Finally, horse chestnut (Aesculus hippocastanum) is the favoured oral treatment in herbal medicine. A review of 13 randomised, controlled trials, involving a total of 1083 patients, provides compelling scientific evidence of the effectiveness of this treatment for all types of chronic venous insufficiency, even when compared with conventional treatments such as compression therapy or the use of hydroxyethylrutosides (Arch Dermatol, 1988; 134: 1356-60). Harald Gaier Harald Gaier has moved to The Diagnostic Clinic (tel: 020 7009 4650).

Q&APCOS and syndrome XQ I am a 35-year-old woman, and I’ve not had a regular period since my teens. I have also been infertile since then, and suffer from hirsutism and a disfiguring skin condition. Recently, I was diagnosed with polycystic ovarian syndrome (PCOS). Could this syndrome be responsible for my skin condition and hirsutism? Does anyone know the cause of the syndrome, and can anything be done about it? - ON, London

A Polcystic ovarian syndrome or PCOS is one of the most common causes of infertility in women - affecting up to 10 per cent of the female population - but it often goes undetected even when the sufferer displays one or more of its symptoms. These include hirsutism (excessive hair growth in a normal or abnormal distribution on the body), male-pattern baldness (alopecia), irregular periods, infertility and weight problems such as obesity. Other symptoms are acne, raised insulin levels, insulin resistance, diabetes and high blood pressure.

The syndrome is caused by abnormal hormone levels - usually of luteinising hormone (LH) or follicle-stimulating hormone (FSH) - which together make ovulation possible. Its name comes from the numerous cysts that usually form on the ovaries, although this is not always the case. In one study, the ovaries of sufferers were of a normal size and had no abnormalities ((Dunaif A, Polycystic Ovary Syndrome, Onhealth Network Co, 1998: 1-4).

Although the cause of the condition is not known, there appears to be a definite link between PCOS and weight problems. Most sufferers have difficulty in controlling their weight, and two-thirds of women with bulimia also have PCOS. Overweight women in general also tend to have far lower levels of sex hormone-binding globulin (SHBG) in their blood, a deficiency that can lead to raised testosterone levels which, in turn, can cause some of the distressing symptoms of PCOS, such as excessive facial hair and balding.

Losing weight is one of the most important non-drug approaches to counter the worst effects of PCOS and may improve ovulation (Clin Endocrinol, 1992; 36: 105-11). This finding was supported by another study where all but one of the women with PCOS who lost weight went on to conceive (Hum Reprod, 1995; 10: 2705-12).

A low-carbohydrate diet that also eliminates all refined carbohydrates - one version of this is the fashionable Atkins diet, although we always recommend the Montignac diet as a safer approach - offers the double benefit of losing weight and lowering insulin levels which, in turn, will reduce the ovaries’ production of testosterone, according to the University of Chicago’s Center for Polycystic Ovarian Syndrome.

The Center has also found that one in three women with PCOS has an abnormal glucose tolerance, and that one in 10 will be diabetic by age 40 (http://centerforpcos.bsd.uchicago.edu/). Studies suggest that 30 per cent of PCOS sufferers are also insulin resistant, and some researchers believe the rate is even greater than that (International Council on Infertility, http://www.inciid.org).