The Short Story on PCOS and SHGB
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PCOS and SHGB (sex hormone-binding globulin)
What is SHGB and how does it relate to PCOS? SHBG (sex hormone-binding globulin) is a protein that is generated mostly by the liver, along with smaller quantities produced in the brain, placenta, and uterus. SHBG binds sex hormones in the blood, means the hormones are carried around reducing the circulating levels of free hormones.3 When SHBG levels are low the level of free testosterone goes up. Women with PCOS often present with these types of levels. 3
Polycystic Ovarian Syndrome is one of the most common disorders found in women of child-bearing age. Although the definitive cause of this condition is not clearly known, insulin resistance is thought to play an important role in PCOS. 7 SHBG levels are reduced with insulin resistance and the test measuring sex hormone binding globulin has become an extremely good marker for insulin resistance and important diagnostic tool for PCOS.3
Insulin resistance is thought to reduce the liver’s production of SHBG while significantly increasing the production of andogens (male hormones) by the ovaries. 7 This double dose of hormones can often manifest itself as the numerous PCOS symptoms such as male pattern baldness, excessive hair growth, acne and menstrual irregularities because even a little increase in testosterone can create hormonal imbalance. Even if you have low SHBG levels and PCOS you can manage this condition with many effective treatments such as diet, regular exercise, medication and nutritional supplements.
Studies Show Low SHGB is linked to Insulin Resistance
Studies have shown that women with polycystic ovarian syndrome have low levels of sex hormone-binding globulin and this is also linked to insulin resistance which is commonly found in women with PCOS. 3
Does PCOS cause low SHGB levels?
The actual cause of low sex hormone-binding globulin is not completely clear but it is decreased by high insulin levels, high androgen levelsand prolactin, as well as growth hormone and increases with high estrogen. 4 Insulin resistance also seems to create low SHGB levels so the fact these two markers have been shown to influence PCOS is not surprising. 4 SHBG can serve as a marker of insulin resistance in women with Polycystic Ovarian Syndrome, especially those who are clinically obese. Higher body mass index is also a marker of insulin resistance.
Increased levels of SHBG can be seen with:
- Estrogen therapy
- Liver disease
- Eating disorders (anorexia)
- Decreased sex hormone production (9)
Low levels of SHBG are present with:
- Polycystic Ovarian Syndrome
- Steroid use
- Cushing disease(9)
All these disorders are characterized by insulin resistance or imbalanced hormones and sometimes both.
Are there symptoms linked to low SHBG levels or is low SHBG levels a symptom?
Low levels of SHBG are a good indicator of insulin resistance but these low levels do not have definitive symptoms themselves; SHBG levels simply are there (or not there in this case). Someone would have to look at the symptoms of a condition like PCOS as markers for women with insulin resistance and corresponding low levels of sex hormone-binding globulin. 6 Symptoms of PCOS tend to gradually get worse when not treated and can range from inconvenient to serious.
The symptoms of Polycystic Ovarian Syndrome are:
- Male pattern baldness
- Excessive hair growth
- Irregular periods
- Absent periods
- Ovarian cysts
- Heavy or prolonged periods
- Weight gain
- Menstrual pain
- Fluid retention
- Darkening of the skin
- Mood swings
- Acne not associated with puberty2
Medical Treatment Options for PCOS Hormonal Imbalance
Can you change your level of SHBG with treatment? Women with PCOS and low sex hormone-binding globulin cannot directly change their levels. There are treatments that can correct deficiencies in the sex hormones such as estrogen replacement therapy but the best ways to improve your levels of SHBG is to treat PCOS-related insulin resistance and improve PCOS hormones.
Some common PCOS treatment options can include:
Metformin: It has been found that insulin resistance causes decreased sex hormone-binding globulin (SHBG) so taking a medication designed to address that condition can impact SHBG levels as well.7 Metformin is actually primarily used to treat type 2 diabetes but has been used with success by women with Polycystic Ovarian Syndrome. This drug increases the body’s response to insulin and lowers testosterone production.
Oral contraception: Birth control pills are often the first line of defense for women with PCOS, especially if they are not trying to conceive. These drugs come in several strengths and can be combinations of estrogen and progesterone or simply progesterone alone. Birth control pills containing estrogen can reduce male hormone levels, raise SHBG levels, normalize the menstrual cycle and clear up some of the visual symptoms of PCOS like acne. Your doctor may insist on a blood test before prescribing oral contraception to rule out pregnancy.
Anti-androgens: These drugs are often used in conjunction with birth control and can reduce the effect of male hormones on hair growth in women. Some common anti-androgens are Spironolactone and Finasteride. 6
Surgery: Surgery is not usually the first choice of treatment for women with Polycystic Ovarian Syndrome but it can help when all other options have been exhausted. The procedure is called ovarian drilling and it is thought that this surgical intervention will reduce androgen and LH secretion by making tiny burns on swollen ovarian follicles. It is done by laparoscopy but any surgery is invasive so consultation with your doctor should take place before committing to this treatment. 6
Can you positively impact PCOS with natural treatments?
Natural therapies can have a positive influence on women who have Polycystic Ovarian Syndrome and hormone imbalances. PCOS might seem like it has an overwhelming array of symptoms but making healthy lifestyle can often correct the insulin resistance which is an underlying influence of PCOS. Choosing to follow a balanced diet, getting regular exercise, and taking recommended nutritional supplements can reduce your PCOS symptoms and improve the quality of your life.
PCOS Friendly Diet
One of the most effective treatments of PCOS is a healthy diet and since women with PCOS are often obese this natural therapy will also address that issue. The old saying “you are what you eat” is not just empty words; it points out that food can significantly impact your body and even heal it in the right circumstances. Diet choices can actually influence very specific systems and prevent diseases. 2 For example, certain foods and dietary substances can increase SHBG (sex hormone-binding globulin) and help to lower excessive levels of testosterone connected to PCOS. 5 This in turn can improve symptoms like acne and male pattern baldness. Everything is connected.
Some simple diet guidelines to follow for PCOS are:
- Eat foods that are high in lignans: This is a group of chemical compounds found in certain foods that can increase the level of sex hormone-binding globulin (SHBG) and improve ovarian function. Lignans are prevalent in high-fiber foods like flaxseed and sesame. Other foods high in lignans are wheat, pumpkin, barley, yams, eggplant, chickpeas, kidney beans and carrots. 2
- Eat six or seven small meals instead of the traditional meals three times a day
- Follow a low glycemic diet
- Reduce simple sugars: Many sweet foods are very pleasing to the palate and hard to give up but they also play havoc with your blood glucose levels. Avoid soda, energy drinks, fruit juices, candy and desserts.
- Increase lean protein consumption
- Reduce alcohol and caffeine intake
- Eat a variety of fresh fruits and vegetables
- Chose whole grains instead of processed products like white rice
Would it surprise you to know that exercise is extremely important in treating insulin resistance? Exercise is crucial to managing your PCOS symptoms because even a single occurrence of some sort of moderate exercise undertaken for 30 minutes can significantly increase the rate of glucose removal in the body. 8 This improvement can continue for hours after the tennis racket is put away or you have hauled yourself out of the pool but eventually will slacken without another activity fix. This means the key to a long-term effect on insulin sensitivity is regular exercise. Exercise also can assist in weight loss goals which can have a very positive effect on self-esteem and cut the severity of PCOS-related symptoms.2
One important issue of PCOS is the decreased levels of SHBG and increased testosterone present in women who have this condition. With a little research you will find that there are quite a few nutritional supplements that are very effective therapies for both the symptoms and underlying influences of PCOS like low SHBG levels and insulin resistance.1
Some good choices can include:
- Vitamin D: low levels of vitamin D have been linked to insulin resistance, PCOS and obesity. Taking this supplement can contribute to the normal development of ovarian follicles, improve insulin sensitivity and stabilize mood. 1
- Stinging nettle (Urtica dioca): The root of this plant contains compounds that can increase the level of sex hormone-binding globulin. 1
- Flax seed: This seed contains compounds that will increase the levels of SHBG and help lower testosterone levels in the blood.
- Licorice root (Glycyrrhiza glabra): Women with PCOS will find their testosterone secretion is reduced after several months of taking this botanical. 1
- Spearmint (mentha spicata): Spearmint tea is a lovely treatment that should be consumed during the first two weeks of the menstrual cycle to increase estrogen levels and decrease testosterone. 5
- Tulsi (Ocimum sanctum): This plant can help lessen weight gain by normalizing insulin levels. It also can affect androgen-sensitive areas of the body by reducing androgen levels in the blood. This plant is usually grown in India.
- Saw palmetto (serenoa repens): This botanical can be beneficial for women with PCOS related acne and hair loss. (1)
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- Dunne, Dr Nancy. Natural Solutions for PCOS: The Best Supplements. Dr Nancy Dunne. [Online] 2010. [Cited: 07 19, 2012.] http://www.drnandunne.com/?p=1808.
- Frank M. Painter, D.C. Polycystic Ovary Syndrome:Clinical Considerations . Alternative Medicine Review. [Online] 06 2001. [Cited: 07 19, 2012.] http://www.chiro.org/nutrition/ABSTRACTS/Polycystic_Ovary_Syndrome.shtml.
- Friedman, Dr. SHBG and polycystic ovarian syndrome (PCOS). Good Hormone Health. [Online] [Cited: 07 19, 2012.] http://www.goodhormonehealth.com/SHBG%20and%20polycystic%20ovarian%20syndrome%20(PCOS).pdf.
- V. JAYAGOPAL, E. S. KILPATRICK, P. E. JENNINGS, D. A. HEPBURN, AND S. L. ATKIN. The Biological Variation of Testosterone and Sex Hormone-Binding Globulin (SHBG) in Polycystic Ovarian Syndrome. Endo Journals. [Online] 2003. [Cited: 07 19, 2012.] http://jcem.endojournals.org/content/88/4/1528.full.pdf.
- Natural Solutions for PCOS and Infertility. Steel Smith Health. [Online] 06 03, 2011. [Cited: 07 19, 2012.] http://steelsmithhealth.com/natural-solutions-for-pcos-and-infertility/.
- Polycystic Ovary Syndrome (PCOS) . Wellness Alternatives. [Online] 2011. [Cited: 07 19, 2012.] http://www.wellnessalternatives-stl.com/library/pcos.htm.
- Natia Kajaia, Helge Binder, Ralf Dittrich, Patricia G Oppelt, Bianca Flor, Susanne Cupisti, Matthias W Beckmann and Andreas Mueller. Low sex hormone-binding globulin as a predictive marker for insulin resistance in women with hyperandrogenic syndrome. European Journal of Endocrinology. [Online] 07 24, 2007. [Cited: 07 19, 2012.] http://www.eje-online.org/content/157/4/499.full.
- ANDRÉ TCHERNOF, PHD, MICHAEL J. TOTH, PHD, ERIC T. POEHLMAN, PHD. Sex Hormone–Binding Globulin Levels in Middle-Aged Premenopausal Wo m e n. Diabetes Journal. [Online] 11 1999. [Cited: 07 19, 2012.] http://care.diabetesjournals.org/content/22/11/1875.full.pdf.
- SHBG. Lab Tests Online. [Online] 02 13, 2012. [Cited: 07 19, 2012.] http://labtestsonline.org/understanding/analytes/shbg/tab/faq.
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