The following article has some amazing information about PCOS and Thyroid functions. It's kind of long but has a lot of useful information.
I read an article entitled Thyroid and Fertility by a Naturopathic Doctor based in Toronto Canada named Dr. Fiona McCulloch and I was intrigued. I discovered that Fiona has PCOS herself and that she commonly works with women who have PCOS and sub optimal thyroid hormone levels. I knew she would be the perfect person to invite to write a guest post about this important connection between PCOS and thyroid health.
Written by Dr. Fiona McCulloch ND, Founder of White Lotus Naturopathic
Polycystic ovarian syndrome (PCOS) is the most common reproductive disorder, affecting up to 12 percent of all women. It is a disorder with many different faces, and it causes great emotional and physical distress to the millions of women worldwide who suffer from it.
2 of the 3 following criteria are required for a diagnosis of PCOS (as defined by the Rotterdam Criteria):
1) Anovulation or Irregular Periods
2) Hyper-androgenism/elevated male hormone levels
Clinical hyper-androgenism: adult acne, hirsutism (a male pattern of body or facial hair), or hair loss (androgenic alopecia)
3) Polycystic appearing ovaries on ultrasound, containing multiple small follicles
Women with PCOS are at risk for infertility and early pregnancy loss. Many are overweight, find it difficult to lose weight, and suffer with fatigue, depression and anxiety. There’s a significant overlap of symptoms between PCOS and Thyroid Disease, despite the fact that they are two very different conditions.
Is there an actual relationship between PCOS and thyroid function? Let’s take a look at the research to learn more about this important connection.
PCOS, Thyroid, and Insulin Resistance First and foremost, it is known that insulin resistance is a major component of PCOS, and 50-70% of those suffering from it have high insulin levels or impaired blood sugar regulation. It’s important to note that insulin resistance develops many years before diabetes, so the most common tests for diabetes don’t often pick it up. Insulin resistance is caused by a variety of factors, including genetics, weight, diet, and lifestyle.
Insulin is a hormone that signals muscle and fatty tissue to take up glucose from the bloodstream and to store it as fat or energy. When the body tissues are “resistant” to insulin, the pancreas simply makes more insulin to compensate and to keep the blood sugar levels controlled. As such, a woman with PCOS will often have much higher insulin levels in her blood than normal.
With PCOS, even though other tissues in the body are resistant to insulin, for some reason the ovaries and pituitary gland remain very sensitive to it. High insulin levels cause the pituitary gland to make too much luteinizing hormone (LH), and too much LH causes the overproduction of testosterone, thus hindering ovulation.
As part of a vicious cycle, the high testosterone in PCOS sparks even more insulin resistance.1 You can get a general idea of how high levels of insulin contribute to the overall picture of PCOS as a result: the higher the insulin, the more severe hormonal dysregulations become.
Interestingly, research suggests that low thyroid function aggravates insulin resistance in PCOS.2
Subclinical Hypothyroidism. Is it related to PCOS?On average, women with PCOS have higher TSH levels and are also more likely to have subclinical hypothyroidism when compared to age-matched controls without PCOS.3
When it comes to defining subclinical hypothyroidism itself, there is great controversy which I’m sure that many readers of this blog will be well aware of. Several studies have suggested a lower cut off than the conventional 4-5 miU/L to define subclinical hypothyroidism. The National Academy of Clinical Biochemistry (NACB)’s laboratory guidelines state that >95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L.4
There is little research on the use of FT3 and FT4 for the diagnosis of subclinical hypothyroidism, but countless patients and clinicians have experienced that these markers are important correlations to overall wellness and energy levels. In my own naturopathic practice, I find it generally best to treat the patient’s signs and symptoms, as patients feel best at different “personal” ranges for thyroid markers. That being said, some evidence does suggest that women who have PCOS with a TSH out of a specific range may be at increased risk.
TSH levels and PCOSA 2009 study looked at a group of 337 women with PCOS. All of the women were assessed for the key markers of PCOS, including hirsutism, acne, and menstrual irregularity.
What the researchers found was that the women who had the lowest levels of insulin resistance also had the lowest TSH values (under 2miU/L). Women with the highest TSH values tended to have the most severe insulin resistance. Interestingly, this was not related to weight: subclinical hypothyroidism caused insulin resistance in women in all weight categories.
The study concluded that a TSH above 2 miU/L was associated with insulin resistance in PCOS.
Another study on women with PCOS5 found that those who had a TSH > or =2.5 mIU/L had a higher BMI, higher fasting insulin levels, higher total testosterone, and decreased sex hormone-binding globulin concentrations in comparison with women with a TSH <2.5 mIU/L.
As such it appears that for women with PCOS, an optimal TSH range may be below 2-2.5 mIU/L.
Again, the research existing on this topic is focused on TSH, but it is also highly likely that an optimal range exists for FT3 and FT4 in PCOS. In my practice, I have found that values at the top 1/3 to 1/4 of the range may provide benefit for some women with PCOS.
Sex Hormone Binding Globulin, Thyroid and PCOS Changes in thyroid function can also influence levels of sex hormone binding globulin (SHBG). This compound serves to bind up the male hormones in the blood, and when levels are low, male hormones run rampant in the body, producing all of the unpleasant symptoms of PCOS. Typically in PCOS, high levels of insulin push down the SHBG, leaving androgenic hormones free to create problems.
Thyroid hormones increase the levels of SHBG.6 A deficiency in thyroid hormones will make androgenic symptoms such as hair loss, acne, and hirsutism worse.
Ovarian Volume and Ovarian Cysts in Hypothyroidism. Interestingly, hypothyroidism itself may induce a PCOS-like picture. Hypothroidism increases the size of the ovaries and promotes cyst formation, and collagen deposits are found within the ovaries of animals with hypothyroidism. Interestingly, in humans, hypothyroidism causes the deposit of mucopolysaccharides within various organs. Material deposited in the ovaries hampers ovarian function and hormone synthesis, resulting in disrupted menstrual cycling. The “cysts” of PCOS are actually follicles that have not ovulated, having undergone partial development. As such, the disruption of ovulation by hypothyroidism may also produce similar cysts.
A 2011 study7 compared two groups of women with hypothyroidism—one group with polycystic ovaries and the other with normal ovaries—to a group of women with normal thyroid function. The researchers discovered that the hypothyroid women had larger ovaries. Providing thyroid hormone replacement therapy reduced the size of the ovaries in both groups of hypothyroid women, and improved TSH, FT3 and FT4, prolactin, estradiol, free testosterone and total testosterone levels.
Interestingly, in all hypothyroid women in this study, the polycystic ovary appearance completely disappeared when thyroid function was restored. Although many of the women experienced improved menstrual regularity, 50% of the women with polycystic ovaries still did not begin to cycle regularly.
As such, we can see that hypothyroidism can create an ovarian condition similar to PCOS, but the two conditions can also co-exist.
Autoimmune Thyroiditis and PCOS Autoimmune thyroid disease, also known as Hashimoto’s thyroiditis, is the leading cause of hypothyroidism in women of reproductive age. There is a clear correlation between Hashimoto’s thyroiditis and PCOS.
A 2012 study8 found that women with PCOS had a 65% increase in thyroid peroxidase antibodies, and a 26.6% increase in the incidence of goiter, when compared to age-matched subjects.
Another 2013 analysis9 found that in a total of 6 studies involving 1605 women, there was an increased prevalence of autoimmune thyroiditis, increased serum TSH, increased anti TPO antibodies, and anti TG antibodies in women with PCOS when compared to control groups.
In addition to the higher incidence of autoimmune thyroid disease in women with PCOS, a recent study10 showed that women suffering with PCOS-related infertility who also had high anti-TPO levels were significantly more likely to be resistant to Clomid. The study went on to conclude that autoimmune thyroid disease is associated with poor treatment response in infertile women who suffer from PCOS.
The Bottom Line on PCOS and Thyroid Function At this point, one thing is absolutely clear: all women with PCOS should have their thyroids evaluated thoroughly (TSH, FT3, FT4, Anti TPO, Anti TG). Thyroid health has a profound impact on the pathology of PCOS, affecting all aspects of the disorder. In my practice, I commonly work with women who have PCOS and “suboptimal” thyroid hormone levels, and I have found that correcting subclinical hypothyroidism is key to improving overall hormonal and metabolic health.
Some patients with PCOS require thyroid hormone replacement therapies, but there are also PCOS patients with mild thyroid hypofunction or Hashimoto’s who benefit greatly from therapies such as adrenal support, thyroid specific nutritional supplements, and dietary changes to reduce autoimmunity.
As a Naturopathic Doctor as well as a woman with PCOS, I have firsthand experience with the results that can be achieved via lifestyle change, a diet that lowers inflammation and insulin levels, and supplements/herbs that address hormone regulation. These simple changes work together to create a truly effective reversal of this disorder.
When it comes to both thyroid conditions and PCOS, each patient is truly unique in her needs. Our hormonal systems are complex and intertwined, and doctors should look at the specific relationships that exist in each and every patient to create a plan that helps to restore optimal metabolic and hormonal health.
About Dr. Fiona McCulloch
Dr. Fiona McCulloch is a board certified Naturopathic Doctor who has been in practice since 2001 in Toronto, Canada. She graduated with a Bachelor of Science degree (Biological Sciences) from the University of Guelph and went on to graduate from the Canadian College of Naturopathic Medicine. Dr. Fiona is the founder and owner of White Lotus Naturopathic, a busy urban clinic specializing in women’s health, endocrinology and fertility. Her clinical focus is on the treatment of fertility and hormonal conditions and she is an avid writer and researcher, developing naturopathic treatment protocols for hormonal concerns based on the most current evidence. Dr. Fiona has published a variety of articles in naturopathic journals and is currently working on her first book on the naturopathic treatment of PCOS by clinical phenotype. She lives in Toronto with her husband and 3 boys.
I've researched what vitamins are suggested for those with PCOS. These are all the vitamins that were talked about the most in several articles.
Once thought of as a gift fit only for monarchy and Gods, this spice is widely used in the 21st century. Cinnamon has shown to significantly reduce appetite when consumed daily. Cinnamon can help maintain blood sugar levels, which in turn can reduce sugar cravings and promote weight loss. There have been no reported side effects of consuming cinnamon for a prolonged period of time.
Many claim that Chromium Picolinate can lower the instance of insulin resistance, can reduce carbohydrate cravings and alleviate signs of depression. Women with PCOS have a higher chance of becoming diabetic later in life. This is why Chromium Picolinate can be beneficial for women with PCOS.
Vitamin B Complex
Consisting of 8 essential vitamins; thiamine, riboflavin, niacin, pantothenic acid, biotin, folate, B6 and B12, B complex has shown to be beneficial to women. Vitamin B complex can reduce symptoms of depression and increase energy levels.
Also found in Vitamin B Complex, biotin in larger doses can reduce hair loss and help lower blood sugar levels. Biotin is generally targeted to improving hair, skin and nails.
Generally found in fish, avocado and nuts, Omega-3 fatty acids have shown to reduce inflammation. Omega-3 supplements can reduce the pain and swelling around the abdomen that many women with PCOS experience. Omega-3 is great for aging men and women, as it lubricates the joints and may prevent osteoporosis.
Sometimes known as vitamin B-8, inosotol reduced insulin resistance and improved symptoms in women with PCOS in a study conducted by Virginia Commonwealth University. A 2007 Italian study conducted by the University of Perugia and reported by lead author S. Gerli also found that inosotol given with another B vitamin, folic acid, improved ovulatory function and also raised high-density lipoprotein levels, the protective “good” type of cholesterol. The study, which lasted 14 weeks, followed 92 women, half taking folic acid only as placebo and half taking a combination of inositol and folic acid. The inositol plus folic acid began to ovulate in 25 percent of cases, compared to 15 percent for the folic acid only group.
In the University of Perugia study, folic acid, also known as vitamin B-9 was given along with inositol. The combination of the two worked better than folic acid alone to improve PCOS symptoms. Folic acid has a protective effect against neural tube defects that occur in early pregnancy, so women with PCOS trying to get pregnant should take at least 400 mg of folic acid daily.
The Yale PCOS Program states that vitamin D is given as part of their lifestyle management program to treat PCOS, because many of the symptoms of vitamin D deficiency also affect women with PCOS. Symptoms include insulin resistance, increased weight and increased risk of developing heart disease and diabetes. Both vitamin D and calcium are given to decrease insulin resistance and decrease PCOS symptoms. Yale University is currently conducting a clinical trial on the benefits of Vitamin D and calcium in PCOS.
I've just started taking these vitamins and I'll update you at a later time how they are working and what effects I'm noticing!
Vitex (Chasteberry), Fertility
and PCOS Vitex agnus-castus (chaste tree berry) is a well-known herb that has been used for centuries in Europe for hormonal imbalances in women.
It may help women with PCOS who are lacking a normal menstrual cycle and thus don't ovulate or menstruate. A high percentage of these menstrual problems are related to insufficient progesterone during the luteal phase of the menstrual cycle. This condition is called a luteal phase defect or corpus luteum insufficiency. A corpus luteum insufficiency is defined as an abnormally low progesterone level 3 weeks after the onset of menstruation. Insufficient levels of progesterone may result in the formation of ovarian cysts.
In addition, some PCOS women have too much prolactin, which can inhibit fertility. Vitex may help with both of these problems
"I've spent thousands of dollars, been to five different gynecologists and had no results from their treatment for PCOS for the past ten years. It was one of your success stories that gave me the courage to try the alternative.
I'm happy to tell you that I took the vitex tablets and I am now 3 months pregnant. My husband and I are very happy. I now definitely believe that alternative medicine is the best way to go."
- Janet Beckford
How does Vitex Work? Chaste tree berry acts on the hypothalamus and pituitary glands inside your brain by increasing luteinizing hormone (LH) production and mildly inhibiting the release of follicle stimulating hormone (FSH). The result is a shift in the ratio of estrogen to progesterone, in favor of progesterone. The ability of chaste tree berry to raise progesterone levels in the body is an indirect effect, so the herb itself is not a hormone.
When you don't ovulate to start the second half of your monthly cycle, your body does not produce enough progesterone. The resulting progesterone deficiency contributes to symptoms of PCOS. It also contributes to a hormone imbalance called "estrogen dominance". Women with polycystic ovary syndrome frequently have estrogen dominance combined with a progesterone insufficiency. This is part of the hormonal imbalance typically associated with this disorder.
If you were to take oral progesterone or apply progesterone cream to your skin, and a normal cycle occurs, then you can suspect that you have a problem producing enough progesterone.
Chaste tree berry helps your body to solve this problem.
A progesterone-induced menses indicates an intact reproductive system that just isn't going through its cycle. It suggests that the body is producing enough FSH to stimulate the ovaries, and that the ovaries are able develop follicles. It also indicates that production of estrogen by the follicles is sufficient to cause the lining of the uterus (endometrium) to grow and that the sloughed endometrium is able to pass through the cervical opening and the vagina.
Therefore it's possible that the problem is a dysfunction in your hypothalamus or pituitary glands in your brain. The ability of chaste tree to influence the hypothalamus or pituitary then makes this herb a good possibility for treating infertility associated with lack of a normal monthly cycle.
Also, high levels of the hormone prolactin are commonly found with corpus luteum insufficiency. Vitex is useful for reducing high prolactin levels. It inhibits prolactin release by the pituitary gland, especially when you are under stress.
Is Vitex a Hormone? Vitex is not a hormone, nor does it contain hormones. It is a gentle and slow-acting herbal extract as opposed to a hormone prescription that can be expected to have a forceful and immediate impact on your glands and organs.
It does not have the side effects that synthetic hormones have.
What's the Medical Evidence for Vitex Agnus Castus? There's not a huge body of research about the chaste tree berry in relation to PCOS. However, there is enough evidence to suggest that it could be useful for issues associated with polycystic ovary syndrome such as infertility, acne, hyperprolactemia, female hair loss, and chronic inflammation.
Infertility In one study, a chasteberry preparation was used in a study of 3,162 women to assess the effectiveness of vitex for corpus luteum insufficiency. 77.4% had menstrual cycle disturbances of various types and the others suffered from a range of gynecological problems which included symptoms of corpus luteum insufficiency. The average length of treatment was 5 months.
One-third of the women reported the treatment to be completely effective. Fifty-five percent reported significant improvement , and only 7% reported no improvement. Their doctors reported very good results in 68% of cases, adequate in 22%, and no change in 7%. (1)
In another research study, 20 women with secondary amenorrhea took the extract for 6 months. Lab testing was done to measure progesterone, FSH, and LH, and pap smears were done at the beginning of the study, at 3 months, and at 6 months. At the end of the study, the researchers were able to evaluate 15 of the women. Ten out of the 15 women had a return of their menstrual cycles. Testing showed that values for progesterone and LH increased, and FSH values either did not change or decreased slightly.(2)
In a third study, 18 women with abnormally low progesterone levels were given chaste tree berry extract daily. After 3 months of treatment, 13 showed increases in progesterone and 2 became pregnant.(3)
Hyperprolactinemia In one research study, fifty two women with luteal phase defects due to latent hyperprolactinemia (high prolactin levels) were given either vitex or a placebo. Prolactin levels were normalized after three months in the treatment group and deficits in luteal progesterone production were eliminated. Two of the women became pregnant.(4)
In another study, 13 women with high prolactin levels and irregular cycles were given a vitex compound. Their prolactin levels fell, and a normal menstrual cycles returned to all of the women.(5)
Acne In this study, a chasteberry preparation was used in women with menstrual cycle abnormalities. Acne was either eliminated or improved during treatment.(6)
In another study, 117 women with four different types of acne were treated with a chasteberry preparation for 1-2 years. Improvement was seen after 6 weeks and by 3 months, about 70% were free of acne. Some treatment relapses were observed after 3-6 weeks.(7)
Chronic Inflammation and Hair Loss The extract also appears, according to some medical studies, to reduce chronic inflammation. Chronic inflammation is a major contributor to all chronic diseases, including PCOS, diabetes and heart disease.
For example, chronic inflammation causes your ovaries to produce more male hormones. An excess of male hormones cause hair problems such as hirsutism and hair loss.
How Much Should You Take? Don't expect immediate results if you take chaste tree berry extract. You may need to take it for 2-6 months before you can expect to notice any effect. Chasteberry can be taken daily for up to 18 continuous months, unless pregnancy occurs. Vitex can be taken once or twice a day.
It's not the same as taking progesterone. You don't take it, stop it, and then expect a withdrawal bleed a few days later as you would if you were taking progesterone or synthetic progestins.
Vitex agnus castus is exceptionally safe. In one study, chaste tree berry was given up to 9 years with very few side effects. But it's advisable to not take it if you are pregnant.
Every person is unique, so the amount and form of vitex you need won't be the same as for the next person.
We recommend you seek guidance from a licensed naturopathic doctor. They have extensive knowledge of herbs and botanical medicines. If you don't consult with a qualified health professional, a general guideline for your daily dose could be:
Where Can You Get It? You can obtain the highest quality vitex product from our PCOS Supplements Store.
Drug Interactions Interactions with hormone replacement therapy (potential/theoretical). Animal studies and human data have reported that chasteberry constituents have hormonal activity that may alter the effects of these medications and possibly the dose needed for treatment. conjugated estrogens, estradiol, estrone, esterified estrogens, estropipate, ethinyl estradiol, progesterone, medroxyprogesterone, hydroxyprogesterone, norethindrone.
Interactions with oral contraceptives (potential/theoretical). Animal studies and human data have reported that chasteberry constituents have hormonal activity that may alter the effects of these medications and possibly the dose needed for treatment: norethindrone, ethynodiol diacetate, norgestrel, norgestimate, ethinyl estradiol, drospirenone, desogestrel, levonorgestrel .
Interactions with dopamine agonists (potential/theoretical). An in-vitro study reported that chasteberry constituents had dopaminergic activity that may alter the effects of these medications and possibly the dose needed for treatment: selegeline, amantadine, carbidopa, levadopa, pramipexole, ropinirole, bromocriptine, pergolide. If you are taking any of these medication, it's a good idea to consult with your physician before taking this compound.
Hi my name is Whitney and I'm a mom to 2 adorable boys. Here you'll find our story of infertility, adoption, grief, and hope. I'm an open book so you'll never know what I'll post next!