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Clinical Review Fortnightly Review

Polycystic ovarian syndrome: the metabolic syndrome comes to gynaecology

BMJ 1998; 317 doi: (Published 01 August 1998) Cite this as: BMJ 1998;317:329

Polycystic ovarian syndrome, the Pill and mineral deficiencies.

The puzzle of polycystic ovarian syndrome (PCOS) is emphasised by the
continuation of the Rapid Responses to Hopkinson and colleagues’ Clinical
Review of 1998. Several responses include questions unanswered so far.

In my experience the missing link is likely to be common nutritional
deficiencies, especially of zinc, magnesium, manganese, chromium , copper,
B vitamins and essential fatty acids. Essential nutrient status is largely
ignored by the medical profession.

1 Can PCOS be due to use of hormonal contraceptives?

The propaganda message has been that Pill use prevents ovarian cysts.
The reality is only functional cysts are less likely because ovulation is
usually suppressed. A four times increased risk of dysfunctional ovarian
cysts was found in the Walnut Creek Contraceptive Drug Study in women
under age 40.1 Hormone takers are more likely to have higher copper,
lower zinc and lower magnesium levels than non-takers. Mineral
deficiencies and imbalances block essential fatty acid pathways and impair
the function of B vitamins.2

2. What is the relation of anorexia nervosa and PCOS?

Clearly anorexia nervosa involves starvation and sufferers are likely
to be deficient in zinc and magnesium, which I think, causes ovarian
cysts. These deficiencies also impair brain function which helps to
maintain aversion to food or binging and vomiting in bulimia nervosa.

4. What is the relation of PCOS and insulin resistance and diabetes
and obesity?

Deficiencies of zinc, magnesium, chromium and B vitamins are common
in patients with diabetes and in women with PCO.

5. What is the relation of PCOS disease and hair loss?

Hair loss is a feature of zinc deficiency. Hair mineral analysis
results can be confusing as hair growth slows in zinc deficient states and
normal range or even high hair zinc levels can be found. Toxic metal
levels also accumulate as an adequate zinc status helps to eliminate toxic
metals like cadmium from smoking, mercury for dental amalgams and the
ubiquitous nickel. Lead free petrol has helped to reduce body burdens of

6. What is the relation of PCOS to infertility.

The commonest cause of unexplained infertility and recurrent
miscarriages appears to be zinc and magnesium deficiencies.3 Use of
ovarian or pituitary stimulating fertility drugs can make these
deficiencies worse and ovarian cysts are a listed side-effect. In my
experience many women treated with these drugs, and not with monitored
essential nutrients supplementation, develop ovarian cysts.

The missing link, in the responses so far, is the importance of
adequate micronutrient status in the prevention and treatment of PCOS.

1 Hopkinson ZEC, Sattar N, Fleming R, Greer IA. Fortnightly Review:
Polycystic ovarian syndrome: the metabolic syndrome comes to gynaecology.
BMJ 1998; 317: 329-332.

2 Ramcharan S, Pellegrin FA, Ray R, Hsu J-P. The Walnut Creek
Contraceptive Drug Study. A prospective study of the side effects of oral
contraceptives. Vol 111 CPR; NIH Publication No 81-564 ,1981.

3 Grant ECG. The pill, hormone replacement therapy, vascular and mood
over-reactivity, and mineral imbalance. J Nutr Environ Med 1998; 8: 105-

4 Grant ECG. Nutritional supplements to prevent pregnancy
complications., 16 Jul 2004

Competing interests:
None declared

Competing interests: No competing interests

01 August 2004
Ellen C G Grant
physician and medical gynaecologist
20 Coombe Ridings, Kingston-upon-Thames, KT2 7JU, UK