Compliments of Electrawoman:
Nan Dunne Boggs Natural PCOS Newsletter
P C O S__ HEALTH REVIEW
Natural Health Ideas for Polycystic Ovary Syndrome
A fr*e monthly newsletter for women with ovarian cysts or PCOS.
Issue #004__ _________________ September 24, 2002
Nancy Dunne Boggs, N.D., Naturopathic Physician
Bill Slater, Research Associate
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TABLE OF CONTENTS
***_ DOCTOR'S COMMENTARY ***
1)_ Answers to Your Questions
2)_ Important Changes to our Newsletter that Will Affect You
***_ QUESTIONS & ANSWERS ***
3)_ Getting Pregnant - A Burning Issue
4)_ What Are My Chances of Miscarriage?
5)_ What Can Help Me Get Pregnant Besides Hormone Therapy?
6)_ Will Plant Estrogens Increase My Risk of Cancer?
7)_ Did taking birth control pills when I was younger contribute to
my PCOS?
8)_ Is it true that women with PCOS can only have one child?
***_ THE MONTHLY RESEARCH PEARL ***
9)_ NAC Improves Insulin Sensitivity in Women with PCOS
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~~~~~~~~~~~~~DOCTOR'S COMMENTARY~~~~~~~~~~~~~
1)_ ANSWERS TO YOUR QUESTIONS
Hello!_ Thanks to all who have written to tell us what's important
to you._ We wish we had the time to individually and completely
answer all of your questions!__ But we don't, because we're so
involved in clinic practice and in writing our Natural Solutions for
PCOS book.
However, starting in this issue, we'll spend some time
responding
to some of your questions and concerns.
We're also adding a new feature to our newsletter called "The
Monthly Research Pearl"._ In the research process for writing our
NATURAL SOLUTIONS FOR PCOS book, we come across
interesting research that may be relevant to you. Rather than wait
until our book is published, we'll sharing some of this
information
with you as we discover it.
Sincerely,
Nan Dunne Boggs, N.D.
~~~~~~~~~~~~~QUESTIONS & ANSWERS~~~~~~~~~~~~~
3)__ GETTING PREGNANT - A BURNING ISSUE
By far the most common questions women ask us are about
having
successful pregnancies.
--_ "My first and main concern is will I ever be able to have__
children and will they be healthy?…"__
--_ "My whole life I have wanted kids but last Thursday my dreams
were shattered…"__
--_ "What are my chances of conceiving…?"__
--_ "I am heartbroken and fearful that I won't have
children…"
We plan to visit this important issue on a frequent basis._ For
now,
here's some basic information about PCOS and infertility.
40% to 80% of women with PCOS have a problem with fertility.
The reason for this wide variation is that PCOS is a complex
metabolic syndrome, with any number of ways to interrupt
fertility._
In addition, some women have other factors that reduce fertility
(like a husband with a low sperm count or a uterus scarred by a
previous infection), which have nothing to do with PCOS._ If you
have PCOS, it's difficult to estimate your chances of having a
baby._
We don't have specific statistics about natural therapies for
PCOS
or their impact on fertility. However, common sense as well as
the
clinical experience of naturopathic physicians and
acupuncturists
indicates that improving your health will increase your chances
for
conception. Safe, nontoxic and effective natural therapies can
shift
you into regular ovulatory cycles that will produce thriving eggs.
Whatever method you choose to achieve pregnancy, building
and
maintaining your well-being all the way through to motherhood is
essential for having a successful pregnancy and healthy baby.
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4)_ WHAT ARE MY CHANCES OF MISCARRIAGE?_
Q: "I have had this disease for almost fifteen years._ I've recently
found out I'm pregnant and am concerned about the baby's
health
or the chance of a miscarriage."
A: When a women with PCOS becomes pregnant, she is at risk
for
complications. More frequent early miscarriage is the primary
risk.
Gestational diabetes and high blood pressure can complicate
the
second and third trimesters.
Blood sugar abnormalities can mean a large baby._ These
babies
have to be closely watched for hypoglycemia. They will usually be
fine once they have established their skill at breast (or bottle)
feeding and are getting steady nutrition._
If a woman develops high blood pressure in pregnancy, the
blood
flow to her baby may be slowed and result in a baby that is born
small. Growth-restricted babies can have multiple
developmental
problems after birth.
Most women with PCOS have normal, average-weight babies.
Interestingly, it seems that those who have either remarkably
small
or large babies turn out to have been either very small or large at
birth themselves!
Get regular prenatal care to monitor your blood sugar and blood
pressure so you can catch any problems before they develop.
Allow your healthcare team to help you minimize unhappy
outcomes.
Early studies have suggested that the insulin-sensitizing agent
metformin may be safe and useful in reducing the risk of first-
trimester miscarriages. Currently, most practitioners who use
metformin during ovulation induction discontinue its use once
pregnancy occurs, or don't continue it beyond the first trimester.
More study is needed to determine the safety and value of this
drug
during pregnancy.
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5)_ WHAT CAN HELP ME GET PREGNANT BESIDES
HORMONE THERAPY?
Q: "What may help someone with PCOS in getting pregnant
without the hormone replacement therapy"
A: Weight loss, even as a little as 5%-7%, can decrease the
amount
of circulating androgens and thus help induce ovulation. Weight
loss is also associated with decreased insulin and testosterone
levels. In one study, reversal of ovarian dysfunction was striking,
with 82% of women in the group showing marked improvement
in
fertility, including five pregnancies in women who had long-
standing infertility.(1)
Regular ovulation is a primary goal of all fertility treatments.
Exercise by itself, with or without weight loss, improves regularity
of ovulation. A study of adolescent women found a significant
decrease in the frequency of self-reported acne, painful periods,
and irregular menses in those engaging in more than eight
hours of
sports each week.(2) Although few studies have reported on the
link between exercise and PCOS, it's clear that exercise has
positive effects on obesity and insulin resistance, which are
common attributes of PCOS.
I also recommend you find or create a support group. A recent
Harvard study showed that women who participated in an
infertility support group had a 25% increase in their success rate
over women who just got the usual infertility clinic care.(3)_ An
excellent resource for PCOS support groups is the Polycystic
Ovarian Syndrome Association
http://www.pcosupport.org/support/
According to a recent study, acupuncture timed with in-vitro
fertilization increased conception rates._ The group receiving
acupuncture had a success rate of 43% vs. only 26% for the
control
group.(4)
Naturopathic physicians and acupuncturists who specialize in
helping infertile couples have reported increased success for
couples who have had failed attempts with fertility technology.
Natural medicine and acupuncture have helped a significant
number of women have their babies. These are anecdotal
reports
and the causes for the infertility are not exclusively due to PCOS.
The support that natural medicines provide to reproductive
function and basic health will inevitably help restore fertility in
some women. We look forward to more research to confirm this
common-sense approach.
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6)_ WILL PLANT ESTROGENS INCREASE MY RISK OF
CANCER?
Q: "Since people with PCOS already have long menstrual cycles
and their uterus and breasts are subject to longer exposures to
estrogens, thus increasing their risk of cancer, should they avoid
foods high in phytoestrogens, e.g., soy products?"
A: "Phytoestrogens" is the name given to a family of plant
compounds that have both estrogenic and anti-estrogenic
properties. Flaxseed, soy, alfalfa are examples of plants
containing
phytoestrogens.
Research indicates that these plants, and isolated lignans
(proteins)
from these plants, have many protective effects in the body._
Consumption of flaxseed and its lignans increases SHBG (sex
hormone binding globulin) synthesis, as well as reduce breast
tumor formation and growth. SHBG inhibits the action of
testosterone._ Excessive testosterone contributes to infertility,
hirsutism, and acne.
Hundreds of research studies demonstrate that soy foods are
safe.
Soy has a moderating influence on both estrogen and
testosterone.
There is some evidence to suggest that the more the food has
been
processed to be drug-like, the more likely there could be adverse
effects._ Therefore, eating soy beans in chile, putting ground flax
seed in your smoothie, or having a tofu scramble for breakfast, is
preferable to taking capsules of isolated soy proteins.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7)_ DID TAKING BIRTH CONTROL PILLS WHEN I WAS
YOUNGER CONTRIBUTE TO MY PCOS?
Q:_ "Now that I want to start a family, the dr's are finding answers
to the problems. My mother thinks that it is because I was taking
the birth control pill from age 19 to 25. Can this be a contributing
factor for PCOS? Wouldn't this in turn help the problem? I was on
4 different kinds of birth control pills and still none of them made
me regular."
A: There is concern among some physicians about the use of
oral
contraceptives and the long-term impact on women with PCOS.
Oral contraceptives reduce acne and hirsutism by inhibiting
ovarian steroid hormone production. Oral contraceptives are
also
used to "flush" the endometrium (create a bleeding episode
once a
month) and reduce the suggested, but unproven, increased risk
of
endometrial cancer in PCOS.
One study of 16 non-diabetic women with high testosterone
levels
showed that those treated with oral contraceptives developed a
poorer glucose tolerance over six months. Two of the women
actually developed diabetes.(5) This raises doubts about the
safety
of oral contraceptives for treating PCOS. The use of oral
contraceptives to treat menstrual irregularities should be halted
until further studies specifically determine the long-term effects
of
oral contraceptives on women with PCOS.
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8)_ IS IT TRUE THAT WOMEN WITH PCOS CAN ONLY
HAVE ONE CHILD?
Q: "I heard of women only being able to have one child while
dealing with Polycystic Ovary Syndrome._ Is that true?"
A: A characteristic of PCOS is "early fertility", which means a
woman with PCOS is more likely to conceive and give birth to
one
or two children when relatively young, say in her early to mid
twenties. As she gets older, her PCOS symptoms become more
entrenched, including irregular or no ovulation, and thus there
are
no more pregnancies later on.
We presume this problem applies primarily to women who are
not
being properly treated. If you incorporate regular exercise, whole
foods, appropriate protein, good quality fats, and fresh fruits and
vegetables into your lifestyle, your health and fertility are less
likely to follow this sad, unnecessary pattern.
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~~~~~~~~~~THE MONTHLY RESEARCH PEARL~~~~~~~~~~
9)_ NAC IMPROVES INSULIN SENSITVITY IN WOMEN
WITH PCOS
ARTICLE TITLE:_ N-acetyl-cysteine treatment improves insulin
sensitivity in women with polycystic ovary syndrome, Fulghesu
AM, et al, Fertil Steril 2002 Jun;77(6):1128-35
ARTICLE SUMMARY: This study evaluated the effect of N-
acetyl-cysteine (NAC) on insulin secretion and peripheral insulin
resistance in subjects with polycystic ovary syndrome (PCOS).
Six
lean and 31 obese subjects, aged 19-33 years, were treated for
5-6
weeks with NAC at a dose of 1.8 g/day orally._ A dose of 3 g/day
was arbitrarily chosen for massively obese subjects. Six of 31
obese patients with PCOS were treated with placebo and served
as
controls.
Before and after the treatment period, the hormonal and lipid
blood
profile and insulin sensitivity, assessed by an hyperinsulinemic
euglycemic clamp, were evaluated and an oral glucose
tolerance
test (OGTT) was performed.
STUDY RESULTS:_ Fasting glucose, fasting insulin, and glucose
area under curve (AUC) were unchanged after treatment. Insulin
AUC after OGTT was significantly reduced, and the peripheral
insulin sensitivity increased after NAC administration, whereas
the
hepatic insulin extraction was unaffected._ The NAC treatment
induced a significant fall in T levels and in free androgen index
values._ In analyzing patients according to their insulinemic
response to OGTT, normoinsulinemic subjects and
placebo-treated
patients did not show any modification of the above parameters,
whereas a significant improvement was observed in
hyperinsulinemic subjects.
STUDY CONCLUSTIONS: NAC may be a new treatment for the
improvement of insulin circulating levels and insulin sensitivity in
hyperinsulinemic patients with polycystic ovary syndrome.
DR. DUNNE BOGGS' COMMENTS:_ N-acetyl cysteine (NAC) is
an altered form of the amino acid cysteine, which is commonly
found in food and synthesized by the body._ NAC supports your
antioxidant system and thus helps prevent cell damage. It's
available as a dietary supplement.
I do NOT recommend that you start using NAC at the 1.8
– 3 gram
(that's 1,800 – 3,000 milligrams) dose used in this study._
A
qualified physician should assist you with this, especially if you
are taking metformin._ However, 250-500 milligrams daily should
be OK for a start.
Although this is a small study, it suggests that NAC can play a
role
in improving your insulin sensitivity._ Many of you are taking
metformin for the same purpose. Improved insulin sensitivity is
crucial to reversing PCOS._ Our book will talk about NAC and all
the other natural things you can do to control insulin and avoid
the
side effects of metformin.
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The numbers in parentheses in the above articles are footnotes
to
medical journal articles._ Go to
http://www.ovarian-cysts-pcos.com/news.html
to see the newsletter with complete footnote references
included.
For more information about Dr. Nancy Dunne Boggs, go to
http://www.ovarian-cysts-pcos.com/ndb.html.
How can we make this newsletter more valuable to you?_ What
do
you want to know?__ Please send your comments or questions to
mailto:newsletter004@o...
Dr. Nancy Dunne Boggs, N.D. may be contacted at:
Bitterroot Natural Medicine
127 N. Higgins, Suite 202
Missoula MT 59802
Tel: 406-728-8544
Email: mailto:drdunne@o...
Website:
http://www.ovarian-cysts-pcos.com
Dr. Dunne Boggs is a Professional Member of the Polycystic
Ovarian Syndrome Association
~~~~~~~~~~~~~~~~~~DISCLAIMER~~~~~~~~~~~~~~~~~~~~
The information in this newsletter has not been evaluated by the
FDA. This information is not intended to treat, diagnose, cure or
prevent any disease, and is provided for educational purposes
only.
Always seek the advice of your physician or other qualified health
care provider with any questions you have regarding a medical
condition, and before undertaking any diet, exercise or other
health
program.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Copyright 2002 Nancy Dunne Boggs and Bill Slater._ All rights
reserved.
