Interview

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PCOS, Oral Contraceptives and Inflammation (part 2)

On Monday, we published the first part of our PCOS interview with sexual health advisor Jenny Koos, also known as Vulverine. If you missed Monday’s post, you will find it here.

Polycystic ovarian syndrome, PCOS, is part of or a precursor to a metabolic syndrome, and women with the diagnosis often have irregular menstrual cycles and can suffer from acne, increased hair and obesity around the waist. Many also have problems with ovulation and therefore difficult to get pregnant.

The syndrome can be divided into several different types and so far Jenny has told about the insulin-resistant type as well as the fact that a large portion of PCOS women have problems with glucose tolerance. PCOS is a people’s disease with a basis in diet and health and, as Jenny herself puts it, it’s not just about a couple of ovaries.

Okay, time for part 2.

–If the first and foremost type of PCOS is the insulin-resistant, what are the others?

The second most common type I see is PCOS developed after the use of the pill, so-called post-pill PCOS. I meet a number of women every month who are put on birth control pills in their teens due to irregular cycles, PCO and pimples, all of which are quite normal in the first years before the menstrual cycle has really started. Then they stay on the pill for X years, regardless of whether they want a contraceptive or not.

When they stop, the menstruation cycle will not always return, and after a couple of months they go to the gynecologist and see the “pearl band”. At the same time, acne has often broken out because the pills they have taken previously reduced skin sebum production. Now it is overproduced instead and goes wild because the androgens that have been oppressed shoot up to the roof. Many times, this post-pill acne is at its worst about 6 months after getting off the pill, and then slowly improves, and the menstrual cycle and androgen levels usually settle within 1-2 years.

All of this is due to the fact that birth control pills raise SHBG, which binds up testosterone (this is one of the main reasons why many lose their sex drive on the pill). SHBG remains elevated for many months after termination, and just before the patient believes that the drug’s effect should be over, the androgens break through and she believes that the acne is “her own” and not a delayed side effect of the contraceptive.

The tragic thing in this scenario is that in most cases the patient is put on the pill just to treat her “PCOS”.

– Is contraceptive pill a viable drug treatment for PCOS?

No, birth control pills are not a treatment for PCOS, but they offer a masking of symptoms. The anti-androgenic varieties, e.g. Yasmin can remove acne and hirsutism and provides a monthly bleeding. For those suffering from such symptoms, it is often a welcome treatment.

Because a too thick uterine mucosa is a cancer risk, the gynecologist would of course like for you to menstruate every now and then. But you no longer have a menstrual cycle on the pill, and have not “fixed” this issue either. In other words, PCOS can be masked with birth control pills, but they will not help one to heal it – on the contrary.

Remember that insulin resistance is the main cause of PCOS, and the known side effects of the hormone disruptive contraceptives are insulin resistance. Another thing that contraceptive pills unfortunately do is to create nutritional deficiency, typically the nutrients needed to drive a healthy menstruation cycle. It is also proven that they cause chronic inflammation.

From a health perspective, bioidentical progesterone, properly dosed, would be much better than the progestin of the median, if regular bleeding is the target. Treating cyclically with true progesterone also lowers the LH secretion from the brain. One might wonder why this is not used to a greater extent?

Inserting a hormone disruptive contraceptive whose whole point is to shut down ovulation, in a body struggling with just ovulating, may seem somewhat counterproductive – especially in women who do not actually want the preventive effect of birth control pills.

– Is it true that PCOS can also be linked to inflammation in the body?

Yes, it can also be an inflammatory PCOS. If you have IBS (which is also a rather murky diagnosis), you probably suffer from chronic inflammation. It expresses itself as stomach issues, eczema and rash, pain – and / or PCOS. In this situation, you need to review what drives the inflammation, work with your stress management and switch to an anti-inflammatory diet. Antioxidants like NAC can work, probiotics are a good idea, but you have to remove the irritants first. Severe and / or chronic stress gives similar effects, see e.g. this study on how cortisol affects inflammation.

– Is it a congenital disease?

There is a great deal of evidence that toxins in fetal life and during childhood can trigger PCOS, and that the father’s weight and mother’s level of AMH during pregnancy (read more here and here) will affect. Thus, to some extent you can inherit the conditions for PCOS, however the environment also plays a role in its development? You control, to a large extent, yourself how your genes will express themselves, and if you know what triggers it then you can keep it in check. I have met many, many clients who have healed their PCOS!

In health care it is reiterated that “the cause of PCOS is unknown” as a mantra, and one focuses on managing individual symptoms or facets of the syndrome. But with a holistic perspective on, what in our western diet and lifestyle has changed as PCOS has increased – i.e. lack of darkness and sunlight, combined with chronic low-intensity stress and constant intake of sugar in a generation of high -ambitious women – it is no wonder that about 1 in 5 women suffer from this metabolic syndrome.

“When any condition crosses disciplines and does not have a full investment in [one of them], it often falls through the cracks. There are elements of reproduction in PCOS, but most reproductive endocrinologists mostly do in-vitro fertilization and are not necessarily interested in metabolism. Medical endocrinologists, who are mostly interested in metabolism, are usually interested in reproduction and ovarian function. ”- Dr Dumesic (The Atlantic, 2015)

– Finally, what can a woman who has the diagnosis do to improve her PCOS?

  • Learn the Justisse Method so that you can learn to identify your ovulation and get an overview of your cycle health.
  • Promote ovulation by:
    • regulating your blood sugar through diet,
    • control your thyroid function
    • adapt an anti-inflammatory lifestyle and diet as much as possible
    • handle stress
    • Make sure you’re getting important nutrients, especially regarding magnesium and vitamin D.

These factors improve if you give up caffeine completely. If you have to lower androgens that are already high, you can use a variety of herbs and supplements, eg. alphalipoic acid or berberine.

– Thank you, Jenny!

Jenny Koos is Justisse Holistic Reproductive Health Practitioner, but also known as Vulverine, or simply the holistic-minded sexual health advisor. You can find her on facebook and instagram.

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