Case History

A 28-year-old female attended the clinic concerned that she and her partner had been trying to conceive over the last 12 months and had not yet been successful.  Alongside her concern, the patient also had been experiencing extreme fatigue, weight gain, dark facial hair growth and desperately wanted to 'gain control of her health again'. The client was reluctant to commit to temperature charting as her sleep was broken during the night due to her young daughter waking her however, using an ovulation tester, the client suspected that she ovulated some months around day 24 of her cycle.

The client had been diagnosed with Polycystic Ovarian Syndrome at 18 years of age(via pathology testing and an ultrasound) and was prescribed the oral contraceptive pill to regulate menstruation. Fortunately, the client had fallen pregnant with her first child with relative ease and her daughter was now 2.5 years old.  

Upon review of the client's diet, I found that it consisted of three cups of coffee each day alongside predominantly high carbohydrate meals and refined sugars.

Treatment

The client's symptoms of sugar cravings, fatigue mid-afternoon and weight gain made it evident that she was experiencing insulin resistance; managing insulin resistance is integral to regulating hormones due to the impact raised insulin has on testosterone levels and inhibition of sex hormone binding globulin (SHBG).

We started improving blood sugar control by optimising the effect of insulin in the body; we used a combination including Gymnema sylvestre, chromium, zinc, magnesium and B3. After discussion with the client regarding preferences and lifestyle and with a priority of low glycemic index meals, reduction of refined sugars and increased intake of anti-inflammatory compounds in the diet, the Mediterranean style diet was selected as being the most appropriate dietary approach alongside a morning protein based smoothie. The vegan protein powder was chosen due to a possible dairy sensitivity (the client experienced loose bowel motions immediately following dairy consumption each day) and was recommended as a part of a morning smoothie regime to improve satiety and reduce cravings throughout the day. The client's sugar cravings and mid afternoon fatigue were reduced within two weeks.

We also included a herbal formulation of Paeonia lactiflora (Peony), (Chaste tree); Licorice's ability to reduce testosterone levels is thought to be due to inhibition of 17- hydroxysteroid dehydrogenase and 17-20 lyase, while Peony may stimulate ovulatory processes within the ovary, Rosemary has traditionally been used to uplift mood and is an antioxidant while Chaste Tree is used to reduce the impact of prolactin on FSH levels and estrogen (Rafieian & Movahedi, 2017). 

We slowly reduced coffee consumption by swapping coffee for a green tea and spearmint leaf blend ; this blend was chosen as research suggests that spearmint may have antiandrogenic properties (Goswani, Khale & Ogane, 2017).  

Nutritional preconception support included omega 3 fish oils and a pregnancy multivitamin and mineral complex and we requested some pathology testing to investigate thyroid function, Vitamin D and iron levels. Pathology test results showed subclinical hypothyroidism  (TSH levels were 2.7) and, combined with the client's fatigue, dry skin, mental fogginess and hair fall, led us to support thyroid function with the addition of Fucus vesiculosus, Bacopa monnier in tablet form; dosage recommended was two tablets daily.

Follow-Up

Over the following three cycles, the length of the client's cycle reduced from 38-40 days to 32 days in length and ovulation was recorded around day 15 of the menstrual cycle; she reported an increase in energy levels as well as feeling more balanced throughout the day emotionally. Reduction of hirsutism, mental fogginess and hair fall were also noted.

Five months later and at a healthier body weight, the client attended the clinic thrilled to share the news that she had conceived.