The scientific basis of PCOS disease.
Why the conventional pills and surgeries are absolutely wrong
Where it all begins - the hypothalamic persistent stress reaction
Our body is equipped with a stress management system, with hypothalamus sensing the dangers outside and inside the body, and making stress hormones which can help us to make a fight or run response. PCOS begins as a stress reaction, which is abnormally sustained at a higher level. The CRH and ACTH are elevated, creating an elevated level of blood sugar in the body. Usually, stress reactions are short lived and CRH, ACTH levels fall down with blood sugar level coming down to normal. In PCOS, the levels are kept high, due to abnormal signals coming from the hypothalamus.
This hypothalamic persistent stress reaction response is fixed in the body, and once it begins, it promotes a cascade of events. We may see a lot of different problems based on this primary event.
Why the reaction? As we are dealing with a lifestyle problem, we must know how a lifestyle problem works. The body is equipped with a stress response. And there are different stressors. If one stressor comes and goes off, the body can quickly come back to normal. If there are multiple stressors, and one or two of the stressors are more or less persistent, the body fixes that response permanently. After some time, even in the absence of stressors, the stress reaction may continue with its own momentum.
The stress reaction causes cortisol to rise permanently elevated.
This is an important and crucial step. The hypothalamus gives signals to produce CRH, and CRH elevation leads to the production of ACTH, and ACTH causes the production of cortisol- the final stress hormone. The role of cortisol is to elevate blood sugar level and to make the body alert.
This persistent sugar elevation can cause other secondary responses.
Cortisol elevation causes insulin elevation
The sugar in blood stimulates pancreas, and a lot of insulin is poured into the blood, to control the blood sugar. The levels of insulin required to control this much of sugar is fairly high, and there will be hyperinsulinemia.
Along with this, too much cortisol causes salt and water retention, and other problems.
Now we have two hormones systems elevated. Insulin elevation leads to a lot of problems in the body- alteration of Leptin, alteration of male and female hormones, alteration of growth factors and so on.
Insulin elevation leads to metabolic stress, which in turn cause more cortisol secretion.
This in turn causes a vicious cycle. The stress reaction causes elevation of blood sugar levels.The sugar level elevation causes insulin resistance, the insulin resistance causes metabolic stress, which in turn causes a stress reaction, and thus further elevation of cortisol.
Insulin elevation leads to male hormone elevation and leptin abnormalities.
Hyper insulinism leads to elevation of male hormones, especially testosterone. This is normally produced in Ovaries. If the ovaries are removed, the fat cells, adrenals etc can produce this hormone.
Male hormone elevation leads to dis-regulation of female hormones
In normal females, GnRH –FSH-LH secretion regulates estrogen and progesterone production. GnRH regulatory hormone is secreted by hypothalamus, rhythmically, based on the biological clock. GnRH controls FSH and LH production from pituitary. When there is male hormone elevation, this hormone axis is disrupted, and there is havoc in the system, leading to irregularity in menstruation. This irregularity can be of any nature-missing periods, continuous bleeding or scanty bleeding or painful bleeding etc.
All regulations mix up and further add to a set of vicious cycles, and the response continue in spite of the absence of any stress.
Finally, a stage reaches where all hormone systems are irregularly controlled and each hormonal abnormality causes further problems in other hormone systems. for example;
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Elevated ACTH causes mineralocorticoid elevation
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Elevated insulin causes growth hormone dysfunction
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Insulin causes leptin to work abnormally
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Leptin irregularities causes a lot of problems leading to dyspnea, autoimmune dysfunctions, depression, etc.
How PCOS develops in body
In PCOS, the events occur at multiple levels, and it is difficult to explain the complex biology. Anyway, for the simplicity of explanation, we summarize the events as follows. We follow this understanding to develop the paradigm for treatment. This explanation is fairly simple and it fits with the clinical presentations.
Now we have 4 basic hormone issues. These 4 basic issues will produce a lot of clinical problems either independantly or working together.
Do not forget the fact that, all clinics problems or symptoms may not be seen in all persons.
Finally these interconnected abnormalities fixes permanently as an altered homeostasis. The elevated insulin and errots in leptin causes metabolic stress, and this in turn creates elevation of cortisol. A vicious cycle is formed which makes the problem fixed forever.
The conventional treatments are foolish attempts to control a complicated lifestyle disease through a pill or surgery. The commonly used pills and surgeries are listed below.
Metformin
A diabetes pill with still unknown action, believed to reduce insulin resistance.
Since there are no other pills usable, everyone with PCOS is getting metformin. However, many large studies say that metformin is totally useless in PCOS. Some argue that metformin causes weight loss, but PCOS is not caused by weight, and there are many patients with very low weight.
Why not to use Metformin?
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It won"t correct the root cause.
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It can lead to diabetes later.
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It may promote renal failure.
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The long-term consequences in children and young adults are unknown.
Hormone Pills
This is the most commonly prescribed pills to “cure” PCOS. They are either steroid contraceptive pills or pills with more progesterone. These pills actually create an artificial bleeding, mimicking menstrual periods.
Why not to use Hormone pills?
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It wont correct the root cause. It just a way to fool yourself. The monthly bleeding you see is just an artificial bleeding. It will bleed if you eat hormone pills for few days and then stopping them.You may be asked to eat pills for 21 days and then stop.If you eat these pills for 35 days for 57 days or 100 days, and stop, you will bleed. It is not menstraution, because there is no ovulation.
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They can cause liver cancer in prolonged use.
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They cause further worsening of PCOS by increasing weight. They can cause worsening of many of the symptoms of PCOS like depression.
Cutting part of ovaries, or drilling cysts.
This was the first surgery used to treat PCOS. People believed that the ovaries ( or the cysts in the ovaries) are the “cause”. And by cutting them off, we can cure the problem. Cysts in ovaries are not the cause, and in most PCOS victims, ovaries are normal.
Why not to use these methods?
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Again, they do not solve root cause.
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They make you believe that ovaries are the cause. It is not true. PCOS is essentially a hypothalamic disease.
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They can cause problems in your body by making adhesions.
If ovaries are the cause, why not to remove entire ovaries? You know now-it wont work.
Infertility treatments
In some PCOS patients, infertility is a major problem. They see different kinds of experts and do umpteen numbers of tests. Finally they have to choose from the two options-either go for IVF ( test tube baby) or go for clomiphene or letrazol treatments.
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IVF will not cure PCOS.
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Since there is always a risk of miscarriages less than 90 days, the pregnancy can be lost and you have to do the IVF again and again. If you have this miscarriage problem, correct PCOS first.
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Since the patient is having uncorrected PCOS and pregnancy, she may develop diabetes, hypertension, eclampsia etc.
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However, if you are desperate to have a baby, you can try these methods, but make sure that you correct your PCOS first, then you can get pregnant safely in the normal biological way.
Herbal medicine, nutritional supplements and alternative medicine
There is no role for any medicine or supplements in a lifestyle disease. No chemical in the world, can "cure" PCOS, because it is primarily a lifestyle error, going out of control in the body. Some of the herbal medicines contain metformin like compounds ( metformin type compounds are plenty in various plants, and these herbs were used for diabetes treatments for centuries), and these compounds are generally toxic.
Likewise, no role exists for homeopathy, Chinese medicine, acupuncture or ayurveda in PCOS management. We often equate a disease with a remedy. PCOS not a nutritional deficiency to be treated with a pill. Nor it is an infection to be cured with an antibiotic.
Treating the symptoms of PCOS than treating the PCOS.
You may get treatments for acne, neck pigmentation, migraine, hair loss, infertility, depression etc etc, without even realizing the fact that you have PCOS.
Many patients will not have any abnormalities in menstruation, and they experience all other problems. They wont know that they have PCOS. The problems can be single or multiple. They go to a specialist, and he prescribes a medicine for the single problem. In most cases, the problem will remain unsolved, and the specialist will prescribe more pills. Sometimes these pills themselves can aggravate PCOS.
For example- Patient A, a migraine patient goes to a neurologist. Her periods are normal but she have some oiliness in the face and some lethargy. She gets sumatriptan. Fine. The headache goes off . But she gets repeated attacks, and each time she takes pills.
Another example- pateint B gets depression. Psychiatrist gives anti depressants. Most anti-depressants causes weight gain, alteration in leptin function etc, and causing worsening of PCOS. If PCOS is worsening, depression is going to worsen further. What is the option for the psychiatrist? To give more antidepressant!.
This happening around the globe. PCOS can appear as different unrelated disorders. Most specialists are not aware of the general hormonal dysfunction, and see only their part of the problem as an isolated one.
