The Facts About Polycystic Ovarian Syndrome (PCOS)

By: Michael Lam, MD, MPH

A woman needing information about Polycystic Ovarian SyndromeLearn what you need to know about polycystic ovarian syndrome in the article, and imrove your health. The following is a summary of an article by Dr. John Lee on this serious female dysfunction due to hormonal imbalance. This article about Polycystic Ovarian Syndrome was published in his medical letter dated July 1999.

All women should be made aware about polycystic ovarian syndrome. Aside from what Dr. Lee will be discussing, we know that Polycystic Ovarian Syndrome (PCOS) is associated with insulin resistance and Syndrome X, a condition afflicting over 50 million Americans. One of the hallmarks of Syndrome X hyperinsulemia caused by insulin resistance. Increase blood insulin causes the ovary to secrete more androgen like testosterone, since it is quite insulin sensitive.

A New Epidemic that Causes Infertility, Excess Hair, Acne and More

It is estimated that 10 to 20 percent of women today have PCOS, and among young women, this figure could be even higher, thus qualifying PCOS as an epidemic, and making it a necessity for you to learn about polycystic ovarian syndrome.

Doctors today have only 2 mainstream treatments for PCOS in their arsenal, and neither is particularly successful. One treatment uses drugs like birth control pills, hormone pills like androgens, androgens blockers, synthetic estrogens or pills that inhibit hormone production like Lupron. The other treatment is also drug-based, however this ones makes use of new drugs which are meant for Type II diabetes, which lowers insulin resistance.

Dr. John Lee, the world’s leading authority on natural progesterone, has a new approach which is safer, simpler, less costly and more effective method of treating PCOS. It targets the cause itself, and not just the symptoms.  Below you will learn more about polycystic ovarian syndrome and this cutting edge treatment.

About Polycystic Ovarian Syndrome

PCOS is a condition whereby there are multiple cysts found on the ovaries together with other symptoms like anovulation (lack of ovulation) and menstrual abnormalities, hirsutism (facial hair), male pattern baldness, acne, and often obesity. These women may also at the same time have different degrees of insulin resistance and therefore higher incidence of Type II diabetes, unfavorable lipid patterns (usually high triglycerides), and a low bone density. Laboratory tests often show higher than normal circulating androgens, especially testosterone.

PCOS takes place when the normal ovulation cycle of a woman is disrupted or stopped, which thus creates an unbalance in the interrelationship between her hormones, brain and ovaries. When in normal condition, the hypothalamus regulates the hormone output of the ovaries and synchronizes the menstrual cycle. At the end of the cycle, the hypothalamus secretes gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland in the brain to release follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones will then in turn cause the production of estrogen and stimulate the maturation of eggs in about 120 follicles.

Examples of symptoms and more about Polycystic Ovarian SyndromeThe first follicle that ovulates will release its egg into the fallopian tube and continue its journey to the uterus. Once inside the uterus, the egg will quickly transform into a corpus luteum, which is a factory for making progesterone, and raises progesterone’s concentrations to 200 to 300 times higher than that of estradiol. This increase in progesterone will then stimulate the uterus lining, thus putting it in its ripening phase and at the same time, shuts down ovary production for the time being. If fertilization does not take place, the corpus luteum will stop its elevated production of both estrogen and progesterone. This will thus cause the uterine lining to shed in the process known as menstruation. Then, in response to low hormone levels, there is a rise in GnRH and the cycle starts all over again.

PCOS happens when this cycle is disrupted due to unsuccessful ovulation. This could take place via a myriad of reasons, e.g. the follicle migrates to the outside of the ovary, but does not “pop” the egg and release it. This follicle thus becomes a cyst and there will be no progesterone production. This lack of progesterone is detected by the hypothalamus, which continues to try to stimulate the ovary by increasing its production of GnRH, which increases the pituitary production of FSH and LH. This stimulates the ovary to make more estrogen and androgens, which stimulates more follicles toward ovulation. If for some reason these follicles are also unable to produce a mature egg which can secrete the progesterone, the menstrual cycle is dominated by increased estrogen and androgen production without progesterone. This hormonal imbalance is the main reason behind PCOS.

Why Eggs Won’t Pop and Progesterone Isn’t Made

A. Xenobiotics

So, what can you do to discover more about polycystic ovarian syndrome causes?  Keep reading! So, what causes dysfunctional follicles that won’t release eggs? One possible reason is the exposure female embryos to xenobiotics, environmental pollutants that chemically act like estrogen on the developing baby’s tissues. This is a phenomenon that has been observed in wildlife studies.

When a female embryo develops in the womb, 500 to 800 thousand follicles are created in the embryo, each enclosing an immature ovum. It has been noted that the growth of these ovarian follicles is extremely sensitive to the toxicity of environmental pollutants. When the mother is exposed to these chemicals, she experiences no apparent damage. However the baby is more vulnerable to these toxins, which may may damage its ovarian follicles and make them dysfunctional. This will not be apparent will the baby reaches puberty, where symptoms of incomplete ovulation or insufficient progesterone production can be noted.

B. Lifestyle Factors that Cause Dysfunctional Follicles

Besides xenobiotics, other factors that can contribute to dysfunctional follicles are lack of exercise, poor nutrition and stress. Stress in itself can lead to anovulatory cycles by stimulating high levels of cortisol production. Birth control pills shut down normal ovary function, and sometimes it never recovers when the pills are stopped. Our diets are full of petrochemical contaminants–also xenobiotics–that derail normal metabolism. Drugs like Prozac impair the functioning of our limbic brain, including the hypothalamus, which may affect the menstrual cycle.

C. Diet

A woman who is stressed and looking for information about Polycystic Ovarian SyndromeBy far the biggest lifestyle contributor to PCOS is poor diet. Many young women with PCOS eat a diet with too much sugar and highly refined carbohydrates. These foods cause an unhealthy rise in insulin levels. According to Jerilyn Prior, M.D., insulin stimulates androgen receptors on the outside of the ovary, causing the typical PCOS symptoms of excess hair (on the face, arms, legs), thin hair (on the head), and acne. This will lead to obesity in the long run along with resistance to insulin, which will further worsen the PCOS. The androgens also play a role in blocking the release of the egg from the follicle.

Women, who were exposed to xenobiotics as babies in their mother’s wombs, will exacerbate the problem if their diets are high in sugary foods and low in nutrition. Since this is exactly the type of diet favored by teens and young women, it’s easy to understand why there is so much PCOS in that age group. Fifty years ago, the average person ate one pound of sugar a year. Today the average teenager today eats one pound a week! Other staples like pasta, white rice, or potato and corn chips also act on the body much the same way as sugars do.

When the whole background of PCOS is taken into consideration, then it’s easy to see why the hormone-blocking and insulin-lowering drugs don’t work for very long. These approaches merely treats the symptoms and not the underlying cause of PCOS. Improvement is only temporary and both types of drugs have terribly unpleasant side effects. By the same token, one can’t just take progesterone, and you can’t just cut out the sugar. These usually need to work together in order to produce the best results. Exercise and good nutrition are also very important in maintaining hormone balance.

Treatment of PCOS

So, what can you do about polycystic ovarian syndrome? Dr. Lee recommends supplementation of normal physiologic doses of progesterone to treat PCOS. PCOS occurs when the progesterone levels do not rise each month as they are supposed to do during the luteal phase of the cycle. Natural progesterone supplementation therefore should be the basis of PCOS treatment, along with attention to stress, exercise, and nutrition.

It is recommended for PCOS patients to use 15 to 20 mg of progesterone cream daily from day 14 to day 28 of their menstrual cycle. This dosage can be adjusted accordingly if the cycle is longer or shorter than the usual. The first signs of the hormones balancing out would be the disappearance of facial hair and acne. However, it will take at least 6 months for the progesterone cream to take effect. This must also be combined with proper diet and exercise.

Once the symptoms of PCOS fade, it is possible to gradually reduce the dosage and to keep a lookout for PCOS symptoms. If the symptoms reappear, the regular dosage should be restored and progress monitored again. It would be most ideal for the patient to allow her body to return to its normal hormonal patterns. However, some women with PCOS may have too many damaged follicles and would always need some progesterone supplementation to maintain the regular cycle.

Why Haven’t Doctors Figured This Out?

Doctors are still learning about Polycystic Ovarian SyndromeThere are several reasons why doctors don’t recognize the role of progesterone deficiency in PCOS. They may not be aware that the hypothalamus responds not only to the rise and fall of estrogen, but also to the rise and fall of progesterone. Since standard tests usually indicate that a woman with PCOS has plenty of estrogen, and she is still having periods, the doctor assumes she is still ovulating and producing plenty of progesterone.
The odds of a woman having estrogen dominance and progesterone deficiency rise to 50 percent in the female population by age 35, yet doctors rarely measure progesterone concentrations. They may fear giving progesterone because of all the side effects caused by synthetic progestins, and may not be aware that natural progesterone, unlike synthetic progestins, is remarkably free of side effects when given in normal physiologic doses.

About Polycystic Ovarian Syndrome
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  • John says:

    Dr. Lam,

    My 23 y/o daughter has been diagnosed with PCOS. She is testosterone dominate and her binding globulin is low. Her insulin is very high and progesterone normal. Thyroid was normal however T3 reverse was not tested. Estrogen was also not tested.

    For several years she has had weight, mood and depression issues.

    Her Dr has prescribed birth control and Metformin and expects that things should normalize within a month. Her Dr is very optimistic that these steps combined with lifestyle, food, and exercise changes will produce great results.

    Could you please comment on this course of treatment and let us know if this works well to actually solve the problem or is it a treatment that will work only for a certain time period.

    Thanks you.

    • Dr.Lam says:

      PCOS is a symptom of an underlying problem. You need to focus on the root of the problem first of all. Metabolic and hormonal issues can be related. Click Estrogen Dominance for more information.

      Dr. Lam

  • niila hasan says:

    Hi dr.
    this is niila from Bangladesh i have pcos problem and both overries have one cysts.i try for baby last 5 yers but not happen. i also search progesterone cream but not get it.pleasle tell me how can i get it.

  • anita says:

    i have adrenal pcos.high dheas levels.if i used progestrone cream i couldn’t sleep.cortisol increases.already incresed with high to lower dheas levels.

    • Dr.Lam says:

      Your clinical picture points to a body that is shunting thru to cortisol from progesterone as well as estrogen effect. This is not common and indicates underlying problem. Focus on DHEA alone does not usually help but can actually make things worse. Be careful.

      Dr Lam

  • nrani2124 says:

    Hello Dr. Lam,

    I have been diagnosed with PCOS in year 2012. Since then I have made lifestyle changes. following gluten free and vegan diet. I do not smoke nor drink. I was 180 lbs when I was diagnosed then I started yoga along with diet changes and I use to take herbal supplements for Hormonal balance and vitex. I reduce 25 lbs. It is been a year I have stopped yoga and gained all the weight back though still following gf and vegan diet. We are ttc from past year and no luck. My gynaec is suggesting IUI. Is there any way following natural herbal medications that I can conceive then please advise. I have stopped taking Female Hormone balance herbal supplemetns but I do take Vitex, Ashwagandha and CO Q 10.

    Thank You!!

    • Dr.Lam says:

      The underlying issue with PCOS may be metabolic or hormonal issues or a combination. We need to first find out the root cause and help the body with tools to heal itself. Reproductive complexities would be reduced.
      Click Estrogen Dominance for more information.

      Dr Lam

  • worried Rose :( says:

    Hi Dr Lam,

    I am 24 years old, I am over weight and for the last 4-5 years my periods have been non stop ( bleeding every day except maybe 1-2 days a month). I have had rapidly increasing hirsutism on the neck jawline and stomach, and am becoming very depressed ontop of having poor memory and a foggy brain.

    I always thought that because of the hirsutism i must have too much testosterone. But ive had my hormones tested and they came back normal ( estrogen and testosterone were only tested not progesterone).

    I understand that i really need to lose weight , and im trying my hardest. But I guess my biggest confusion is if I have hirsutism- am i able to be estrogen dominant? i always thought i must be testosterone dominant as i had hirsutism .and I have been taking some estrogen mimicking herbs supplemnts etc.

    I also just had a hormonal iud inserted in my uterus last week. how do u think i should go about reversing this? is there any hope? and should i supplement with progesterone cream even though i already have the hormonal iud?

    • Dr.Lam says:

      Hirsuitiam in women is a very complex matter. When you are in estrogen domninance, there are flow thru into a variety of hormones including testosterone and its metabolites. Testosterone is involved to a certain degree but more often than not it is not only about testosterone as there are many associated metabolic pathways involved that can contribute to this. If it is severe, you need to see a doctor and get a detailed history and work up step by step.

      Dr Lam

  • melissa says:

    fantastic article!!! so clear, thank you! Just wondering, if a woman is taking BC pills, and would like to start on natural progesterone, should she wean off the BC pills first before starting the progesterone cream? Is there a brand you recommend? Thanks!

    • Dr.Lam says:

      If a women is on BCP, there is no need to take natural progesterone generally speaking.

      Dr Lam

  • Ashley says:

    This is a serious topic, but I really like the familiar way it’s presented. Well done, Dr. Lam!

    My sister is trying to find a doctor to help her with her PCOS and has just moved to a new area.

    What questions should she ask a potential doctor to get a feel if he or she is aware of the connections between the hypothalamus and estrogen?

  • Laina says:

    So PCOS is having too high of estrogen AND testosterone due in progesterone? Am I understanding correctly? Are there ever cases where women “grew out of it” or simply reversed the symptoms due to a healthy diet and exercise regimen?

    • Dr.Lam says:

      PCOS is related to insulin problem as well as high estrogen which commonly is associated with Estrogen Dominance. Correcting PCOS should therefore focus on both. Read Estrogen Dominance for more information.

      Dr Lam

  • Sonya says:

    I like that progesterone helps me sleep but I think it makes a bit too groggy in the morning. What can I do to offset this?

  • Kyana says:

    Wow! Thank you for explaining PCOS in a way that I could understand! Will increasing my progesterone help offset the high testosterone? If not, what can I do to lower my testosterone? Is it the high testosterone that causes the excessive facial hair?

    • Newsletter says:

      High testosterone is an associated symptom of PCOS and not directly related to progesterone. High DHT, a form of testosterone, is usually responsible for hair loss.

      Dr Lam