Polycystic Ovarian Syndrome (PCOS) and Endometriosis

Polycystic ovary syndrome (PCOS) is a set of symptoms due to a hormone imbalance in women.

Symptoms may include irregular or occasional periods, with heavy or light bleeding, amenorrhoea (lack of periods), weight gain, acne, excessive hair growth (hirsutism) and ovulatory problems.

What are polycystic ovaries (PCO)? Polycystic ovaries contain a large number of harmless cysts up to 8mm in size. The cysts are under-developed sacs in which eggs develop. Often in PCOS, these sacs are unable to release an egg, and so ovulation does not take place.

There is some confusion between PCO and PCOS. PCO and PCOS are NOT the same. It is possible to have polycystic ovaries (PCO) in one or both ovaries and not to have PCOS. It is also possible to have PCOS symptoms and not to have polycystic ovaries. PCO is essentially a reproductive hormone disorder. PCOS is a systemic (body wide) metabolic disorder which affects the digestive and reproductive systems. Polycystic ovaries (PCO) can only be diagnosed through ultrasound examination. PCOS is primarily diagnosed through history taking and confirmed by ultrasound.

According to the Rotterdam criteria, to be diagnosed with PCOS a woman must have two of the following three manifestations:

  • Irregular or absent ovulation
  • Elevated levels of androgenic hormones (leading to acne and excess body hair)
  • And/or enlarged ovaries containing at least 12 follicles each

The two most common profiles for women with PCOS are:

Type 1: Women with normal menstrual periods and normal fertility, but who have androgen excess and polycystic ovaries on ultrasound.

Type 2: Women with irregular periods and polycystic ovaries on ultrasound, but normal androgen levels.

A PCOS diagnosis does not necessarily mean that you are not fertile!

PCOS is a spectrum disorder. Studies show that simply gaining or losing weight can move a woman with PCOS up or down the spectrum. For example, irregular cycles may become regular as a woman loses weight.

PCOS is due to a combination of genetic and environmental factors. Risk factors include obesity, insufficient physical exercise, and a family history of PCOS. Conventional treatment may involve lifestyle changes such as weight loss and exercise. Birth control pills may be prescribed to improve the regularity of periods, excess hair, and acne. Measures to improve fertility include weight loss and medications such as clomiphene, or metformin. In vitro fertilization (IVF) is used by some in whom other measures are not effective. PCOS affects 5-10% of women between 18 and 44. PCOS may be associated with type 2 diabetes, obesity, obstructive sleep apnoea, heart disease, mood disorders, and endometrial cancer.

About Endometriosis

Endometriosis is a common chronic condition in which cells which usually line the womb are found elsewhere in the body. These pieces of tissue can be found in many different areas of the body, but are most commonly found on the ovaries, the fallopian tubes, on the lining of the pelvis behind the uterus and covering the top of the vagina. The endometrial cells behave in the same way as those in the womb, growing during the menstrual cycle and then shedding blood. This may result in pain and swelling as the shed blood cannot leave the body. The causes of endometriosis are unknown. Endometriosis can cause painful or heavy periods, pain in the lower abdomen, pelvis or lower back, as well as reduced fertility. However, the symptoms of endometriosis can vary significantly and some women have few or no symptoms at all.

Endometriosis can only be diagnosed through laparoscopic examination by a surgeon.

Acupuncture for PCOS AND Endometriosis

A World Health Organization review and analysis of controlled acupuncture clinical trials includes polycystic ovary syndrome as one of the “conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed”. Subsequent studies suggest that acupuncture may specifically help with symptoms of PCOS by:

  • Regulating follicle stimulating hormone (FSH), luteinising hormone (LH) and androgens
  • Modulating sympathetic nervous system activity and improving blood flow to the ovaries
  • Regulating steroid hormone receptors
  • Downregulating levels of testosterone and oestradiol
  • Controlling hyperglycaemia by increasing insulin sensitivity and decreasing blood glucose and insulin levels
  • Reducing the brain’s sensitivity to stress
  • Reducing swelling

The evidence to support acupuncture for the treatment of endometriosis is still preliminary. It is suggested that acupuncture may specifically help those with endometriosis by:

  • Providing pain relief
  • Reducing inflammation
  • Regulating prostaglandin levels

See also:

Treating PCOS
“It’s important to understand that having PCO or PCOS does not necessarily mean you are infertile. It’s also important to check with your GP that the necessary tests have been carried out to confirm your diagnosis.

PCOS is a chronic condition. In my experience it can take 6 to 12 months of acupuncture treatment to help restore ovulation and whilst it may not be possible in all cases, acupuncture alongside lifestyle changes can really help”.

Judy Bowen-Jones Lic Ac BSc Hons Ac MBAcC
FURTHER INFORMATION

Maciocia, G. (2007). Obstetrics & Gynaecology in Chinese Medicine. Elsevier

White, J. (2013). PCOS and Endometriosis. Naturechild

World Health Organization 2003. Acupuncture: Review and Analysis on Controlled Clinical Trials – http://apps.who.int/medicinedocs/pdf/s4926e/s4926e.pdf

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For more information see the British Acupuncture Council Research Fact Sheet below.

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