Can progesterone help with Polycystic Ovarian Syndrome (PCOS)?

PCOS is a condition that is alarmingly on the rise globally and poses a significant issue for young girls and women. It impacts up to 10% of those aged 15 to 50, soaring to nearly 25% when accounting for women with mild cystic ovaries and those whose ovaries have been affected by the contraceptive pill.

Polycystic Ovary Syndrome is also known by several other names, including Stein-Leventhal Syndrome, hyperandrogenic chronic anovulation, functional ovarian hyperandrogenism, and Polycystic Ovary Disease.

Symptoms vary and include some or all of the following...

• oligomenorrhoea - absent or infrequent periods or amenorrhea - no menstrual period. The normal cycle length is between 21 to 35 days. But for women with PCO the cycle length can vary from every 6 weeks, to only 1 to 8 periods a year, to none at all. Other symptoms include lengthy bleeding episodes, scant or heavy periods, or frequent spotting. Ovulation would be infrequent or not at all, leading to a drop in progesterone levels
• enlarged ovaries - usually 1.5 to 3 times larger than average, with a variable number of follicles halted in development, these are commonly referred to as... cysts - fluid-filled sacs that create the distinctive "string of pearls" appearance of ovaries laden with cysts. Diagnosing PCOS is often challenging without evidence of some cysts or ovarian enlargement. Frequently, the root cause is inflammation, which may not be detected by the radiographer. Cystic ovaries may result in...
• chronic pelvic pain - however the precise cause of this pain remains unclear, inflammation is the most probable factor. It is classified as chronic when pain endures for more than six months. However, follicles that halt their growth are unable to ovulate, resulting in... 
• anovulation—an absence of ovulation—which is relatively common since follicles mature infrequently. This consequently contributes to... 
• low progesterone levels, as it is only post-ovulation that the follicle, now referred to as the corpus luteum, generates progesterone. However, diminished progesterone levels result in...
• elevated levels of luteinising hormone (LH) suggest that the pituitary gland is trying to trigger ovulation. However, increased LH levels suppress follicle-stimulating hormone (FSH), leading to the interruption of follicle maturation in the following cycle. Moreover, LH stimulates the thecal cells in the ovary to produce androgens, which consequently results in....
• high androgens -hyperandrogenism, characterized by elevated levels of testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS), can result in excessive facial and body hair, male-pattern baldness, a deepened voice, weight issues including obesity and a reduced hip-to-waist ratio, as well as acne, oily skin, dandruff, and suppression of ovarian function, ultimately causing anovulation....
• infertility - the inability to get pregnant within six to 12 months of unprotected intercourse, depending on age and low progesterone levels
• high blood glucose - level is sometimes found, leading to...
• high insulin - this leads to...
• high androgens - anovulation and low progesterone
• A prolonged high insulin level leads to...
• insulin resistance - a condition characterized by the body's inefficient use of insulin, which can subsequently result in weight gain or obesity, complications with blood glucose levels, and acanthosis nigricans—dark, velvety patches commonly found on the neck, armpits, groin, vulva, and other areas, indicating insulin resistance. Additionally, this condition may manifest as skin tags (acrochordons), elevated androgen levels, increased triglycerides, high LDL cholesterol, and reduced HDL cholesterol levels. As a result, this creates a heightened susceptibility to various health issues....
• heart disease - which is often associated with...
• hypertension - high blood pressure and...
• high homocysteine - which is caused by a lack of vitamins B2, 6, 12, folic acid and zinc. Lack of zinc can lead to...
• acne - and a suppressed progesterone level. But heart disease, insulin resistance and malfunctioning ovaries are caused by...
• oxidative stress - which in turn is caused by...
• a lack of antioxidants - which includes zinc, selenium, arginine, N-acetyl cysteine, glutathione, and in particular Vitamin D3. Oxidative stress is also caused by...
• high sugar intake and foods which convert to sugar, these are the most oxidizing foods we can eat. It causes glycation, which releases free radicals, damaging cells in the process and leading to...
• inflammation

Natural treatment

• A Vitamin D3 test is essential and take a minimum of 5000 IU's per day, bringing the level in the blood to 50ng/ml (125nmol/L) or above. A lack of Vitamin D3 is found in PCO, with many authorities believing it could be the main contributing factor. A lack also leads to hyperparathyroidism which is often present in PCOS. High levels of parathyroid hormone suppresses thyroid activity, leading to a higher than normal TSH level. The year round level of Vitamin D3 should be 70ng/ml (125nmol/L) or higher.
• A lack of Vitamin D3 reduces the benefits of progesterone.
• Use between 150-250mg per day progesterone, more maybe needed. This will help stabilise blood sugar and suppresses androgen production. It also helps to correct ovarian malfunction.
• Take the B vitamin inositol, this aids in reversing insulin resistance and stabilizing glucose levels. Studies have shown this restores gonadal function.
• Take the antioxidant amino acids L-arginine and N-acetyl cysteine, studies have shown these restore gonadal function.
• The amino acids L-glutamine and L-glycine are very helpful. The brain uses them in place of glucose for energy, so they stop all binging, tiredness, cravings for sugary foods and alcohol. Glutamine also heals the lining of the gut, it boosts the immune system and is the most abundant amino acid in the muscles, so helping with muscle weakness. These two amino acids are also two of the three precursors to glutathione, which apart from Vitamin D3, is the most important antioxidant the body makes. The third amino precursor is cysteine, which is essential to take.
• MCT oil - medium chain triglyceride is another excellent source of energy which is not converted to fat, but can be used directly by the cells for energy, take 5-60ml/day. It's extracted from coconut oil and comprises 60% caprylic acid, which kills candida, and 40% capric acid.

The following amino acids, vitamins etc treat PCOS successfully:

Reduce androgen levels - utilize progesterone to inhibit these effects and eliminate all foods that convert to glucose, thereby lowering insulin levels, which in turn leads to an increase in androgens.

Reduce insulin levels - eat organic protein while steering clear of all starchy carbohydrates, including grains, legumes, sweet or starchy fruits, and root vegetables. Focus exclusively on non-starchy leaves, shoots, sprouts, non-sweet fruits, and fruiting vegetables.

Check homocysteine levels - given that this can be a contributing factor, a blood test is recommended. If the result exceeds 6, it is crucial to incorporate the following nutrients to reduce it...

• 150mg B2 - riboflavin
• 75mg B6 - pyrodoxine
• 1000mg B12 - cyanocobalamin
• 1200mcg folic acid
• 3000mg TMG-tri-methyl glycine (anhydrous)
• 100mg zinc for 3 months, then reduce slowly to the normal daily dose of 15mg. This will also help the acne if present.

Additional information

Progesterone - use 150-250mg possibly more depending on how severe symptoms are. Once the body has adjusted and progesterone is the dominant hormone, progesterone should only be used at ovulation, for the last 14 days of the cycle, taking day 1 as the first day of bleeding but only after it has been used for 2-6 months or until one feels stable and all symptoms have improved. Then and ONLY then should it be used at ovulation. 

Cycles can be very erratic or non-existent in PCOS even after using for 2-6 months, if this is the case use a 28 day cycle to begin with, until the natural cycle exerts itself. This would mean using the cream from day 15 to 28.

For more information please see this web page on how to use progesterone.

Some authorities advise using the cream every day without a break to prevent any eggs from growing and maturing, as they only result in more cysts. If this route is followed use half the dose given above for the first two to three months. A scan will confirm if the cysts are being absorbed back into the body.

After the two to three months of using the cream every day, a cycle can be started using the progesterone following a 28 day cycle. This should prevent any further cysts developing and hopefully initiate ovulation with the help of necessary antioxidants.

If there is a cycle, but with spotting before a full period, between 200-250mg of progesterone will be needed during the last 14 days to prevent the spotting. The spotting is a sign that the progesterone level is dropping too low, too soon, to support the endometrium.

Stress drops progesterone levels sharply. Increase the amount used if stress should occur.

Before using progesterone it's essential to first read the page on Estrogen Dominance.

Medical treatment

The medications used to treat PCO's include...

• birth control pills
• spironolactone
• flutamide
• clomiphene citrate

Treatment with clomiphene induces the pituitary gland to produce more FSH, which in turn stimulates maturity and release of the eggs. Although one study found a high level of bioactive FSH in PCO granulosa cells which failed to effect maturity of an egg.

The birth control pill contains progestins (synthetic progesterone) and estrogen, which not only stops ovulation, but reduces the level of natural progesterone in a woman, plus the many adverse side affects it has. For more on this please see the web page on Contraceptive Research Papers.

Contraceptives also increase insulin resistance.

If insulin resistance is present glycophage (Metformin) or one of the thiazolidinedione medications is given. Glycophage reduces vitamin B12 levels, which could cause homocysteine to rise.

Standard tests for PCOS include…

• Abdominal ultrasound
• Abdominal MRI
• Biopsy of the ovary
• Estrogen levels
• Fasting glucose and insulin levels
• FSH levels
• Laparoscopy
• LH levels
• Male hormone (testosterone) levels
• Urine 17-ketosteroids
• Vaginal ultrasound

(Medline)

Further recommended tests...

• Vitamin D3 - low - this is an essential test. The test should be done for 25-hydroxyVitamin D3, also called calcidiol. The following list gives an indication of levels of Vitamin D3 found in the blood (Vitamin D Society):
• Sufficient 50-100ng/ml or 124.80-249.60nmol/L
• Hypovitaminosis less than 30ng/ml or 75 nmol/L
• Deficiency less than 25ng/ml or 62.4nmol/L
• CRP - increased levels - another essential test. The level of CRP rises when there is inflammation throughout the body, normally none should be found. Levels if found, vary from <1.0mg/L to >3.0mg/L (Medline CRP)
• Parathyroid hormone - often increased
  Normal values are 10-55 pg/mL
  (Medline Parathyroid hormone)
• Homocysteine (increased levels) 0.54-2.3 mg/L (4-17 micromoles per liter (mcmol/L) (WebMD)
• DHEA-sulfate - increased levels - normal values for serum can differ with age (Medline DHEA-S)
• Ages 18 - 19: 145 - 395 ug/dL
• Ages 20 - 29: 65 - 380 ug/dL
• Ages 30 - 39: 45 - 270 ug/dL
• Ages 40 - 49: 32 - 240 ug/dL
• TSH -levels sometimes increased. Normal values are 0.4 - 4.0 mIU/L (Medline TSH)
• Glucose test - levels sometimes increased (Medline Glucose)
• Normal levels are up to 100 milligrams per decilitre (mg/dL)
• Persons with levels between 100 and 126 mg/dL may have impaired fasting glucose or insulin resistance
• Diabetes is diagnosed when fasting blood glucose levels are 126 mg/dL or higher
• Insulin resistance - sometimes observed. (Medline Insulin resistance) There is no single test for IR, but the following are often tested...
• blood pressure equal to or higher than 130/85 mmHg
• fasting blood sugar (glucose) equal to or higher than 100 mg/dL
• elevated insulin levels
• elevated CRP - a marker for inflammation
• large waist circumference - 35 inches (87.5cm) or more
• low HDL cholesterol - Under 50 mg/dL
• triglycerides equal to or higher than 150 mg/dL