Hormones and Polycystic Ovarian Syndrome

Our hormones are the rulers of our reproductive health, yet many of us don't know how they work, or where they come from. A woman's reproductive hormones are produced in the brain and in the Ovaries. The main hormones affecting a woman's reproductive cycles are; GnRH (Gonadotropin-Releasing Hormone), FSH (Follicle Stimulating Hormone), LH (Luteinizing Hormone), Estrogen, and Progesterone.

In those with PCOS, these hormones are non properly balanced. By understanding how these hormones naturally work, we can understand how imbalances can lead to PCOS, and thus how to properly support and treat it.

• GnRH: Produced by the Hypothalamus, this hormone triggers the pituitary. The production of GnRH is inversly related to the amount of Estrogen (Estradiol) in the body. The more Estrogen there is, the less GnRH is secreted, and vica versa. Therefore if the Estrogen levels are high (as is in PCOS), the GnRH is not produced to stimulate the Pituitary Gland...which is responsible for secreting both FSH and LH.
• FSH: Produced by the Pituitary after it was been signaled by GnRH, FSH is essential for the development and function of the ovaries. This hormone is primarily responsible for stimulating the formation of follicles on the ovaries. When there is enough FSH in the ovaries, Estrogen is produced to signal the stop of the GnRH production, to then stop the production of FSH.
• LH: Also produced by the Pituitary after being signaled by GnRH, LH is essential for the function of the ovaries. LH works two fold in reproduction. In the early days of the menstrual cycle, LH stimulates Estradiol. Around day 14 a large surge of LH causes the ovarian follicle to tear open, release the egg inside (YEAH OVULATION). After ovulation, LH stimulates the Corpus Luteum (shell of the broken follicle) to stimulate progesterone. 
• Estrogen: Made from cholesterol and produce primarily in the ovaries, there are 3 forms. Estradiol, Estrone, Estriol, with Estradiol being the most important. The stimulation of Estradiol by LH causes the egg to grow inside the follicle. It also causes the endometrium of the uterus to support pregnancy.
• Progesterone: Produced, primarily, by the corpus luteum after ovulation. Progesterone begins preparing the body for when and if the egg is fertilized. If the egg is not fertilzed, the corpus luteum dissolves and no more progesterone is secreted. If the egg is fertilized, the egg produces another hormone called hCG (human Chorionic Gonadotripin) which stimulates the follicle to remain actively producing progesterone to support pregnancy. If fertilized, progesterone stimulates the development of blood vessels between the uterus and developing placenta, and produces chemicals to make the endometrium favorable for implantation. Once the placenta takes over at about 12 weeks, it also takes over the production of progesterone throughout pregnancy. Progesterone then stimulates the growth of the baby, breast tissue growth, and tonifies the pelvic muscles. Progesterone levels should rise steadily during pregnancy and drop after birth.
• Testosterone: Also made from cholesterol, and  typically considered a male hormone, it is produced in women by the ovaries and the adrenal glands. It is responsible for sex drive in women and naturally surges around ovulation (why women have increased libido while ovulating).

There are many others, but these are the most important when discussing Polycystic Ovarian Syndrome (PCOS).

What Happens to the Hormones in PCOS

There are still a lot of unknowns with Polycystic Ovarian Syndrome. In reality, Ovarian Cysts are just a symptom. In Traditional Chinese Medicine, we take this symptom and we use it to determine the exact underlying imbalance and we treat. In TCM there are over 5 different patterns associated with PCOS, and each is treated differently and differently between women. In Western Medicine Ovarian Cysts were all lumped into one category. The problem is that there is not one pattern of PCOS. Now, Western Medicine is realizing this and have come up with 5 differentiations of PCOS, sadly, they are all still treated the same. With medications that overstimulate ovulation, and medication to treat insulin resistance. This treatment doesn't work for everyone.

• Type 1: This is the most common. This is a combination of anovulation, increased testosterone, and insulin resistance
• Type 2: This is the next most common. This is a combination of anovulation, increased testosterone and NO insulin resistance.
• Type 3: This is a combination of anovulation, NO increased testosterone and insulin resistance
• Type 4: This is a combination of anovulation, increased testosterone and borderline insulin resistance

So, if there are forms of PCOS WITHOUT insulin resistance, why do we highlight it so much? Because, there is a strong correlation with the progression of PCOS into insulin resistance (even when not originally present) and the direct correlation between PCOS and Diabetes in future life. Also, almost all of the symptoms associated with PCOS are directly affected by insulin. Insulin does much more than handle glucose transport. 

So, how does all of this come together? PCOS is characterized by High Levels of Testosterone, High Levels of Luteinzing Hormones with inability to ovulate. 

• There are insulin receptors on the Ovaries. Insulin levels directly affect and regulates the production of androgen (both estrogens and testosterone on the Ovaries
• There are insulin receptors on the Pituitary Gland. Insulin levels are directly related to the the amount of LH produced and how often it is produced. 

There are many theories, but nothing concrete as to the cause of PCOS, and why some cases have insulin resistance and some do not. I believe it is a progressive disease and there are many processes we are not aware of. Poor Diet can cause spikes in insulin that can hyperstimulate the recptors, and resistance can cause a deficiency of insulin needed to regulate hormones. 

Breakfast #6 Honey Nut Baked Quinoa

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• 1 cup Uncooked Quinoa
• 2 cups Coconut Milk
• 2 Eggs
• 1/2 tsp Vanilla
• 1 1/2 tsp Cinnamon
• 1/8 tsp Cloves
• 1/8 tsp Nutmeg
• 1 Tbsp Raw, Unfiltered Honey
• 1/2 cup Chopped Nuts (I used Pecans)

Makes 9 servings
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GI: 44
GL: 9

Preheat oven to 350, and grease a 7X11 or 8x8 dish
In a bowl, mix Coconut Milk, Honey, and Eggs until smooth. Add in Vanilla, Cinnamon, Cloves, and Nutmeg, and blend. Add in Quinoa and stir in. Pour into baking dish and top with nuts. Bake for 1 hr, remove and let rest 10-15 minutes. 

Lunch #6 Turkey Avocado Lettuce Wraps

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• 4 slices of Lunch Meat
• 2 Tbsp Hummus 
• 1/4 Avocado
• 1/4 cup Cucumber, Sliced
• 1/4 cup Bell Pepper Sliced
• 2 large Lettuce Leaves

GI: 21
GL: 1

On a lettuce leaf, spear a tbsp of hummus on each leaf. Layer lunch meat, avocado, and veggies. (add any veggies you want).

Snack #7 Leftover Thai Brussels Salad

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I highly recommend making large batches of meals so that you have ready to serve, healthy, balanced, mini-meal snacks.

Dinner #6 Lemon Caper Salmon, Wild Rice with Pine Nuts, Steamed Green Beans

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Lemon, Caper, Dill Salmon

• 1 Large Salmon Fillet
• 2 Tbsp Olive Oil
• 1 Lemon, halved
• 1 Tbsp Dill, Chopped
• 1 Tbsp Capers
• S/P

Makes 5 servings
GI: 48
GL: <1
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Preheat oven to 350
In a baking dish, coat salmon in olive oil. Juice 1/2 of the lemon onto the salmon. Generously S/P. Top with Capers, Dill and Lemon Slices. Bake until flaked with a fork, about 20min. 

Herbed Wild Rice with Pine Nuts

• 1 cup Wild Rice
• 1 Tbsp Olive Oil
• 3 cups Chicken Stock
• 1 tsp Herbs De Provence
• 1/2 tsp Garlic Powder
• 1 tsp salt
• 1/3 cup pine nuts
• 1 Tbsp Olive Oil

Makes 6 servings
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GI: 50
​GL: 8

In a stockpot, add all ingredients. Bring to a boil, and reduce to a simmer. Cook until all the liquid is absorbed. 

In a skillet heat 1 tbsp olive oil, add pine nuts and toast until golden. Remove and add to rice. 

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Simple Steamed Green Beans

• 1 pound Green Beans
• S/P

Makes 4 servings 
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GI: 32
GL: 2
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In a steamer, add whole green beans. Cook 1 minute, stir, cook another minute, stir, continue until the color changes form opaque to brilliant green. This will be a tender crisp steam. Remove and toss with S/P

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​PCOS Nutrition Part 1: Basic Dietary Principles
PCOS Nutrition Part 2: Avoiding Dairy
PCOS Nutrition Part 3: Sugar
PCOS Nutrition Part 4: Glycemic Index vs. Glycemic Load
PCOS Nutrition Part 5: Building Your Meal

​To Continue...
PCOS Nutrition Part 7: Fat Soluble Vitamins
PCOS Nutrition Part 8: Increasing Dietary Fats
PCOS Nutrition Part 9: Top 10 Foods for PCOS
PCOS Nutrition Part 10: Tips for Implementing the PCOS Diet