Hello there, so I've been reviewing some of the notes and got a little confused. With PCOS it says that there's generally elevated LH and decreased FSH. I was under the impression Vitex tends to increased LH and decrease FSH, hence it helps the corpus luteum form and thus increases progesterone production. I'm also seeing that the follicle continues to grow but doesn't reach maturity and anovulation is common. I guess i'm confused because I thought FSH is what causes the follicle to grow and the LH surge is what causes ovulation... but if LH is elevated and FSH is decreased wouldn't the follicle not grow as well and ovulation happen with higher LH. How is PCOS becoming estrogen dominant when FSH is lower than it should be? Is it primarily from excess insulin increasing aromatization and cortisol steal decreasing progesterone? Perhaps I need to find the corresponding part of the video to follow along with the notes as reading the notes on their own is a little bit confusing and feels out of context. Basically I've been down a Vitex rabbit hole lately and got a little confused.... thanks. These hormonal cycles sometimes make my head spin!!😵‍💫

Wendy said: In PCOS, there appears to be a higher than typical LH production directly from the brain, likely related to the kisspeptin neurotransmitter system (not important for you to know that!). This LH drives DHEA production, which leads to alopecia/acne. Both the LH and high DHEA contribute to poor follicular maturation; insulin resistance from PCOS contributes to this as well. (FSH isn't actually low, just a different ratio due to higher LH) The poor follicular maturation/ lack of ovulation means there will be low progesterone production. Hence "estrogen dominance". High insulin also leads to higher aromatization, so even more estrogen, leading to estrogen dominance. Add a lot of stress and the cortisol steal happens, making things worse re: estrogen/progesterone balance. Yes, I almost always use vitex with these women, but the focus of treatment for me is actually more about stabilizing glucose/ lowering insulin and lowering the androgens (testosterone and dhea). Focus on that area actually results in faster improvement than focusing on estrogen/progesterone imbalance. That is likely why getting these women to exercise has such a huge impact, as it stabilizes insulin so quickly.

Thanks for this. So even though Vitex tends to increase LH and decrease FSH, it's still indicated for PCOS even though it tends to have high LH. I think that's where I got a little stuck/confused. Is Vitex supportive here because it's helping raise progesterone levels? I guess i'm trying to understand a little bit more of the mechanism of action of how Vitex is supporting this condition when the high LH part of the pathophysiology seems like it would be increased by Vitex. And even though LH is high, does the lack of ovulation occur because there isn't enough FSH to mature it completely, hence it can't be released? Hopefully that makes sense. Thank you very much Wendy!

Wendy said: Yes, vitex helps clinically because it helps raise progesterone. You have to put PCOS in a different category when it comes to high LH—that is being caused by a brain issue that is genetic, not as a reaction to some other hormone change. In women with PCOS, vitex doesn't raise LH , it typically stays the same. Lack of ovulation in PCOS is probably caused by many things, we're not really sure. It could be the relatively low FSH leads to poor antral follicle development; could be that there is a negative feedback from the excess androgens suppressing ovulation, could be a role of higher insulin also (we know women with type 2 diabetes tend to have more anovulatory cycles). In women without PCOS, using vitex may or may not raise LH. ​