Traditional Chinese Medicine for Polycystic Ovarian Syndrome (PCOS)Anne Clossen, R.TCMP, RAc November 18, 2013
Five to ten percent of women of childbearing age have polycystic ovary syndrome, also known as PCOS. It can occur in girls as young as 11 years old.
In approximately 75% of cases where young women have problems with menstruation due to late puberty, PCOS is often diagnosed. Irregular, infrequent or absent periods, or periods with heavy flow and unbearable pain, are all variations of the problem. Sometimes PCOS presents itself much later in life when a woman of childbearing age stops using contraceptive pills and finds herself having very long cycles or no cycles at all, and is unable to conceive.
Symptoms of PCOS
Polycystic ovary syndrome (PCOS) is a complex syndrome that includes problems with a woman’s menstrual cycle (length, intensity), her ability to have children, her hormone levels, and her appearance (excessive hair growth on the chin and cheeks, acne, weight gain, baldness).
Women with PCOS often have ovaries that contain many small cysts, of a size seldom exceeding 0.5 cm.
The symptoms of PCOS can vary from woman to woman, with some women suffering more than others. Symptoms can include any of the following:
• Infertility due to lack of ovulation (PCOS is the most common cause of infertility); Anxiety; Depression
• Menstrual irregularities: irregular or absent menses;
• Heavy menstruation (especially if periods are late);
• Painful menstruation or pain during ovulation, bleeding in the middle of a cycle;
• Pelvic pain (distention, heaviness, stabbing pain);
• Physical changes (often occurring at a later stage but not always): increased hair growth on the face, chest, stomach, back, thumbs or toes, weight gain around the waist, an inability to lose weight despite physical exercise, acne, dandruff, thinning hair (looking like male baldness);
• Multiple cysts on the ovaries diagnosed by ultrasound.
What Causes PCOS?
The cause of PCOS is unknown, but most experts think that several factors, including genetics, could play a role. One main underlying problem with PCOS is hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. High levels of these hormones affect the development and release of eggs during ovulation. Researchers also think that insulin may be linked to PCOS. Insulin is a hormone that controls the conversion of sugar, starches, and other food into energy for the body to use or store.
PCOS is generally diagnosed by a medical doctor after a thorough investigation of patient history, a physical and/or pelvic examination, pelvic ultrasound and endometrial lining thickness and blood tests to check hormonal levels. PCOS cysts need to be differentiated from functional cysts, which resolve on their own and require no treatment.
The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.
In women with PCOS, the ovary doesn’t produce all of the hormones an egg needs in order to fully mature. The follicles may start to grow and build up fluid, but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone, progesterone, is not produced. Without progesterone, a woman’s menstrual cycle is irregular or absent altogether. PCOS is a cause of infertility, as the eggs are not released and ovulation occurs irregularly or not at all.
Conventional Treatment for PCOS
• Birth control pills – are sometimes recommended for women who don’t want to get pregnant (this approach does not really treat PCOS; it merely masks the symptoms and may facilitate the need for fertility treatments if pregnancy later becomes a goal).
• Diabetes medications – The medicine metformin (Glucophage) is used to treat Type 2 diabetes. It has also been found to help with PCOS symptoms, though it isn’t approved for this use.
• Fertility medications (clomifene-clomid, serophene, injections of Gonadotropins) for women trying to get pregnant. Lack of ovulation is usually the reason for fertility problems in women with PCOS.
Traditional Chinese Medicine for PCOS
Chinese medicine has studied polycystic ovaries since ancient times. There are many ancient and modern text books which mention abdominal masses (ie polycystic ovaries), along with scanty menstruation and absent or delayed menstruation.
According to Traditional Chinese Medicine theory, organs involved with PCOS include the Spleen, Kidney and Liver, with a subsequent disharmony of Chong and Ren channels / meridians.
In my Traditional Chinese Medicine practice, the condition known as PCOS has become a very common diagnosis. I see young women diagnosed with PCOS who are quite thin, have no facial or body hair growth, and suffer from very painful menstruation that is relieved by the application of hot pads. These women tend to feel more chilly, especially around the time of their periods.
Other women, also diagnosed with PCOS, have very irregular periods occurring only 4 or 5 times a year, but with a heavy and debilitating flow. They most often come to me for help because they have been trying unsuccessfully to get pregnant for a couple of years. Some mature women come because of persistent, painful acne and later find out they have PCOS.
Chinese medicine views PCOS as a complex combination of different patterns. Ovarian cysts are seen and treated as an accumulation of ‘phlegm damp’ in the uterus, enlarging the ovaries. This pattern is often accompanied by blood stagnation that is responsible for painful menstruation (stabbing pain) and dark, scanty, thick blood.
At the root of the disease is a kidney deficiency (hormonal imbalance), and a spleen qi deficiency (digestive problems) which causes accumulation of dampness. Very often a liver qi stagnation, worsened by years of stress or frustration, is added to the mix.
To effect complete recovery from PCOS, Chinese medicine uses herbs and acupuncture to regulate menstrual cycles, improve digestion, dissolve cysts, promote ovulation, improve egg quality, support conception and prevent a miscarriage when a pregnancy is achieved.
Pattern Differentiations and Treatment
Deficiency of Spleen Qi and Kidney Yang, Accumulation of Phlegm and Damp – Women suffering from this pattern have very long menstrual cycles (more than 35 days between periods which occur only 4 or 5 times a year), scanty bleeding that can alternate with flooding periods, which contain stringy tissue or mucus, or watery blood. Or they have no periods at all and come for fertility treatments. Such women also have a tendency to put on weight easily, feel bloated, don’t like cold weather and tire easily. Their appetite is not necessarily strong but they crave pastries and carbs, especially after meals. They can have chronic yeast infections, or chronic vaginal discharge. The tongue shows swollen and enlarged, with teethmarks on the sides, and is sometimes covered by a thick white coat.
In North America, despite cold winters, the overconsumption of large quantities of ice cream (with its high sugar and fat content), milk-shakes, cream cheese and other dairy products impact the digestive system from a young age. This accumulation of toxins in the body manifests as damp phlegm that blocks proper channel circulation in the abdomen, where the toxins tend to accumulate (think belly fat).
Treatment aims at strengthening the digestive system, removing dampness, and dissolving phlegm (removing cysts) with herbal supplements that include Gui zhi (cinnamon), Tu si zi, Du zhong, fu ling, Cang zhu, etc.
Gui zhi (cinnamon bark) is very good at warming the uterus and promoting blood circulation in the uterus, especially for women who have painful periods that are relieved with the application of hot compresses or hot pads. In many cases I like to add the herbs Lu lu tong and Ze lan to promote circulation in the abdomen. Lu lu Tong is used to unblock clogged tubes and dissolve phlegm. Fu ling and Cang zhu help the digestive system deal with excessive dampness and also promote urination, while Tu si Zi and Du zhong tonify the kidneys.
Liver Qi Stagnation and Blood Stasis – Enduring stress, depression or anxiety may lead to liver qi stagnation. This eventually impairs proper circulation of the blood, since qi makes blood circulate in the liver as well as in the ren and chong channels that traverse and connect with the uterus.
Another common cause of blood stagnation in the uterus is the invasion of cold. Cold causes contraction and prevents proper blood circulation. The liver channel begins at the big toe and travels up the leg, encircling the genitals. Coldness can easily enter the body through the feet and invade the uterus via the liver channel. This is one of the reasons why we advise women not to swim during their menstrual periods, when the uterus is particularly open and vulnerable, and to keep their feet, legs, abdomen and lower back warm.
Long term liver qi stagnation can also transform into heat, causing severe PMS symptoms: feelings of heat, restlessness and irritability, headaches, distended breast or abdomen, irregular periods and particularly heavy and clotty periods (when heat has transformed into blood stasis).
We use herbs that promote qi and blood circulation in the uterus, reduce clotting, reduce pain and distention, calm emotions and remove heat.
Formulas such as chai hu shu gan san or Dan zhi xiao yao san can be used with modifications. Ge xia zhu yu tang, with added herbs, can also be used if blood stasis is particularly strong.
With this pattern, the pulse is often wiry (feeling like a wire hitting the finger), and the tongue is reddish with redder sides. Sometimes you can see purplish spots on the sides of the tongue, indicating blood stasis.
Phlegm, kidney yang deficiency, spleen qi deficiency, liver qi stagnation, blood stasis (with either heat or cold symptoms) and finally, some possible blood and yin deficiency, can all combine as symptoms.
Acupuncture for PCOS
Acupuncture treatments are typically given once a week and sometimes more often, especially when there is pain before menstruation or mid-cycle. The duration of treatment with acupuncture and Chinese herbs depends on the duration of the disease, intensity of the symptoms, and the Chinese medicine diagnosis. Typically, at least three months of continuous treatment is required.
i) Young women should have regular moderate exercise in the sun. Around the time of menstruation, exercise should be reduced.
ii) Relax and avoid strong emotions, especially around menstruation time.
iii) Avoid cold environments, foods and beverages (cheese, dairy products especially ice creams and milkshakes). On cold days during menstruation, use a hot water bottle and place it on the abdomen. Do not swim while menstruating.
iv) Cut out all forms of refined sugar and carbohydrates: white bread, pasta, white rice, rice cakes, most breakfast cereals, and all starchy, low-fibre foods.
Avoid sweeteners, soda, fruit juice and any drinks that rapidly raise the blood sugar level, as PCOS is linked to Type 2 diabetes.
v) It is important to record day one of your menstrual cycle, the duration, condition of the blood (quality, amount, colour). If you suffer from delayed periods or period pain, it is recommended you address this in the early stages in order to avoid polycystic ovaries.
Young women are often unaware of their menstrual cycle and would be wise to start paying more attention.
A registered Chinese medicine practitioner and Herbalist can properly assess and diagnose which symptoms need to be addressed first, and what is causing them.
I recently had a patient diagnosed with PCOS who had found a Chinese herbal formula in a blog. She had been taking powdered herbs (in the same dosage mentioned in the blog for raw herbs) and she had basically overdosed by 10 times, making herself really sick.
I strongly advise people against taking herbal formulas blindly, without proper dosage and professional diagnosis.
Anne Clossen, R.TCMP, RAc
Anne Clossen is a Registered Chinese medicine practitioner (Acupuncturist and Herbalist) specializing in women's health, fertility, digestion, and healthy aging. Formerly with a private practice in Toronto, Anne has now moved her practice to France. For more information, email: Anne.email@example.com, or find Anne on Facebook at: AnneclossenTCMP
Anne Clossen, R.TCMP, RAc
Anne Clossen is a Registered Chinese medicine practitioner (Acupuncturist and Herbalist) specializing in women's health, fertility, digestion, and healthy aging. Formerly with a private practice in Toronto, Anne has now moved her practice to France. For more information, email: <a href="mailto:Anne.firstname.lastname@example.org">Anne.email@example.com</a>, or find Anne on Facebook at: <a href="https://www.facebook.com/AnneclossenTCMP/">AnneclossenTCMP</a>
Hi Anne, I am a woman who is 24 and discovered i had pcos over 2 years now. My family doctor referred me to a Endocrinologist and she is nice but when i talk about my concern of infertility or my periods shes not concern about that once i get them. Her onlu solution for everything is birth control pills. I have beem on them before and i dont want be back on them. Reading your article really fascinated me about Chinese medicine and acupuncture. I read many articles but yours is the first to mention. I’m 5”6 and 147lbs most my weight is lower body my gut looks like im pregnant. I am Guyanese geographically south americam culturally caribbean (west Indian) race Indian. I skip periods most of the time 2 times a year. I have hair on my chin and tummy that are corse and around aerola of the breast. Ultra sound says i have 12 or more tiny cyst in my ovaries. I reside in North Etobicoke by humber college hwy 27 & finch. Also near etobicoke general hospital. I msg you because i woulf like a gynecologist recommendation or somone who special was in pcos and knows about chinese medicine as well accupunture. And noy force me on pill. As well tell me what type of diet i should have and how much exercise i should incorporate i am still very young but i would love to prevent future illnesses or diseases. Ex, diabetes. I hope you can help and advice me.
Hello Malissa, We recommend you contact Yuxiang Wang at the Canadian Gynecology Institute of Chinese Medicine. Website: https://www.CGICM.ca For info and appointments call (416) 644-1937 (clinic at 1061 Eglinton Ave West), or (416) 354-2045 (clinic at 2951 Lakeshore Blvd West, Etobicoke). Her book Handbook of Pediatric Chinese Dietary Therapy is published by PublishAmerica.
I’m so happy to have found your post. I am 21 and have been diagnosed with PCOS. I am not overweight, my thyroid is healthy. I don’t get my period regularly. I can go up to 3 months or more without a period. I have been on three different birth control pills and I would like to come off. My BIGGEST problem is that I am losing my hair. I go between Miami, Florida and New Orleans Luisiana. I am petrified of losing my hair and not being able to have kids. Can you put me in touch with any specialists in those areas. I really look froward to your advice.
Hello JJ, The only expert we can recommend is Yuxiang Wang in Toronto. We are not aware of any experts in your area. Sorry about that.
its really nice to read your post.i am 30 years old and was diagnosed with pcos for few years but i didnt give much attention to it. Though i have consulted to doctorz and took medicines too but not regular.i dont have acne or weight issue.the main problem is shedding of hairs it falls in the form of big snowball.please suggest any good doctor in xian china
Hello! I am 29 years old. I was diagnosed with PCOS at the age of 23. I’ve had irregular periods since the age of 12. It took me 11 years to find a doc who listened instead of telling me I’m young and it will even out. I was diagnosed through ultrasound and blood work. I was never told what any of my levels were or what they even looked for or found. I was told my only option was to take BC and lose weight. I made several complaints about the effects that the BC had on me and was told to wait it out. When nothing changed, I was told that I must be doing something wrong, but I was doing everything as prescribed. Now, I can’t find a Dr. to help and don’t know where to turn!
Hi im van i have been diagnosed with pcos since 2004 i think. Dr saying right uterus is ovulating nut the other isnt. I am taking Diane35 as recommended by my ob but i need to stop once in a while as it is still a pill and not good for the body its also giving me migraine and too much mood swings and depression. I was also diagnosed having hypo thyrodism as it was linked having a hormonal imbalance. I am living here in Philippines.
My daughter, who is 34years old, and has fibromyalgia, was diagnosed today as having PCOS. I’m very concerned and want the best/most effective treatment for her. She has had unusual weight gain, but tries to stay pretty active. She also has bouts of depression and difficulty sleeping.
This is my brief assessment, and I ‘d like to find an herbal, more natural method of treating this, with a recommended practitioner in the Los Angeles area. We anxiously look forward to the time very soon when no one will say ” I’m sick”. (Isaiah 33:24)