by Hayley Stobbs, R.Ac., CNC
Polycystic ovarian syndrome (PCOS) is a common hormone disorder that affects women of reproductive age. Its characteristic pathology relates to the development of multiple small fluid-filled follicles on the ovaries. This occurs when ovulation, the release of an egg from an ovarian follicle, ceases to occur for multiple cycles. This disruption is the cause and effect of disharmony in the normal, cyclical interconnection between the brain, hormones, and ovaries.
PCOS is more complex than the name presents as it often involves varying degrees of endocrine, cardiovascular, metabolic, and/or mental-emotional co-conditions. The following post focuses on PCOS awareness as a syndrome through a pathophysiology overview followed by the explanation of how acupuncture works as an effective treatment method.
Underlying Causes of PCOS
Insulin resistance (1)
Chronic low-grade inflammation (food sensitivities/allergies, environmental, stress)
Lack of regular menstruation after ceasing birth control pill use (2)
Hypothyroidism (3, 4)
Environmental (chemicals, toxins, pollutants, iatrogenic)
Circadian rhythm disruption (5)
Common Signs & Symptoms of PCOS
Long-standing menstrual abnormalities including irregular periods, lack of menstruation, severe menstrual cramping, or prolonged or heavy bleeding.
Signs of high testosterone including excessive hair growth (ie. on the face, abdomen, chest, arms, etc.), acne, and male pattern baldness.
Fertility issues including inability to conceive and miscarriage in the first trimester (6).
NOTE: PCOS accounts for 75% of anovulatory infertility (7) and infertility affects 40% of women with PCOS (8). Infertility is defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.
Insulin resistance (IR) which can present as darkening of the skin at the nape of the neck and under the arms (acanthosis nigricans), high BMI, high cholesterol, high blood sugar and/or high blood pressure (9)
NOTE: IR affects 65 – 70% of women with PCOS, 1/2-2/3 of whom are overweight or obese (10).
Mental health disorders including depression, anxiety, bipolar disorder, and binge eating disorder.
How is PCOS Diagnosed?
PCOS diagnosis must include two of the following, based on the Rotterdam criteria (11):
Ultrasound confirming the presence of multiple ovarian cysts.
Hyperandrogenism: high androgens on lab work (ie. testosterone), or clinical signs of high androgens.
Menstrual dysfunction including anovulation, oligo-ovulation, amenorrhea, or oligomennorrhea.
PCOS is associated with multiple conditions, therefore regular testing should include:
Fasting insulin and glucose levels
Full thyroid panel
Total testosterone and free
LH and prolactin
Inflammatory markers: CRP ESR
PCOS Treatment & Management
Conventional management options include: oral contraceptives, metformin, clomiphene, gonadotropin therapy, progestin, assisted reproductive technology (ie. IUI or IVF), and weight regulation.
Alternative or complementary options include: acupuncture and bodywork, whole foods or low carbohydrate nutrition therapy, weight loss, lifestyle counselling, botanical medicine, natural progesterone therapy, and nutritional supplementation.
What is PCOS According to Chinese Medicine?
PCOS is a western diagnosis that was developed according to biomedical perspectives and standards. A registered acupuncturist learns about modern western illnesses, yet focuses on each individual’s unique pattern of symptoms in relation to a specific traditional Chinese medicine (TCM) diagnosis. Syndrome differentiation comes to fruition by comprehensively differentiating all areas of the patient’s life in relation to the disharmony, which includes environmental, diet, and lifestyle observation and questioning, in addition to whole body, tongue and pulse analysis, and palpation. This information guides the practitioner towards making an acupuncture prescription and treatment plan, which addresses the mind, body, and spirit. PCOS may reflect any one or more of the following TCM diagnosis patterns: spleen qi deficiency, phlegm-damp or damp, kidney deficiency, blood stasis, liver qi stagnation, blood deficiency, and Ren-Chong Mai disharmony.
Acupuncture as an Effective Treatment Option for PCOS
Acupuncture treatments work with the patient’s innate regulatory ability to harmonize any number of unique PCOS patterns through balancing the communication network between energy meridians and the brain, hormones, and ovaries. Specifically, it is an effective treatment option for regulating menstruation and ovulation (12), insulin sensitivity (13), inflammation and immune function, mood and stress response (14, 15), detoxification, and weight loss (16). Acupuncture is thus able to target a number of root causes and manifestations. The recommended treatment frequency includes 2 treatments per week for the first 2 weeks, followed by 1 treatment per week for 3 – 6 months. In addition to needling an acupuncturist will implement diet and lifestyle counselling into the overall treatment plan. After symptoms dissipate it is recommended to keep up with one treatment per month to prevent re-occurrence.