The NFP files

(Polycystic Ovarian Syndrome)

Natural treatment and fertility awareness

"I was irregular and had painful periods so my doctor put me on the pill."

Estimates are 20%  of women have PCOS. The cause is unproven; symptoms vary widely but could include infertility (sometimes the first indication that anything is wrong), hirsuitism (male pattern hair, even baldness), overweight, lack of cycles, acne, dark skin spots, and menstrual irregularity. You may have no periods, or bleed all the time. Both are bad.  Untreated, it can cause various cancers and vascular disorders.

The standard care for adolescents with PCOS, painful periods or irregularity is to put them on OC's (oral contraceptives). It makes you bleed "on time."  It is easy for the doctor, and he can just keep you on OC's during your fertile years, and hormone replacement after. Guaranteeing a customer for 30+ years is pretty good. The problem for the patient: the Pill doesn't treat the underlying PCOS; it trades one set of problems for another (as explained in this report, excerpt below). It may not even offer any relief. It doesn't repair your fertility. And there are the usual problems with risk and side effects (more about that on the rest of our website). But there is hope.

There are lots of PCOS websites, but Dr. John Lee has written an excellent article that explains what causes PCOS, why the common treatments tend to be ineffective, and how you can overcome it, mainly treating yourself. Check it out here. 

To sum up his points:
  • An interesting theory: predisposition to PCOS starts when you are conceived. Xenoestrogens (synthetic hormones) are almost everywhere in our environment
  • It is triggered by the usual diet of the teenager: refined sugar and carbs, animal fat, and generally low nutrition, along with excess body fat
  • Chemical castration through artificial hormones is a common treatment, but attacks the symptoms only
  • Natural progesterone administered during the luteal phase, along with nutrition and lifestyle changes, treats the hormone imbalance directly


First of all, you should learn NFP and chart your fertility symptoms so you know what is going on. If you take a class, be sure to talk to the teachers so they know you have (or suspect) this problem.  Your charts won't look like the "perfect" ones in the textbook. Don't give up, but keep charting! It will give you quick feedback on the effectiveness of treatment. This is valuable data for your doctor, too.

Your mucus symptoms may not be so helpful; in fact, they could be wild and unpredictable, with mucus all the time and no dryup, or long patches. Mucus doesn't show ovulation; the BBT does that. Even in the Billings/OM/Creighton methods of NFP, temps are allowed when necessary to confirm ovulation even if not used to determine Phase 3 (post-ovulation infertility).  Being STM teachers, we recommend a full sympto-thermal charting. Your mucus will return to a normal pattern when your hormones straighten out after proper treatment.  Meanwhile, your temperature will tell you a lot.

PCOS is a hormonal problem, and your chart indicates the two most important: estrogen (mucus) and progesterone (temperature).  When you get a number of cycles charted, analyze them or have your teachers analyze them (CCL members can send them in to Central for interpretation, if necessary). If you have a scanner, set it to grayscale at 200 dots per inch and e-mail it.  It will be obvious if you aren't ovulating. This happens to everyone once in a while due to stress or whatever, but shouldn't happen every cycle.  Other problems such as luteal phase inadequacy, unruptured follicles, low progesterone or low thyroid will also be apparent. (We're looking for a PCOS representative chart for this page, so if you can, send it to Jim at work, james.vandamme (at), where he's got a high speed connection.)


Effective self-treatment for PCOS consists of some combination of diet modification, exercise, and natural progesterone. Since everybody's PCOS is different, you will have to experiment to see what gives you relief. It won't hurt to try everything to see how well it works. Then you could slack off on one thing at a time to see if the PCOS comes back.

Improving your health through diet and exercise is the primary part of your treatment. The latest edition of the book we go to in cases of menstrual problems, Marilyn Shannon's Fertility, Cycles and Nutrition, has 2 appendices on the subject of PCOS.  The recommendations of other authorities look very similar to her PMS diet, which after all is designed to restore hormonal balance. Shannon's recommendations for supplements include chromium picolinate and vanadium for insulin resistance, and flax oil. A small Japanese study (2) suggests that 750 mg daily of vitamin C increases progesterone. Try it and see. 

The proper amount of body fat is also necessary to store the right amount of estrogen. Too much or too little can cause menstrual and fertility problems, although PCOS is usually less severe the skinnier you are. The Atkins diet is good for eliminating carbs and losing weight if needed, but watch the meat fat and do eat some whole grains and fiber. The Sugarbusters diet is another good one because it doesn't eliminate any food groups but reduces sugar intake and restricts a small group of foods. Of course weight should be adjusted slowly; but exercising and getting rid of junk food will start to help you right away.

If your chart shows that you are low on progesterone, you can supplement with natural progesterone cream applied at the right time in your cycle. Artificial progestin drugs are not as safe or effective. You will have to experiment with the amount of progesterone, but the maximum dose won't be harmful. It simply supplements the hormone you should be making with the same hormone at the correct time. When using the cream, wait a couple days past ovulation as indicated by a temp rise or mucus dryup. Applied too early, it can prevent ovulation, so allow your body to try to function normally. Continue it until day 28, or your usual cycle end, or if you are ovulating, stop 14 days after the first day of temp rise. If you suspect you are pregnant, it isn't harmful since you are supposed to be making your own progesterone; but taper it off gradually since stopping abruptly might cause a miscarriage. Remember, 3 weeks of elevated temperatures after ovulation is indicative of pregnancy.

Make sure you chart the use of progesterone. Charts are blank on the back; make good use of that space with notes.

CCL Central has more corporate knowledge on PCOS treatments, but first learn NFP well, chart, and try the easy stuff.

Other treatments

PCOS varies widely in severity, so treatment is an art. It will become apparent within a few cycles how well a treatment is working. Getting your hormones to work right is of course the best way to treat PCOS, but don't expect your doctor to be your dietician or personal trainer.

It's worth it to find a NFP only doctor, who can use your chart as a valuable tool for diagnosis and treatment. If you have your hormone levels tested, it has to be at the proper time in your cycle to be accurate, and of course they change over your cycle. Your temp chart indicates relative levels of progesterone, but you may need a blood test to find out if your progesterone is adequate in your luteal phase.

If you do use OC (birth control pills) as a last resort to try to get some relief, the effect on your cycles will vary widely depending on the type of pill. Some pills do not suppress ovulation, and the temp chart will show this; they are also abortifacient if you do conceive during one of these ovulations. Perhaps the standard phase 1 rules for avoiding conception will prevent this, but no one is sure. 

Your doctor might put you on Glucophage (metformin) to see if that helps normalize your hormones by fixing your insulin sensitivity. In theory, the hormonal imbalances that cause the PCOS also, in turn, cause insulin resistance. Insulin blockers prevent ovulation which causes the pituitary gland to continuously try for another ovulation, unsuccessfully, resulting in cystic follicles. Metformin works to inhibit the insulin blockers. This may restore ovulation. Treating the insulin resistance also addresses a dangerous symptom, although you can have PCOS and not have insulin resistance.

At the Pope Paul VI clinic in Omaha, headquarters of the Creighton Method of NFP, they do ovarian wedge resection for severe cases, and natural progesterone therapy for others. You may be able to find a local Creighton/NaProTech doctor to help you. Resection cuts the ovary down to a manageable size while leaving fertility intact. This alleviates the pain and removes the risk of rupture and emergency surgery. Zapping the ovary through a small incision with diathermy or lasers is also an option, but usually less effective. Removal of the ovaries is not necessary and would immediately put you into menopause.

Other good links  started by  Kat Carney (Health reporter for CNN)  is a pretty good place for camaraderie   Fellow sufferers, who tend to be very well-informed has a PCOS FAQ of 116 questions, including tables of what your blood work levels should be, but they're still stuck on using OC's

Your comments are solicited: use the "contact" button above or write us at vandamme (at) juno dot com.

1. A modern medical quandary: polycystic ovary syndrome, insulin resistance, and oral contraceptive pills.  J Clin Endocrinol Metab, 2003; 88: 1927-32.,
Diamanti-Kandarakis, Baillargeon, Iuorno, Jakubowicz, and Nestler.

 " However, more recently a critical examination of whether OCs might exert adverse metabolic effects with long-term consequences, especially in a group of women with known insulin resistance and predisposition to type 2 diabetics and cardiovascular disease has been explored. Limited evidence raises the issue that OCs may aggravate insulin resistance and exert other adverse metabolic reactions. That is, OCs may decrease insulin sensitivity and/or impair glucose tolerance in some women with PCOS. OCs may be associated with an increased risk of type 2 diabetes in healthy women. Women with PCOS represent a group characterized by baseline insulin resistance who are already at high risk for type 2 diabetes, and OCs, therefore, might be expected to increase their relative risk for type 2 diabetes even more. Evidence also suggests that OCs may increase the risk of cardiovascular disease in women. Given that PCOS is already associated with multiple risk factors for cardiovascular disease, there is a concern that OCs may enhance cardiovascular risk in PCOS. "

2.   Henmi, H., Endo, T., Kitajima, Y. et al. Effects of ascorbic acid supplementation on serum progesterone levels in patients with a luteal phase defect. Fertility and Sterility. 2002;80:459‑461.  

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Updated: 9 Feb 2007