PCOS Review Newsletter #14

Natural Health Ideas for Polycystic Ovary Syndrome
A free monthly newsletter for women with ovarian cysts or PCOS.

Issue #014      July 14, 2004 Bill Slater, Research Associate


TABLE OF CONTENTS

1) Link Between Hashimoto's Disease and PCOS

2) Help Prevent Insulin Resistance with Vitamin D

3) Rosiglitazone Shows Promise as Treatment for PCOS


1) Link Between Hashimoto's Disease and PCOS

A medical study was recently published that showed a relationship between PCOS and Hashimoto's Disease, which is autoimmune thyroiditis. Autoimmune thyroiditis is an inflammatory condition where your immune system attacks and damages your thyroid gland. As we said in our April newsletter, the thyroid is important for reproductive health.

The purpose of this multicenter study was to investigate the prevalence of autoimmune thyroiditis in women with polycystic ovary syndrome (PCOS). There were 175 women with PCOS and 168 women who did not have PCOS in the study. All of the women had extensive lab work.

The PCOS patients were characterized by an increased LH/FSH ratio, low progesterone, elevated testosterone and a high prevalence of hirsutism, but no differences in estrogen levels were found. In addition, 27% of the PCOS women had elevated thyroid-specific antibodies as compared to only 8.3% of the normal women. Elevated antibodies suggest an aroused immune system that is causing inflammation.

Thyroid ultrasound showed that 42.3% of PCOS women, but only 6.5% of the controls, had thyroid tissue images typical of autoimmune thyroiditis (Hashimoto's Disease). The PCOS women also had higher levels of TSH (thyroid stimulating hormone) than the non-PCOS women, suggesting that the PCOS thyroid is not as successful in making enough thyroid hormone.

The importance of the thyroid hormone for the adequate functioning of multiple organ systems within the body cannot be overstated. The production of adequate quantities of thyroid hormones is necessary for normal fetal and neonatal growth and development, as well as proper functioning of adult organ systems, cardiovascular system, lipid and carbohydrate metabolism, and the neuromuscular and skeletal systems.

A major effect of abnormal thyroid levels is changes in ovulation and menstruation. Ovulation may be impaired by changes in the production of: sex hormone binding globulin (SHBG), follicle stimulating hormone (FSH), estrogen, and androgens. The body compensates by altering the production of thyroid releasing hormone (TRH). The changes in TRH will affect the feedback loop between the hypothalamus, pituitary, and the ovary, leading to changes in ovulation and menstruation. Early stages of thyroid dysfunction (before symptoms are obvious) can lead to subtle changes in ovulation and endometrial receptivity, which then may have profound effects on fertility.

Bottom Line: This study suggests that 4 of every 10 PCOS women probably have impaired thyroid function, due to autoimmune thyroiditis (Hashimoto's Disease). Therefore, an important component of your PCOS treatment is to get a thorough thyroid evaluation from your doctor. As we've said before, just taking birth control pills is not the answer to PCOS.

Sources:
Janssen, OE et al, High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome, Eur J Endocrinol. 2004 Mar;150(3):363-9


2) Help Prevent Insulin Resistance with Vitamin D

Getting optimal amounts of vitamin D may have a positive influence on blood-sugar levels, possibly preventing diabetes and “metabolic syndrome,” a group of metabolism abnormalities associated with insulin resistance.

More than 10 million Americans suffer from diabetes, which often leads to heart disease, kidney damage, nervous system impairments, and other health problems. Even more people have "metabolic syndrome", which is characterized by heart-disease risk factors such as high blood pressure, elevated levels of triglycerides, low levels of HDL (“good”) cholesterol, and abdominal obesity. PCOS shares many of attributes of metabolic syndrome, and women with PCOS are more likely to develop diabetes and cardiovascular disease.

In many cases of polycystic ovarian syndrome, diabetes and metabolic syndrome, insulin resistance is a significant contributing factor. Insulin is a hormone produced by the pancreas that helps transport glucose from the bloodstream into the cells, where it is used to produce energy. In people with insulin resistance, plenty of insulin is available, but the body has an impaired capacity to recognize or respond to its hormonal signal.

In a new study, vitamin D status was assessed in a group of healthy young volunteers. The degree of insulin resistance and the capacity of the pancreas to secrete insulin were also measured in each volunteer. The results showed that lower blood levels of vitamin D were associated with a greater degree of insulin resistance and with weaker pancreatic function. Of those with subnormal vitamin D levels, 30% had one or more components of the metabolic syndrome, compared with only 11% of those with normal vitamin D levels. These results suggest that vitamin D deficiency increases the risk of insulin resistance or of the metabolic syndrome.

As many as 40% of Americans may have vitamin D deficiency. Vitamin D is present in only a few foods, such as cod-liver oil, oily fish (salmon, mackerel, sardines), and vitamin D-fortified dairy products and breakfast cereals.

Most of the vitamin D in your body is manufactured in the skin after exposure to sunlight. People who don't receive adequate amounts of sun exposure are at risk of developing vitamin D deficiency.

According to one report, adequate vitamin D levels can be achieved by daily exposure of your hands, face, and arms to sunlight for one-quarter the time it would take to produce a light pinkness of the skin. If you're unable to obtain that amount of sunlight exposure, vitamin D supplementation should be considered. The amount recommended by most doctors ranges from 400 IU to 1,000 IU per day. Although excessive doses of vitamin D can be toxic, recent research suggests that long-term use of 1,000 IU per day is safe.

Source: Chiu, KC et al, Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction, Am. J. Clinical Nutrition, May 2004; 79:820-825


3) Rosiglitazone Shows Promise as Treatment for PCOS

Rosiglitazone (Avandia) therapy may improve ovulation and insulin sensitivity in women with polycystic ovary syndrome and insulin resistance, according to a new study.

Insulin resistance, a common finding in PCOS women, leads to elevated levels of insulin, which stimulates androgen release, making the problem worse. Therefore, by promoting a drop in insulin levels, insulin-sensitizing agents may improve the symptoms of PCOS.

For many years, metformin (Glucophage) has been used to treat insulin resistance associated with polycystic ovarian syndrome. However, many women experience gastrointestinal side effects such as diarrhea, nausea, and loss of appetite.

Rosiglitazone is not to be confused with troglitazone, an insulin sensitizer approved for use in 1997, which was studied briefly as a treatment for PCOS before it was taken off the market in 2000 after being linked to rare but serious liver side effects..

In this study, 42 women with PCOS and insulin resistance were randomized to receive one of three rosiglitazone doses for 12 weeks. Treatment with rosiglitazone improved their insulin resistance and reduced their insulin levels. Those receiving the highest dose has the best effect. 55% of the women ovulated at least once during the 12-week period.

In addition, rosiglitazone was well tolerated and did not produce the troubling gastrointestinal side effects often seen with metformin.

Because rosiglitazone is limited in its ability to reduce androgen (male hormone) levels, the lead author of the study said he does not envision the drug being taken on a continuous basis for problems like hirsutism. Rather, he sees the drug being used on a short-term basis as a means to promote ovulation.

Sources:
Findings were presented in June 2004 at the 86th annual meeting of The Endocrine Society.
Cataldo, NA et al, Improvement in insulin sensitivity followed by ovulation and pregnancy in a woman with polycystic ovary syndrome who was treated with rosiglitazone, Fertil Steril. 2001 Nov;76(5):1057-9


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