PCOS: A Western and Chinese Medical Overview

PCOS (Polycystic Ovarian Syndrome) is defined as an endocrine condition caused by undeveloped follicle clumping on the ovaries that interfere with normal ovarian function. It is however not just an ovarian issue but a problem with hormonal signaling, ovarian hormone production, pituitary action and hypothalamic action, important for reproductive health.

It affects around 5-10% of the population and is the biggest cause of infertility.

PCOS is often seen in the sisters or mothers of those affected suggesting a genetic component, however the patho-physiology and aetiology are unknown and may be developmental.

The main primary indication of PCOS is irregular or absent periods often dating back to menarche. There are many other symptoms, which include acne, facial and body hair, high lipid levels in the blood, and some irregularities in sugar metabolism.

The two most consistent elements of PCOS are elevated androgenic hormones and lack of ovulation. In PCOS small cysts, which are tiny follicles that have not developed inside the ovaries and do not develop into mature eggs, produce male hormones called androgens. These hormones block follicular development and cause the follicles to degenerate preventing ovulation.

There are two main groups:

Overweight and insulin resistant. It is not known whether women are obese because of their PCOS or if those who are obese are more predisposed to PCOS. The role that obesity plays in the patho-physiology of PCOS is unclear, however it is known that oestrogen is produced in the fat cells and that high levels of insulin directly stimulate testosterone production. So levels of both testosterone and oestrogen are high. The high levels of insulin push the balance from oestrogen to testosterone giving the facial hair and acne commonly seen. Abdominal obesity particularly worsens both the clinical and endocrine features of PCOS.

The Thin Cysters. There are now more women presenting with PCOS who are thin, known as thin cysters. Women with polycystic ovary syndrome (PCOS) tend to exhibit abnormal fat distribution even if they are not obese, perhaps indicating an increased risk of metabolic disorders, research indicates. The abnormal fat distribution in non-obese patients was seen in the peritoneal cavity and the visceral fat surrounding the internal organs.

Some women with PCOS have been seen to have inflammatory markers in altered circulation levels indicating a state of chronic inflammation.

Women with PCOS are often prescribed clomiphene,  銅鑼灣推拿 letrozole, hCG, metformin and gonadotropin. If these fail then your doctor may suggest surgery to control PCOS symptoms and improve your fertility, for example laparoscopic ovarian drilling. This is a type of keyhole procedure that destroys the tissue on your ovaries that produces testosterone. As levels of testosterone fall, your PCOS symptoms should improve and your ovaries should start to release eggs again.

Traditional Chinese Medicine (TCM) and acupuncture seeks to change the whole hormonal picture that is seen in PCOS. The common pattern is dampness or phlegm. As a holistic therapy, TCM pinpoints the individual manifestation and treats it accordingly. Common patterns are:

1- Kidney Yang deficiency- presents as delayed periods, scant and light colour menses, gradual amenorrhea, dizziness/tinnitus, cold limbs, sore/weak lumbus/knees, loss of libido, clear and copious urine, loose stools, lower jiao heaviness, tongue is pale with thin moist white coat, weak/thin pulse. The treatment principal is to tonify kidney yang to regulate and encourage the menses.

2- Phlegm Damp Retention- Scant/absent menses, excessive leucorrhea/vaginal discharge, heavy sensation in head, lassitude of limbs, obesity, loose stools, heaviness or fullness of chest, swollen tongue body, tooth marks, white