What is polycystic ovarian syndrome (PCOS)?
1 in 10 people are affected by Polycystic ovarian syndrome (PCOS), and yet despite this staggering number it is still not fully understood what causes it and there is no cure.
But that doesn't mean that acupuncture cannot help manage those signs and symptoms.
In PCOS the hypothalamus and GnRH preferentially promote luteinising hormone (LH) over follicle-stimulating hormone (FSH).
This causes the anterior pituitary gland to increase the LH/FSH ratio and in turn, the ovaries create hypersecretion of androgen (an example of which is testosterone).
With this increase in androgen, there is an increase in insulin resistance.
The result is high androgen, high insulin and low FSH = follicles continue growing but not maturing and no ovulation.
= PCOS
If like me, you would like more information on the hormones involved in the menstrual cycle, you can find more in my recent blog here.
Signs and symptoms of PCOS
With these hormonal changes we will expect to see:
no or irregular periods/infertility
acne
increase in bodily hair
the polycystic appearance of ovaries on an ultrasound
increase in weight
risk of developing non-insulin-dependent diabetes
high blood pressure
cardiovascular disease
The exact cause of PCOS is not well understood but could be an interaction between genetics and environmental factors.
How does acupuncture look at PCOS?
In acupuncture, we treat the individual symptom and whilst a diagnosis of PCOS is helpful we will take the whole picture and treat it accordingly.
If we look at the individual signs and symptoms e.g. no or irregular periods there are a number of TCM patterns we can explore including:
Qi & Blood deficiency
Yin deficiency
Qi stagnation or Blood stasis
Liver Fire
However, there are four acupuncture 'patterns' that we might look for. These would be:
Spleen & Kidney Yang Deficiency
delayed / irregular periods
scanty light coloured period blood
infertility
dizziness & tinnitus
aching or weak lower back and knees
cold sensation in body and limbs
clear and profuse urine
loose stools
loss of libido
obesity
Phlegm Dampness
scanty, delayed, or no periods
infertility
vaginal discharge
dizziness or muzziness
nausea
profuse sputum in throat
loose stool
obesity
Liver Fire
no periods or scanty periods
irregular periods
infertility
thick hair
acne
distending pain in the chest or breasts
dry mouth with thirst
constipation
Qi Stagnation & Blood Stasis
delayed menstruation
scanty period with clots
abdominal pain during menstruation
no periods
infertility
mental depression
fullness in the chest
So, what can acupuncture do for PCOS?
In this podcast published in January 2022, Sandro Graca talks about acupuncture for PCOS. The episode is about 1 hour long, however, the show notes themselves are fascinating with lots of excellent guidance.
I have summarised the evidence he talks about below
Date | Title | Author | Results |
2013 | Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial | Johansson | repeated acupuncture treatments with manual and electrical stimulation in lean/overweight women with PCOS results in a higher ovulation frequency during the treatment period than in the control group |
2000 | Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome | Stener-Victorin | Repeated EA treatments induce regular ovulations in more than one third of the women with PCOS |
2013 | Polycystic ovary syndrome: effect and mechanisms of acupuncture for ovulation induction | Johansson | Several clinical and animal experimental studies indicate that acupuncture is beneficial for ovulatory dysfunction in PCOS. This is also related to decreased levels of sex steroids and possibly inhibin B |
2007 | Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence | Stener-Victorin | Experimental observations in rat models of steroid-induced polycystic ovaries and clinical data from studies in women with PCOS suggest that acupuncture exert long-lasting beneficial effects on metabolic and endocrine systems and ovulation. |
2020 | Electroacupuncture Mimics Exercise-Induced Changes in Skeletal Muscle Gene Expression in Women With Polycystic Ovary Syndrome | Benrick | electroacupuncture normalizes gene expression in skeletal muscle in a manner similar to acute exercise. Electroacupuncture might therefore be a useful way of assisting those who have difficulties performing exercise. |
2013 | Acupuncture and physical exercise for affective symptoms and health-related quality of life in polycystic ovary syndrome: secondary analysis from a randomized controlled trial | Stener-Victorin | There was a modest improvement in depression and anxiety scores in women treated with acupuncture, and improved HRQoL scores were noted in both intervention groups. While not a primary focus of the trial, these data suggest continued investigation of mental health outcomes in women treated for PCOS. |
The British Acupuncture Council website and the research that they have on PCOS say that acupuncture treatment may specifically help with symptoms by:
impacting on beta-endorphin production, which may affect gonadotropin-releasing hormone (GnRH) secretion (Lim 2010; Stener-Victorin 2009; Feng 2009; Manneras 2009);
a regulatory effect on follicle stimulation hormone (FSH), luteinising hormone ( LH) and androgens (Lim 2010; Feng 2009);
modulating the activity of the sympathetic nervous system and improving blood flow to the ovaries (Stener-Victorin 2006, 2009);
regulating steroid hormone/peptide receptors (Feng 2012);
downregulating the expressions of serum levels of testosterone and oestradiol (Zang 2009);
controlling hyperglycaemia by increasing insulin sensitivity and decreasing blood glucose and insulin levels (Lim 2010);
acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);
increasing the release of adenosine, which has antinociceptive properties (Goldman 2010), and;
reducing inflammation, by promoting the release of vascular and immunomodulatory factors (Kavoussi 2007).
The Stener-Victorin protocol can also be used for people who suffer from PCOS but who have a low BMI (see picture below). Their study found that electro-acupuncture may be beneficial for people with PCOS.
Chinese Medicine nutritional advice would also advise you, depending on your pattern, on lifestyle changes you could incorporate between treatments.
Other things to consider and by the wonder that is Dr Anita Mitra (@gynaegeek on IG) the following will also be helpful in managing the signs and symptoms of your PCOS.
Foods to eat
Fruits and vegetables for more fibre
Protein is essential for hormone production and helps with blood sugar regulation. eg. fish, chicken, tofu, soybeans, lentils
Low GI carbohydrates maintain blood sugar control – eg. porridge oat, wholegrain bread or pasta, brown rice.
Good quality fats are a building block for hormone production eg. nuts, avocado, salmon
Foods/drinks to avoid
High glycemic index foods e.g. fruit juice, cakes, white bread, pasta, starchy vegetables
Excess caffeine
Excess alcohol
Prolonged periods of starvation
Other things to consider
1. Exercise
Build and maintain lean muscle, which helps to reduce insulin resistance. Exercise can also increase sex-hormone binding globulin (SHBG) levels, a hormone that can bind testosterone, making it less potent. Yoga can also combine exercise and mindfulness.
2. Stress
This can drive the adrenal glands to make more testosterone
3. Sleep
Ensure adequate sleep quantity and quality, the lack of which can further disrupt hormone function.
4. Smoking
Given the increased risk of heart disease with PCOS then quitting smoking would be recommended.
In Doctor Anita Mitra's words
"It’s important to point out that even with the best intentions, some people will not be able to manage their symptoms entirely in this way, and if that’s you, it’s not your fault. There are lots of medical treatments that we can also offer to manage symptoms, and it’s also helpful to ensure that you see a doctor discuss these, and also to ensure that PCOS is in fact the correct diagnosis in your case"
If you have any questions at all, about how acupuncture might help with PCOS, please get in touch. I would love to chat with you.
Love your fave acupuncturist
Andrea