Tori Hudson, ND
Polycystic ovary syndrome (PCOS) is a complex hormonal condition that affects the metabolic and reproductive physiological functions of a woman’s system. It is associated with a multitude of symptoms and issues, including irregular menstrual cycle, reduced fertility, hyperinsulinemia, insulin resistance, obesity, hyperandrogenism (hirsutism, acne, hair loss), and skin discolorations.
Conventional medicine typically offers anti-androgenic drugs, cyclic progestin/combine oral contraceptives, metformin, or thiazolidinediones, all used alone or in combination. They all can cause side effects although certainly not in all women, and they should be considered by knowledgeable practitioners. However, natural medicine has some significant researched therapies.
Natural medicine has offered many significant options that can address the underlying causes of insulin resistance and hyperandrogenism, which then can have the outcome of improving the day-to-day issues that women experience. Lifestyle modification is considered one of the initial treatment options to improve insulin sensitivity, which then results in weight loss in those who are overweight, improved glucose/insulin mechanism, reduced testosterone, and improved ovulatory function. Lifestyle modifications generally focus on low-sugar, low-starch diets and regular aerobic exercise as well as strength training.
Besides these, several nutritional supplements and botanicals have shown evidence to either improve insulin sensitivity and reduce hyperinsulinemia, and/or lower androgens. I will not go into the research here, but the research is dominated by N-acetylcysteine (NAC) and myo-inositol; others include cinnamon, chromium, licorice root, marjoram tea, spearmint tea, curcumin, green tea, and chamomile.
Recently, probiotics have gained attention due to their ability to correct gut microbiota dysbiosis, reduce inflammatory markers, and improve various metabolic diseases. Several studies have suggested the involvement of compromised gut health in the etiology of PCOS. One study showed that PCOS women had fewer types of gut microbes as compared to normal women and this was related to an increase in androgens. Because of this, supplemental probiotics might be a tool to modify gut microbiota in the treatment of women with PCOS.
A multi-strain probiotic formulation was used in the current study,1 and included Lactobacillus acidophilus UBLA-34, L. rhamnosus UBLR-58, L. reuteri UBL Ru-87, L. planarum UBLP-40, L. casei UBLC42, L. fermentum UBLF-31, Bifidobacterium bifidum UBBB-55, and fructo-oligosaccharides. Each of these was formulated with the acidophilus, rhamnosus and reuteri having 2 billion colony forming units (CFU) each with plantrum, casei, fermentum and Bifidobacterium at 1 billion each and fructo-oligosaccharides of 100 mg.
A total of 104 women with PCOS were randomized to either the probiotic or the placebo group for six months. One group received the 10 billion total of probiotics daily for 2 months and then 20 billion per day for 4 months. The other group received placebo. Both groups received healthy diet plans and exercise plans. Evaluations included hormonal testing, pelvic ultrasound of the ovaries, insulin resistance testing, weight, weight-hip ratio, and assessing menstrual cycle regularity.
The probiotic supplement along with dietary and exercise modifications significantly regulated the menstrual cycle and improved total testosterone levels and the menstrual-related quality of life evaluation.
Commentary: PCOS is one of the most widely reported hormonal disorders in reproductive-age women. While contraceptives, metformin, and anti-androgenic medications have an important selective role, natural medicine is a strong contender when used with adequate knowledge about PCOS and the practitioner is familiar with the research and dosages for nutraceuticals and botanicals. In addition to the current study, a systematic review and meta-analysis also suggest that at least 12 weeks of supplementation with select probiotic combinations may result in improvement in weight, insulin, insulin resistance, total testosterone, and menstrual regularity.
Reference
- Kaur I, Suri V, Sachdeva N, et al. Efficacy of multi-strain probiotic along with dietary and lifestyle modifications on polycystic ovary syndrome: a randomized, double-blind placebo-controlled study. European J of Nutrition. July 2022.
Published May 20, 2023
About the Author
Tori Hudson, ND, is a nationally recognized author (book: Women’s Encyclopedia of Natural Medicine second edition, McGraw Hill 2008), speaker, educator, researcher, and clinician. She serves on several editorial boards, advisory panels and as a consultant to the natural products industry. Dr. Hudson graduated from the National University of Natural Medicine (NUNM) in 1984 and has served the college in several capacities, including Medical Director, Associate Academic Dean, and Academic Dean. She is currently a clinical adjunct professor at NUNM, Southwest College of Naturopathic Medicine, Bastyr University, and the Canadian College of Naturopathic Medicine.
Dr Hudson has been in practice for more than 36 years. She is the medical director of her clinic, A Woman’s Time in Portland, Oregon, co-owner and director of product research and education for VITANICA, and the program director for the Institute of Women’s Health and Integrative Medicine. She is also the founder and co-director of NERC (Naturopathic Education and Research Consortium), a non-profit organization for accredited naturopathic residencies.