By Xiaomei Cai, L.Ac., Ph.D.
Polycystic Ovarian Syndrome (PCOS) is a common hormonal condition that affects 10-20% of women during their reproductive years. PCOS is also one of the most prevalent causes of infertility among women. The primary problems of PCOS are hormonal imbalances and dysfunction of the ovaries. Women with PCOS have irregular or missing periods, anovulatory menstrual cycles, and elevated androgen and/or testosterone levels.
Medical interventions for PCOS often involve using birth control pills to stimulate regular menses, but this treatment does not address the issue at its source. Additionally, many women struggling with PCOS are actively trying to get pregnant, so contraceptive medications are not useful in these cases. TCM and acupuncture are able to help resolve many women’s health problems, including PCOS and the resulting infertility, restoring normal function to the female reproductive system without the side effects that medications can cause.
What Is PCOS?
PCOS is a syndrome, which means it is a collection of symptoms that occur together and help to define a disease even though its medical causes are not completely understood yet.
Most women with PCOS ovulate infrequently or not at all. Women with PCOS also might experience:
- Irregular Periods
- Heavy and/or painful periods
- Insulin resistance
- Excess hair on body and face (hirsutism)
- Thinning hair on head
- Acne, oily skin
PCOS is considered a disorder of both the reproductive and endocrine systems. The majority of women with PCOS also exhibit hyperandrogenemia – an excess amount of androgen hormones. In many cases, this condition starts early, when a girl is going through puberty. The problems begin to manifest shortly after a girl gets her first period (menarche).
Androgens are commonly referred to as the “male” sex hormones, although they naturally occur in both men and women, just in differing amounts. The primary androgens are testosterone and androstenedione. In women, androgens are produced by the ovaries and adrenal glands, whereas in men they are produced in the testes, usually in larger quantities. Hyperandrogenemia can be helped by weight loss, because adipose tissue (fat) itself is hormonally active, meaning the fat cells themselves also produce excess androgens.
Insulin resistance is also widespread among women with PCOS; about 85% of women with PCOS are insulin resistant, causing them to be at risk for Type 2 Diabetes. Sometimes women are prescribed Metformin to lower insulin and blood sugar levels.
PCOS often goes undiagnosed for years. In many cases, women do not find out they have it until they are trying to get pregnant and then seek help for infertility. For most women, PCOS causes irregular periods. In these cases, women may go months without having a period, and then have a very heavy, painful period. Often, PCOS begins when girls are teens, and this condition causes them to struggle with being overweight, prone to getting pimples, and having extreme period pain (dysmenorrhea) and heavy periods that can cause embarrassing accidents. Girls may not realize that their experience is not normal, and may not talk to anyone about it. When they do seek help, they are usually prescribed birth control pills.
Birth control pills “regulate” the menstrual hormone cycle, causing a period to predictably start every 28 days. This use of contraceptives to “correct” menstrual problems and help clear acne during the teenage years leads to the masking of PCOS for many years–often until a woman is well into adulthood and ready to conceive. Then, when the birth control is stopped, the PCOS symptoms appear, which generally means that regular periods stop.
At this point, a firm diagnosis of PCOS is often reached after an internal ultrasound reveals the phenomenon which gives the syndrome its name: multiple small cysts forming around the edges of the ovaries. These fluid-filled bubbles, only a few millimeters in diameter, are partially formed eggs that have not been released. These cysts do not in and of themselves cause problems. Blood tests are done to find the high levels of androgens (testosterone) and also to measure the hormones involved in egg production and release. Women with PCOS often have higher levels of luteinizing hormone (LH), which triggers ovulation. The ratio of LH to FSH (follicle stimulation hormone) is higher in women with PCOS.
Conventional medicine provides the means to pinpoint the manifestations of PCOS in the body, hormonally and physically, but it does not offer much in the way of causal understanding or effective treatment.
TCM Perspective of PCOS
Traditional Chinese Medicine is based on the concepts of Qi, life force energy that travels through the body along meridians, and the balanced energies of Yin and Yang. Elemental pathogenic factors such as Wind/Cold, Dampness, Fire/Heat and Dryness come into play. Disease is created by either external or internal factors and can be discovered through diagnostic techniques of observation, inquiry, and palpation.
In a sense, TCM looks at all diseases as “syndromes.” In TCM, we do not look for one single cause of the symptom for which the patient is seeking relief. We look for other signs and symptoms that the patient may not have realized were related. We study the whole collection of indications and look for a pattern. An illness can be the result of any one of several different patterns.
When working with a patient who is experiencing reproductive and hormonal problems, a TCM provider will take into consideration the lab results of blood tests showing hormone levels, but will also be looking for clues as to what is happening throughout the organ systems of the body. In TCM, PCOS is categorized as a “Zheng Jia” diagnosis. Zheng Jia means “masses” (tumors), and includes uterine fibroids, endometriosis, ovarian cysts, and even reproductive cancers.
Internal factors are at the root of PCOS and other Zheng Jia disorders. Most clinical manifestations of PCOS arise from patterns of too much Dampness and Phlegm in the reproductive organs, which is what causes the fluid-filled cysts to form. This excess dampness is also what causes weight gain. Kidney deficiency contributes to the imbalances in hormone production. Blood deficiency causes absent or scanty periods, while blood stasis leads to painful periods.
Acupuncture and TCM for PCOS and Hormonal Imbalance in Women
Standard medical treatment for PCOS and infertility in women involves using medications to alter hormone levels: either OCP to regulate periods, Metformin to lower insulin, or Clomid or Letrozole to stimulate ovulation.
Acupuncture and TCM treatment for PCOS focuses on clearing excess dampness and phlegm from the uterus and other female reproductive organs, tonifying and nourishing the kidneys, invigorating the blood and clearing blood stasis. Electro-acupuncture has been shown to help facilitate natural ovulation.
A TCM provider will also focus on lifestyle and nutrition changes that will help alter the internal factors involved. Tracking basal body temperature can help both doctor and patient understand what is going on during the follicular and luteal phases of the menstrual cycle in each individual. Specially chosen combinations of herbs can be very helpful for making the subtle adjustments needed to normalize the hormones, increasing blood flow, and even balancing the emotions.
PCOS and Endometriosis
Endometriosis is another common women’s health problem in which uterine lining tissue begins growing outside of the uterus. It is estimated that about 10% of reproductive-age women have endometriosis, although we cannot be sure because, like PCOS, endometriosis is also often undiagnosed. It is not uncommon for women to have both conditions. When women with endometriosis have a menstrual period, there can also be bleeding in other parts of the abdomen. This can cause severe pain and create a lot of scar tissue in the pelvic region. Sometimes surgery is recommended to remove this scar tissue. This can help alleviate pain and increase the chances of conception, but it does not address the root problem, so the bleeding often recurs. Like PCOS, endometriosis can be a cause of infertility, making the use of birth control pills to control the hormones far from ideal.
According to TCM, endometriosis and PCOS are both Zheng Jia disorders; they are part and parcel of the same root problem. An acupuncturist can help correct both of these disorders, and the related infertility, all at the same time.
Integrative Medicine for PCOS and Infertility in Women
TCM has been using acupuncture and herbs to help women’s reproductive disorders and increase fertility for many centuries. In the past few decades, it has become increasingly common for patients to seek out acupuncture to help address infertility due to PCOS, both on its own and as an adjunct to Assisted Reproductive Technologies (ART). Studies have shown that acupuncture and herbal supplementation used in concert with infertility procedures such as Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF) improve outcomes. Acupuncture treatment also helps to reduce the pain and anxiety many women experience while undergoing ART procedures.
Top 5 Self-Care Tips for PCOS
One of the main internal factors causing the excess dampness and stasis of PCOS is too much cold in the body. Maintaining your warm energy is key. Habits like drinking ice cold beverages and eating ice cream, especially around the menstrual period, can really have a negative impact. It may seem old-fashioned, but a lot of the advice we associate with our grandmothers’ time still applies today.
- Dress appropriately for potentially chilly weather. Always bring your jacket with you.
- Avoid exercising to the point of sweating and then allowing yourself to get chilled. Change into dry clothes right after your workout.
- Keep the abdomen covered and warm.
- Don’t wear sandals or go barefoot when it is cold outside.
- Don’t go to bed with wet hair.
Acupuncture Near Me for PCOS
At Art of Wellness, our doctors have over 30 years of experience in the successful management of women’s health issues, including PCOS and infertility. In China, Dr. Cai practiced and taught at Chengdu University’s TCM Hospital as a gynecologist. During a two-year period of specialty training, she had the opportunity to study and work with some of China’s foremost experts, pioneers in integrative medicine for reproductive health.
Since 1997, Drs. Cai and Tan have brought their unique experience to Santa Monica and Los Angeles. Their knowledge of both Western medicine and Traditional Chinese Medicine allows them to recommend, when necessary, a mixture of medical modalities and to advise whatever course of treatment is most beneficial for each patient.
*This article is for education from the perspective of Traditional Chinese Medicine only. The education provided by this article is not approved by FDA to diagnose, prevent, treat and cure human diseases. It should not stop you from consulting with your physician for your medical conditions. Traditional Chinese Medicine is based on Qi, which is an invisible force that usually cannot be observed by modern science. Because science focuses on testing ideas about the natural world with evidence obtained through observation, these aspects of acupuncture can’t be studied by science. Therefore acupuncture and Chinese herbs are often not supported by double-blind, randomized trials, and they are considered alternative medicine therapies in the United States.