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Taking Charge of Your Health


Hello, everybody. My name is Dr. Talia Marcheggiani. I’m recording to you guys from my clinic in
Bloor West Village. It’s called Bloor West Wellness Clinic. And today I want to talk to you guys about
one of my favourite conditions to treat when it comes to naturopathic medicine. And this condition is called Polycystic Ovarian
Syndrome. And this is an endocrine, or hormonal condition,
and it affects about 10% of women. It’s the most common cause of hormonal imbalance
in women of menstruating age. And it’s a syndrome, so it’s not a disease. There’s a different constellation of symptoms
that arise with it and this could be one of the causes of infertility in a lot of women. And because the symptom pictures are so diverse,
it’s really hard for a lot of women to be suspected for a diagnosis of PCOS, or polycystic
ovarian syndrome. So, PCOS, the hallmark, the diagnostic criteria,
based on the Rotterdam Criteria, is having either two of these three symptoms: anovulation
or oligomenorrhea, which means having periods that are irregular. So, either having more than one period per
month or missed cycles and long cycles of 6 weeks or more. The average female menstrual cycle is about
26-34 days, so having periods outside of that “normal” range could indicate one of the symptoms
of PCOS. The other one is something called “hirsutism”,
which is caused by high androgens, or male sex hormones, like testosterone or DHEA. And some of the symptoms of that are acne,
so hormonal acne, those pustular, cystic acne that happens around the chin and jaw-line,
or the chest and back. And “hirsutism”, which is the male-pattern
hair growth, which is great, if you’re a woman, to have, which is the hair on the mustache
and chin. So, you kind of sport a Frida Kahlo mustache
and probably have to deal with that on the regular. Similarly, having hair loss on the scalp,
is another sign. So, when you think of men, men will typically
experience male-pattern hair loss, and hair-growth in the facial area. And the third symptoms is the presence of
cysts on the ovaries, which is diagnosed or sighted with a transvaginal ultrasound. There’s a scope placed through the vagina
and an ultrasound is done to see if there are cysts on the ovaries. It can also be diagnosed with lab work, so
that’s not using the Rotterdam criteria, but there are two hormones that the brain makes
that control the ovaries and these are called FSH, or follicle-stimulating hormone, and
LH, lutenizing hormone. The brain makes the hormones and they tell
the ovaries when to ovulate and the ovaries also make LH, lutenizing hormone after they’ve
ovulated, or after the corpus luteum forms, after ovulation should happen, so whether
the egg is fertilized or not, the corpus luteum will form. And so PCOS is probable when you order labs
and find that, so the FSH and LH should be almost the same, they should be at a 1:1 ratio
and PCOS suspect when the LH to FSH ratio is 2:1 or higher. So you have either 2 or more times the LH
than you have FSH. And this is because in PCOS, the ovaries will
secrete a lot more LH and that is one of the reasons why they hypothesize that there are
high androgens, because the LH can stimulate more androgen release. So, there’s a “skinny PCOS”, so these are
women with those symptoms that don’t experience obesity or metabolic syndrome, and then there’s
the metabolic syndrome type of PCOS and in these patients there’s an insulin-resistance
present, or a glucose-intolerance. And so these women will frequently experience
hypoglycaemic crashes. They’ll also probably be on the obese side
and really struggle to keep weight off and they’ll experience the low energy, the cravings
for carbs. They’ll experience the hunger that comes two
hours after a meal, despite having eaten an adequate amount of fat and protein, and this
is really problematic for them because they’re set up for diabetes and for cardiovascular
disease down the line. And then they’re also experiencing symptoms
of obesity and they’re not super happy with how they look. And we’re not exactly sure what causes PCOS
in women. There’s evidence for it being heritable, so
genetically passed on. There’s evidence for it being caused by insulin-dysregulation,
and perhaps the ovaries are not responding properly to insulin. What insulin does, is it helps us take in
fuel or glucose into our cells and, just like all the cells in our body, the ovaries require
insulin to absorb glucose so that they can function properly. And so one of the theories of PCOS is that
the ovaries are resisting insulin and the insulin is signalling them to grow, but they’re
growing in the absence of proper fuel, or proper glucose as fuel and so they’re creating
these follicles, or cysts. And so, absence of periods, or irregular periods;
male-pattern hair growth; obesity; infertility and then the presence of those cysts on the
ovaries are all symptoms of PCOS. So, when we’re trying to get a diagnosis,
we’ll send patients in for a transvaginal ultrasound. We’ll also look at their fasting blood glucose
and fasting insulin. We’ll look at their progesterone and estrogen,
because oftentimes these women are suffering from estrogen-dominance: there’s low progesterone
and high estrogen in relation to the levels of progesterone. We’ll look at their FSH and their LH, and
I’ll also check out their thyroid because oftentimes the symptoms of hypothyroidism
and PCOS are overlapping and so I want to find out if there’s a thyroid pathology happening
in the background. So, one of the main reasons that women will
come in with PCOS is because they’re trying to get pregnant, or they want to preserve
their fertility in the future. They might come in for acne issues or the
hair growth, or just to sort out their periods, but the main reason that they come in is fertility. And 40% of women with PCOS do experience infertility
or fertility challenges. So this is a big issue for them. And the reason I love treating PCOS in my
practice is I find that, and this is sort of perhaps not technical or scientific, but
I find that the personality of women with PCOS tends to be more phlegmatic, so they’re
usually more agreeable, and happier and patients that really want to do good work and so it’s
really enjoyable to work with them. But also, the reason I love treating patients
with PCOS is because there are so many effective strategies that naturopathic medicine offers
and I don’t see an equal amount of strategies in the conventional system. And I’ll talk a little bit about some of the
conventional therapies of PCOS. So, what happens is, in conventional therapy,
is they kind of look at the symptoms in the syndrome spectrum and they kind of try to
deal with each symptom individually. So they look at irregular periods and they’ll
prescribe a birth control pill. So, like, “ok, we’ll just over-ride your own
hormonal production and we’ll control your periods and get you cycling regularly”, which
obviously doesn’t treat the underlying hormonal imbalance, because you’re just placing exogenous,
fake hormones on top of the picture. Or they’ll say, “ok, there’s blood-sugar dysregulation,
so I’m going to prescribe a diabetic medication called ‘metformin’, which will help resensitize
your cells to insulin”, which again is not the best strategy, although there’s some evidence
to support that this helps. But, we’re not again treating the underlying
issue of insulin resistance and metformin is pretty toxic to oocytes, or ovarian cells,
so when you’re treating infertility you’re not setting the body up for healthy ovulation
and producing a healthy baby. So, ehh, metformin. And then we have, they’ll treat the high androgen
symptoms, the hirsutism symptoms, the hyperandrogenism, by prescribing spironolactone, or Yas or Yasmin
birth control pills, that block androgens. And, again, not the best strategy because
it’s not treating the underlying cause, and there’s some evidence that Yas and Yasmin
are one of the oral contraceptive pills that set you up for a higher risk of blood clots
compared to other pills. So, women who are taking these are slightly
higher than normal, compared to other birth control pills, risk of pulmonary embolism,
deep vein thromboses, and those kind of blood clotting issues, which could be fatal. So, that’s an issue, right? And, again, not treating the underlying cause. So there’s not that many great therapies and
they’re not holistic. They’re not looking at the whole picture,
they’re kind of reactionary and they’re just treating the symptoms. And then in terms of fertility, so women will
undergo IVF treatments or they’ll be prescribed ovulation drugs like Clomid, which increase
estrogen and get your body ovulating, kind of forcing ovulation to happen and again can
be an issue because these women with PCOS are having sometimes an estrogen dominance
picture, so their estrogen is high in relation to their low progesterone and so adding more
estrogen-promoting drugs like clomid could just make life a mental and emotional disaster
for these women while they still have the drug in their bodies. That could happen to a lot of women, but,
again, not the best. It could achieve the end goal of getting pregnant,
by increasing your chances, but we’re not looking at what’s going on. And so, what happens, if when I first see
a patient with PCOS, we’ll run the labs, or I’ll get the labs that their family doctor
has run, if that was done recently, and we’ll take a look at their symptoms, so I’ll ask
them how their periods are, and if they get PMS symptoms, and how often their periods
come. And I’ll get them to track their periods,
so I can see are they happening regularly, and they’re just very far apart? Or are they all over the place? We’ll look at their FSH and their LH, to see
if they have that classic high LH to FSH ratio, and we’ll look at their insulin and fasting
blood glucose and their testosterone. And I’ll ask them about symptoms, like acne
and hair growth and we’ll talk about weight loss and if they’re getting those hypoglycaemic
or insulin resistance symptoms. And we’ll talk about mood and emotions and
digestion as well, which I talk about with all my patients, and energy and things like
that, because we want to get a holistic picture and we want to —the reason is when I’m treating
people I’m treating from the premise that it’s possible to be healthy and we can influence
our health and the more I examine healthcare, and the healthcare model that is conventional,
the more I doubt that that’s the premise that they’re standing on. Right? They’re kind of looking at making symptoms
manageable, or maybe achieving outcomes or end goals, or preventing death and things
like that, but they’re not coming at health conditions from a place of: “this person can
influence the situation that they’re in through targeting and trying to understand the root
cause of what’s going on, and then treating that.” So that’s where I’m coming at it. I’m looking at the whole picture, and I’m
trying to understand this person’s unique hormonal imbalance and what the symptoms are
that manifest from that. Then it comes to choosing a treatment plan,
so there’s lot of treatment that have a robust amount of evidence surrounding them and so
you frequently hear people say that naturopathic medicine, or functional medicine, of these
natural forms of medicine have no evidence and they’re pseudoscientific, well there’s
tons of evidence for increasing fertility and improving PCOS using natural remedies,
like nutriceutical remedies and herbal remedies. So, first of all we have something called
inositol. Inositol acts like a sugar in the body and
what it does is it re-sensitizes the ovaries to insulin and serves as a fuel for the ovaries. And inositol doesn’t have much of a taste,
it doesn’t have any side effects. It actually has some positive effects in helping
with bipolar disorder and psychosis and those kind of mental health disorders, so if those
are comorbid, then it’s great. If you have PCOS and you have bipolar, then
inositol is a great choice. And with inositol, there’s some studies that
show that in 3 months of supplementing with inositol periods have become regular, hyperandrogenism
symptoms have gone down, so the acne and hair growth, and women had a 1 in 2 chance of getting
pregnant. And then another 3 months of that, and their
chances went up. So, inositol on its own is pretty powerful. Another nutriceutical is N-acetyl cysteine,
so NAC, which helps the liver clear out hormones and rebalance hormones and another great remedy
for PCOS. We’re not exactly sure how it works, but there’s
some theories about it rebalancing hormones, and perhaps through it’s antioxidant activity,
because NAC creates an antioxidant, the main antioxidant in the body called “glutathione”. So, probably through its antioxidant activity,
it’s helping the mitochondria, those fuel-houses for the cell, work better. Another thing, when it comes to PCOS are some
herbal remedies. So there’s an herb called vitex that helps
establish a healthy hormonal estrogen and progesterone balance and that could be appropriate
for some women. And there’s some studies using white peony
and licorice that can help lower those hyperandrogenism symptoms. And then there are some herbs like saw palmetto
that can help balance those high androgens as well, as they bind up testosterone and
DHEA in the blood, so they increase something called sex hormone binding globulin (SHBG)
and that can help clear out excess testosterone. So those are just a few of these herbal and
nutriceutical remedies that can be helpful in PCOS and I might prescribe some B-complex
or some magnesium depending on how the adrenal glands are functioning and how hormones are
cycling. And another thing we really like to do is
tackle PCOS with diet and improve that blood-sugar balance if some of those insulin resistant
symptoms or metabolic syndrome symptoms are there. And there’s a great study that shows that
front-loading, so really increasing the calories that women are eating in the morning, having
moderate calories at lunch and then having a lower or lighter dinner, kind of a snack
for dinner, is really helpful in promoting fertility, lowering those androgens, resensitizing
the ovaries and the other cells in their bodies to insulin and thereby resetting the hormonal
stage. Really cool that this study just by changing
your diet, although not the easiest change, is helpful for balancing hormones and you’re
not doing something toxic, like the birth control pill or metformin, or something like
that. Also, a paleolithic diet, so changing the
glycemic index of your diet by choosing fruits and vegetables that are lower on the glycemic
index, so those leafy greens and adding fat and protein to every meal. It’s difficult as a vegetarian to shift hormones
for the better and so I often recommend a more paleolithic diet to women, however, vegetarians,
it is possible to increase your protein, it just takes a little bit more of conscious
effort. And the reason that paleo diet is helpful
is because it is lower glycemic index and has those higher fruits and vegetables with
their antioxidant properties, but it also promotes the healthy fats and having an adequate
intake of lean protein, such as your chicken, fish, lean beef, or eggs and even some dairy
products depending on how someone tolerates that. And the last thing I’m going to talk about—this
is just sort of a PCOS overview—the last thing I’m going to talk about is, with my
patients I always work on self-care and stress relief because we know that the stress hormone
cortisol can really mess up the other hormones in our body. It can contribute to insulin or worsen insulin
resistance. It can worse that estrogen-dominance picture,
it can prevent us from making enough progesterone because the progesterone and the cortisol
pathway follows the same pathway and so that could be problematic if we need more progesterone
but we’re using all of the resources to make it on making cortisol to deal with our stressful
lifestyle. And a big part of managing PCOS, I find, is
just getting cortisol under control and that might include increasing self-care, getting
into things like yoga or meditation or doing some shin-rin yoku, like in the other video
where I talk about Japanese Forest Bathing, so spending time in nature. That could be walking in the woods, or gardening,
even watering a plant or hanging out with a pet or animal. Doing these things that feel nurturing and
feel supportive to the mind and the emotions and help us face the daily stressors that
we face with more resilience are all great strategies for managing hormonal health. So, if you have any questions, just send me
an email at [email protected] or you can check out my website at taliand.com and my
blog for other articles on hormonal balance, such as estrogen dominance, choosing an oral
contraceptive pill, if you need one, and another article that I wrote about PCOS. Have a great day, and I’ll see you guys soon.

8 thoughts on “Naturopathic Treatment of Polycystic Ovarian Syndrome

  1. Hey this look pretty convincing, thank you. By the way did you take a look at Tilly Strankten's website? there's a method to feel energized and relaxed, and forgetting about the stabbing pain if that's what you're looking for. Usually takes 30-60 days to take full effect, even though you can begin feeling the relief in a week.

  2. Great video thank you!! Everything you have said is spot on with my PCOS and the journey it has taken me in onto regaining and managing my health.

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