PCOS Review Newsletter #3
Natural Health Ideas for Polycystic Ovary Syndrome
A free monthly newsletter for women with ovarian cysts or PCOS.
Issue #003 August 18, 2002
Nancy Dunne Boggs, N.D., Naturopathic Physician
Bill Slater, Research Associate
1) Special Issue - Unwanted Hair Growth
4) Removing Unwanted Hair - Depilation & Epilation
5) Removing Unwanted Hair - Electrolysis
6) Removing Unwanted Hair - Laser Treatment
7) Reducing Hair Growth with Drugs
8) Reducing Hair Growth with Natural Methods
12) Get Help from a Knowledgeable Physician
1) SPECIAL ISSUE - UNWANTED HAIR GROWTH
Hello! Thanks to all who have written to tell us what’s important to you. Your feedback has made it clear that many of you are very concerned about unwanted hair growth. The medical term for this is "hirsutism".
In this issue we’ll give you basic information about hirsutism, and describe what some of your options are.
Hirsutism is caused by a multiplicity of direct and indirect factors. It’s treatable, but there is no "ideal" treatment. We didn’t have room in this newsletter to tell you the complete story on what to do about hirsutism. Look for detailed recommendations in our forthcoming book.
Parts of this newsletter are pretty technical. I suggest you print it out, get a cup of tea, find a quiet spot, and read it thoughtfully.
2) WHAT IS HIRSUTISM?
Hirsutism (HER-SUIT-ISM) is the abundant growth of coarser, more visible hairs in men or women. Hirsute (HER-SUIT) women have thicker growth of easily visible hair on the upper lip, around the jaw and up the cheeks to the temple. Some women also have coarse, dark hair on the chest, around the nipples, up toward the belly button from the pubic area, and on the upper thighs. The arms, legs, toes and fingers can also be involved.
Hirsutism affects 5-10% of all women and a much higher percentage of women with PCOS. Women of European ancestry have higher rates of hirsutism than women of African descent. Asian women have the lowest rate
Too much hair in the wrong places is emotionally painful for many women. The definition of feminine beauty in the U.S. includes smooth, apparently hairless skin. There are many cultures and individuals that don’t agree with this particular idea of beauty. However, American women are bombarded daily by TV, movie and magazine images that make it seem that women don’t have any hair at all except on top of their heads.
Because physical appearance has so much to do with how people relate to each other, hirsutism can be a painful, even devastating experience. At the very least, women may be chronically stressed by the amount of time and money they spend removing unwanted hair. And the darn stuff is constantly growing back!
3) WHAT CAUSES HIRSUITISM?
Interacting factors - hormonal, genetic, and lifestyle - combine to determine how much hair you have, and where it grows.
Hirsutism is thought to be mostly due to excessive levels of androgenic hormones. Examples of androgens are testosterone, androstenedione, and DHEA. Testosterone is the main androgen we’re concerned about. It’s normal for men to have a lot of testosterone and for women to have some. When women have too much testosterone, hirsutism may result. When men have excessive testosterone, prostate problems can occur.
But even if your androgens are normal, you may develop hirsutism because your body is overly sensitive to hormones. And some women who have normal androgens and don’t have PCOS will develop excessive hair. This is called "idiopathic" hirsutism, meaning the cause is unknown.
Your genes are a contributing factor to hirsutism. Your inherited genetic predisposition may incline your metabolism towards creating conditions favorable to the growth of unwanted hair. However, what you eat, whether you exercise, how well you sleep, how you manage stress, and the pollutants you are exposed to will directly influence what your genes do. So your hirsutism is partially subject to your control.
We’ll discuss the pieces of this complex puzzle more fully in our book. For now, let's look at some specific things you can do about unwanted hair.
There are basically two ways to handle hirsutism. You can physically remove or destroy the unwanted hair, or you can reduce the androgen and related hormone imbalances that are causing the hair to grow.
4) REMOVING UNWANTED HAIR - DEPILATION & EPILATION
Temporary hair removal can be achieved through depilation or epilation. Continued use of these methods works well for many women.
Depilation is the removal of the part of the hair above the skin's surface. It can produce results lasting several hours to several days. Two main depilation methods are shaving and creams. Shaving is inexpensive, virtually painless, and provides good results in the privacy of your own home.
There are creams and lotions that chemically dissolve your hair away. The effect is similar to shaving, but using them can leave a rather bad smell that lasts for days afterward and may cause rashes if you have sensitive skin.
Epilation is the removal of the entire hair from the follicle. Tweezing can work well for small areas. Waxing or sugaring works by applying a sticky paste and then peeling it off the skin, along with the hairs embedded in it. Friction, using a mitt with a rough surface, is used mainly for fine leg hair. Threading involves rolling a twisted thread across the hairs to catch and pull them out. Rotary epilators are similar to electric razors, except they have tweezers that pull your hairs out.
Hair removal can be painful. There is also a tendency for rashy bumps and possible infection after treatment. If you’re doing epilation at home, you may not be able to reach all the areas that need treatment. Epilation works better on hair that grows straight and lies flat. Curly hair or hair that grows in different directions is more painful to pull out and often requires repeated applications over the same area to get a hairless result.
5) REMOVING UNWANTED HAIR - ELECTROLYSIS
More permanent hair removal may be achieved with methods that destroy the hair follicle. The success of these methods depends a great deal on the skill of the practitioner, and your skin and hair type. Despite some advertising claims, none of these methods are 100% painless, and none can guarantee 100% permanent results for all women.
All involve risk of infection or some kind of damage to the skin surrounding the hair follicle. Your best chance of a happy result will be with a method that has been around for a while, in the hands of an experienced practitioner. Regulation varies by state, so check to see if the practitioner is licensed or registered. If there is regulation, there will be a mechanism for you to verify the practitioner’s credentials through a state agency. Contact your state consumer protection division for information. At the very least, get a referral to a competent practitioner from someone who has been a satisfied client.
Electrolysis is one of the oldest hair removal methods and has a reliable track record. In the hands of a well-trained and experienced technician, it is safe and effective. A thin metal probe is slid into a hair follicle and electricity flows along the probe to damage the follicle so that the hair does not re-grow. Electrolysis can be expensive, painful, tedious and difficult for large amounts of hair. If done improperly, it can result in infection, scarring, and possible re-growth of hair. Small battery-powered probe units are advertised as easy to use, but performing electrolysis on yourself is difficult and not recommended.
6) REMOVING UNWANTED HAIR - LASER TREATMENT
Laser hair removal is newer than electrolysis. Lasers use a special light wave that is absorbed by dark hairs and damages the hair follicle. Laser therapies have not been in use long enough to fully determine how permanent the hair destruction is.
Laser treatment should not be used by dark-skinned women and is less effective with blond, red or white hair. Light-skinned women with dark hair get the best results. Laser treatment is useful for large areas of hair. Most types of laser hair removal are considered safe if performed properly. However, recent studies suggest other skin structures can be adversely affected by laser irradiation and no one yet knows what the long-term consequences are. Hair re-growth will occur in some women.
7) REDUCING HAIR GROWTH WITH DRUGS
If you have seen a medical doctor about hirsutism, you’re probably taking birth control pills, possibly in combination with one or more other drugs. Drugs to retard hirsutism fall into three broad categories:(1)
- Androgen receptor blockers: Cyproterone, flutamide (Eulexin), and spironolactone (Aldactone).
- Androgen-suppressing agents: GnRH agonists (Lupron), estroprogestins (birth control pills), corticosteroids, and insulin-sensitizing agents (metformin/Glucophage).
- 5 alpha-reductase inhibitors: Finasteride (Proscar), eflornithine hydrochloride (Vaniqua).
All of these drugs work to some extent. They have helped some women see measurable reductions in androgen levels and unwanted hair growth. Most have side effects. All are recommended in conjunction with birth control pills, partly to control the side effects of these medications.
These synthetic drugs are designed to either suppress testosterone production or inhibit its effect so that new hair growth is reduced Existing hair is not affected; it falls out on its own, like all hair eventually does.
You can expect to take these medications for at least six months before seeing significant results. It’s advisable to defer electrolysis or laser therapy until the drug treatment has had at least six months to suppress new growth. Then, your doctor may recommend electrolysis or laser treatment to remove existing hair.
Impaired liver function is a potentially serious side effect as you metabolize and eliminate these synthetic drugs. We discussed this same problem relative to birth control pills in our July newsletter. Research also suggests that most of these drugs work best when used along with some other drug, so choosing medicine for hirsutism usually involves multiple medicines. The health consequences of using these drugs for more than about two years has not been studied. The benefits and risks of using medications to reduce unwanted hair is a complex issue that will be discussed in our book.
For some women, the reduction of unwanted hair is well worth the expense and potential health risks of these drugs. Others are concerned about side effects and long term consequences of using drug treatments. Some feel strongly about avoiding drugs of all kinds. So, other than drugs, depilation or expilation, is there anything else you can do?
8) REDUCING HAIR GROWTH WITH NATURAL METHODS
A healthy diet, supplementation, exercise, stress management, and quality healthcare will have a profoundly beneficial effect for PCOS women. A thoughtful self-care program will do much to reduce the manifestations of PCOS, including hirsutism.
This type of program is designed to:
- Reduce the excess insulin that contributes to increased androgen production and hirsutism.(2)
- Help restore your normal menstrual cycle and fertility.
- Help prevent type 2 diabetes and heart disease.(3)
Portions of this program are described below.
9) HEALTHY PCOS DIET
HEALTHY DIET - FATS. You can improve your diet by choosing the appropriate amounts and types of fat and oils. If you are overweight, you can benefit from consuming less than 25% of total calories as fat. Eating the right kind of fats and oils is very important. Olive oil and fish oil supplements are healthy choices. We'll have more information about fats and oils in our upcoming book.
For now, we recommend you increase your consumption of omega-3 fats, which is one of the essential fatty acids or EFAs. The word "essential" means they are essential for life and must be obtained from the diet because they are not manufactured inside your body. Omega-3 fats are found in cod liver oil, EPA/DHA capsules, and in fatty fish such as salmon, sardines and mackerel.
We also recommend you eliminate trans-fatty acids from your diet. A trans-fat is an unsaturated liquid oil that has been chemically transformed into a saturated fat so that it will be a solid instead of a liquid. Margarine, which is a solid made from a liquid, is an example of a product containing trans-fats. The problem with trans-fats is that they have been implicated as contributors to heart disease and diabetes. We have every reason to believe they also contribute to PCOS problems. In packaged products, you can identify a trans-fat by the word "partially hydrogenated". If you see "partially hydrogenated" on any food product label, we recommend that you not consume that product.
HEALTHY DIET - PROTEIN. The consumption of protein is another complex topic. Some of you are on low carbohydrate diets that emphasize adequate protein. If your protein is land animal protein, it also means you may be eating a high saturated fat diet, because saturated fats are found in most animal protein. A diet high in saturated fat is associated with heart disease and diabetes. It also indirectly alters your hormonal patterns.
Consider animal protein foods that are lower in saturated fat such as fish, non-fat cheese, turkey and chicken. Convenient plant-based proteins are soy and rice protein powders, which are free of saturated fat.
HEALTHY DIET - CARBOHYDRATES. The amount and type of carbohydrate you eat will influence your hormones. A diet high in refined carbohydrates will lead to an excessive insulin response, which in turn can stimulate the androgen production that contributes to hirsutism and other PCOS symptoms.
You’ve probably heard about "low-glycemic carbohydrates". Carbohydrates (starches and sugars) are found in grains, nuts, seeds, vegetables and fruit - and in all manufactured products containing these items. A low-glycemic carbohydrate is one that causes only a small rise in blood sugar, thus avoiding a problem with insulin, which is the hormone that lowers blood sugar.
We favor low-glycemic foods. But that’s not the whole story. Especially important is whether the carbohydrate is complex or refined. For example, a rice cracker is a refined carbohydrate. Brown rice is a complex carbohydrate. Not only does brown rice give you better nutrition, it’s also lower on the glycemic index. You will be healthier and have better balance of your hormones if you consume unrefined, complex carbohydrates as opposed to refined carbohydrates. A complex carbohydrate is something you find in nature, not at the end of an assembly line.
And don’t forget that fresh vegetables, fresh fruit, and unprocessed nuts and seeds are nutritious sources of essential fats and protein as well as complex carbohydrates.
HEALTHY DIET – FLUIDS. Even what you drink can have an effect on hirsutism and other PCOS difficulties. For example, studies show that the ingredients in green tea can reduce the effects of testosterone.(4)
HEALTHY DIET – CALORIE RESTRICTION. We’ve spoken about the type of foods to eat. But how much should you eat? A very modest level of calories appears to be effective for reducing insulin levels and increasing sex hormone binding globulin (SHBG). SHBG is necessary for the control of testosterone. In one small study using a low-calorie, low-fat diet, 40% of hirsute obese women who lost at least 5% of their body weight had a reduction in hirsutism.(5)
However, low-calorie diets are potential gateways to eating disorders and health-devastating failure experiences. Any calorie restricted diet or any other major change in your diet should be done with the support and supervision of a knowledgeable healthcare provider.
10) SUPPLEMENTS FOR HIRSUTISM
SUPPLEMENTATION - VITAMINS & MINERALS. Quite a number of vitamins and minerals are helpful for normalizing insulin and androgens, or reducing the effects of testosterone. They include chromium, vitamin E, magnesium, zinc, copper, and vitamin B6, to name a few.(6-9)
Supplementation may also be indicated if your diet has been less than optimal and if you are taking multiple medications. Take vitamin B6 for example. The processing of foods may transform B6 into another compound that your body can’t use.(10). The chronic use of birth control pills has long been suspected of creating a vitamin B6 deficiency, although this has not been conclusively proven.(11).
You want to have some B6 on board because it appears to reduce the production of prolactin (12-13), a hormone that causes testosterone to be taken up by tissues. Some women with PCOS have too much prolactin. Vitamin B6 also dampens the responsiveness of cells to hormones, and when there is a vitamin B6 deficiency, the cells appear to have an exaggerated response to hormones.(14)
In summary, supplementation with vitamin B6 and other nutrients should be considered for inclusion as part of your overall program to control hirsutism and other PCOS symptoms.
SUPPLEMENTATION - HERBS. There are herbal medicines that work like anti-androgen drugs by inhibiting the enzyme that converts testosterone into the much more potent DHT (dihydrotestosterone). DHT is the hormone in your skin that stimulates hirsutism.
Serenoa repens (saw palmetto), pygeum africans (15), urtica dioca (stinging nettles) (16-17) all inhibit the action of testosterone. There have been many studies of men with testosterone disorders that demonstrate the effectiveness and safety of these herbs. There aren’t yet any studies of hirsute PCOS women. However, naturopathic physicians using these herbs for PCOS are seeing consistently favorable results. (18-19)
Vitex agnus-castus (chastetree berry) has traditionally been used to treat menstrual irregularities and improve fertility. It is thought that vitex normalizes LH (luteinizing hormone). High levels of LH contribute to androgen production.(20) Vitex is an important herb for natural treatment of PCOS.
11) EXERCISE.
Regular exercise is a critical component to any program for reducing hirsutism, obesity, insulin resistance and other problems associated with PCOS.
Any exercise is beneficial, for a multitude of reasons. However, you may need to increase the intensity of your exercise to get maximum effect. A recent study reported that intense aerobic exercise for 30 minutes at least 5 times a week improves insulin sensitivity, thus helping to reduce hirsutism. Women who exercised less or not at all didn’t have an improvement in insulin sensitivity.(21) Of course, we strongly recommend you consult with your physician before starting any exercise program.
BOTTOM LINE: NUTRITION + EXERCISE. You may be taking drugs because you will do almost anything to get rid of unwanted hair. You can substantially improve your probability of success with better nutrition and exercise. A healthy diet and lifestyle work exactly like drugs do, only there are no side effects.
12) GET HELP FROM A KNOWLEDGEABLE PHYSICIAN.
The final component of your natural approach to dealing with hirsutism and PCOS is to periodically consult with a qualified and knowledgeable physician.
Naturopathic physicians are especially well trained in all of the natural health-building methods outlined above.
A knowledgeable medical or naturopathic doctor will also want to carefully evaluate your organ systems. In order to bring your hormones into balance, your liver, kidneys, adrenals, thyroid and GI tract need to function properly. If there is malfunction, special treatment will be recommended. You need healthy organs if you want to eventually be free of reliance on medications.
NOTE: Our forthcoming book will go into much greater detail on all the topics reviewed in this article.
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