The defining hallmark of PCOS is lack of ovulation, which in turn causes progesterone deficiency.
Progesterone for PCOS was pioneered by John R Lee MD, who wrote extensively about his experience treating PCOS with cyclic progesterone. Cyclic progesterone is thought to reset the hypothalamic-pituitary axis which controls ovulation, thus helping restart normal ovulation in the PCOS patient when taken over a 3-6 months of use.
Seventeen year old Alice has PCOS (Polycystic Ovary Syndrome) came with her Mom into the office and told me her story. Alice has been overweight, borderline diabetic, and has facial hair and acne caused by elevated testosterone. At age 12, Alice started normal menstrual cycles, but her cycles began fluctuating and periods stopped at age 15.
Her gynae doctor diagnosed PCOS (Polycystic Ovary Syndrome), and put her on birth control pills to regulate her cycles. The birth control pills caused adverse side effects of weight gain weight and elevated blood pressure (hypertension), so she stopped them.
Progesterone is the Most Logical Form of Treatment and Actually Works
Two months ago, Alice was switched over from the synthetic progestins in the birth control pills to natural progesterone, The progesterone was successful, restoring a normal menstrual period, and a return to regular cycles.
BCP’s (birth control pills) are usually prescribed by the ob-gyne doctor to regulate cycles in the PCOS patient. This standard treatment is not the best one. There is a better more logical alternative that actually works called natural progesterone.
Both John R Lee MD, and JeriLynn Prior MD advocate the use of natural progesterone as a far better alternative to birth control pills. After all, birth control pills (BCP’s) are a chemical form of castration, and work by inhibiting ovulation.
This article will explain the cause of PCOS, and will describe the signs and symptoms of PCOS, including the clinical features of PCOS, and give you a simple questionnaire to determine if you have PCOS. This article will also explain why natural progesterone is the best treatment, and a much better choice compared to birth control pills.
Clinical Signs and Symptoms Of PCOS
When PCOS (polycystic ovary syndrome) was first described in 1935 by Stein and Leventhal, it was fairly rare. Nowadays, it is quite common, involving 6 to 10 per cent of the female population, affecting 3.5 to 5 million women.
Why the increased incidence? Some believe that endocrine disruptor chemicals in the environment are to blame.
PCOS symptoms include:
Oligomenorrhea or amenorrhea (no periods)
Anovulation (no ovulation)
Weight gain, obesity
Hirsutism (excessive hair growth, male pattern)
Insulin resistance (pre-diabetes)
Multiple small ovarian cysts on sonogram
Acanthosis Nigrans (darkening of the skin at the nape of the neck and under arms)-indicator of hyperinsulinemia
How Do You Know If You Have PCOS?
If you answer Yes to 2 out of 3 of the following questions, this indicates high likelihood (80%) of PCOS.
Length of Menstrual Cycle, Variable Length
1) Between the ages of 16 and 40, was length of your menstrual cycle (on average) greater than 35 days and/or totally variable?
Hair Growth (Male Pattern)
2) During your menstruating years (not including during pregnancy), did you have dark, coarse hair on your three or more of these sites? Upper lip? chin? breasts? chest between the breasts? back? belly? upper arms? upper thighs?
3) Were you ever obese or overweight between the ages of 16 and 40?
The world’s greatest authority, Leon Speroff MD, says: “A question which has puzzled gynecologists and endocrinologists for many years is what causes polycystic ovaries. There is an answer which is appealing in its logic and clinical applicability. The characteristic polycystic ovary emerges when a state of anovulation persists for any length of time”
PCOS is the end result of not ovulating, (no progesterone production) for a long time (a few years), resulting in a vicious cycle which self perpetuates anovulation, causing increased testosterone production by the ovary. Insulin resistant diabetes and obesity aggravate the problem.
As you might expect, PCOS is a major cause of infertility.
About 10% of patients thought to have PCOS actually have an underlying genetic enzyme defect in adrenal steroid synthesis called Non-Classical CAH. If present, treatment is successful with low dose adrenal steroid tablets which restores fertility and reverses the acne.
Oral Contraceptives for PCOS (BCP’s)
Birth control pills are a chemical form of castration, which prevent ovulation. Lack of ovulation is the primary defect in PCOS, so birth control pills merely perpetuate the primary defect.
Birth control pills can restore regular bleeding periods, however, this is artificial, and aggravate the underlying PCOS problem rather than solve it. In addition, birth control pills are known to worsen insulin resistance and diabetes.
JeriLynn Prior MD Says: “The fundamental problem with PCOS is not making progesterone for two weeks every cycle. This lack of progesterone leads to an imbalance in the ovary, causes the stimulation of higher male hormones and leads to the irregular periods and trouble getting pregnant. Progesterone is usually missing—replacing it therefore makes sense. “
John R Lee MD said: “I recommend supplementation of normal physiologic doses of progesterone to treat PCOS. If progesterone levels rise each month during the luteal phase of the cycle, as they are supposed to do, this maintains the normal synchronal pattern each month, and PCOS rarely, if ever, occurs. Natural progesterone should be the basis of PCOS treatment, along with attention to stress, exercise, and nutrition.
If you have PCOS, you can use 15 to 20 mg of progesterone cream daily from day 14 to day 28 of your cycle. If you have a longer or a shorter cycle, adjust accordingly. The disappearance of facial hair and acne are usually obvious signs that hormones are becoming balanced, but to see these results, you’ll need to give the treatment at least six months, in conjunction with proper diet and exercise.”
This above is quoted from The John R Lee Medical Letter 1999.(10)
Some young women find out about progesterone on internet messenger boards, and then proceed on their own to buy it over-the-counter. The progesterone cream may successfully restores cycles in many cases. However, self – medication is not recommended. It is best to work with a knowledgeable physician.
If you have PCOS and need a doctor to prescribe progesterone, you can find a knowledgeable physician on the ACAM or A4M doctor’s directory (In the UK, see www.bio-hormone-health/team) and it is best to always work closely with a knowledgeable physician.
Can PCOS be Treated with Natural Progesterone?
YES by Dr. Jerilynn Prior: “Progesterone talks back to the hypothalamic and pituitary (brain) hormones that control the ovaries and stops them from stimulating the ovaries to make too much testosterone.”
Dr Prior recognizes that the (BCP) pill, with its synthetic type of progesterone, does help women with PCOS to a certain degree. But her goal for PCOS patients is, “to return the brain/ovary system to a normal balance. The goal of the BCP Pill is the opposite – it must suppress the brain-ovary system to prevent pregnancy.”
Interestingly, Dr. Prior believes there is another benefit of cyclic progesterone therapy. She explains, “most doctors don’t realize progesterone antagonizes and inhibits the enzyme (called 5-alpha reductase) that is needed to make testosterone into dihydrotestosterone. Dihydrotestosterone is the powerful male hormone that talks hair follicles into making coarse hair and too much oil that causes acne.”
Above quote is attributed to Jerilyn Prior MD Web Site.
What can you do?
Experts in the area agree that supplemental progesterone, a good amount of exercise, and a low sugar diet, low simple carbohydrate and low fat diet with plenty of vegetables will often restore balance.
A diet high in sugar and refined carbohydrates, such as white bread and pasta, aggravates polycystic ovary syndrome. The excess sugar creates high insulin levels, which stimulate androgen production in the ovary, which suppresses ovulation.
Jeffrey Dach, MD is an international expert on bioidentical hormones and he has shared his views on how best to help PCOS.
Low progesterone levels are linked to a number of hormonal health conditions, including infertility, and often related to oestrogen dominance so the following article will be helpful: