Polycystic Ovary and the Functional Medicine Approach


Before adding the functional medicine perspective to my list of medical practices, one of my biggest points of anxiety was that I was not able to bring an approach to polycystic ovary that I was personally comfortable to share.


In our standard education, metabolic syndrome or chronic inflammation, the fact that functional problems in hormonal functions could have systemic consequences was a field with limited and, in fact, insufficient information.


Presuming that polycystic ovary is limited to:


*Difficulty during ovulation,

* Difficulty in conceiving a child

*Inconsistent rarity in the menstrual cycle

*Tendency to gain weight

*Increase in body hair



We can utilize more mechanical treatments according to the case at hand.


This is the reason you can observe so many women using birth control pills over the years, starting from a very young age. Since birth control pills, which are used only for menstruation, suppress hormone functions from the pituitary gland, of course, hair growth and acne are also reduced. If there is menstrual pain, it also provides help and emerges as an easy-to-use form of treatment for a lot of women’s lives in general.


Then, does birth control pills have any significance in the polycystic over treatment?


The answer is, ultimately, no.


Polycystic ovary is a condition that we see in 23% of young women ultrasonographically, but only 9% of these women have true, factual, clinical findings. According to the Rotterdam Criteria, three basic findings must be present for the diagnosis of polycystic ovary syndrome:

-Seeing the ovaries as polycystic on USG

– A constant rarity of menstruation

-Increase in body hair and/or acne (acne alone is not satisfactory.)


How is the treatment itself done?


First of all, I must say that the polycystic ovary syndrome we see in young women is a metabolic syndrome. The first thing we will investigate is insulin resistance. In order to eliminate insulin resistance, it is necessary to make certain lifestyle changes. Polycystic ovary is not a condition that we will suddenly treat. It is a reality that belongs to us only and only if we must learn to live together.


The most important way to eliminate insulin resistance is through the correct functioning of metabolism. This should start not only with insulin metabolism, but also with calming the overactive adrenal axis (stress and unavoidable cortisol elevation), regulating thyroid functions, determining and replacing mineral and vitamin deficiencies in the body.


Let’s look at how only magnesium deficiency affects polycystic ovary:


Serum testosterone level and intracellular magnesium level are inversely proportional in polycystic ovary. Although studies are limited in number, cases of PCOS are thought to be magnesium deficient. At the same time, the higher the HOMA-IR value, the lower the magnesium level. For these reasons, magnesium replacement in PCOS is necessary for both hyperandrogenism and relief of insulin resistance.


Magnesium regulates electrical activity and insulin secretion in pancreatic B cells. The intracellular magnesium concentration is critical for the phosphorylation of the insulin receptor. At low magnesium levels, tyrosine kinase activity decreases and post-receptor insulin activity is impaired, resulting in resistance to glucose entering the cell. Which, in turn, implies a resistance to insulin.

The human body is an extremely complex mechanism, and the lack of something as focal as magnesium, which over 800 different enzymes require to function, may end up making the system to break down entirely.


In these cases, much like the basis of all things that relate to the health of the body, the treatment lies in a healthy diet, and a calculated amount of intestinal microbiota. Ultimately, our livelihood is practically defined by the microbiome which represents the healthy bacteria that is within our bowels. Our metabolism positions and prepares itself according to our eating habits and times. In a daily diet that uses constant snacks, especially involving sugar and carbohydrates, insulin remains on the continuous release alarm so that it can control the sugar value by inserting the blood sugar into the cell.


We cannot protect our gut health, nor can we protect ourselves from chronic inflammation and metabolic syndrome, unless we stop seeing healthy eating as a weight loss goal and turn it into a lifestyle. It would be extremely beneficial to add intermittent fasting periods, in which we gradually increase the fasting times, to the nutrition program. Snacks may only be needed when overcoming difficult times such as severe insulin resistance, but the concept of snacks is not suitable for the concept of getting a healthy age. 8/16 intermittent fasting may not be suitable for everyone. Maybe you can start with just 10 hours. It will be an advantage to spend the hunger hours mostly at night. You can eat three meals if you want, but you should stay away from snacks. With the decrease of adipose tissue, SHBG, which binds sex hormones and prevents them from traveling freely in the blood, will increase, and estrogen dominance and androgenic hormones will be suppressed. The decrease in androgenic hormones will mean a decrease in the conversion to estrogen, as well as the most important part of the fight against hair growth and acne.


Regular exercise has a great therapeutic effect on metabolic syndrome, insulin resistance and polycystic ovary. Doing cardio and resistance exercises together plays an important role in the introduction of glucose into the cell. Unfortunately, walking alone is not enough. We need to add weights that will increase our muscle density or activities where we use our own body weight. We can count the numerous benefits of exercise, which is one of the five main goals of functional medicine, from cardiovascular diseases to the prevention of dementia and Alzheimer’s. Unfortunately, it is not possible for us to set the pattern of ‘I don’t like doing sports’ to the goal of a healthy life. We just need to discover a model that we can do with pleasure.


Medical support can be given according to the severity of polycystic ovary and metabolic syndrome in order to eliminate insulin resistance. While the use of metformin in appropriate time periods and doses may be recommended, the use of berberine may also be preferred due to its effect on introducing blood sugar into the cell and removing harmful bacteria in the intestine. It would be appropriate to mention the undeniable role of metformin in anti-aging medicine and cancer prevention. In the meantime, we need to create a detoxification health that leads to healthy defecation, especially methylation, for the excretion of hormone metabolites and toxic substances from the body.

The biggest hormonal problem related to polycystic ovary and insulin resistance, especially if your fat tissue is high, is estrogen dominance. In the polycystic ovary, progesterone hormone will be insufficient due to infrequent or absent ovulation and the estrogen hormone, which should be controlled as a mitogen, will not be met. If this situation is detected, progesterone hormone can be used in treatment in personalized doses.