PCOS, Fertility and Thyroid Function

Poly Cystic Ovarian Disorder (PCOS) influences fertility and although you may not yet be ready to have a baby, managing your PCOS naturally is something everyone with PCOS should know how to do.

The causes of PCOS vary and can be a combination of genetics, digestive problems, autoimmune problems and infections (to name but a few). The key to correctly managing your PCOS is to identify what's causing it and then adopting natural strategies to maintain your fertility health so your body is ready to have a baby when you are.

Unexplained infertility linked to PCOS can be caused by mercury and other environmental pollutants. This is why the BUMP®Fertility method utilizes the most up to date natural fertility screening techniques based on peer review research and modern science.

How do you get to maintain your fertility or pregnant naturally with PCOS and thyroid problems? PCOS (Poly Cystic Ovarian Disorder) is a cause of infertility and thyroid problems affecting 6 -10% of women of reproductive age. Symptoms of PCOS include irregular periods, infertility, acne, male pattern hair growth, and for many women problems with weight. As there is overlap between the symptoms of PCOS and those of poor thyroid function, it can be difficult for women trying to conceive with PCOS to successfully manage their fertility without expert guidance, support and learning about their condition.  This is why I have condensed my 2 decades of clinical practice knowledge into my online BUMP Fertility course.

PCOS and hypothyroid share similarities in their influence on fertility

One of the first things to learn is the similarities in symptoms of PCOS and thyroid problems, including irregular periods, low levels of SHBG, high or elevated levels of testosterone and LH, and even high cholesterol, this is why I refer to PCOS a complex health disorder. Either condition can cause these symptoms and influence fertility, which is why learning about your condition will dramatically improve your odds of conceiving and having a healthy pregnancy.

The thyroid and ovaries communicate

Understanding the strong interaction between the thyroid and the ovaries is important if you have PCOS. Ovarian cells have receptors for the thyroid hormones Thyroglobulin (TBG) and Thyroid Stimulating Hormone (TSH), while reproductive hormones such as human chorionic gonadotropin (hCG) have a stimulating effect on the thyroid. This means female hormones affect thyroid function and thyroid activity affects the female hormones. What's important to acknowledge is this connection can't be managed with diet alone. From my experience as a clinician, therapeutic herbal medicine dispensed as a tonic and individualized to the patient offers the most effective support and should be considered as part of every natural management strategy for PCOS.

PCOS and autoimmune thyroiditis

Another element that needs managing with PCOS is irregular ovulation and low progesterone production. Women with PCOS have an estrogen dominant environment. It's important to understand estrogen excess has been linked to many kinds of autoimmune diseases, including autoimmune thyroid disease because it increases the levels of the inflammatory markers IL-6 and CRP. This creates a state of chronic inflammation that could contribute to the development of autoimmune disorders, including autoimmune thyroid disease. In healthy women, the influence of estrogen on the immune system is inhibited by progesterone after ovulation (progesterone has an anti-inflammatory effect), but low levels of progesterone in women with PCOS leads to an overstimulated immune system and potentially to autoimmune disorders. This further illustrates the reason why it is so important to not only get to the cause of your PCOS but most importantly learn how to effectively manage it and my BUMP Fertility course is designed to do just that.

Autoimmune thyroid disease is more prevalent amongst women with PCOS than women without, but the sad truth is that it is often undiagnosed for many years because TSH levels may remain within ‘normal range’. This reinforces why it is so important to learn about your condition and develop strategic ways to manage it. it's complex and some researchers suggest that it is estrogen dominance that causes autoimmune thyroid disease in the first place.

Thyroid function and PCOS

Just to confuse you, other researchers suggest that it is the other way around and that low thyroid function contributes to PCOS. They found that the size of the ovaries was significantly larger in women with hypothyroidism than in those without, and that hypothyroidism contributed to the development of ovarian cysts and the polycystic appearance of ovaries. They noticed that the polycystic appearance disappeared after treatment with thyroid medication, suggesting it is hypothyroidism that causes PCOS. Successfully managing your thyroid naturally is important with diet, exercise and individualized therapeutic herbal tonics, which is why I ensure this is included in your course.

Thyroid function and insulin resistance

There is also a strong relationship between thyroid function and insulin sensitivity. Insulin sensitivity symptoms can include fatigue, weight gain, stubborn tummy fat, cravings, and acne and should not be left unmanaged as they will manifest into more complex health conditions.

So how do you know if you have a thyroid problem? For starters, get your TSH levels tested. What researchers have found is that women with TSH levels over 2.5 have higher fasting insulin concentrations, higher total testosterone, and free androgens, and lower SHBG levels than women with TSH levels below 2.5. The good news is the administration of thyroid medication improved insulin sensitivity and managing your thyroid with therapeutic herbs provides effective support. 

It's also important to take into consideration is that TSH levels of 2.5 are still classified as ‘normal’ by most labs, even though many researchers agree that an optimal level is roundabout 2. As part of managing your condition, you need to ensure you keep a record of your test results and in some cases, seek a second opinion.

On the other hand, administration of Metformin resulted in a significant decrease in TSH levels in obese women with PCOS – but other studies showed this was not the case in women without PCOS. This shows that thyroid function affects insulin sensitivity, but also that insulin levels affect thyroid function. It's the complexity of this disorder that means you need to learn how to manage it effectively and even more so if you are trying to have a baby.

It is obvious that there is a link between the thyroid and PCOS, but what is cause and effect has not yet been established. This is why it is important to assess thyroid function routinely in women with PCOS. It is best to not only check TSH, T4 and T3 levels but to also check for thyroid autoimmune antibodies TPO and TG as women with PCOS are at higher risk of having autoimmune thyroiditis.

If you do have PCOS but never have had your thyroid function tested, talk to your GP about this and ask for a copy of your test results. Even if everything is within ‘normal range’, it doesn’t necessarily mean you are at the optimal levels. Don’t wait until your readings move outside the normal range, but be proactive and prevent this from happening. Gaining expert knowledge and developing natural strategies to effectively manage your PCOS is the only way to ensure you stay fertile and healthy.

How can I confirm I have PCOS and thyroid problems?

One of the most reliable ways to determine if PCOS and thyroid problems may be causing your symptoms is to keep a diary of symptoms. Common symptoms include fatigue, irregular ovulation, Premature Ovarian Failure, failed IVF cycles, poor egg or sperm quality, recurrent miscarriage and many more.

In addition, several tests are available to help confirm PCOS and thyroid problems. 

BUMP offers both thyroid and PCOS hormone testing.

When it comes to hormone testing, this can be done in three ways:  blood, saliva or urine.  There are several key advantages to testing hormones in the urine. The disadvantage of blood testing is that there is no differentiation between bound hormone and free hormone, which can lead to misleading results as it’s only the free hormone that is active.  Salivary testing measure free and bound sex hormones, but unfortunately does not measure hormone metabolites, and levels are artificially elevated when hormones are applied in cream.

Both blood and saliva test miss a critical factor that urine testing has which is the metabolites. 

When hormones circulate through the body they are metabolized by the liver and broken down into metabolites. Those metabolites have their own physiological effects and are rarely if ever measured or taken into account. 

Urine hormone testing shows the free hormone, as well as the bound form to measure the total pool of bioavailable hormones.  Interestingly, it’s the metabolites of hormones that can increase or decrease the risk of breast and uterine cancer, as well as give us a picture of the overall health of the adrenal glands long term.  

There are 3 different types of estrogen:  estrone, estradiol, and estriol and each bind with higher or lower affinity to estrogen receptor alpha or beta receptor sites.  The beta sites are “better” because they are anti-carcinogenic, whereas the alpha sites tend to promote cell growth and proliferation.  One noticeable difference in the urine test we use is in its ability to measure 2-methoxyestradiol. 2-methoxyestradiol is the most protective of the estrogens and in ongoing clinical research, it is showing promise of being an adjunct to cancer treatment.

The metabolites of the hormones found in the urine also show how well a person is methylating. Methylation occurs not just in the metabolism of sex hormones, but also for most biochemical reactions in the body associated with fertility.  Therefore this urine test can show if you are methylating well or not.

The urine test also measures progesterone and testosterone, as well as adrenal function, which gives us a complete look at all the sex hormones. Based on the results that show up in the urine of the adrenal hormones your doctor can deduce how long you may have had adrenal fatigue and which are the best herbal protocols for it.

In summary, urinary hormone testing demonstrates free and total hormone levels, and how healthy you are metabolizing your hormones.   This comprehensive test provides a wealth of information about your health that both blood and saliva miss. 

Other detective work may include:

  • Stool analysis – Which will confirm whether the gut is functioning optimally
  • Liver function testing - to determine ALT and the ability to remove heavy metals
  • Genetic testing – To help establish whether genetic defects may be contributing

How can Narelle help?

Navigating unexplained infertility alone can be both isolating and confusing, particularly when undertaking IVF. Working with a Naturopath can provide you with the necessary support to pinpoint the issue and work on correcting it.

For more information on managing PCOS and thyroid problems or if you think you are experiencing symptoms of unexplained infertility decide to take action to work with us so we can tailor a treatment plan to your own unique needs and ensure the most successful outcome.

** research references available on request.

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