The following article has some amazing information about PCOS and Thyroid functions. It's kind of long but has a lot of useful information. 
http://hypothyroidmom.com/pcos-and-thyroid-health/


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

OR

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.

Website:  http://www.whitelotusclinic.ca

Facebook:  http://www.facebook.com/drfionand

Twitter:  http://www.twitter.com/drfionand

References

1. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997;18:774-800 ↩
2. Mueller A, Schöfl C, Dittrich R, Cupisti S, Oppelt PG, Schild RL, Beckmann MW, Häberle L. Thyroid-stimulating hormone is associated with insulin resistance independently of body mass index and age in women with polycystic ovary syndrome. Hum Reprod. 2009 Nov;24(11):2924-30 ↩
3. Janssen OE, Mehlmauer N, Hahn S, Offner AH, Gärtner R. High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrinol. 2004 Mar;150(3):363-9 ↩
4. NACB: Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease. Laurence M. Demers, Ph.D., F.A.C.B.and Carole A. Spencer Ph.D., F.A.C.B. ↩
5. Dittrich R, Kajaia N, Cupisti S, Hoffmann I, Beckmann MW, Mueller A. Association of thyroid-stimulating hormone with insulin resistance and androgen parameters in women with PCOS. Reprod Biomed Online. 2009 Sep;19(3):319-25 ↩
6. Selva DM, Hammond GL. Thyroid hormones act indirectly to increase sex hormone-binding globulin production by liver via hepatocyte nuclear factor-4alpha. J Mol Endocrinol. 2009 Jul;43(1):19-27 ↩
7. Muderris II, Boztosun A, Oner G, Bayram F. Effect of thyroid hormone replacement therapy on ovarian volume and androgen hormones in patients with untreated primary hypothyroidism. Ann Saudi Med. 2011 Mar-Apr;31(2):145-51 ↩
8. Kachuei M, Jafari F, Kachuei A, Keshteli AH. Prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Arch Gynecol Obstet. 2012 Mar;285(3):853-6 ↩
9. Du D, Li X. The relationship between thyroiditis and polycystic ovary syndrome: a meta-analysis. Int J Clin Exp Med. 2013 Oct 25;6(10):880-9 ↩
10. Ott J, Aust S, Kurz C, Nouri K, Wirth S, Huber JC, Mayerhofer K. Elevated antithyroid peroxidase antibodies indicating Hashimoto’s thyroiditis are associated with the treatment response in infertile women with polycystic ovary syndrome. Fertil Steril. 2010 Dec;94(7):2895-7 

A few months ago I went to a doctor who specializes in women's health. She was very informative about PCOS as well as many other concerns. She pointed out the importance of staying away from processed foods because of the added hormones that are added into them. She mentioned that she had went to a seminar at Mayo clinic in Arizona that previous month and a big topic of discussion was the rise of PCOS diagnosis and the rise in hormones added to our food. If you think about it, it makes perfect sense. Having PCOS means we already have an imbalance in hormones, why add more hormones from our food into the mix and expect our body to know what to do with them?
She also mentioned a few other things that we should really avoid.
I found a great article with basically the same suggestions she had for me. 

1. Sugar and refined carbohydrates.
This includes sugar, biscuits, cakes, pies, white bread, rolls, white pasta, rice (brown rice is okay in small amounts), many breakfast cereals (including toasted cereal with or without dried fruit, fruit loops, coco pops), dried fruits, soft drinks, candy, ice cream; but also ‘hidden sugars’ in flavoured yoghurt, many processed foods, fruit juices, packaged soups and sauces etc.
Insulin resistance and impaired glucose tolerance are one of the main causes for PCOS; and a diet high in sugar or foods easily converted into sugar (such as refined carbohydrates) is directly linked to this. (10-14), A diet high in sugar not only affects insulin levels, but also hinders ovulation. A study in 2003 found that making diet and lifestyle changes to improve glucose metabolism improved ovulation just as effectively if not better than Metformin and/or Clomiphene (15).

2. Trans fatty acids.
A 2% increase in the daily intake of energy from trans unsaturated fats was associated with a 73% greater risk of ovulation problems in one study, while and obtaining 2% of daily energy intake from trans fats rather than from monounsaturated fats (found in nuts, seeds, fish etc) was associated with a more than doubled risk of ovulation problems. (18)
Trans fatty acids are found in vegetable oils (eg canola), cakes, biscuits, muffins, pies, crusts, margarine, shortening, cake/pancake mixes, donuts, French fries, chips, candy, frozen dinners and other processed foods. If you are looking for a snack, a small handful of unroasted, unsalted nuts and seeds is a far better idea than a biscuit, cake or any of the above mentioned foods.

3. Caffeine
Just two cups of coffee a day boosts levels of oestradiol, the type of oestrogen produced in your ovaries. Women who drink 4-5 cups of coffee a day produce 70% more oestrogen in the follicular phase (weeks after ovulation) of the menstrual cycle (20).

4. Alcohol
It has been well known for a long time that alcohol consumption increases the risk on PCOS. Some studies show that the risk on developing PCOS is 50% higher in those who consume alcohol (11). The liver is responsible for eliminating excessive levels of oestrogen from your body. Consumption of alcohol puts an excessive burden on the liver. Elimination of alcohol from the body becomes paramount and thereby hinders its capacity of eliminating the oestrogen from your body and thus contributes to an oestrogen dominant environment. Apart from that, alcohol is quickly converted into sugar in your body, contributing to impaired glucose tolerance, insulin resistance and diabetes type II. Finally, alcohol creates acidity which in its turn causes inflammation that can then feed into impaired glucose tolerance.

5. Processed foods
All processed foods come with additives, preservatives and chemical flavours which stimulate the production of prostaglandins (a type of hormone or messenger) that trigger inflammation. Inflammation is not only a result of PCOS, but also a contributing factor as it increases insulin levels. The negative health effects of additives are too many to list. If you are interested in more detailed information on how they affect female hormones, “The Chemical Maze” by Bill Statham lists them one by one. This book is also available as an app.

6. Artificial sweeteners
Artificial sweeteners have been linked with increased oestrogen levels, increased inflammation and increased testosterone levels (19). Artificial sweeteners are often found in ‘diet’ products, implying that they are healthy while the opposite is true. Natural sweeteners are a better choice if you really want to sweeten your food or drink, for instance stevia, agave syrup, yacon syrup or Xylitol.

7. Saturated fat.
There is an association between a diet high fat, particularly saturated fat, and reduced insulin sensitivity (16,17). Saturated fats are found in foods such as fat on meat, chicken with the skin left on, full fat dairy products, butter and take-away foods. Saturated fats are always listed on the nutrition panel so when choosing between foods in the supermarket, compare the nutrition information panel on the back and choose the one lowest in saturated fat. Choosing lean meat, skin-off chicken (preferably organic) and low fat diary is a better option.

Basically the best way to eat correctly with PCOS is to choose healthy, complex carbs, choose organic and unprocessed foods, avoid caffeine, if you must drink alcohol do so in moderation, and stay away from artificial sweeteners.
It is so hard to do and I struggle with it on a daily basis. My best advise is to shop smart and plan ahead!

It's crazy to learn new things about PCOS and realize how long you've had it without knowing. Ever since high school I have always needed contact lenses, but can't wear them because my eyes are super dry. Ten minutes after inserting the lens, they are literally stuck to my eyeball, because they are so dry. It turns out that PCOS has a lot to do with dry eye.

As you can guess our hormones are the culprit. Hormones are what is responsible for tear production and when they aren't in sync, dry eye happens. The hormonal imbalance due to PCOS is knows to cause inflammation which also inflames the tear ducts.

Some things that you can do to help dry eye is to get adequate amounts Omega-3 oil, avoid sitting in front of the computer or tv for too long, use artificial tears, and use a mild soap (like baby shampoo) to gently clean eyes.

As if being hormonal, increase hair growth in random places, and acne weren't enough to deal with; now we can add dry eye to the list! Yay us ;)

When women are young, they are taught that once a month, in addition to having a period, they will also ovulate. This general truth is usually presented as an absolute fact.  Optimally, your reproductive system will ovulate each month,  but there are times when it doesn’t ovulate as it should.  The following information will explain to you exactly what anovulation  is, what causes it, and what can be done to diagnose and treat an anovulatory cycle.

Anovulatory Cycle – What Is It and What Causes It? 
Quite simply, an anovulatory cycle occurs when a woman skips ovulation. If a woman is not tracking her ovulation, she may not even know it has happened. When anovulation takes place, most women will appear to menstruate as normal, but ovulation will not occur. During the early and late years of menstruation, this is a common occurrence. In these instances, a woman’s body is changing drastically and anovulatory cycles will happen quite often. If a woman is in her prime, it is common to have the odd cycle without ovulation. The trouble occurs when anovulation is a common theme in a woman’s life.

Common, easily regulated causes for anovulatory cycles are stress, overexertion, and eating habits. When women are over or underweight, their bodies will react differently to hormonal changes as they occur. A vigorous exercise program or extremely active lifestyle can affect hormones and thus ovulation and fertility. For example, a lot of gymnasts and ballerinas will experience anovulatory cycles quite often. When women use “The Pill” or “The Shot”, they are chemically imitating anovulation. Over an extended period of time, the use of these drugs can negatively affect the function of your reproductive organs.

Diagnosis and Treatment of Anovulation. 
There are women who do not menstruate (amenorrhea) or have extremely irregular periods (oligomenorrhea). In this case, anovulation is easy to spot. For the majority of women, detecting anovulatory cycles can be difficult. A doctor can test for several factors that may indicate a woman is experiencing irregular ovulation. Testing progesterone levels, the endometrial lining, and testing for the presence of specific antibodies, will help a physician to diagnose anovulation.

Treatment of anovulatory cycles will depend greatly on the findings of the administered tests. If it is decided that the causes are natural or stemming from outside influence, natural remedies will be prescribed. These include regulating eating habits and other methods that we have already discussed. If the cause of anovulation is decided to stem from internal imbalances, there is no need to worry. There are several fertility boosters that can combat a varied set of factors. These may include drugs designed to increase estrogen, ripen the follicles, or to help a woman release her egg when she is supposed to ovulate. The most drastic and last scenario a woman may encounter would be surgery. Normally this will only take place if she is found to have tumors.

If you or someone you know is experiencing regular bouts of anovulation, heed the advice above. The first thing you should do is try to make small changes to the things you can control. Eat healthier, exercise without over doing it, and try to make time for relaxation and stress relief. If these methods don’t help, you should seek the help of a professional. Your doctor can run some tests to figure out the causes of irregular ovulation and find a solution suited to your circumstances that will help you avoid an anovulatory cycle.

Reference-
http://www.babyhopes.com/articles/anovulation.html

 Reference- http://youngwomenshealth.org/2014/02/25/metformin/


Key Facts

Young women with PCOS often have elevated insulin levels and are more likely to develop diabetes. Metformin is a medication often prescribed for women with PCOS to help prevent diabetes. A lifestyle that includes healthy nutrition and daily exercise is the most important part of a PCOS treatment plan.

What is insulin?Insulin is a hormone made by an organ in the body called the pancreas. The food you eat is broken down into simple sugar (glucose) during digestion. Glucose is absorbed into the blood after you eat. Insulin helps glucose enter the cells of the body to be used as energy. If there’s not enough insulin in the body, or if the body can’t use the insulin, sugar levels in the blood become higher.

What is insulin resistance?If your body is resistant to insulin, it means you need high levels of insulin to keep your blood sugar normal. Certain medical conditions such as being overweight or having PCOS can cause insulin resistance. Insulin resistance tends to run in families.

What can insulin resistance do to me? High insulin levels can cause thickening and darkening of the skin (acanthosis nigricans) on the back of the neck, axilla (under the arms), and groin area. In young women with PCOS, high insulin levels can cause the ovaries to make more androgen hormones such as testosterone. This can cause increased body hair, acne, and irregular or few periods. Having insulin resistance can increase your risk of developing diabetes.

How can I lower my insulin levels? You can help lower your insulin levels naturally by eating less starches and sugars, and more foods that are high in fiber and low refined carbohydrates (such as white flour and sugars). Low glycemic foods, on the other hand, don’t raise your blood sugar or insulin levels as much as foods that are high in sugar or refined carbohydrates. Exercising is another way to improve your PCOS. Fitting in 60 minutes of exercise each day is recommended, but any amount of exercise you do will help manage your PCOS. Exercise decreases insulin resistance.

What else will lower my insulin level? Metformin (also known as Glucophage®) helps to regulate the amount of glucose (sugar) in your blood. It makes your body more sensitive to insulin, and decreases the amount of glucose your liver releases. Young women with high insulin who take Metformin are less likely to develop type 2 diabetes than those who don’t take a medication that lowers insulin. Research studies have shown that young women with PCOS who are overweight and who were treated with Metformin and a healthy lifestyle (healthy nutrition and exercise) were able to lose weight and lower their fasting blood sugar. Taking Metformin and maintaining a healthy weight also improves cholesterol levels. Metformin is not approved by the FDA (Federal Drug Administration) for PCOS, but it’s commonly prescribed for this condition.

How do I take Metformin? Metformin is available as a pill or liquid. It is usually taken 2–3 times a day with your meals (usually breakfast and dinner). Your health care provider will tell you to begin at a very low dose and slowly increase the amount of medicine you take over a few months—”start low, go slow.” Your health care provider may prescribe once a day long acting (XR–extended release) Metformin instead. It’s important that you take this medication exactly as prescribed by your health care provider. Do not break, chew, or crush the pills. Be sure to swallow the whole pill(s).

How do I store Metformin? Keep your Metformin tightly closed, in the same bottle it came in. Do not remove the label on the bottle. Store it at room temperature away from high temperatures and any moisture. Do not store Metformin in the bathroom. Be sure to keep your medicine away from young children.

Are there any reasons not to take Metformin? People with kidney or liver problems should not take Metformin. Your health care provider will check your blood to make sure that you do not have blood, kidney or liver problems before you start Metformin and then usually once a year after that. If you get sick and throw up or have diarrhea, call your health care provider and stop your Metformin until you feel completely well. It’s very important not to be dehydrated (not having enough fluids in your body) while taking Metformin. You should not binge drink alcohol and take Metformin. Also, if you’re going to have surgery or a medical or dental procedure where you can’t have anything to eat or drink, talk to your health care provider about stopping the Metformin for 48 hours before the procedure. If you’re scheduled for an X–ray that includes a “contrast material” (a dye that helps the radiologist see the images better), you should talk to your health care provider about stopping your Metformin for up to 48 hours before and after the test. Getting dehydrated, having kidney problems, or having a serious infection can cause the rare condition called “lactic acidosis”, so it’s important to talk to your health care provider about any of these problems.

Does Metformin have any side effects? In general, healthy young people don’t have many side effects. About a third of people who take Metformin have stomach upset such as nausea, diarrhea, gas, and loss of appetite. Some people may complain of a metallic taste. If the side effects are a problem for you, it’s important to talk with your health care provider. You may be able to lower your dose for a few days and slowly build back up to your regular dose.

What if I miss a dose of my Metformin? When you first start taking Metformin, it’s a good idea to ask your health care provider what to do if you miss a dose. Write down the answer so you will have a plan if it happens. In general, you will probably be told NOT to take the pills that you missed, especially if it’s almost time for your next dose. Never double up on pills to make up for a missed dose.

Can I get pregnant while taking Metformin? Yes. If you’re sexually active and you’re not taking oral contraceptive pills or using another method of birth control, it’s possible that you’ll have menstrual cycles and ovulate (release an egg). If your egg is fertilized (sperm from a male comes together with an egg of a female), you could become pregnant. Women with PCOS are more likely to get pregnant while taking Metformin. You should talk with your health care provider about a method of birth control that’s right for you.

Important things to remember when taking Metformin:

• If you’re prescribed Metformin for PCOS, be sure to tell your health care provider and pharmacist about all the prescription medications and over–the–counter medicines that you’re taking.
• If you’re having surgery, including dental surgery, tell your health care provider or dentist that you’re taking Meformin for PCOS. Ask when you should stop taking it before the procedure.
• Metformin can lower your body’s ability to absorb certain vitamins (B12 and folate), so it’s a good idea to take a multivitamin (with B vitamins).
• Alcohol can be dangerous while taking Metformin. You’re more likely to get dehydrated or develop liver problems. If you have 3–4 drinks at a time, Metformin is not a good treatment option for your PCOS. Ask your health care provider about other treatment options or decrease your use of alcohol.
• If you’re sexually active, be sure to talk with your health care provider about taking the oral contraceptive pill or about using another reliable birth control method.
• Talk to a dietitian about planning meals and snacks that are PCOS–friendly.
• Try to fit in about 60 minutes of exercise every day.
• Keep all of your medical appointments and be sure to go for any lab tests that your health care provider might order.

This article describes the natural treatments available to combat PCOS hair loss. It may be crass, or in some social circles, politically incorrect to admit it, but for many people, women included, physical appearance plays a major role in one’s personal and business success. With the societal expectations regarding the appearance of women, this issue is especially compounded when it comes to women, unfair as it may seem. PCOS hair loss can be a very embarrassing side effect of the syndrome, but it doesn’t have to be.

One thing that is not debatable is this: a dramatic sudden deterioration in one’s physical looks due to disease has severe implications for the self-esteem and self-concept of those affected. PCOS, or Polycystic Ovarian Syndrome, are one of these disorders, as not only does it drive hard-to-control weight gain, acne outbreaks, and cysts that inhibit infertility, but it can also drive embarrassing losses of hair, dramaticallyaffecting their perception in society1, and of themselves.

Hormonal imbalances related to PCOS can cause sufferers to lose scalp hair due to the overbearing influence of testosterone, leading to a worsening self-concept and a negative view of PCOS individuals by other people. Indeed, most women that come to the doctor complaining of excessive sudden hair loss have been found to also have PCOS 1. The mechanisms that drive other PCOS symptoms, such as obesity, also play a role in aggressive hair attrition, as we will show in the para1graphs to come.

It is vitally important that those afflicted by this disease know that there are ways to halt and reverse the damage that this genetic condition does not just to a female’s hair follicles, but to her spirit. In the following article, we will learn how PCOS hair loss works, and then how to take action against these causes, so that those affected can get back on the road to regaining their dignity.

The Evil Origins of PCOS Hair LossOne of the key manifestations of PCOS is the insulin resistance that it causes in affected women. It is this hallmark that contributes to obesity and Type II diabetes in sufferers of this hormone disorder, but the excessive androgen, testosterone, and its converted form, DHT that results from the irritation of excess insulin also drives the process behind PCOS hair loss in patients.

According to a study conducted by the University of Oulu in Finland 2, women with insulin resistance had been shown to experience alopecia (hair loss) in much the same fashion of PCOS women, drawing a solid link between this fact and the scourge of premature loss of hair follicles.

The cause and effect relationship goes deeper than that however, as attempted hair re-growth in women that have PCOS has often hit frustrating obstacles. One of the key discoveries that greatly aided the cause of helping these women regain their dignity was that DHT, a sex hormone that is produced in excess quantities in PCOS sufferers, was squarely behind the PCOS hair loss that this disorder induces.

With it present in abundance, the DHT compound circulates to your scalp and starts to latch onto hair follicles, starting the deterioration process of the hair strand and blocking the absorption of essential nutrients. Eventually, the hair strand dies and falls out, but DHT’s troublemaking doesn’t end there. It remains attached to the follicle, inhibiting or flat-out preventing the regeneration of new hair, posing a significant problem for those looking to rejuvenate the hair on their head to the way it used to be 3.

How To Stop PCOS Hair Loss And Reverse The DamageNow that we know how the factors behind PCOS hair loss work1s, we can begin to craft a plan of action to start tackling the aspects that are wreaking havoc on your beautiful, luscious locks.

The good news that there is a road map that will be laid out in the coming paragraphs that will help you overcome this obstacle to your self-esteem.

The bad news is that it is going to take a lot of work.

The inputs in your daily life that have conspired to cause PCOS to manifest in the manner that it has will need to be changed, with some changes being drastic in nature. In order to reduce the aggravating effects of insulin, androgen, testosterone, and other hormones, lifestyle changes involving the diet you eat, the drinks you consume, and the stressors you allow into your life will need to be controlled, reduced, and if possible, eliminated.

Are you up for the challenge? I know you are, so let’s get started together!

Drugs, Drugs, Drugs: Some Are Good, Some Are Bad!Those looking to treat the PCOS induced loss of their hair have several treatment options available to them, such as Finasteride, which blocks an enzyme that converts testosterone to its more active form, thus suppressing the activities of this hormone that contributes to PCOS hair loss in women.

Side effects of this drug include breast tenderness and increased libido (e.g. it puts you in the mood to get busy). While this may seem like a good thing for women suffering from a disease that stifles fertility, use of this drug while trying to conceive is discouraged, as it has been shown to stunt or deform the growth of male sex organs in a developing male fetus 4.

A supplement you may want to consider adding to your arsenal in your own personal war against PCOS should be N-acetyl Cysteine. Despite the scary-sounding, tongue-twisting name, this compound has been shown to markedly improve the insulin sensitivity in cells of those suffering from resistance to this normally accepted hormone 5, reducing its excess circulation that leads to the problems with androgen that you are familiar with by now.

One thing you will definitely want to avoid in your quest to retain and reclaim your hair from the ravages of this disease are hormonal therapies, such as estrogen and progesterone. While it has been proven that these treatments do succeed in regaining lost hair, it comes at the tremendous risk of developing breast and ovarian cancer, high blood pressure, and potentially fatal blood clots.

Eating A Low-Carb, High Protein DietEating a healthy diet is another big preventative step towards minimizing the PCOS hair loss associated with the metabolic ravages of the syndrome. The overproduction of testosterone that leads to unwanted hair loss is strongly linked with insulin resistance, as mentioned in the introduction to this article. Therefore, if one consumes a diet that is low in simple carbs and high in protein, the spikes in insulin produced by very high amounts of blood sugar will become a thing of the past, reducing the amounts of harmful inputs that drive PCOS hair loss in women 6.

When you are at the grocery store overhauling your diet, it is vital to also ensure that the meats, veggies, and fruits that you are purchasing are also free of environmental pollution, hormones, and antibiotics. The industrial nature of our modern food system has seen all of these unsavoury elements enter it, which has contributing to a creeping toxicity in people throughout the world. In women with PCOS, compounds such as BPA, various heavy metals, and pesticides often interfere with already unbalanced hormone levels, aggravating the effects of this complex disorder 7.

One must also be consistent with regards to eating times, as irregular eating habits have been shown to cause insulin spikes 8. Given insulin’s role in aggressively producing the androgen that is behind PCOS hair loss in women, keeping consistent meal times on a tight schedule (no skipping breakfast/lunch, avoiding later or earlier than usual dinners, etc) along with the advised diet mentioned just previously will go a long way to limiting this all too apparent symptom of PCOS.

In addition to eating properly according to low carb Paleo principles at predictable times, taking additional natural supplements may be advisable as well. For example, it is known that taking saw palmetto suppresses hormonal and enzyme activity that converts testosterone to DHT (its more troublesome form) for PCOS sufferers, not only leading to a reduction in PCOS hair loss, but also outbreaks of acne and unwanted hair in places where they don’t normally occur in women (goodbye ugly facial hair!) 9.

Another wrinkle that you may want to add to your daily routine may also include a refreshing cup of spearmint tea. Already a perky way to begin your day or to relax after the hectic parts of it have past, the compounds within this herbal remedy have been analysed by studies, which have revealed that they have a significant effect in reducing androgen levels in the bodies of women suffering from PCOS 10, which accordingly has the effect of tripping up the mechanism by which hair loss occurs.

Chill Out, Sista! How Sweating The Small Stuff Makes Your Hair Fall OutControlling your stress can also go a long way to reducing PCOS hair loss. When you freak out over the myriad of stressors present in today’s hectic and harried modern world, your body produces cortisol, a hormone that brings more blood sugar out of your cells and into your bloodstream 11.

This response was likely related to our hunter-gatherer past, when constant danger lurked in the shadows, causing this metabolic pathway to evolve to allow for a quick response to any threats that arised. These days, immediate threats to our lives aren’t nearly as present, but these mechanisms are much slower to change.

In PCOS patients, the effect of bringing excess glucose into your body also is a harbinger of excess insulin, which drives androgen that causes rapid hair loss in women in their prime. As such, it is vital to take care of your mental health when the demands of the world hammer away at your door, lest you let it cause your hair to fall out!

Ugh, Nothing’s Working … WHAT NOW?By following the dietary and lifestyle changes outlined above, you can enjoy much of the benefits afforded by this hazardous shortcut, while assuming none of the potential risk to your life. Better off with a little less hair and being fully alive, than gaining back a full head of hair and dying shortly after due to an illness brought on by side effects that are widely known by all in the medical community!

However, if you have done all of the above and you are still experiencing significant problems with hair loss potentially related to PCOS, you may want to book an appointment with your doctor. Ask him or her to check your thyroid gland for hypothyroidism, which can result in slow growth of hair, and hair losses throughout many areas of the body 12.

While it is not fully known whether PCOS can lead to hypothyroidism, or vice versa, women that have PCOS and who struggle with hair loss despite cleaning up their diet and lifestyle should be checked for this thyroid condition 13. Drugs like Levothroid, Levoxyl, or Synthroid will be prescribed to treat this condition, which are generic names for the compound levothyroxine. This drug effective replaces the thyroxine that your thyroid is not producing, allowing balance to be restored to your bodies’ functions.

Dealing With PCOS Hair LossLosing hair in your prime can be a traumatic experience. No matter the cause, the loss of this highly valued barometer of attractiveness can cause anyone to question their self-worth, while certain judgmental gatekeepers in society may be subconsciously influenced by issues of physical attractiveness.

While the latter case is clearly unacceptable in today’s society, the presence of this bias that has predominated in the past still lingers, and while one hopes that one day appearance won’t matter when it comes to one’s merit, maintaining appearances in the present has a much larger net benefit to one’s self-esteem.
However, risking your health to validate yourself in eyes of a few people certainly isn’t worth it either. As such, it is vital to consult a physician before undertaking any of the recommended treatments and modalities laid out in this report.

It is better to take your time, do things as directed as experts in the field, than to get impatient and get sucked in by snake oil peddlers promising a quick fix, or worse, take a dangerous drug in dosages that are outside what was indicated and end up dying of an overdose, or end up getting a chronic health condition such as heart disease or cancer.

Rome took more than one day to construct, but when it was finished, it was the pride of the civilized world. With your scalp, you may not have those smooth silky strands back tomorrow, but one year out from your post PCOS lifestyle change, you’ll look back at where you were compared to the vision of loveliness that you will be, and you will beam with the pride that comes from having earned your reward.

References

1. European Society of Endocrinology
2. European Journal of Preventive Cardiology
3. Medical News Today (MNT)
4. Clinical Interventions in Aging
5. Fertility and Sterility
6. The American Journal of Clinical Nutrition
7. Natural Health Solutions for PCOS
8. European Journal of Clinical Nutrition
9. Longevity Medical Health Center
10. Phytotherapy Research
11. Medscape
12. Alopecia in Hypothyroidism
13. Archives of Gynecology and Obstetrics

 "The No. 1 treatment for PCOS is not metformin or clomid or birth control
pills or spironolactone; but attaining and maintaining a normal weight through a good diet (low glycemic index) and regular exercise," says Dr. Serena H. Chen,
the director of reproductive endocrine and infertility at St. Barnabas Medical
Center.
"Losing weight or maintaining a normal weight will lower the risk for cancer,
and make PCOS patients much more responsive to treatment. For people who are
trying to conceive, it will improve responses to fertility drugs and not only
improve the pregnancy rate but lower the miscarriage rate."

Since losing all my weight I have gone to 2 different doctors, a holistic doctor specializing in women's care and my fertility specialist, both have repeatedly told me that because I've lost so much weight I have basically taken my fertility into my own hands. The effects of losing weight with PCOS is tremendous. By losing 5% body weight you can control your insulin levels which can restart ovulation and normalize your cycles.

Diet that follows a low glycemic index generally work best for people with PCOS. Carbs are what is most responsible for the spike in your blood sugar, but cutting out carbs completely is not recommended. Eating carbohydrates like whole grain breads and pastas should be included in your diet, but in moderation. 1-2 servings of complex carbohydrates with meals is perfect. A serving is considered 1/2 cup whole grain pasta and/or brown Rice or 1 slice of whole wheat bread. Reading labels to know the serving size is important. 

To help your blood sugar from spiking, it's also beneficial to eat some protein along with the complex carbs. For instance, add a skinless chicken breast with your brown rice or eat turkey with your bread slice. The possibilities are endless! 
 
Losing weight with PCOS can be very difficult but it is possible with the right diet and exercise. Because of the difficulty a lot of times you'll get discouraged and want to give up. Just remind yourself that it won't happen over night, it may not even happen in a month, but it will happen. Knowing that you have so much power in your health can be your biggest motivation.

SEPTEMBER 17, 2012 BY DR. HEATHER RUPE

PCOS Made Simple

I don’t fault patients for finding the diagnosis of PCOS perplexing. It took me nearly 4 years of medical school to fully grasp it.  September is PCOS Awareness Month and with 5 % of  reproductive age women affected, we plan to bring you several posts this month on this often confusing diagnosis.

Polycystic Ovarian Syndrome is a misnomer. It is not an ‘ovarian syndrome’ at all. The root cause of PCOS is a combined genetic and metabolic issue. Women with PCOS do not react normally to insulin. When sugars hit their blood stream, their body requires extra insulin to process the sugar. The higher levels of insulin have several effects in different areas of their body, including messing with their ovaries. The insulin molecule is very similar in shape to another molecule that has receptors on the ovary.  Insulin then falsely attaches to the ovary, causing it to release too much male hormone, leading to lovely features like acne, abnormal hair growth and even male pattern baldness in extreme cases. The extra male hormone gets converted to excess estrogen in the fat cells, which prevents ovulation. The excess insulin makes weight loss more difficult, which can lead to obesity.

Estrogen is the hormone responsible for creating the blood and nutrient rich lining of the uterus. A normal amount of estrogen makes a healthy lining for an embryo to implant.With PCOS, there is an elevated level of estrogen, creating excess tissue, leading to heavy, crampy periods. In extreme untreated cases, it can lead to precancer of the uterus.

It is much harder for women with PCOS to lose weight and keep it off, due to their body’s resistance to insulin. As they get heavier, the fat cells themselves secrete additional hormones that worsen the insulin resistance.  Essentially, the more weight a woman with PCOS gains, the harder it is to loose the weight. This helps explain why 80% of women with PCOS are obese.

Some of you extra smart ladies are already thinking, “Isn’t extra insulin just like diabetes?” Yes and no. PCOS is in many ways a pre-diabetic condition. However, there has to be a genetic predisposition to PCOS as well.  PCOS is caused by how a woman’s body reacts to the excess insulin. Not all diabetics have PCOS. Many diabetics will ovulate regularly and have no excess of male hormone, despite their elevated insulin. We also see that PCOS tends to run in the family.  In studies of identical twins, if one twin has it, there is a 70% chance the other twin will have it as well. This leads us to think that the abnormal insulin metabolism is caused by an inherited genetic defect…yet another thing that we get to blame our mothers for.

Despite the hormonal imbalances going on in the body with PCOS, the ovary tries its best to ovulate. Much like the “Little Engine That Could” the ovary desperately attempts to make its eggs grow each month, but rarely will it mange to get an egg mature enough to fully ovulate. This leads to a swollen ovary with multiple tiny cysts of immature eggs (follicles). The PCOS ovary stays enlarged and swollen, but the ‘cysts’ associated with PCOS are multiple tiny cysts; not the large painful kind that women often need to be surgically removed.

I often see women for second opinions for PCOS. One doctor told them they had it, then another said that they didn’t. They are frustrated and want answers. However, PCOS is a clinical diagnosis, making it subjective. When your throat hurts, you go to the doctor.  She thrusts a q-tip down your throat and runs a test. The test is straightforward: positive or negative. Alternately, PCOS  is based on a collection of findings that can be supported by blood work, but there isn’t a definitive test.

To further add to the confusion, there are currently 3 sets of diagnostic criteria for PCOS floating around. Also, in Europe physicians put a lot more emphasis on ultrasound finding, while in the US clinicians look more at symptoms.

The most common definition in the US is the NIH {National Institutes of Health} criteria:

1. Irregular periods

2. Evidence of elevated male hormone (either lab work or symptoms)

3. Exclusion of other causes of elevated male hormone.

The classic patient with PCOS is overweight, with most of their obesity in their abdomen. Weight loss is extremely challenging due to their body’s insulin resistance.Their cycles are sporadic, every 2 to 3 months. They struggle with fertility due to their ovary’s inability to ovulate despite its best efforts. They get the added bonus of often needing to wax their chin way more than their friends.