Ask the Expert on Polycystic Ovaries

Q: I have just been diagnosed with Polycystic Ovaries and told that pregnancy is unlikely, is there anything I can do?

What is polycystic ovary syndrome (PCOS)?

In each menstrual cycle, follicles grow on the ovaries. Within those follicles eggs develop, one of which will reach maturity faster than the others and be released into the fallopian tubes. This is known as ovulation. The remaining follicles (sometimes hundreds) will degenerate. In the case of polycystic ovaries, however, the ovaries are much larger than normal, and there are a series of undeveloped follicles that appear in clumps, rather like a bunch of grapes. Polycystic ovaries are not particularly troublesome and in many cases they will not even affect your fertility. Where the problem starts, however, is when the cysts cause a hormonal imbalance, leading to a series of other symptoms. These symptoms are the difference between suffering from PCOS and from polycystic ovaries. So a woman can have polycystic ovaries without having PCOS but all women with PCOS will have polycystic ovaries.

Symptoms:

• absent, infrequent or irregular periods
• infertility - you need to ovulate to become pregnant and you may not be ovulating regularly or at all
• obesity or being overweight, especially with excess fat around your waist
• excess hair (hirsutism) on your face, around your nipples or on your lower tummy
• thinning of your hair on the top of your head
• acne which lasts longer than your teenage years

Nutritional Consultant - Kate Arnold

How diet can help.
Foods to avoid:

• Refined carbohydrates ie all white flour, white pasta, white sugar and dairy produce.
• Caffeine
• Alcohol
• White sugar, brown sugar, sucrose
• Fructose, glucose, dextrose, corn syrup, maltose
• Caramel, golden syrup, treacle, molasses, maple syrup
• Honey
• Cakes, biscuits, pastries, croissants, puddings ice-cream
• Fizzy drinks, fruit squash, concentrated fruit juice
• Hidden sugars in packaged and processed foods
• Chocolate and other sweets
• Dates, raisins, dried fruit, bananas, melon, grapes, white rice, sweetened cereals, rice cakes, cooked carrots, parsnips.
• Red meat - if you are prone to anaemia, try Floradix (iron tonic)
• Any food that raises your GI. If you have to eat it, always eat with protein which lessens the response in your body.
• No dairy produce means no cream, milk, yoghurt, cheese or butter. It's a good idea to try and avoid this for a minimum of three months totally. You can buy soya milk and yoghurts, and margarine can be used instead.

Foods to eat:

• Avocado
• Pulses
• Chicken, tofu, nuts, eggs, baked beans, oily fish, and chickpeas as protein sources
• Whole grains and brown rice
• High levels of fruit and green vegetables
• Drink 1½ litres water daily
• Dark unrefined organic chocolate

Make sure you snack mid morning and mid afternoon on protein and carb snacks like oatcakes with hummous or nuts and fruit.

Balancing blood sugar is crucial as insulin resistance could mean a steady but consistent weight gain. Following a low GI diet could help enormously cutting out anything that raises the blood sugar too much and eating little and often. Eat protein at every meal. Try not to go longer than 3 hours without food and keep well hydrated throughout the day. Its extremely important to keep your bowels functioning on a daily basis and not get constipated.
Also exercise is paramount - try and get some good cardiovascular exercise at least three times a week supplementing with something less strenuous like yoga once a week.
Contact details: Tel 01323 737814 email katenut @aol.com katearnoldnutrition.co.uk

Fertility Expert - Dr Marilyn Glenville PhD

PCOS is the most common hormonal imbalance in women of childbearing age and unfortunately it is a major cause of infertility.

In PCOS higher than normal levels of certain sex hormones like testosterone can trigger symptoms such as irregular or absent periods, acne, excess hair and weight gain. Women with PCOS are more likely to have problems balancing blood sugar and can become insulin resistance.

There is now overwhelming evidence to suggest that diet plays a significant role in helping with PCOS and increasing the chances of conceiving. If you're overweight, it's crucial that you lose weight as losing weight results in lower insulin levels, which in turn reduces the testosterone levels that are interfering with ovulation.

Adapting your eating habits so that you keep your blood-sugar levels on an even keel throughout the day is essential. Aim to eat little and often to keep your blood sugar under control. Include phytoestrogens such as soya and chickpeas as these  help to control levels of testosterone in the blood.

SUPPLEMENTS
The main aims of supplementation are to help your body to regulate its insulin levels and to balance your blood sugar.
B-COMPLEX
Deficiencies in B-vitamins can make symptoms of PCOS worse. One study found that B-vitamin supplementation boosted weight loss and improved ovulation in PCOS sufferers by 23 percent.
CHROMIUM
Low levels of chromium can trigger insulin resistance and chromium has been shown to stem hunger and reduce food cravings.
MAGNESIUM
Adequate magnesium intake is essential for controlling blood-sugar and insulin level.
ZINC
Zinc is not only vital for appetite control but also for insulin regulation and hormone balance.
ALPHA LIPOIC ACID
Alpha lipoic acid releases energy by burning glucose (sugar) so that your body has to release less insulin to deal with blood-glucose levels and has to store less fat.
CO-ENZYME Q10
This nutrient can help lower levels of glucose and insulin in the blood, helping to stabilize blood sugar.
(These nutrients are all combined in a supplement called NutriSupport obtainable from your local health food shop or from naturalhealthpractice.com)

Dr Marilyn Glenville PhD is the UK's leading nutritionist specialising in women's health. She is the Former President of the Food and Health Forum at the Royal Society of Medicine and the author of a number of internationally best selling books including ‘Fat around the Middle', ‘Getting Pregnant Faster' and ‘The Natural Health Bible for Women' or go to www.marilynglenville.com. Her new book ‘Natural Solutions to PCOS' will be published early 2012. She works in a gynaecology clinic in London and also in Tunbridge Wells. If you are interested in a consultation, you can contact Dr Glenville's clinic on 0870 5329244 or by email: health @marilynglenville.com.

Herbalist - Frances Hambly

Polycystic ovarian syndrome is something I come across frequently in my practice. Skin and weight problems are the most common issues, along with irregular or absent periods, and excess body hair.

I use Herbal Medicine alongside nutrition when looking at these problems. I usually advise a low GI ( Glycaemic Index ) diet or a restricted carbohydrate diet to help achieve and maintain a stable weight.

This diet along with herbs like Licorice, Milkthistle and Vitex agnus-castus help address insulin resistance, reduce sugar craving and balance the hormones. Essential fatty acids are important for healthy hormone function, as well as helping the skin. I normally suggest Omega 3 fish or flax oil or a cold-pressed Omega 3,6,9 oil depending on nutritional needs. I will also advise probiotics and a good quality multivitamin and mineral as appropriate.

With fertility issues hormone levels need to be established and absent periods, lack of ovulation, high androgen and prolactin levels addressed accordingly in order to enable conception. The outcome will also be dependent on age and general wellbeing.

"A patient I first saw two years ago was in her late 20's with an established diagnosis of Polycystic ovarian disease. With this knowledge and her desire for a family with her partner, she was keen to do everything possible to optimise her chances of becoming pregnant as soon as possible.
She was already on a low GI diet which she had been following for several years and her weight was stable. She had come off the Pill the previous Autumn, her periods were quite regular and she was ovulating.
She was suffering from bad acne every month and constipation. We looked at altering her diet further, and I prescribed herbs to promote liver function to help her constipation, balance her hormones and help her stress levels.
She had already just started using herbs she had self-prescribed before I saw her. One of these was Vitex agnus-castus which remained a key part of her treatment.
She continued on a programme of herbs and supplements alongside the diet, and conceived a year after first seeing me without any conventional fertilty treatment.
She had a very good pregnancy and had a healthy baby this summer, who was born at full term and a good weight."

HERBS
The following herbs are useful for PCOS:
AGNUS CASTUS
helps to balance hormones
regulator.
BLACK COHOSH
This herb helps to suppress LH levels.
MILK THISTLE
Helps to improve liver function
SAW PALMETTO
can reduce high levels of male hormones.

Please seek advice from a qualified practitioner who will be able to advise on the correct supplementation and diet.

Frances Hambly MNIMH, Herbal Medicine and Nutrition
Hamblys Natural Health Centre & Herbal Dispensary The Old Dairy, Durgates Wadhurst, East Sussex TN5 6DE
Tel: 01892 783027 frances @hamblys.net www.hamblys.net