Her lipid panel was normal and hemoglobin A 1C was 5.3%.Īt her first visit, our patient was started on the herbal supplement Vitex agnus-castus 400 mg twice daily for its progestogenic activity and to aid in menstrual regulation. MRI of the brain showed no pituitary adenoma, and prolactin and TSH were normal. Trans-vaginal ultrasound showed normal sized ovaries with multiple follicles. Luteinizing hormone (LH) to follicle stimulating hormone (FSH) ratio was elevated at almost 3:1. Sex hormone binding globulin was normal at 78 nmol/L. Baseline labs showed elevated total and free testosterone levels, at 96 ng/dL and 8.4 pg/dL respectively. Physical exam was notable for a normal BMI of 20.5 kg/m 2 and shaved hair along the linea alba. She followed a gluten- and dairy-free diet with low refined sugar intake to control her IBS, and she exercised twice per week, mostly doing weight training. She took no prescription medications but had been taking a botanical supplement containing proanthocyanidins from grape seed and pine bark with the intention of regulating her hormone levels naturally (this was subsequently discontinued). Family history was notable only for PCOS in her younger sister. Her past medical history was significant for asthma and constipation-predominant irritable bowel syndrome (IBS). Her predominant symptoms were abnormal menstrual cycles, dysmenorrhea, acne, and hirsutism. The diagnosis was based on characteristic findings on transvaginal ultrasound as well as clinical and biochemical evidence of hyperandrogenism. When her irregular cycles persisted after stopping the OCPs at the age of 20, she was evaluated for and diagnosed with PCOS. She had a history of abnormal menstrual cycles and was started on oral contraceptive pills (OCPs) at the age of 13 for menstrual regulation. She requested a natural approach to balance her hormones and lower her androgen levels. Our patient is a 21-year-old female with a history of PCOS who presented for an Integrative Medicine consult. This report underscores the need for an integrative approach to the management of multifactorial disorders such as PCOS and highlights the basic science and clinical data supporting the use of acupuncture, Vitex agnus-castus, and diindolylmethane in patients with this condition. The patient regained menstrual cyclicity, and clinical and biochemical hyperandrogenism normalized. In this case, acupuncture as well as the botanicals Vitex agnus-castus and diindolylmethane were used over a 10-month period. We present the case of a young woman with a strong preference for a natural approach to her care who presented with PCOS manifesting in menstrual irregularity, acne, and hirsutism. Many women prefer to avoid OCPs due to concerns about risks and adverse effects, or simply because they desire a non-pharmacologic approach. Conventional treatment is centered around the use of oral contraceptive pills (OCPs) to regulate menstrual cycles, protect against endometrial hyperplasia, and manage clinically evident androgen excess. Polycystic ovarian syndrome (PCOS) is a common cause of menstrual irregularity and hyperandrogenism in women of reproductive age.
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