-health-problems/menstrual-disorders-and-abnormal-vaginal-bleeding/polycystic-ovary-syndrome-pcos

https://www.rosenfluh.ch/media/gynaekologie/2012/01/das_pcosyndrom.pdf