What’s Up with the PCOS/Autoimmune Thyroiditis Combo?
Polycystic Ovarian Syndrome. When I first heard the term in medical school. It sounded a little creepy. Then three women in my family came down with it, and I realized how lame the usual treatments are. Something had to be done.
Polycystic Ovarian Syndrome (PCOS) produces symptoms in about 10 to 20% of reproductive aged women (12-50+), and is the leading cause of female infertility. Similar to thyroid dysfunction, about 70% of women with PCOS are undiagnosed.
This means: read on and please tell your friends. It’ll take grass roots to change this ship around.
How do you know if you have PCOS?
The main symptoms are
- Not ovulating regularly, also known as anovulation in medical parlance. This results in irregular periods.
- Acne and increased hair growth in a male pattern, as a result of high androgens, such as testosterone.
- High insulin or insulin resistance with can cause obesity, diabetes and high cholesterol. The high insulin appears toxic to the ovary and causes the increased testosterone production.
- Cysts on the ovaries in 70% of women with PCOS, so it’s not the defining symptom but a common sign. Women usually have between 10 and 100 cysts, leading to a characteristic “string of pearls” image on the on ultrasound of the ovaries.
In other words, PCOS is a weird mix of symptoms and the cause cannot be determined in all patients. No one single symptom or lab tests states definitively that you’ve got it. It’s more a gestalt of several symptoms together. Genetic causes – in an autosomal dominant inheritance – account for only a fraction of cases, but know that among women with PCOS, 40% have a sister with PCOS and 35% have a mother with PCOS. You can inherit PCOS from your mother or father, and the gene can be passed to sons who are asymptomatic carriers to future female offspring.
Link Between PCOS and Autoimmune Thyroiditis
But here’s the part that we don’t fully understand: Women with PCOS are much more likely to have autoimmune thyroiditis (Hashimoto’s thyroiditis). We don’t know why but PCOS seems to trigger all sorts of autoimmune fallout against many proteins but the most common target appears to be thyroid proteins. In one study of 78 patients with PCOS, 62% had a goiter and the level of anti-thyroid antibodies was double in the PCOS group compared to controls (Kachuei, 2011).
In other words, if you have Hashi’s, get checked out for PCOS with your clinician. If you’ve got PCOS, get checked out for Hashi’s.
On to Natural Solutions for PCOS
Here’s where you start with solving PCOS: you need a clinician who is both interested and has the bulk time to investigate thoroughly your root causes and the natural solution.
Even so, let your body be your guide. PCOS symptoms tell me a lot about your relationship with yourself and others, your hormone levels, your general energy – both amount and consistency, and your health.
Women fit into one of three categories when it comes to health: super-vital, OK or sick. I find that super-vital women rarely have a problem with PCOS. But women who just feel OK? They’d rather be on Facebook than do the hard work that PCOS demands. And I have a soft spot for them. Here are a few suggestions.
3 Natural Cures for PCOS
- Inositol. I’m going to start with an easy one that’s well proven with science. Inositol is a naturally-occurring B-complex vitamin known to improve insulin sensitivity (Larner, 2002). Two inositol supplements show promise in correcting PCOS: D-chiro-inositol (DCI) and myo-inositol. Your ability to clear DCI in the urine is an independent predictor for insulin resistance, and women with PCOS clear DCI in the urine six-fold faster than normal women. Overall, women with PCOS appear to be deficient in DCI, probably because of the increased urinary clearance, and giving them prescription insulin-sensitizers, such as metformin, increases DCI (Baillargeon, 2004). But I don’t recommend metformin until you’ve exhausted all other natural options such as inositol. Women with PCOS who take DCI improve insulin sensitivity (Cheang, 2008). DCI is regulated as a dietary supplement in the United States and most studies looked at 600 mg twice per day or 0.6 grams twice per day, but you can also find DCI in carob, buckwheat and grapefruits. Data on D-chiro-inositol first hit the tony medical publication, The New England Journal of Medicine, in 1999 with the bold news that DCI cut free testosterone by more than half, lowered blood pressure and triglycerides in women with PCOS (Nestler, 1999) in eight weeks or less. Further data showed that DCI has the same effects in lean women with PCOS (Iuorno, 2002). You can pick this up at your local health food store. Overall, myo-inositol has been shown to decrease testosterone, improve insulin, and correct ovulation (Genazzani, 2008; Constantino, 2009). One study documeted significant weight loss in women with PCOS whereas the placebo group gained weight (Gerli, 2007). Inositol also improves egg quality in women with PCOS and infertility (Ciotta, 2011), and seems to be more effective in “eu-glycemic” women with PCOS than DCI, which means they have a normal insulin response (Unfer, 2011). Most trials compared myo-inositol at a dose of 2 grams once or twice per day with 200 micrograms of folic acid to placebo (in this case, 200 micrograms of folic acid) for twelve to fourteen weeks. Much larger doses have been shown to be safe (Carlomagno, 2011) but I don’t recommend taking doses higher than those in the trials.
- Avoid sugar and high-glycemic foods. This is harder to pull off but supported by robust evidence (Smith, 2008) showing that you can lower androgens by 20% by eating a low-glycemic index diet for seven days. That is amazing news! Low glycemic means eating foods with a glycemic index (GI) less than 55, so nuts, non-starchy vegetables, lean protein and blueberries, please. In the study, volunteers were fed a high-glycemic diet initially of 15% protein, 55% carbohydrates and 30% fat, which is, unfortunately, very close to the Standard American Diet (SAD). Even with 5% weight loss, you can dramatically change your metabolic biomarkers with PCOS.
- Check your neck. I find that most doctors under-diagnose thyroid problems, yet they are a leading cause of low sex drive. Many clinicians use an older scale for normal thyroid function, rather than the latest recommendation of a Thyroid Stimulating Hormone (TSH) of 0.3 to 3.0. For women trying to conceive or in pregnancy, we want an even tighter range.
One member of Dear Thyroid asked me about Saw Pawmetto for PCOS, which reduces androgens, and unfortunately, we don’t have high quality evidence that it helps. It seems to help some but not all women with PCOS.
The first step with PCOS is to stop blaming yourself, suffering in silence and isolation, and to learn what’s been proven to help, such as these 3 natural strategies. Next, find a doctor who is willing to work with you on finding natural solutions such as those mentioned above. The new paradigm of 4P medicine – predictive, preventive, personalized and participatory medicine – will best serve to optimize your PCOS, and the happy byproducts are greater vitality, weight loss, less risk as you age and more consistent energy.
Dr. Sara Gottfried, M.D. specializes in teaching women how to re-ignite sex drive, increase energy and lose weight with natural hormone balancing. She is a Harvard-trained, Board-Certified integrative physician with a mostly virtual practice in Berkeley, CA. She offers wellness and hormone coaching to women across the country. For a FREE “How to Balance Your Hormones” WELLNESS BREAKTHROUGH KIT, visit http://www.SaraGottfriedMD.com and opt-in to our “get vitalized” weekly or monthly.
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