Although I am an Acupuncturist, I feel it is important to present information in a language people are more familiar with, thus for the purpose of this discussion I am presenting in more of a western medical language.
Furthermore, those who have been diagnosed with the syndrome have most likely already hit the internet to learn more about the condition.
Regardless what ‘language’ I use, I would like to emphasize that in diagnosis and treatment I use the meridians, acupuncture points, and reflective area palpation that is always guided by Acupuncture philosophy and concepts.
To gain a general perspective of polycystic ovary syndrome it is important to view the hypothalamic pituitary gonadal axis in its physiological (balanced) state, as well as in its pathological (imbalanced) state, and the associated systemic effects in both cases.
Hypothalamic Pituitary Gonadal Axis (HPGA) (physiology)
These hormones travel via the blood stream and act on the ovaries, specifically causing the expansion and growth of the primordial follicles within the ovaries.
These follicles (within the ovaries) then begin to secrete estrogen, which travels in the blood stream to reach the anterior pituitary gland.
This feedback signals the pituitary to release a surge of luteinizing hormone (LH) which impacts the ovaries and causes the most mature follicle to burst and release its oocyte.
The oocyte finds its way to the fallopian tube where it awaits fertilization, and naturally if the egg is not fertilised it will be shed along with the lining of the uterus (endometrium) upon menstruation.
The remaining follicles that did not reach their pinnacle of maturation and subsequently release their oocyte, dissolve.
The follicle remnant that did burst and release the oocyte becomes the corpus luteum which produces progesterone, and continues to shrink until it dissolves.
Hypothalamic Pituitary Gonadal Axis (HPGA) (pathophysiology relating to PCOS)
Additionally the pancreas is stimulated to secrete more insulin into the blood stream, which when coupled with high levels of LH, instigates the ovaries to produce high levels of testosterone which unfortunately further prevents ovulation.
This brief explanation of the hypothalamic pituitary gonadal axis in relations to PCOS highlights why the pathology is seen to affect so many systems in the body and furthermore why the symptoms of the syndrome present as they do.
- Oligoovulation and/or Anovulation
- Excess androgen activity
- Polycystic Ovaries (more than 12) however some research states 20-25 or more…
PCOS symptoms in relation to HPGA
Fertility issues: can occur but some women with a PCOS diagnosis conceive just fine. If infertility is an issue it would possibly relate to the disrupted menstrual cycle and anovulation.
Excess androgen activity: increased testosterone may show as (hirsutism) the male hair patterns some women experience. This relates to the high insulin levels coupled with the LH surge effecting the ovaries to excessively produce testosterone.
Polycystic Ovaries: Due to a proportion of the follicles not dissolving as in normal physiology, they give the appearance of Poly=many Cystic=fluid filled sac. Which are not really cysts but rather follicles.
Insulin resistance: As the beta cells of the pancreas are stimulated to produce excessive amounts of insulin, over time this can inhibit the effectiveness of insulin in lowering blood sugar.
Acne: again this can be due to increased testosterone levels.
Women that I see in the acupuncture clinic who have been labelled with this syndrome generally have tried the standard medical treatment options such as:
The contraceptive pill: to regulate the menstrual cycle and decrease testosterone production.
Anti-androgen meds: to assist with the presentation of the hair growth and acne.
Metformin: A medication administered to type 2 diabetics.
Fertility Drugs: To stimulate ovulation and the likelihood of conceiving, if she wishes to conceive
Relating all this to an Acupuncture framework...
However I always take into account the western medical diagnosis, and I like to have somewhat of an understanding of the pathophysiology. As this is another tool that I can use to bring me closer to understanding what is holding this individual back from being in a state of balance and optimal health.
Here I will give a brief insight into how I view the presentation of Polycystic Ovary Syndrome, as well as concepts that I focus on when treating an individual diagnosed with this condition.
However for the purpose of this discussion in a generalised sense I focus on the menstrual cycle in great detail from menarche to now, medications taken in the past to present, and emotional health.
Menstrual cycle as foundation...
Therefore my intention is in regulating cycle length, menstruation duration and quality, pain experienced (physical or emotional). All of these parameters are of the upmost importance, and the beautiful thing is that we can effectively gauge the treatments effect by the release of pressure pain on reflective areas/meridians and by the state of the menstrual cycle when it occurs.
Key meridians I focus on may be for example the Liver meridian or Kidney meridian. Reason being is that the ovaries like the majority of the glands fall into the domain of the Kidneys in Chinese medical philosophy, and the Uterus falls into the domain of the Liver. I cross check these theories on the table by seeing whether points on the Liver and Kidney channels best release the pressure pain I find on reflective areas through palpation.
A woman has presented to the acupuncture clinic with a main complaint of infertility which she is told by her GP is due to her diagnosis of Polycystic ovary syndrome and subsequent anovulation. Upon palpation I find many reflective areas with pressure pain, one of which is the stomach meridian in the region of the acupuncture point Shuidao. This reflective region, to me, relates to the ovaries and the subsequent pressure pain may relate to an ovarian imbalance. Thus I want to release this pressure pain, the acupuncture point I find that does the best job in this case is Fuliu on the kidney meridian. Theoretically Fuliu is one of the principle tonification points for kidney deficiency and thus is the metal point on the water channel, and as I stated the ovaries in Chinese Medicine fall into the concept of the Kidney.
Therefore I tested the ‘theory’ through palpation and her body gave me the answer through the immediate release of pressure pain. This concept of testing ‘theory’ directly on the body through palpation is the essence of the style of acupuncture I employ, and it provides a benchmark during the treatment process. This coupled in this case with the parameter of the menstrual cycle occurring in a regular manner, is ideal to gauge the effectiveness of treatment, and thus the ultimate goal in this case being, conception.
In regards to other key areas I would focus on if the need was confirmed via palpation would be: Down regulation of the nervous system i.e. releasing the sternocleidomastoid and any subsequent compression of the vagus nerve, releasing the Ren Mai to assist with emotional balance, addressing a weak dan tien, resolving Ren 9 pulse, releasing pressure pain on any of the pituitary reflective areas or associated meridians, releasing Kid 2 & Liv 2 p. pain, addressing any thyroid imbalance, Liver and Pancreas imbalance, or any related structural imbalance/meridian imbalance.
If we induce a state through acupuncture whereby a woman’s menstrual cycle can occur naturally, regularly, without pain or discomfort, without emotional upset, and the menstrual flow to be neither too heavy nor too light, we have regulation on a systemic scale. As we know the menstrual cycle is a reflective culmination of all the systems in the body working in a state of balance and harmony or imbalance and dysfunction. Not to mention it is a direct manifestation of the individuals connection to the heavens (lunar cycle), thus further compounding its importance and relevance.
(Giancarlo Nerini - Acupuncturist)