PCOS and Fertility

Changing Hormones and Fertility

Hormonal imbalances affect millions of people worldwide, in the forms of common disorders such as menstrual irregularities, infertility, low testosterone and estrogen dominance, diabetes, and thyroid disorders. Along with hormone levels dipping as age progresses, poor gut health, inflammation, high amounts of stress, genetic susceptibility, and toxicity intensify symptoms.

Understanding your personal health challenges helps make this this normal human transition manageable by choosing natural treatments include eating an anti-inflammatory diet which targets the good fats and vegetables, avoiding refined foods that disrupt endocrine function, plenty of fibre, omitting gut destroying genetically modified grains, consuming enough omega-3s, getting a good restful sleep, exercising and controlling stress.

For those people already diagnosed with hormonal disorders such as type 1 or type 2 diabetes, adrenal insufficiency, Addison’s Disease, and Graves’s Disease for example, your doctor makes the call on medications before relying fully on natural treatments. It is however a very positive step to make dietary and lifestyle changes to help you overcome your illness and greatly reduce symptoms. Because hormone imbalances vary so widely in terms of severity of symptoms, your research and evaluation of how you respond and feel is very important.

Healthcare is trending more and more toward taking responsibility for your own health based on researched advice from qualified experts. It also considers your lifestyle, genetics, current state and other health issues. The role of the clinician is to recommend possible ways forward to include a number of options which consider all of your symptoms and include changes to diet, and lifestyle. Afterall, we were not born dependent on medications.

In recent decades, the incidence of fertility related problems has increased significantly in men and women alongside insulin resistance, high oxidative stress and hormonal disorders. One in six couples have difficulty conceiving and the number seeking medical help has risen dramatically.

Sperm counts in males have fallen by almost a half in the past 50 years and many believe this to be due to exposure to environmental chemicals. Overall counts are down as well as abnormal sperm. Smoking, poor diet, obesity, and inactivity are contributing culprits leading to poor quality sperm.

My gynecology colleague highlighted the effect of stress, changes in lifestyle and the recent contributing trend of late marriages as impacting hormonal issues and frequently discussed in medical review papers. She emphasised the major causes of subfertility are poor insulin management, thyroid issues, ovulation disorder, fallopian tube damage and sperm dysfunction.

Polycystic ovarian syndrome (PCOS) is the leading cause of infertility in women in the UAE and one of the most common endocrine disorders affecting women of reproductive age. There is a genetic tendency and lifestyle changes are a big contributor for PCOS. She emphasized that many people here do not take a healthy diet seriously and along with inactivity and a sedentary life lead to obesity and insulin resistance, the most predominant platform for PCOS.

The female reproductive system is comprised of a very delicate cycle of hormones that rely heavily on estrogen. That delicate system is further complicated with PCOS and any environmental and dietary factors that could compromise this balance should be addressed.

PCOS is a disorder whereby many small cysts from within a woman’s ovaries. The underlying cause of PCOS is a hormonal imbalance causing Oligo ovulation (irregular ovulation) and/or anovulation (failure of the ovary to release ova), excess androgen activity causing hirsuitism, acne, virilization, hormone dysfunction, and polycystic ovaries on ultra sonogram.

The positive aspect is that PCOS responds to treatment better than other causes of infertility.

Increased ovarian androgen production seen in PCOS is a result of a series of complex biochemical processes which begins with or in response to insulin like growth factor to cause excessive luteinizing hormones (LH) which increases the LH/FSH ratio. The final outcome is LH induced androgen production and the accumulation of androgens in the ovary while also blocking follicular maturation. In males the  genetic predisposition is expressed as premature balding.

Other common symptoms of excess androgenic hormones (Hirsutism, Acne, Alopecia and Seborrhea), mood disorders including depression, anxiety, bipolar disorder and binge eating occur more frequently in women with PCOS.

The diagnostic criteria for PCOS

  1. Clinical and/or biochemical hyperandrogenism
  2. Menstrual dysfunction – Oligo-ovulation or anovulation
  3. Polycystic ovaries and cysts seen on ultra sound

PCOS among adolescents is an emerging problem that needs careful assessment, timely intervention, and appropriate treatment.

Dietary and lifestyle approach with PCOS focuses on the statistics revealing that excess insulin (hyperinsulinemia) is usually present and obese girls with PCOS were more hirsute, hypertensive, and had significantly higher mean insulin after glucose challenges.

Treatment for PCOD includes diet control, weight loss, oral contraceptives, anti-androgens, and insulin sensitizing agents such as metformin can have a favourable response but not without side effects. Studies also show myoinositol in ratio with D-chiro inositol (a vitamin B group molecule) reduces serum androgens, serum free testosterone concentrations and improves ovulation in women with PCOS.

Myoinositol (MI) and D-chiro inosoitol have raised much interest as a novel insulin sensitizer and alternative to metformin treatment. Emerging research has focused on its effectiveness in reducing hormonal, metabolic and oxidative abnormalities in PCOS patients due probably by improving insulin resistance, HDL cholesterol and reducing oxidative damage.

Hormones — such as estrogen, testosterone, adrenaline and insulin — are extremely important chemical messengers that affect many aspects of your overall health and are influenced by the organs they are secreted from including the thyroid, adrenals, pituitary, ovaries, testicles and pancreas. When one is disrupted, the system can cause widespread, major health problems as the endocrine function is reliant on balance.

Conventional treatments focused on forcing balance using medications, which we now identify as masking the cause and not solving the problem. Other more serious side effects are also common.

The good news is there are ways to balance your hormones naturally by pinpointing your specific symptoms. Most common are infertility and irregular menstruation, unexplained weight gain or weight loss, depression and anxiety, fatigue, low libido, changes in appetite, hair fall and thinning, poor sleep and digestive issues.

The effect on specific hormones depends on the type of disorder such as high estrogen is related to endometriosis, and PCOS is related to low estrogen converting to testosterone.

  • Polycystic Ovarian Syndrome (PCOS): infertility, weight gain, higher risk for diabetes, acne, abnormal hair growth
  • Estrogen dominance:changes in sleep patterns, changes in weight and appetite, higher perceived stress, slowed metabolism
  • Low estrogen: low sex drive, reproductive problems, menstrual irregularity, changes in mood
  • Low testosterone: erectile dysfunction, muscle loss, weight gain, fatigue, mood-related problems
  • Hypothyroidism: slowed metabolism, weight gain, fatigue, anxiety, irritability, digestive issues, irregular periods
  • Hyperthyroidism & Grave’s Disease: anxiety, thinning hair, weight loss, IBS, trouble sleeping, irregular heartbeats
  • Diabetes: weight gain, nerve damage, deteriorating vision, fatigue, breathing problems, dry mouth, pigmentation and skin changes
  • Adrenal fatigue: fatigue, muscle aches and pains, anxiety and depression, trouble sleeping, brain fog, reproductive problems

Assessing your most prominent risk areas is helpful and could include also include identifying food allergies and gut issues that cause inflammation and put many aspects of health out of balance. I have often heard patients say once their digestive issues disappeared, weight loss occurred and hormonal imbalances also corrected.

A good probiotic will be in the starter pack for improved gastro health for the obvious reason that modern foods and genetically modified grains have been game changers to gut bacteria killing off what we need and feeding problematic strains. I would suggest about 20 to 30 billion colonies once per day. Addressing stomach acid levels is also crucial as this is where food breakdown begins.

Being overweight or obese has a major impact on hormones and the enzymes that keep the pathways on target. Aromatase is a big player in the conversion of estrogen. Females need it, men don’t!

High levels of inflammation caused by a poor diet, inactivity and food sensitivities

Genetic susceptibility and its effect on important pathways such as detoxification, methylation and oxidation.

Toxicity (exposure to pesticides, toxins, viruses, and harmful chemicals)

Habitual stress, and poor sleep and sleep patterns.

As not only an applied clinical nutritionist but an avid health researcher, dealing with PCOS is a multi-faceted health issue. Insulin resistance is mostly a big driver of symptoms, however claims that avoiding sugar and starches to deal with insulin resistance is dodging around the problem rather than healing it, “and” long-term restrictive dieting ultimately leads to more health issues down the road. To truly correct insulin resistance, you must heal your metabolism and that does not mean eliminating the macro-nutrients – protein, fat or scandalous carbohydrates. The root cause is likely a combination of poor fats accumulated in your tissues (which is estrogenic), toxic build-up of xenoestogens (toxic chemical pollutants) and phytoestrogens – soy being the worst offender, oral contraceptive use, oxidative stress and repeated attempts at weight loss based on depriving the body of critical nutrition.

A healthy diet is a must and doesn’t come under any swanky name or require a recipe book. A shopping list – Yes! and a few things to focus on.

  1. Eat Healthy Fats – including avocados, poly-unsaturated oils rather than saturated and coconut oil

It is the nature of the fatty acids that make these fats so impressive. This also includes how they are extracted and the effect heat has on them as to how they will influence your health. Hormone production needs fat as fundamental building block, they keep inflammation levels low, and boost metabolism to promote weight loss.

Balancing your intake of omega 3 fats needs consistency and good planning. We all know olive oil is a good fat but it’s not hugely high in omega 3’s. And vegetable oil intake has rocketed away to really put the omega 3 to omega 6 ratio out of balance. That is the key, to draw the ratio back in as the escalation of chronic diseases caused by inflammatory processes is because of a disproportionate fatty acids ratio typical of the modern diet.

Omega-3 fatty acids are a big part of brain-cell membranes and cell-to-cell communication to influence learning, mood, behavior, memory and cognition. Try to steer clear from oils high in omega-6 fats (safflower, sunflower, corn, cottonseed, canola, soybean and peanut), and load up on rich sources of natural omega-3s instead (wild fish, flaxseed, chia seeds, walnuts and grass-fed animal products). Another very valuable fatty acid is gamma-linoleic acid (GLA) found in evening primrose oil and borage oil, as well as supplements and shows great results to support healthy progesterone levels which in women can relieve breast tenderness.

  1. Carbs

This very desirable macro nutrient group is most people’s weakness and intake has gotten way out of control to spike blood sugar levels throughout the day and disrupt insulin sensitivity. Carbs need to be identified as either being slow release and therefore not so quick to open the flood gates to release insulin or quick release which maybe beneficial for athletes in small quantities. That means wholegrain over refined cereals, whole fruit over fr

uit juice, unsweetened milk products over flavoured milk and yoghurt, limited starchy vegetable portions and more non-starchy vege, confectionary to be taken as a treat and not as an everyday food. Carb counting is usually well managed by understanding what 15gram portions look like – 1 slice bread, 1/3 cup cooked rice, ½ cup cooked  pasta, ½ cup cooked oats, 1 small fruit; and for a recommended number of these portions to be staggered over the day.

  1. Is dairy in or out

Dairy has been researched as to its impact on ovulation, specifically the fat content. Ironically the results showed that low-fat dairy products caused more hormonal disruption and anovulatory infertility compared to those taking high-fat dairy and my initial thought is that if you are going to have dairy, full fat would be the way to go. A lot of low fat products are full of sugar or sweeteners that will cause insulin levels to spike.

The main problem with dairy is that contains a chemical called Insulin-Growth Factor 1 or IGF-1, which basically mimics insulin in the body. It is present in all forms of milk, from human breast milk to goat’s milk. To keep dairy cows lactating, they also have higher levels of hormones naturally present that are not beneficial for human balance. As expected IGF-1 stimulates growth and in the first few months of life, milk is the elixir of life for babies and promotes exponential growth with high weight gain.

Although IGF-1 is present in other forms of animal protein, it doesn’t seem to have as much impact as dairy does on our IGF-1 levels. And the IGF-1 in PCOS causes the ovaries to release too much testosterone – something we really needing to be avoid. One of the ways that Metformin works for women with PCOS is by helping to normalise the ratio between IGF-1 and IGFBP-1.

Other dairy products such as butter contain very little milk product and is predominantly fat. It is a great source of vitamins and minerals (especially fat soluble ones). Grass fed butter is your best bet and both New Zealand Anchor butter and Kerrygold Pure Irish butter is grass fed and readily available in the UAE.

Eggs are not considered dairy and have a lot of great nutrients. Eggs make the best breakfast choise not just for PCOS but for managing blood glucose by avoiding excessive carbohydrates.

The key to bone health is not just calcium but looking after your Vitamin D. Supplementation is highly recommended.

  1. Soy and PCOS

In response to the call on dairy, many people substitute milk for soy. To address soy we need to understand why and how soy affects the process of ovulation and the menstrual cycle.

Ovarian function is mainly based on two hormones, follicle stimulating hormone (FSH) and luteinizing hormone (LH). The ovaries produce estrogen in the cells of the follicles growing in the ovaries, which signals the release of FSH and LH. When estrogen is low, FSH and LH step in to encourage and stimulate follicles to allow for more estrogen production and LH signals ovulation to occur.

Birth control pills work by constantly suppressing the LH surge (which causes ovulation) with high levels of estrogen and disrupts the LH release therefore preventing fertilization. Soy is a phytoestrogen and exhibits estrogenic activity similar to taking estrogen. There is enough data from studies conducted to confirm  that  “a soy-rich diet can exert enough estrogenic activity to have a biological effect in women.” It can be hypothesized that interfering with estrogen will effect ovulation and therefore PCOS. 

It also needs highlighting that phytoestrogens can have a positive effect on cardio vascular health and lipids to reduce triglycerides and LDL cholesterol as well as testosterone and DHEA, but it also lowers LH and this is the critical disadvantage to consider as to the value of soy and PCOS.

If soy is a valued part of your diet, how much soy is too much as far as having a negative impact to affect hormones, PCOS, ovulation and fertility, and what are your best choices. Traditional Asian foods such as miso and tempeh contain less phytoestrogen compared to soy milk and could be taken in a healthy PCOS diet.

Research shows there is room for caution of consuming soy in a PCOS diet, particularly if you are trying to conceive and experiencing infertility despite the reduction of DHEAs and testosterone levels

  1. Supplement with Vitamin D3

In 2008 the American Journal of Clinical Nutrition, highlighted the profound roles of vitamin D3 and its impact on promoting health.  “It affects ‘the immune system, insulin secretion, heart functioning and blood pressure regulation, and brain and fetal development’.” 

Vitamin D acts almost like a hormone in the body and helps keep inflammation levels low. People who live in dark areas often suffer from seasonal depression and health problems unless supplemented with vitamin D and sunshine is really the best way to optimize vitamin D levels. Most people should supplement with around 2,000 IU to 5,000 IU daily of vitamin D3 if they live in dark areas, during the winter, and on days when they’re not in the sun.

  1. Address digestive issues

When undigested food particles, like gluten or dairy proteins for example, leak through the gut lining into your bloodstream, the result is disease-causing inflammation that impacts the entire body and systems, especially glands like the thyroid which is very susceptible to heightened inflammation. A common insufficiency of good bacteria is a common cause making a potent probiotic a good start to improved digestion and overall health and immunity. A healthy bacteria is also linked to hormone regulation and weight control as specific bacteria’s called firmicutes and bacteroidetes influence the production of key hormones like insulin, ghrelin and leptin which control appetite.

Steer clear of the foods that can cause damage in your digestive system most, including: genetically modified grains with an intrinsic pesticide/anti-fungal chemical called glycophosphates, processed foods that completely overwhelm your biochemistry, modern gluten, hydrogenated oils, added sugar and a big one – highly concentrated corn syrup loaded with fructose.

Great foods that support healing leaky gut include bone broth like Grandma used to make, kefir, fermented vegetables, and high-fiber foods like vegetables and sprouted seeds. Suplpements to relieve the burden of digesting problem foods are probiotics, digestive enzymes and good healing nutrients such as glutamine, zinc and N-acetyl glucosamine. Add in some essential botanical mucilages to protect and sooth the lining which can include a combination of Slippery Elm, marshmallow root, deglycerolised licorice, and aloe vera. Given the right support, the gut is a prime place for recovery as the cells turn over every three days.

  1. Environmental toxins

Toxic chemicals from conventional body care products, made from potentially-harmful chemicals including DEA, parabens, propylene glycol, sodium lauryl sulfate and chemical solvents and pesticides can be eliminated from the body by supporting your liver. Milk thistle, zinc, N-acetyl cysteine and alpha lipoic acid are key for binding up toxins and helping to eliminate them.

Another consideration in hot climates is drinking water from plastic bottles, aluminum cans and containers. Replacing these with glass and stainless steel to eliminate the effects of BPA makes a considerable difference to liver burden and be cautious with the use of Teflon pans. Many countires have already banned the sale of these.

  1. Exercise (Especially Interval Training)

Exercise can be taken in any way that works for you. If you are just starting out and weight poses a challenge, get moving and make small gains every day. That is how we all started off in a new sport. If you are further down the track, add some resistance work and short fast bursts to cardio. The elliptical machine is great for this. If you are a fitness fanatic but still struggling with weight and imbalance, hit the high intensity interval training or metabolic training.

  1. Reduce Stress & Get More Sleep

Don’t under-estimate the importance of a regular sleep pattern and getting enough sleep during the hours of darkness. This may sound like an unusual comment but I meet a number of young and older people who are up most of the night playing computer games, involved on social media and watching TV series leaving their sleep time to almost dawn to 1pm. This is not in line with your natural circadian rhythm and hormone balance.  Your hormones work on a schedule to regulate cortisol, the primary “stress hormone”, at midnight and encourage it to rise about 6am making you ready to start the day. People who go to bed late never truly get a break from their sympathetic flight/fight stress response.

  1. Other things to watch are caffeine and stimulants

Caffeine in moderate amounts is probably fine for most people, but drinking too much can affect the central nervous system, raise your heart rate, increases alertness, and changes the way your brain produces hormones. Green tea is a good alternative and rich in anti-oxidants, while much research shows two cups of spearmint tea a day to suppress testosterone levels.