How yoga can help your fertility if you have PCOS
There are many factors affecting fertility in both men and women and while a few of them have relatively simple treatments, most of them are very complex including the all too common condition poly-cystic ovarian syndrome (PCOS). With up to an estimated 15-20%[i] of women with PCOS it is no surprise that it is the leading cause of female infertility. The core issue of this condition for fertility is the inability to ovulate regularly or at all, vastly reducing the chances of natural conception. The risk of early miscarriage increases too.
To complicate things even further PCOS is not simply a condition of the reproductive system, it is a systemic metabolic condition that affects hormonal regulation in the adrenal glands and brain (hypothalamus and pituitary glands); blood sugar regulation; and metabolic regulation through disruption of hunger signals and energy metabolism.
Misdiagnosis is quite common so let’s review some of the key presenting features to look out for. Essentially a woman with PCOS is unlikely to be ovulating, even if she sometimes gets her period – which is probably not a monthly occurrence. She struggles with her weight, if she is a healthy weight chances are she works like a demon to stay that way, of course, she may work her butt off figuratively speaking but to no avail, much to her dismay. Her skin shows persistent problems too, with chronic acne and in some cases areas of skin that are darker and thicker than the rest of the body. Hair is another issue; there seems to be a lot of it and in places most women would prefer it not to be. That’s enough to make anyone tired and moody, but for a woman with PCOS her hormones will be contributing to that too. Excess oestrogen and a lack of progesterone can increase tension, anxiety, anger and depression. She will have underdeveloped follicles in her ovaries that appear as cysts (hence the name of the condition) making her quest for pregnancy extremely difficult.
A pretty grim picture to say the least, but there is hope. Though PCOS is certainly not a simple condition to manage there is much that can be achieved with the use of herbal medicine, dietary and lifestyle changes. I have written extensively in the past about natural therapies for PCOS, you can find that article here though I can’t recommend enough how much you should seek the assistance of a qualified natural health practitioner to help you navigate these waters. This article will focus on why a regular, specialised yoga practice will help not only with your PCOS, but also your fertility.
Firstly though, let’s have a look at some of the key hormones responsible for our fertility. During regular menstruation and ovulation, one of your ovaries will release a fully matured follicle, this is called ovulation. This then triggers the body secrete more oestrogen to thicken the layers in the uterus, essentially in preparation for embedding a fertilised egg (pregnancy). When ovulation occurs there is an increase in the hormone progesterone from what is called the corpus luteum, which is part of the follicle from the ovulated egg. If pregnancy does not occur then the endometrial lining of the uterus is shed and you get a period and your levels of the hormones progesterone and oestrogen (amongst others) drop.
If however you have PCOS your body does not produce enough follicle stimulating hormone (FSH) to develop a mature egg and you do not ovulate. This creates a domino type effect, because ovulation has not occurred progesterone levels remain low, oestrogen continues to increase and another hormone, luteinising hormone (LH) which would rapidly decline at ovulation, goes unchecked and continues to increase too. Elevated levels of LH and oestrogen both inhibit FSH - and so the pattern continues, further reducing the likelihood of ovulating each month.
Then there’s the appetite and blood sugar dysregulation. Chronically elevated blood sugar levels can lead to what is known as insulin resistance – essentially the insulin receptors in the body no longer respond as they should – they don’t move the sugar from the blood into the cells for energy. So the body thinks it is starving and tells us to eat more, but because we’re not using the energy efficiently, we build up stores of it….as fat. Even if you’re careful with your diet, your disrupted hormones mean that your body thinks it is in survival mode and stores the food as fat for energy later on. Excess fat increases the synthesis of more oestrogen. Excess insulin (which occurs in insulin resistance) increases the levels of LH. And so we have another mechanism that is stopping ovulation from occurring.
So to get out of this rut you need to start by sending the message to your body that it is not in danger, it is not starving and that you are safe. This is really important because stress is a big trigger of insulin release and hormone disruption; without this step diet and exercise will only have limited success. There are many studies that have shown a multitude of benefits from a regular yoga practice but the specific benefits of yoga for PCOS include:
Stress reduction – yoga has been shown to be more effective than other exercise at reducing our flight or fight sympathetic nervous system response[ii]
Mindfulness – this extends into our response to everyday stress as well as the impact that food, exercise and our thoughts have on our physical body
Weight control – a combination of physical movement coupled with mindfulness around our diet
Restoring insulin sensitivity – primarily through reducing the stress response and by building muscle
Reducing LH – remember the domino effect caused by chronically elevated LH? Excess oestrogen, inhibition of FSH and ultimately no ovulation. Reducing LH will have a positive effect on this cascade.
Increasing menstrual regularity – though menstruation does not automatically indicate ovulation it does mean that the body is closer to hormonal regulation than when menstruation does not occur
A small study[iii] in 2013 of adolescent girls with PCOS found that doing one hour of yoga a day for 12 weeks was significantly more successful than regular exercise at improving some of the parameters associated with PCOS. The key findings were a reduction in LH and testosterone; reduction of abnormal hair growth; and improved menstrual frequency. The type of yoga used in this study is described as a ‘holistic yoga module’. While I’m not quite sure what that actually means, my experience would suggest that a more gentle form of yoga with a focus on stress reduction and reproductive health would provide the most benefit for women wanting to manage their PCOS and improve their fertility.
Links to other useful articles
[i] Sirmans SM, Pate KA, ‘Epidemiology, diagnosis, and management of polycystic ovary syndrome’ Clinical Epidemiology, 2013 December 18; 6:1-13
[ii] Ross A, Thomas S ‘The health benefits of yoga and exercise: a review of comparison studies’ Journal of Alternative and Complementary Medicine, 2010 Jan;16(1):3-12
[iii] Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R ‘Effects of a holistic yoga program on endocrine parameters in adolescents with polycystic ovarian syndrome: a randomized controlled trial’ Journal of Alternative and Complementary Medicine, 2013 Feb:19(2):153-60