Polycystic Ovarian Syndrome (PCOS) is one of the most common reasons for infertility in women. The first thing to understand about PCOS is that it is a syndrome and not a disease, and as such, it does not have a defined primary cause. However, its clinical manifestations and signs are well described.
Introduction
Clinically, some of the most common signs and symptoms of PCOS include: irregular periods, excess male pattern hair growth, and acne. Biochemically, there are elevated levels of Anti Mullerian Hormone (AMH), testosterone, dehydroepiandrosterone sulfate (DHEAS), and Luteinizing Hormone (LH). In addition, the ideal 1:1 ratio between LH and FSH (follicle stimulating hormone) is lost.
While there is currently some disagreement among doctors about the criteria required to make the diagnosis of PCOS, the ASRM (American Society for Reproductive Medicine) suggests that the diagnosis of PCOS can be made if 2 out of 3 of the following are present:
Oligomenorrhea (irregular menstrual periods) or amenorrhea (absence of menstrual periods)
Hyperandrogenism (based on clinical and/or biochemical signs)
Polycystic ovaries (on the ultrasound)
It is very well accepted and documented by the scientific community that PCOS is associated with insulin resistance. One of the earliest studies showing that PCOS is associated with hyperinsulinemia was published in 1980. The study concluded by saying that:
“it is clear that the syndrome has major metabolic as well as reproductive morbidities”.
A more recent study published in January of 2023 by the Journal of Ovarian Research concluded that:
“ PCOS involves various pathophysiological factors, and affected women usually have significant insulin resistance, which is a major cause of PCOS.”
How it all works
With enough evidence showing that there is a clear link between PCOS and insulin resistance, let’s try to understand this relationship. Insulin is a hormone that transports glucose to the cells. When we consume carbohydrates the pancreas secretes insulin to help transport the glucose into the cells. Since virtually every cell in the human body has insulin receptors, when insulin arrives at one of these receptors the cell “opens up” and allows the glucose to enter the cell so that it can be used as fuel.
When cells are overstimulated due to a large consumption of carbohydrates, they protect themselves by downregulating; they become less sensitive. The way they do this is by “turning off” some of their receptors. In the case of insulin, for example, a cell of a normal person has about 20,000 insulin receptors, where the cell of a person with insulin resistance has about 6,000. Insulin resistance creates two main problems; first, the glucose that was not able to enter the cell continues to circulate in the bloodstream creating diabetes, secondly, the additional insulin (hyperinsulinemia) plays a key part in the development of PCOS.
Hyperinsulinemia increases androgen (male hormones such as testosterone and DHEAS) secretion by the ovary and suppresses the liver from producing SHBG (sex-hormone binding globulins). SHBG helps control the amount of sex hormones that are actively working in the body. When the SHBG protein binds to sex hormones, your tissues can't use those hormones. Your tissues can only use sex hormones that are "free," which means they are not attached to proteins, such as SHBG.
The relationship between hyperinsulinemia and hyperandrogenism was documented over 100 years ago when Archard and Thiers published in 1921 a paper titled “the diabetes of bearded women” (diabete des femmes a barbe). In addition, the relationship between suppressed SHBG and PCOS has been documented by several studies. One of these studies, published in 2010 by the Canadian Institutes of Health Research, reported that:
“ Low levels of sex-hormone binding globulin (SHBG) contributes to high free testosterone levels in women with PCOS”
PCOS and Acupuncture
Several clinical trials have shown that acupuncture can improve many symptoms in patients with PCOS. These symptoms include chronic and continuous anovulation, hyperandrogenemia, insulin resistance, glucose and lipid metabolism dysfunction, and negative emotions. As stated earlier, one of the root causes of PCOS is hyperinsulinemia – which triggers the secretion of testosterone. Acupuncture has also been reported to improve insulin sensitivity and decrease testosterone levels. It was also found by another study that ovulation can be improved when acupuncture is combined with moxibustion.
As explained by a paper published in 2010 by Minerva Medica, stress plays a big part in infertility. High levels of cortisol affect the release of critical hormones in the body. For example, stress contributes to the overproduction of androgen hormones (male hormones such as testosterone and DHEAS). In addition, the hypothalamus releases less GnRH which in turn makes the pituitary gland to inhibit the synthesis and release of FSH and LH.
As shown by many studies, acupuncture can reduce cortisol levels and regulate endorphin production and secretion. Since Gonadotropin Releasing Hormone (GnRH) are affected by endorphins, the scientific community is becoming more accepting of acupuncture. A study published in 2022 by Frontiers in Endocrinology mentioned that:
“ Acupuncture may affect the production of β‐endorphin, which may lead to gonadotropin-releasing hormone secretion and then affect ovulation, menstrual cycle, and fertility”.”
Ovarian androgen overload is at the core of PCOS with hyperinsulinemia enhancing the production of androgen, which in turn, leads to impaired follicular maturation. A study published in 2007 by the Journal of Neuroendocrinology concluded that:
“Women struggling with infertility have the same levels of anxiety and depression as women diagnosed with cancer.”
Although acupuncture has been used to treat stress for hundreds of years, it has only been a couple of decades since fertility experts have been using acupuncture to help women relax to increase their chance of conceiving. A study done in 2019 concluded that:
“ Clearly, acupuncture can affect PCOS via modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine and the neuroendocrine system."
Conclusion
As demonstrated by several studies cited here and many others, acupuncture is very well suited to treat PCOS. By increasing insulin receptivity, lowering levels of testosterone, and lowering stress – which in turn helps the pituitary gland to secrete healthy levels of FSH and LH, acupuncture begins to bring the body back into harmony.