A hidden diagnosis

They are seeing me as a naturopathic physician because they want to avoid the birth control pill

Over the last year I have increasingly seen in my practice more young teenagers and women with period problems.

They present with heavier irregular periods, with extensive cramping and some with periods that last several weeks at a time. They are seeing me as a naturopathic physician because they want to avoid the birth control pill and they want to determine the cause of the problem.

One of the first questions I ask these young women is do they have unusual hair growth anywhere (hirsutism) or do they find themselves shaving or using hair removal techniques. They will often light up and say “yes” and then the diagnosis heads towards polycystic ovary syndrome or PCOS. PCOS is the most common endocrine disorder of women, occurring in 5-10 per cent of women of reproductive age.

The exact cause of PCOS is not clear but insulin resistance is often implicated as the main cause. Insulin, secreted by the pancreas, is critical for the metabolism of sugar in the body. When a person is insulin resistant, it takes increasingly more insulin to metabolize sugars, thus causing the pancreas to secrete even more insulin and this in turn increases production of androgens or male hormones, contributing to excess hair growth in women.

Both insulin and testosterone have a direct effect on ovarian cyst formation.

The clinical picture of PCOS varies from woman to woman and not all women will have weight gain, high blood pressure, acne, hirsutism and irregular periods. This is why the diagnosis of PCOS is often missed and young women will be given birth control medications to manage their period symptoms rather than an ultrasound to get a good look at the ovaries.

In the case of the teenagers I am seeing, often times the blood work is still normal: i.e. normal fasting blood glucose, normal testosterone and prolactin and normal insulin.

The goal in this age range is period control rather than fertility. It is important to control the blood sugars through a high protein diet.

Often these teenagers are anemic with very low ferritin because of their frequent and often heavy periods so treating with a well tolerated form of iron improves period control as well.

Essential fatty acids and vitamin D are also routine recommendations for hormonal control.

In addition inositol has been studied to decrease androgens, improve insulin sensitivity as well as restore ovulation in PCOS. I will also prepare herbal tonics specifically for PCOS.

These cases also respond to bio-identical hormone therapy primarily using progesterone (not Provera!) for a short time.

However getting to the underlying cause is always the goal of the naturopathic physician so insulin control is imperative.

For the woman with PCOS who wants to get pregnant, naturopathic remedies work very well to optimize the egg quality of women, improve ovulation rate as well as improve the health of the uterus for implantation.

Naturopathic physicians are medically trained and naturally focused to help you on your road to health.

 

Dr. Ingrid Pincott, naturopathic physician, has been practicing since 1985 and can be reached at 250-286-3655 or www.DrPincott.com

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