Common issues women with polycystic ovary syndrome (PCOS) face include difficulty getting pregnant, acne, weight gain, hair loss, and heightened anxiety and depression. Bioidentical hormones like estriol, progesterone, and estradiol are often used in hormone replacement therapy (HRT) to help manage the symptoms of PCOS. Up to this point, clinical studies and hard, physiological data demonstrate that the benefits of biorhythmic bioidentical hormone therapy for women with PCOS surpass those of other treatment options.
What is polycystic ovary syndrome?
Polycystic ovary syndrome remains to date hard to define. The primary issue associated with PCOS is ovarian dysfunction. A clinical spectrum of symptoms rather than a defined set of criteria provides the grounds for PCOS diagnosis. (Schriock et al.) PCOS can be broadly characterized as a hormonal disorder caused by an imbalance in a woman’s reproductive hormones. This imbalance can lead directly to fertility issues in women of childbearing age. Each month, a woman’s ovaries produce an egg that is released monthly, creating a healthy menstrual cycle. PCOS can cause problems in the development and release of that egg during ovulation. PCOS can also cause the formation of follicular cysts on the ovaries.
The cause of PCOS is of yet not known. Experts in the field point to genetics when trying to understand how certain women develop PCOS. Genetic factors that may play a role are high levels of androgens and high levels of insulin.
Signs, Symptoms, and Risks Associated with PCOS
The most common symptoms of PCOS are irregular menstrual cycle; hair on the face, chin, and other body areas where men typically have hair but women do not; excessive acne, thinning scalp hair; weight gain and a hard time losing weight; darkened skin under the breasts, in neck creases, and around the groin; and skin tags.
Aside from fertility problems, the indirect health issues associated with PCOS are largely related to the symptoms and include obesity, severe acne, increased anxiety and depression, and hirsutism (excess hair growth) in unwanted areas. Some of these issues stem from an increase in androgens produced by women with PCOS. In many cases, the increased anxiety and depression in women with PCOS is caused by obesity, acne, and hirsutism.
Insulin resistance is common in women with PCOS, especially if the woman is obese or overweight or has a family history of diabetes. Those with insulin resistance have a higher chance of developing type 2 diabetes, indirectly linking PCOS with type 2 diabetes. Specifically, up to 35 percent of obese women with PCOS develop pre-diabetes by age 40. Of those 35 percent, 10 percent develop type 2 diabetes.
Women with PCOS have more than double the risk for developing endometrial cancer as well as an increased risk for developing ovarian cancer.
Oral Contraceptives to Treat PCOS
Oral contraceptives containing synthetic hormones called progestins are the most common treatment for PCOS symptoms. They can help regulate the menstrual cycle and control acne and hirsutism in part by increasing the sex hormone-binding globulin and decreasing testosterone levels. Relieving these symptoms can then decrease or eliminate the associated symptoms of anxiety and depression. The regular monthly menstrual cycle that oral contraceptives provide can also protect women from endometrial hyperplasia and cancer.
However, the use of oral contraceptives to treat PCOS symptoms has significant and serious drawbacks. Women who suffer from PCOS have a substantially increased risk of stroke. Oral contraceptives with high estrogen content increase the risk of stroke as well, thus compounding the stroke risk. Specifically, combined oral contraceptives increase the risk of ischemic stroke as well as myocardial infarction (MI), with higher estrogen doses corresponding with higher ischemic stroke and MI risk, according to a study by the American Academy of Family Physicians. Patient safety is essential, making the use of oral contraceptives to treat PCOS far from ideal. Physicians should exercise caution when recommending this method of PCOS treatment. (Nettleton & King)
Why Treat PCOS with Biorhythmic Bioidentical Hormones?
Harvard Health defines bioidentical hormones as hormones with identical molecular structure to the natural hormones women make in their bodies. They are synthesized from yam and soy extracts. The body cannot differentiate between bioidentical hormones and the natural ones produced in the ovaries. Blood tests cannot differentiate between bioidentical hormones and the body’s natural hormones. The same cannot be said for traditional, commercially-available synthetic hormones. Bioidentical hormones include progesterone, estradiol, and estriol.
Patient satisfaction is higher with the use of biorhythmic bioidentical hormones. Analyzing four studies, women reported increased satisfaction, improved quality of life, and fewer side effects after switching to the bioidentical hormone progesterone from the synthetic hormone medroxyprogesterone acetate (MPA). The specific percentages show this clearly. The effect of progesterone on women results in a 50 percent decline in anxiety, a 30 percent decline in sleep issues, a 60 percent decline in depression, a 25 percent decline in the intensity of menstrual bleeding, a 40 percent decline in cognitive issues, and a 30 percent improvement in sexual function. Additionally, while studies, including large randomized clinical trial by the Women’s Health Initiative (WHI), have significantly linked synthetic progestins with an increased risk of breast cancer, studies on progesterone show a decreased risk for breast cancer. (Holtorf)
The WHI study also showed that synthetic progestins have negative effects on the cardiovascular system resulting in a significant increase in heart attack and stroke risk. This occurs because they negate estrogen’s cardioprotective effects. Conversely, the bioidentical hormone progesterone maintains and increases estrogen’s cardioprotective effects, leaving a user at less risk for heart attack and stroke. Estrogen and progesterone decrease coronary artery spasm, which augments heart attack and stroke risk, according to several studies. Adding MPA to estrogen provides the opposite effect and can even increase the risk ofischemic heart disease. Administering estradiol alongside progesterone resulted in the protection of the coronary arteries, while administering estradiol alongside MPA made the protective effect disappear. (Holtorf)
A blinded, randomized, crossover study on exercise-induced myocardial ischemia in postmenopausal women with coronary artery disease revealed even more positive data for bioidentical hormone therapy. The study showed that women receiving estrogen and progesterone rather than estrogen and MPA led to increased exercise time to myocardial ischemia substantially. Further studies have found that progesterone use alone or in combination with estrogen obstructs atherosclerotic plaque formation in the coronary arteries, while synthetic progestins promote atherosclerotic plaque formation, the exact opposite effect. (Holtorf)
Bioidentical hormone therapy allows for adjustable dosing to find each individual’s correct hormonal balance. Bioidentical hormones can be taken via patch, cream, gel, shot, implant, and in some cases, pill. Doses areeasily adjusted based on a patient’s symptoms and reactions. Many bioidentical hormones are FDA-approved individually, though most combinations have not yet been approved. Still, and for good reason, doctors prescribe patients compounded bioidentical hormones to be custom-made by a pharmacy. These compounded bioidentical hormones are developed to meet a patient’s individual needs based on a doctor’s analysis.
The potential for bioidentical hormones to be administered non-orally means they don’t go through first-pass the way oral contraceptives do. Instead, they enter directly into the bloodstream. Avoiding first-pass metabolism by the liver means undesirable metabolites that have been linked to increased risk of hormone-related cancers are not formed.
On top of all the physiological safety concerns associated with PCOS is the psychological impact. PCOS is considered a physiological disorder, but it can have significant psychological effects that are bi-products of the symptoms. Most commonly, depression, anxiety, and low self-esteem plague PCOS patients as a result of infertility, irregular periods, obesity, severe acne, and hyperandrogenism associated with hirsutism. (Karjula et al.)
Lifestyle modification has been shown to help with certain symptoms of PCOS, including obesity, menstrual regularity, and acne. Proper diet and sufficient exercise can greatly impact the quality of life of women with PCOS, lowering their body mass index (BMI), regulating their monthly periods, and reducing the severity of their acne. At the same time, this can relieve them from the anxiety and depression that can accompany their direct symptoms. (Legro et al.)
With the proper treatment, there is potential for the psychological issues associated with PCOS to disappear altogether. Bioidentical hormone therapy accompanied by lifestyle modification as directed by a doctor presents this possibility more strongly than any treatment option to date, given that studies present higher safety treating PCOS with bioidentical hormones rather than with oral contraceptives that contain synthetic hormones.
Conclusion
Women have been using bioidentical hormones for decades globally with no serious reported issues regarding safety. While clinical studies have not yet proven beyond-a-doubt the efficacy of bioidentical hormone use, physicians are not limited to large randomized control trials for data. In the case of bioidentical hormone therapy, more large randomized control trials are needed to explicitly determine the effectiveness and risks of its use to treat PCOS. However, the scientific results and clinical outcomes that are currently available suggest that bioidentical hormone therapy is safer and more efficacious than the synthetic hormones most commonly used. With that in mind, it seems most ethical to offer patients bioidentical hormones to treat PCOS rather than riskier synthetic hormones solely because the latter have been used more often.
References
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Barbieri, R. L. & Ehrmann, D.A. (2019). Patient education: Polycystic ovary syndrome (PCOS) (Beyond the Basics). UpToDate. Retrieved from: https://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics
PCOS and Depression: Understanding the Connection and Finding Relief. Healthline. Retrieved from: https://www.healthline.com/health/depression/pcos-and-depression#treatment
Polycystic ovary syndrome. (2016) Office of Women’s Health. US Department of Health and Human Services.Retrieved from: https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
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Holtorf, K. (2009). The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? Postgraduate Medicine. Volume 121:1; 1-13.
Karjula, S. et al. (2017). Psychological Distress Is More Prevalent in Fertile Age and Premenopausal Women With PCOS Symptoms: 15-Year Follow-Up. J Clin Endocrinol Metab. Volume 102:6; 1861-1869.
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Jess Lakritz 