Another Look at PCOS, from a Neurotransmitter Perspective
ZRT Webinar presentation by Dr. Alison McAllister April 2017
Don't let PCOS control your life any longer. Take the first step towards understanding this complex condition and finding relief from your symptoms. With the right information and support, you can take control of your health and live your best life.
PCOS is essentially a problem with ovulation which results in the overproduction of male hormones (DHEA, androstenedione, and testosterone). It is a treatable but not curable. It is a common, seen in 4 to 10% of the population and some doctors say it is as high as 20%. Genetics may be a factor. We see elevated testosterone levels when 5 alpha reductase converts to dihydrotestosterone and we also see a decrease in aromatase activity so less testosterone converts to estradiol.
Diagnostic criteria: symptoms of high androgens and high androgen on labs (an ultrasound is not necessary).
According to Dr. McAllister there are two types of PCOS:
Ovarian only: lean women, less insulin resistance, difficulties with fertility. Elevated testosterone but normal DHEA
Ovarian & Adrenal: obesity, regular or no cycles, insulin resistance. Both testosterone & DHEA are elevated.
When things go wrong there seems to be a cascade of events which can reach beyond the metabolic hyperinsulemia. The latest research says that 60% of PCOS women have mental issues because the genes that regulate serotonin, GABA & NE are affected. We see an increased level of norepinephrine and a decreased ability to get other neurotransmitters like GABA in the cell. Recall that GABA is not only involved with anxiety but it keeps beta islet cells from degradation. More norepinephrine, more stress, more inflammation all seem to be a lifelong problems (even if the ovaries are removed a women will continue to have the metabolic problems seen with PCOS). New research is centering on understanding the PCOS in a multigenerational, SNS driven and possibly a result of in utero exposure to elevated androgens and/or stress.
Goals of treatment: | Labs Dr. McAllister runs: |
lower androgens | estrogen, progesterone, testosterone, DHEA, cortisol |
increase SHBG | Â thyroid panel with TPO |
normalize insulin resistance & hyperinsulemia | Â fasting insulin |
lower SNS tone | CBC CPR prolactin |
optimize hormone balance | Â FHS/LH day 3 of cycle |
 reduce inflammatory state |
|
Lifestyle Support: | Conventional medications: |
get a pet | Â birth control pills |
weight lifting (promotes health through myokines) | letrozole (aromatase inhibitor) |
eat clean | spironolactone |
happy lifestyle | metformin |
 Clomid |
Birth Control pills: Recommend Yaz or Yazmin to put the ovaries on vacation. Ethinyl estradiol increases SHBG which will decrease testosterone levels. The unique progestin drosperidone is the kissing cousin to spirolactone which also blocks down testosterone.
Yaz contains 0.2mg ethinyl estradiol, 3 mg drosperidone with 21 active pills and 7 inactive pills.
Yazmin contains 0.3mg ethinyl estradiol, 3 mg drosperidone with 24 active pills and 4 inactive pills.
Generic names include Gianvi, Syeda, Kikki and Zarah.
Benefits of BC pills include a change in the SHBG even after discontinuation (Clinical Pearl: If a PCOS woman on BC pills wants to get pregnant the best odds for conception are the first two month after quitting before the testosterone levels ramp back up). BC pills also decrease acne, help with facial hair and can regulate menstrual cycles. Unfortunately, the pill works only for the duration of time that you take it. As soon as you stop it, your androgens will surge higher than they were before.
Spironolactone: Blocks 5 alpha reductase which blocks testosterone from rolling to dihydrotestosterone and decreases ovarian and adrenal androgens. Dosage: 50-200mg day 4 thru 21 of cycle or 50mg BID day 4 thru 21 of cycle. 40% of women seen improvement in 6 months. Side effect: can decrease libido, increase breast cancer & depression.
Metformin: Has anti-obesity effects because it decreases appetite and increases GLP-1 secretion (GLP-1 is a hormone produced in the small intestine that stimulates insulin secretion and inhibits glucagon secretion, thereby lowering blood sugar). Metformin also decreases carbohydrate absorption, inhibits hepatic gluconeogenesis and enhances glucose transport to skeletal muscle. Oral dose is 500 to 1000mg BID. Side effects include digestive problems and it depletes your body of Vitamin B12. Some fertility clinics are compounding 5 to 10mg metformin to use vaginally to reduce miscarriages in the 1 st trimester or using metformin topically in the third trimester to improve lactation (high insulin & testosterone inhibit milk production).
Berberine: Nature's metformin in that it is a plant based insulin sensitizing agent. Decreases insulin, glucose, A1C. Also anti-inflammatory and helpful in cardiovascular patients. Especially good for acne & anxiety. Dose is 500mg BID, take 6 days a week for 3 months then take a month off. Do not use for more than 3 months continuously because it is antimicrobial and could alter the composition of your intestinal bacteria.
Inositol: Works on 200 receptors in the body. Myo-inositol is a carbocyclic sugar that is abundant in brain and other mammalian tissues, mediates cell signal transduction in response to a variety of hormones, neurotransmitter and growth factors and participates in osmoregulation. It is a sugar alcohol with half the sweetness of sucrose. It is made naturally in humans from glucose (a human kidney makes about 2 grams per day). Other tissues synthesize it also and the highest concentration is in the brain where it plays an important role making other neurotransmitters and some steroid hormones bind to their receptors. An added bonus for the PCOS patient trying to get pregnant is that inositol works through calcium channels to help with oocyte maturation. Total pregnancy rate is 48.4%. For the PCOS patient not desiring pregnancy inositol can modulate serotonin levels, help with SNS regulation and be useful in prediabetes. Dose: 2000mg (2 grams) BID best bought in a powder form that you scoop into a liquid and drink.
Progesterone: In PCOS we generally see low levels of progesterone. Recall that when a woman ovulates, it is the corpus luteum that secretes progesterone. Cysts do not release progesterone so over time women can become estrogen dominant (foggy thinking, weight gain, anxiety, headaches, insomnia, emotional). Progesterone also appears to normalize the heightened LH levels associated with PCOS. Raised LH is one of the mechanisms that stimulate testosterone production. In addition, progesterone inhibits the enzyme that allows testosterone to convert into dihydrotestosterone. Note: giving woman progesterone will increase their fertility.
Dose: 20 to 40mg of cream used cyclically on day 14-25 of cycle (or if irregular use two weeks on and two weeks off).
100 to 200mg orally would be preferred if insomnia is a problem.
Other natural products to treat PCOS:
alpha lipoic acid: 300-600mg day | magnesium glycinate 300mg a day | zinc: 20-30mg a day |
 GABA |  licorice root drops | green tea |
saw palmetto (350 to 700mg/day) | probiotics | Vitamin D |
N-acetyl cysteine (NAC): antioxidant which can restore ovulation 500-1000mg/day |
In conclusion: Dr. Alison McAlister's Absolutes for treating a patient with PCOS:
diet is key …… decrease carbohydrates and increase protein
sleep is important
inositol
berberine or metformin
licorice root drops for normalizing stress and its affect upon the adrenals
Book resources: Natural Diet Solution for PCOS and infertility by Nancy Dunn
PCOS the Hidden Epidemic by Dr. Samuel Thatcher
Period Repair Manuel by Dr. Laura Briden
Websites to visit: www.laurabriden.com 4 Types of PCOS (a flowchart) https://www.zrtlab.com/webinars/pcos-from-a-neurotransmitter-perspective https://www.womensinternational.com/blog/portfolio-items/polycystic-ovary-syndrome-pcos/ https://www.womensinternational.com/blog/pcos-and-hormones/