Increased Sympathetic Activity – The Core Cause of PCOS?
What causes PCOS and why acupuncture is effective at restoring ovulation and regulating cycles has puzzled specialists, endocrinologists and gynaecologists for decades. The “bible” on the treatment of infertility (Clinical Gynecologic Endocrinology and Infertility) says “The characteristic of polycystic ovary develops when a chronic anovulatory state persists for a sufficient length of time.” But there are many causes for anovulation.
A recent study published in the Nature magazine could change how we see PCOS. Swedish researchers, who conducted the study, discovered that sympathetic nervous system is hyperactive in PCOS women. And most noteworthy, the sympathetic hyperactivity precedes anovulation. Hence this could potentially be the underlying cause of PCOS. This phenomenon could explain why acupuncture can reverse some of the of the harm done by the syndrome, including restoring regular ovulation, decreasing androgen levels, regulating ovarian blood flow and the function of HPG axis.
- The excess levels of “male hormones” – androgens. This is the central feature of PCOS. Female to male transexuals consume anrdogens to develop male features. This excess androgen levels can result in PCOS.
- Hyperinsulinemia and insulin resistance – excess insulin levels in your blood increase the risk of PCOS. 25-50% of women with PCOS have no insulin resistance. Among women with insulin resistance, the incidence of PCOS is low. Nonetheless, these are the key factors and are cause of hyperandrogenism in some women.
- Increased sympathetic nervous activity. This may be the primary or causing factor of PCOS syndrome. Many of the features of PCOS, such as hyperinsulinaemia, central obesity, obstructive sleep apnoea are all associated with chronic sympathetic nervous system overactivity
Both increased androgens and hyperinsulinemia very likely are playing a role in causing PCOS. However, increased sympathetic activity may be preceding these changes.
- Hyperandrogenism results mostly from excess androgen production in the ovaries.
- Insulin resistance
- Elevated androgen levels. The excess androgen is mostly produced by ovaries. The common signs are hirsutism (excessive hair), acne, hair loss. Androgens affect the ovaries and pituitary ovarian axis.
- Central obesity is not an essential feature of PCOS. It adds to pathophysiology by aggravating insulin resistance and hyperinsulinemia.
Signs and symptoms of PCOS include:
- Irregular periods, anovulation and infertility
- Hirsutism – excessive hair on face and body
- Acne, oily skin
- Excessive hair loss
- Weight gain
You don’t need to have all of above symptoms to be diagnosed with PCOS. Some women are lean, some experience weight gain.
PCOS should not be confused with a common diagnosis of cystic ovaries, which has no other clinical features. Diagnosis normally will involve
- Assessment of symptoms, medical history
- Blood tests: increased testosterone, raised Luteinising hormone level and reversed follicular stimulating hormone/luteinising hormone ratio.
- An ultrasound scan of ovaries
PCOS is associated with health risks. Some of these risks are long term:
- Diabetes: Hyperinsulinemia and insulin resistance can lead to type 2 diabetes
- Increased risk of metabolic syndrome
- Increased blood pressure
- Uterine cancer
- Reduced health related quality of life
- Increased risk of dyslipidaemia (abnormal amount of cholesterol and/or fat in the blood)
- Premature cardiovascular disease
- PCOS-associated morbidities in menopause
- Increased risk of gestational diabetes and other complications in pregnancy
It is important to diagnose and address PCOS early on, so that you can minimise any further damage to your health.
Acupuncture and herbal medicine
Acupuncture has been shown to benefit PCOS in numerous studies. It seems to be especially effective with women who do not have significant weight gain. However, even patients with high body mass index will benefit from acupuncture, it just takes a little longer.
Current pharmaceutical treatment options are symptom oriented and, although effective, can have severe metabolic and gastrointestinal side effects. Treatment of infertility will often result in multiple pregnancies.
Available pharmaceutical options include:
1. Treatment with Estrogen-progestin contraceptive pill or with exogenous Estrogen and Progesterone (slows LH pulse)
2. GnRH antagonist decreases both LH and testosterone concentrations acutely
Lifestyle changes include low GI diet and exercise. We’re happy to discuss your lifestyle during your initial consultation.
When done correctly, acupuncture can restore normal ovulation, decrease ovarian cysts and ovarian size in PCOS patients.
How Acupuncture Helps Polycystic Ovary Syndrome
Acupuncture has been documented to
- increase blood flow to the ovaries
- reduce of ovarian volume and the number of ovarian cysts
- control hyperglycaemia through increasing insulin sensitivity and regulating blood glucose and insulin levels
- reduce cortisol levels and assisting in weight loss and anorexia
- reduce testosterone levels and regulating oestrogen cycles to normalise ovulation
- reduce sympathetic nervous system drive
- increase menstrual frequency by 38%
- reduce the sympathetic nervous outflow
More studies are needed to fully understand the effect of acupuncture on PCOS.
Acupuncture for PCOS is More Effective When Combined with Herbs
A systematic review published in June 2014 found combining herbs with acupuncture to be even more effective than acupuncture alone. They documented acupuncture and herbs help PCOS by reducing:
- luteinizing hormone/follicle-stimulating hormone
- insulin resistance