One of my patients with PCOS had her ovaries removed after being diagnosed with ovarian cancer. She asked me, “So now that my ovaries have gone, does that mean my PCOS has gone too?” My answer was ‘no’. Removing her ovaries might have ‘cured’ her of the ovarian cysts, but it did not entirely cure the underlying culprit. Poly Cystic Ovaries are only one aspect of PCOS.
Our body is such a complicated web of chemical communications, and the functions of our hormones are closely intertwined with one another. PCOS has a medley of out-of-sync hormones, ranging from well-known hormones like insulin, testosterone, and oestrogen, to lesser-known hormones such as Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH).
If you are to conquer your PCOS, you need to know what your hormones are doing and how YOU can balance their functions.
What are hormones?
Hormones are chemical messengers used by the trillions of cells we each have in our body. Hormones are one of the languages our cells use to communicate with each other, in order to work in an organised and unified manner. They have tremendous control over the functioning of every system in our body and also our mind. Hormones are unique in that they exert their actions on organs that are far away from where they are produced.
Where do hormones come from?
Hormones are secreted by specialised glands in our body known as ‘endocrine glands’. These glands include the hypothalamus, pituitary, pineal, thyroid, parathyroid, adrenals, pancreas (Islets of Langerhans), and the gonads, which are the testes in men and ovaries in women. With any changes in our inner or outer environment, these glands release hormones that travel through our bloodstream, telling our cells how to respond.
How do hormones work?
Hormones have specific shapes that can fit into a specialised area on and in our cells, called a ‘receptor’. These hormones fit into areas like a key in a lock and trigger, or stop, specific functions. Every cell has many different receptors, each reserved for a specific hormone.
Hormones interact with each other in a complex manner. The levels of our hormones are relative to each other. They maintain their levels by using what are called ‘feedback loops’. In simple words, each hormone has a signalling system to communicate with other hormones and their glands. They can control the levels of other hormones by facilitating the secretion of some, while stopping the function of others. Your body is innately working to maintain a dynamic balance − called ‘homeostasis’ − of your hormones. It is always trying to keep you safe. However, when chronic hormonal imbalances occur in response to an imbalanced lifestyle, syndromes like PCOS can materialise.
Why learn about hormones?
Hormonal balance is essential for your well-being, growth, development, metabolism, brain function, sexual and reproductive functions and much more. To cut a long story short − your hormones are very important.
Learning about your hormones will give you an understanding of what’s happening to your body, and will give you the much-needed confidence to change your health for the better. Good professional guidance can be critical, but there is no substitute for being the master of your own health − for taking the health reins in your own hands.
When suffering from a complicated hormonal disorder like PCOS, it is important that you understand how your body functions, the effect your hormones have and the steps that you can take to reclaim your hormonal balance. The following section will equip you with the knowledge you need in your crusade against PCOS.
Your hormones and PCOS
The hormonal imbalance of PCOS may present as vague signs and symptoms. Even experienced health practitioners can misdiagnose PCOS due to its many presentations. You may have mild symptoms, or severe.
Vague symptoms, or definite. In this section, we will discuss the hormones − and other important factors − involved in the development of PCOS, and the steps you need to take to restore your hormonal balance.
The hormonal culprits of PCOS
Insulin is a very important hormone secreted by the pancreas in our abdomen. Insulin controls the processing of carbohydrates and proteins and is responsible for metabolism and storage of fat. All our body cells require glucose for energy production, and insulin is the hormone that helps it move from our blood and into our cells.
Insulin Resistance (IR)
Insulin Resistance is a condition where our cells can neither correctly recognise nor use the hormone insulin. Some women are more prone to Insulin Resistance (Asian and black women), however, faulty diet, lifestyle and excessive stress can cause it. Insulin Resistance is a major driver in PCOS. Between 44 to 70% of women with PCOS suffer from Insulin Resistance, irrespective of whether they are overweight or slender. However, women who are obese have an increased risk of developing Insulin Resistance.
A diet laden with sugars, empty calories, unhealthy fats, and processed foods, combined with stress and a lack of movement lowers our body’s sensitivity to normal levels of insulin over a period of time. Our cells have special sites in which the molecules of insulin fit like the pieces of a jigsaw puzzle. In Insulin Resistance, there is a malfunctioning of these sites, so they cannot bind optimally with insulin. They stop responding to normal insulin levels and cannot remove glucose from our blood as they should. High blood sugar levels force our pancreas to produce more insulin, in an attempt to manage the increased blood sugar. This leads to a condition where there is too much insulin in our blood, called ‘hyperinsulinemia’ .
You are most likely to develop Insulin Resistance if you are:
- Overweight, with a Body Mass Index (BMI) more than 25
- 40 plus years of age
- Have a waistline more than 35 inches/88cm*
- Have PCOS
- Have high blood pressure and/or heart disease
How does Insulin Resistance/hyperinsulinemia cause PCOS?
Insulin Resistance has a two-fold effect in PCOS. On one hand, Insulin Resistance increases the secretion of testosterone from the ovaries. On the other hand, it reduces the production of Sex Hormone Binding Globulin (SHBG), which is required for neutralising excessive testosterone in our blood. Excessive free testosterone in the blood can further increase Insulin Resistance7, creating a vicious cycle.
Due to its dual effect, Insulin Resistance can both cause, as well as amplify, the symptoms of PCOS. It is a major culprit behind the central obesity in women with PCOS. Additionally, Insulin Resistance can prevent the ovaries from producing ova or eggs, leading to anovulation and infertility.
Finally, there is a theory that insulin directly causes excessive adrenal androgen production and favours the hypo-pituitary-gonadal axis (HPG-axis) disorder in PCOS, and is thereby directly responsible for aggravating PCOS.
Tell-tale signs of Insulin Resistance
- Central obesity
- Skin tags
- Abnormal skin pigmentation − acanthosis nigricans
- Excessive hair on face and body (and/or loss of hair from the scalp)
- Irregular or absent periods
- Acanthosis nigricans
- Increased triglycerides and/or high blood pressure
- Intestinal bloating
- Sugar cravings
- Fatigue and/or brain fogginess and/or depression and/or mood swings
Diagnosis of Insulin Resistance
Diagnosis may include tests like the two-hour glucose tolerance test, fasting blood glucose and insulin testing.
Dangers of Insulin Resistance
If Insulin Resistance is not managed in its early stages, you can be at a greater risk of developing heart dis-ease, metabolic syndrome, type-2 diabetes, sleep apnoea, fatty liver disease, and endometrial cancer.
Tackling Insulin Resistance
Lifestyle improvement is your most powerful weapon against Insulin Resistance. A well-balanced food plan and physical activity are effective ways of improving your insulin sensitivity. As an added perk, these lifestyle modifications will also improve your fertility. Ensuring enough sleep, managing your stress levels, maintaining healthy levels of physical activity, the food plan recommended throughout this book and supplementation with nutrients such as fish oil, chromium, and magnesium are vital in overcoming Insulin Resistance.
Testosterone is thought of as a ‘male hormone’ as men produce 10 times more testosterone than women. Male hormones are collectively called ‘androgens’. We, women, need a little bit of male hormone too. Testosterone is needed for normal sexual function in both men and women.13 In women, this hormone is normally produced by the ovaries and adrenal glands.
Too much testosterone = PCOS?
For many women, an excessive blood testosterone level − total and/or free testosterone (hyperandrogenism) − is one of the hallmarks of their PCOS, and part of the diagnostic criteria. The excess testosterone in PCOS is due to two mechanisms. Abnormally high levels of the hormone LH (secreted by the pituitary) causes an imbalance in the hypothalamus-pituitary-ovarian axis (the way your brain talks to your ovaries). High LH levels coax the ovaries to produce more testosterone by developing cysts and causing thickening in ovarian tissues.
The second mechanism is Insulin Resistance, which triggers abnormal testosterone production. It also prevents its removal from the blood by reducing the testosterone binding globulin – Sex Hormone Binding Globulin (SHBG), thus leaving too much free male hormone in the body. Excess body weight and obesity can also contribute to excessive testosterone production. Fat tissue contains enzymes that can produce testosterone (from its chemical precursors).
Too much testosterone not only contributes to PCOS, but it can also lead to various psychological disturbances such as depression and mood disorders.
Tell-tale signs of testosterone excess
- Hirsutism − thick hair growth on the chin, upper lip, chest, abdomen, and back
- Male pattern balding of the scalp hair
- Deepening of the voice
- Abnormal or absent menses
- Mood disturbances and depression
Ways of calming down raging testosterone
Conventional treatments with synthetic medicines may help reduce testosterone levels. However, you must understand that these easy options come at the cost of your health and do not address the underlying drivers of PCOS.
The best and safest way to balance testosterone levels is to adopt a healthy lifestyle. Improving your insulin sensitivity and reducing excess body weight, if needed, combined with a healthy food plan and suitable physical activity will slowly yet surely rid your body of excess testosterone.
Typical western foods rich in unhealthy fats and carbo-hydrates favour testosterone production. Research shows dietary changes play a major role in balancing the levels of hormones in women. A study conducted in Milan, Italy showed substituting meats, eggs, and dairy products with vegetarian sources of nutrients like fruits, vegetables, whole grains, and legumes, significantly reduced the levels of excess testosterone in women. Refined carbohydrates like sugar, white bread, and refined flour should be avoided.
Consuming at least one portion of organic soy products like tofu, miso, or tempeh can provide you with natural plant hormones or phytoestrogens, which may help in balancing your hormones. Fish cooked with minimal oil or fat, seaweed, and flaxseeds (linseeds) are some other foods found to be helpful. These food changes also increase the levels of SHBG, which is required to inactivate excess active testosterone.
Decrease or eliminate your alcohol consumption. Alcohol has also been shown to increase the levels of plasma dehydroepiandrosterone sulfate − a weak male hormone in women.
Liquorice root (glycyrrhiza) has also been shown to be effective in decreasing testosterone levels. Research by P. Bergner in Medical Herbalism showed a significant reduction of circulating testosterone in women with PCOS with liquorice root.
What tests can be done?
Total testosterone and free/bio-available testosterone are two blood tests taken to check testosterone levels. Tests to detect SHBG levels should also be performed.
Sex Hormone Binding Globulin (SHBG)
SHBG is a glycoprotein that serves as an escort for testosterone, oestrogen, and progesterone, once they are in the blood. It functions to bind excessive circulating steroid hormones and inactivate them, thereby maintaining their concentration in our blood. SHBG shows more affinity in binding with androgens than oestrogens. SHBG is produced mainly by our liver and in some amounts by the breast tissue in women. Oestrogen stimulates, while testosterone inhibits the production of SHBG.
Women naturally have higher levels of SHBG as compared to men, which help to keep testosterone levels in women in balance.
The SHBG and PCOS connection
Women with PCOS often have low levels of SHBG. This increases the levels of free, or active, testosterone in the blood.
Insulin Resistance and high levels of insulin (hyperinsulinemia) are believed to lead to a lowered SHBG production in PCOS. Women with diabetes also suffer from Insulin Resistance, which leads to lowered SHBG levels. In fact, studies have shown that low SHBG levels can be considered an integrated marker for Insulin Resistance. Increased testosterone production by the ovaries, adrenals and fatty tissue in obese women with PCOS may also contribute. More fat, especially around the belly, can lower your SHBG levels. Women with lowered thyroid hormones (i.e. hypothyroidism) also have low SHBG levels.
Tell-tale signs of low SHBG
Look for the same signs as those seen in increased testosterone levels i.e. hirsutism, acne, a disturbed menstrual cycle etc.
What tests need to be taken?
Blood tests to detect the SHBG levels should be performed along with tests to detect total and free testosterone in women with PCOS. These tests collectively give a clear picture of your SHBG levels, and their impact on your testosterone levels.
How to boost SHBG levels naturally
An appropriate food plan and physical activity improves insulin sensitivity, reduces excess testosterone and helps you lose weight.
It will also give you the additional benefit of boosting your SHBG levels. You should know that SHBG and body weight are inversely related to each other, meaning the higher your body weight, the lower your SHBG level will be.
Vegetarian food plans rank high when it comes to improving the hormonal balance in PCOS. Women who eat a lot of high fibre vegetables and fruits have higher levels of SHBG. Also, diets low in meats and dairy may promote higher SHBG levels.
Oestrogen is produced mainly by the ovaries, and also by the placenta during pregnancy.
It is vital for the development of the breasts, widening of the pelvis, and increasing the amount of body fat at the hips, thighs, and bottom. It is also important for the growth of the uterus, development of the ovum and for normal menstruation.
Oestrogen prepares the uterus for possible fertilisation and pregnancy every month, by developing an egg in the ovary and by thickening the lining of the uterus. Oestrogen is also critical for the normalcy of functions in a woman’s body from digestion, to water and salt balance in blood and tissues, fat metabolism, the health of the heart, blood vessels and bones. It softens your cervix (mouth of the uterus). It helps produce vaginal secretions which both lubricate and aid the sperm in swimming well. The functions of this hormone are essential even for the health of our brain, as it has a huge impact on our memory and emotions.
An imbalance in oestrogen levels can be devastating for a woman’s health due to the sheer magnitude of functions performed by this hormone in our body.
Oestrogen in PCOS
Women with PCOS often have oestrogen dominance. This can occur with high levels, or even with normal levels, of oestrogen.
This ‘dominance’ is not in terms purely of the levels of oestrogen alone but in comparison to the levels of the hormone progesterone. Oestrogen is said to be dominant when the ratio of progesterone to oestrogen is lower than ideal. According to Dr. Lam, for optimum health, the progesterone to oestrogen ratio should be approximately 200 to 1.
An absence of ovulation, as occurs in many women with PCOS, leads to a drop in progesterone levels (as progesterone is released after ovulation, from the corpus luteum). This shifts the ratio of oestrogen to progesterone towards one of oestrogen dominance.
In obese women with PCOS, their fat tissue can convert the free circulating testosterone to oestrogen. This surplus oestrogen contributes to higher levels of oestrogen, also creating an environment of ‘oestrogen dominance’.
Relatively high levels of oestrogen in PCOS can affect the feedback loop to certain parts of the brain (the hypothalamus and pituitary) and can alter the levels of Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) levels. This can upset the menstrual cycle.
Tell-tale signs of oestrogen dominance in PCOS
- Absent or abnormal periods
- Severe PMS-like symptoms such as breast tenderness, headaches, mood swings, weight gain, water retention
- Decreased sex drive
- Insomnia − difficulty falling and staying asleep
- Hair loss
- Decreased memory
Dangers of oestrogen dominance
Oestrogen dominance can increase the risk of developing high blood pressure, breast cancer, endometrial cancer (cancer of the lining of the uterus), infertility, osteoporosis (brittle bones), stroke, diabetes and heart disease.
Tests to detect oestrogen dominance
Simple tests like a saliva test can be used to assess the levels of oestrogen, progesterone and many other hormones. These tests can be done at home and are easy, non-invasive, inexpensive and accurate. Some of the latest ‘Female hormone profile − capillary blood test kits’ provide you with the freedom of testing your hormonal levels within the comfort of your home. They are simple, minimally invasive and accurate.36 Your medical doctor or other health care professional can also refer you for these tests.
How to balance oestrogen levels?
To reduce the levels of oestrogen to within optimal levels, you need to reach your ideal weight, and improve your food plan and lifestyle. Here are some suggestions:
- Increasing your physical activity can help you lose weight and will thereby help to balance your oestrogen : progesterone balance.
- Healthy ways to manage stress, like Yoga and meditation will help you balance your oestrogen levels.
- Avoid the birth control pill − birth control pills often contain synthetic oestrogen, adding to your oestrogen load and oestrogen to progesterone imbalance.
- Processed and refined foods need to be removed (or at least reduced). Processed and sugary foods include white bread, cake, and bakery products.
- Eliminate, or reduce, alcohol consumption.
- Eat plenty of fibre from fresh fruits, vegetables, and some gluten-free whole grains.
- Indole-3 carbinol is a compound contained in cruciferous vegetables like broccoli, Brussels sprouts, cabbage, and kale. It is essential for balancing oestrogen levels.
- Omega-3 fatty acids, such as those contained in flaxseeds, tofu, walnuts, olive oil and in fish like tuna, salmon, mackerel and swordfish, also help in restoring the oestrogen balance.
Chemicals such as parabens, commonly used as preservatives in foods, toothpaste, cosmetics, shampoos and many more products, act like oestrogens when they enter our body. Similarly, breakdown products of DDT, other insecticides, laboratory detergents, industrial surfactants, wood preservatives, dyes and plasticisers may contain Xenoestrogens.
Artificial hormones can also enter our body through consumed meat, poultry, and dairy products. Heating our food in plastic containers, or drinking from warm plastic bottles, can increase our xenoestrogen load, as can exposure to pesticides and fertilisers. These artificial oestrogens can upset our hormonal balance.
Progesterone is secreted by the ovary after ovulation (from the corpus luteum), and by the placenta during pregnancy.
Progesterone is vital for normal menstruation and fertility. It helps the uterus to prepare a cosy and nurturing environment in anticipation of receiving a fertilised egg. It also prevents shedding of the endometrial lining after the fertilised egg embeds in the womb. In addition, it inhibits the contractions of the uterus.
Progesterone is essential in maintaining a pregnancy. A drop in progesterone levels can cause a miscarriage. Progesterone is rightly dubbed the ‘pregnancy hormone’.
Progesterone is an important precursor for the production of other hormones. It also helps to maintain healthy blood sugar levels, thyroid function and normal water balance, is a natural antidepressant and promotes normal sleep.
Progesterone in PCOS
Women with PCOS who do not ovulate have decreased levels of progesterone. Remember, you can have a period, but not ovulate.
The corpus luteum is produced after ovulation when the ‘empty eggshell’ becomes this gland. The corpus luteum produces progesterone. If no ovulation occurs, the corpus luteum is not produced, and so progesterone is not produced. Some progesterone is produced in the adrenal glands, but this is not sufficient for healthy levels of this important hormone. Lowered progesterone levels, even with normal oestrogen levels, cause an oestrogen dominant situation.
Tell-tale signs of low progesterone
- Hair loss
- Irregular periods
- Heavy and/or painful periods
- Unexplained infertility
- Inability to maintain a pregnancy
- Extreme mood swings, panic attacks, and depression
- Headaches, including migraine − often cyclical
- Tender or lumpy breasts
- Bloating and weight gain
- Back pain
- Excessive premenstrual food cravings especially for chocolates and sweets.
Tests to detect progesterone levels
The saliva test and the capillary blood test (as described for oestrogen) can also be used to ascertain progesterone levels. You can also be referred by your medical doctor or health care professional.
PCOS-related low progesterone levels have been effectively treated using physiologic doses of progesterone. Doses of natural progesterone in various forms aim to improve the level of progesterone, especially during the luteal phase of your menstrual cycle. We discuss your menstrual cycle, and the luteal phase, in Chapter 13 – ‘Boost Your Fertility – Learn how to increase your chances of not only becoming pregnant but carrying your healthy baby safely through to term’ on Conquer Your PCOS Naturally.
Such natural supplementation can be in the form of one or more of the following:
- Natural progesterone (in oral form)
- Natural progesterone skin cream
- Vitex agnus-castus (Chasteberry) (promotes the production of progesterone)
I would always err on the side of nature. Supplementation has been shown to be incredibly safe and effective. Skin creams applied to the inner thigh, under the arms and the chest are the most effective as the absorption is faster. You may need to see your medical doctor regarding natural progesterone. Vitex can be purchased from your health care professional.
A wholesome food plan and physical activity to promote weight loss − where needed − of as little as five to 10%, is often effective in restoring ovulation and so boosting progesterone. Vitamin C, zinc and vitamin A are important in the production of progesterone.
Foods like rockmelon, organic liver, and eggs have more than one of these important nutrients. There are reports that wild yam contains hormone-like compounds similar to our progesterone. These compounds may boost progesterone levels.
Luteinising Hormone (LH)
Produced by the pituitary gland at the base of the brain, luteinising hormone (LH) is an important hormone for normal menstruation and fertility. A surge in the level of LH during the menstrual cycle leads to ovulation.
The status of LH in PCOS
The production of oestrogen from the ovaries is stimulated by LH. “e pituitary gland then produces a surge in LH, designed to bring about ovulation. Ovulation leaves an empty egg shell, which becomes the corpus luteum and then produces progesterone.
High levels of LH are found in approximately 60% of women with PCOS.42 An imbalance of hormones such as LH and FSH (follicle stimulating hormone) in PCOS may lead to the incomplete maturation of an egg, and a following lack of ovulation. The elevated LH stimulates luteinising of the cells around the follicle. This can produce more testosterone and upset the menstrual cycle.
In a woman with PCOS, LH level of 18IU/L and FSH level of 6IU/L are a typical find. Although these figures are ‘within normal range’, they represent an elevated LH:FSH ratio, also known as a ratio of 3:1.*
* Measurements vary during the menstrual cycle.
Why are LH levels often higher in women with PCOS?
Gonadotropin Releasing Hormone (GnRH) is secreted by the brain (the hypothalamus), released in pulses at a particular frequency and amplitude. Normally, slow frequency release favours the secretion of FSH and high amplitude release favours the secretion of LH. This difference regulates the secretion of Gonadotropins (LH and FSH). In PCOS, GnRH is released more often and at increased amplitude than normal, which favours the secretion of more LH than FSH.
Consequences of high LH
High levels of LH cause an imbalance of the LH to FSH ratio, shifting it to the higher side. The ovaries respond to increased LH stimulation by producing more androgen than oestrogen. The most common symptom of high LH levels is menstrual irregularity. The most dreaded side effect of high LH levels is infertility. Studies have shown that women with high LH are less likely to conceive despite artificial reproductive therapies like in-vitro fertilisation (IVF). To make matters worse, 65% of women with high LH levels are prone to early pregnancy loss44,45 and higher recurrent miscarriage rates.
How to test your LH levels
You can check your LH levels by using a urinary ovulation predictor kit (LH-kit), typically around the time ovulation is expected. Your doctor, and some other health care professionals, can also refer you for blood tests to measure your LH levels.
How to balance the LH levels
Research studies conducted on obese women with PCOS-related infertility found a low-calorie diet for six weeks helped to lower their LH levels. This diet also helped to balance the LH to FSH levels, and helped them to lose weight.
Follicle Stimulating Hormone (FSH)
Produced by the pituitary gland, FSH is responsible for stimulating the growth of ovarian follicles. It also helps choose one egg to mature each cycle.
Women with PCOS may have low absolute or relative levels of FSH. This means the FSH level may be low according to its outright value, or may be considered ‘within normal limits’ according to its outright value, but may be low when looking at the LH to FSH ratio. The LH:FSH ratio is important for fertility.
Hypothyroidism, which is more common in women with PCOS, can also decrease FSH levels.
The FSH connection in PCOS
Women with PCOS may have low levels of FSH. The levels of FSH should normally peak during the early phase of the menstrual cycle and mid-cycle. However, due to the negative feedback resulting from high oestrogen levels, the pituitary gland lowers its production of FSH. This lowered FSH level results in both decreased maturation of the eggs and the maturation of one egg (normally) for release. These immature follicles are not as sensitive to FSH, and so degenerate. A chronically low FSH level is a main cause behind the poor development of eggs and anovulation (absence of ovulation) in women with PCOS.
High levels of testosterone, oestrogen and Insulin Resistance in women with PCOS, interfere with the action of the hormone prolactin, which can significantly reduce milk production in these women during the post-delivery period.
Losing weight, if needed, can help you balance the LH:FSH ratio and boost your ovulation and fertility.
Prolactin is a hormone produced by the pituitary gland. Its function is to stimulate and support the production of breast milk. This is the hormone of pregnant and breastfeeding mums.
However, this hormone has another function − it suppresses two main hormones that are needed for ovulation − FSH and GnRH (Gonadotropin Releasing Hormone). Now you know why breastfeeding is a natural contraceptive!
Prolactin in PCOS
Prolactin is great for breastfeeding women. However, when it comes to PCOS, this hormone may not make you produce a lot of breast milk but, it may ruin your menstrual cycle and ovulation.
It also acts against the corpus luteum, resulting in decreased progesterone production. Up to 30% of women with PCOS have high prolactin levels.
Elevated prolactin stimulates the production of androgens from the adrenal gland, thereby aggravating PCOS. Moreover, elevated prolactin levels may sometimes be the presenting evidence of an underlying hypothyroidism, which is another potential aggravating factor of PCOS. Hyperprolactinemia also causes sexual dysfunction in women by increasing the risk of painful intercourse (dyspareunia), causing a loss of libido, and decreasing arousal and orgasm.
Tell-tale signs of increased prolactin
- Irregular or absent periods
- Milky discharge from the breast
- Tender breasts
- Signs of excess testosterone − hirsutism, etc.
Certain medications, stress, and a tiny tumour of the pituitary gland called a prolactinoma are some other causes which can increase prolactin levels. The levels of prolactin can be measured by a blood test. The test results are more accurate if the samples are taken just after waking, or after a person has been quietly resting for 30 minutes, as the levels of prolactin vary with the level of activity.
How to balance prolactin
Foods that are high in zinc and vitamin B6 like fish, shrimp, tuna, sunflower seeds, soybeans, pinto beans, and gluten-free whole grains may help your body to naturally reduce high prolactin levels. Vitex (Chasteberry) may also help to balance abnormal prolactin levels.
DHEA is a weak ‘male’ hormone secreted mainly by the adrenal glands, and in small amounts by the brain and the ovaries. It is synthesised from cholesterol. It is a prohormone, being a precursor molecule, from which oestrogen, androstenedione, and testosterone are made. During puberty, DHEA facilitates the growth of armpit and pubic hair. DHEA also helps to maintain healthy cholesterol balance and helps in managing body weight. Also, DHEA has stress-relieving effects and is believed to be a hormone that gives you natural protection from depression.
DHEA connection in PCOS
DHEA levels are found to be high in women suffering from PCOS. Insulin Resistance and high-stress levels may cause excessive DHEA in PCOS sufferers.54 Other causes, such as abnormalities and tumours of the adrenal glands, can also cause high DHEA levels and may need to be ruled out by appropriate testing.
DHEA has some properties that are similar to testosterone.
When you have high levels of DHEA, the signs and symptoms will be similar to those of high testosterone:
- Oily skin
- Excessive body and facial hair
Blood tests can determine your DHEA level.
How to balance DHEA levels
The first step to balancing DHEA is to address Insulin Resistance. Eating plenty of healthy fibre will improve your SHBG levels, which will bind excessive DHEA in your blood.
Adopt healthy stress management techniques to bring your cortisol hormone level under control. As the levels of cortisol reduce, so will the DHEA.56
Thyroid hormones and PCOS
Your thyroid is a butterfly-shaped organ present in front of the windpipe in the neck. Thyroid hormones (thyroxine T4 and triiodothyronine T3) are essential in regulating your metabolic rate. In PCOS, there is a higher incidence of poor thyroid function and thyroid autoimmune disease. The combination of low progesterone relative to normal/excessive oestrogen levels may stimulate the immune system to attack the thyroid gland (autoimmune thyroiditis or Hashimoto’s thyroiditis), causing hypothyroidism.
Hypothyroidism contributes to obesity, lipid abnormalities, menstrual disturbances, lowered FSH levels and is linked with diabetes59,60, all of which in turn aggravate PCOS.
It also increases the risk of death from all causes, including coronary heart disease.
In addition, hypothyroidism may inhibit SHBG synthesis, leading to increased levels of free (and so active) oestrogen and testosterone. Thyroid levels can be assessed by assessing free T3, free T4 and Thyroid Stimulating Hormone (TSH) levels, plus thyroid autoantibody levels in blood after overnight fasting.
Homocysteine is a metabolite − a product of normal metabolism.
It is used to build and maintain tissue. However, high levels are dangerous to our health. With higher levels, there is an increased risk of heart attack and cardiovascular disease. A study in the Journal of the American Medical Association found moderately high levels of plasma homocysteine were associated with greater risk of heart attack. To reduce homocysteine to ideal levels requires vitamins B6, B12, and folic acid. These are involved in the process of ‘breaking it down’. If a person is deficient in these vitamins − due to lack of intake, lack of absorption or taking a medication such a Metformin which is known to decrease the levels of these vitamins − homocysteine levels can remain high. Metformin has been linked to increases in homocysteine levels.66 Levels of homocysteine have been found to be higher in women with PCOS.
How to balance your homocysteine level
Implement the changes discussed throughout this book. Plus, add vitamin B6, B12, and folic acid rich foods and supplements.
Cholesterol has been given an undeserved bad reputation by the media and in medical circles. Did you know, without cholesterol you wouldn’t stay alive, let alone thrive? Cholesterol is needed in our cell walls. It plays a critical role in cellular communication and is important for energy production. It is important both structurally and functionally for our brain. As Dr. Dingle states:
“Cholesterol is the starting material of many essential chemicals including vitamin D, steroid hormones and the bile acids necessary for digestion”. It even helps the function of our happy hormone, serotonin, and is important for our immune system. High cholesterol has been linked to heart disease.
However, low levels of cholesterol are also harmful to our health and increase ‘all-cause mortality’ − that means death from all reasons. As a woman with PCOS, you are more likely to have dyslipidaemia − an imbalance in the lipids in the blood. Please do not jump to the dangerous conclusion that a cholesterol-lowering medication will do anything to either address the underlying condition manifesting itself with a cholesterol imbalance, or in any way extend your lifespan or improve your health. These medications can also have serious − and deadly − side effects.
Balancing and maintaining healthy cholesterol levels is best, and most safely, done by adopting a healthy lifestyle.
PCOS affects the balance of many of your hormones. And the levels of one hormone are affected by those of other hormones. Your body is like an intricate web, one thread being influenced by another, nothing occurring in isolation. With knowledge and action, it is possible to balance your hormones and conquer your PCOS.
From PCOS to perfect health, with love,