Polycystic Ovarian Syndrome (PCOS) is condition that affects hormone levels in women. ‘Poly’ is ancient Greek word for many, with polycystic literally translating to many cysts, that can form in the ovaries.
Cysts can form from follicles that can contain an egg, that never fully mature enough to cause fertilisation (conception) and result in small, fluid-filled sacs that grow inside the ovaries called ‘cysts’.
PCOS is typically caused by abnormally high levels of testosterone and reduced insulin activity (aka insulin resistance).
While the exact cause of PCOS is not fully understood, it is believed that family history, genetics, hormones, and environment all play a role in the development of PCOS.
PCOS is common condition that affects 8-13% of women of reproductive age with almost 70% of cases remaining undiagnosed! While women who have a mother aunt or sister with PCOS are 50% more likely to develop PCOS.
Photo credit: mayoclinic.org
Features of PCOS
PCOS has 4 main features:
- Cysts in the ovaries
- High levels of male hormones (androgens)
- Insulin resistance
- Irregular menstrual cycles
Symptoms of PCOS
Due to hormonal imbalances PCOS can also result in other symptoms that include:
- Irregular menstrual cycles
- Amenorrhoea (absence of menstrual cycle)
- Heavy bleeding
- Excessive facial or body hair growth (hirsutism)
- Weight gain
- Male pattern hair loss
- Mood changes (anxiety and depression)
- Sleep apnoea
- Low sex drive
Complications of PCOS
Due to insulin resistance, the risk of diabetes mellitus is substantially increased in women with PCOS. However, this may also depend on other factors such as obesity (1).
PCOS has significant effects on a women’s reproductive health. These abnormal levels of hormones can lead to an increased risk of infertility, miscarriage and pregnancy complications that can affect 70-80% of females with PCOS.
The good news is that by losing weight and lowering blood sugar levels you can help improve your chances of a healthy pregnancy (2).
Approximately 80% of women with PCOS are overweight or have obesity. Being overweight can increase your risk of high blood sugar, high blood pressure, and unhealthy cholesterol levels.
These combined factors are called metabolic syndrome that is linked to heart disease, diabetes, and stoke (3).
Anxiety and Depression
Anxiety and decreased self-worth can arise due to PCOS symptoms that include excessive hair growth, acne, balding and obesity. While a recent study found higher rates of depression and other mood disorders in women with PCOS (4).
Sleep apnoea is a condition that causes breathing difficulties that affects sleep and is more common in people who are overweight, particularly if you have PCOS. Insulin resistance seen in PCOS is believed to play a principal role in the development of sleep apnoea (5).
Treatment of PCOS
There are a variety of treatment methods that can help to treat and manage PCOS that include a healthy diet, supplements, lifestyle changes, and medical treatments.
Low sugar and carbohydrate diets
Low sugar and carbohydrate diets may help to improve symptoms of PCOS. Insulin has an important role in blood sugar regulation by allowing our cells to absorb sugar in the blood that gives us energy. However, we can start to develop insulin resistance overtime when we eat excessive high sugar and high carbohydrate foods.
Low GI (glycaemic index) foods are a helpful way to reduce your sugar and carbohydrate intake. The glycaemic index (GI) scores carbohydrates according to how quickly they raise the sugar (glucose) levels in the blood.
In general, the more processed a food is the higher the GI is, while the more fibre and fat in a food will typically have a lower GI.
It’s important to not put too much pressure on yourself to only eat low GI foods as this could also create unhealthy eating patterns.
Instead focus of eating a whole-food diet that includes lots of whole-grains, fresh fruits and vegetables, healthy fats, lean meats, legumes, nuts, and seeds. While also doing your best to avoid refined sugars (eg. baked goods, soda etc), processed foods, deep fried foods, take-away foods etc.
Essential fatty acids
Essential fatty acids are fats that can’t be made by the body that we need them from the diet, one of them being omega 3 fatty acids.
Omega 3 fatty acids may help to improve symptoms of PCOS by reducing inflammation. One study found that supplementing omega 3 fatty acids (4g/day) resulted in reduced fat levels and blood pressure in women with PCOS (8).
Omega 3 fatty acids can be found in hemp seeds, fatty fish (eg. sardines, salmon), flaxseeds and algae. Furthermore, we need adequate fats in the diet to make cholesterol that has an important role in producing hormones.
Increase anti-inflammatory foods
Like most conditions, PCOS is also characterised by inflammation. The Mediterranean diet is a diet that has shown to be beneficial in many inflammatory conditions that may also be useful in PCOS (9, 10).
The Mediterranean diet is typically high in healthy fats, whole-grains, fresh fruits and vegetables, nuts and seeds that has demonstrated many health benefits. Healthy fats include hemp seeds, fatty fish (eg. sardines, salmon), olive oil, avocado oil, nuts, and seeds.
B vitamins are a group of vitamins that are essential for many different functions in the body such as metabolism and energy production.
B vitamins are especially important in assisting breaking down carbohydrates into energy, supporting our stress responses, producing brain chemicals, and supporting heart health that are important functions for women who have PCOS (11).
You can find a vast array of B vitamins in whole grains, green leafy vegetables, eggs, legumes, avocados, meat, poultry and fish.
Zinc is an essential mineral that has over 300 different roles in the body including helping to regulate insulin in the body.
One study found that a zinc supplement (30mg/day) for one month helped to improve insulin resistance in obese individuals. These insulin improving effects may be useful for improving insulin activity in PCOS (12).
You can also find zinc in a wide range of foods that include meat, poultry, eggs, seafood, legumes, soy products, nuts and seeds.
Supplements may also help to support symptoms of PCOS. It’s important to first talk to your health professional before trying to treat your PCOS with supplements.
Inositol & Folic acid
Inositol is type of B vitamin that may help to improve PCOS symptoms, especially when combined with another type of B vitamin called folic acid.
While another study indicated that both inositol and folic acid may help to improve infertility by improving ovulation (17).
Chromium is a trace mineral, meaning we only need it in small amounts and is found in cheese, mushrooms, brewer’s yeast and wheat germ.
Some studies have suggested that chromium may have help to reduce insulin resistance and improve PCOS symptoms by supporting blood sugar (glucose) metabolism. It’s important to note that most of these studies are small and short-term suggesting the need for long-term and larger trials (18).
Excessive chromium may also affect the absorption of other minerals such as iron, so it’s important to use with caution (34).
Cinnamon is common spice that may also help to support symptoms of PCOS by improving insulin resistance and regulating blood sugar.
One study found that a cinnamon extract significantly reduced insulin resistance in women with PCOS who took it daily, compared to women with PCOS who didn’t take cinnamon extract (19).
Furthermore, a review of clinical trials that looked at type 2 diabetes found that cinnamon reduced blood sugar, improved cholesterol levels, and triglycerides (fats in the blood) that are common complications seen in PCOS (20).
Turmeric is another potent anti-inflammatory food and supplement that can be helpful in conditions characterised by inflammation. It is believed that turmeric may have a role in improving insulin resistance (21).
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Probiotics can help to improve digestion and gut health. Probiotics also have an important anti-inflammatory role in the body that may help to improve symptoms of PCOS.
One study found that probiotics, in particular a species called lactobacillus reduced inflammation in women with PCOS by regulating the immune system (22).
Healthy weight maintenance
One of the best ways to help manage PCOS is by maintaining a healthy weight.
Studies suggest that even a 5-10% weight reduction can help improve PCOS symptoms by restoring hormonal production, regulate periods, improve fertility, increase mood, reduce hirsutism, balding and acne. Furthermore, you’ll be reducing your risk of developing many chronic health conditions (23).
Aim for smaller meal portions, less processed foods/take away foods (that have lots of hidden calories), and aim for a protein source with every meal that helps to increase satiety (fullness)(24).
Regular physical exercise has many benefits that include weight loss, improved mood, and supports healthy insulin levels and blood sugar metabolism. These factors can help symptoms commonly associated with PCOS (25).
Aim for minimum 30-60 minutes of moderate to heavy exercise a day.
Reducing stress is also an important part of PCOS. Chronic stress can lead to increased inflammation and nutrient depletion (especially B vitamins) (26).
Sleep disturbance is 1.5 times more likely in women who have PCOS compared to women without PCOS. This may be partially due to multiple factors that include sleep apnoea, excessive weight, and hormonal imbalances (27).
You can improve your sleep hygiene by going to sleep and waking up at a regular time, use the bedroom for intimacy and sleep only, avoiding screens in the bedroom (eg. phone or computer), avoiding caffeine in the afternoons and living an active lifestyle.
Aim for minimum 7-9 hours a night.
Avoid or limit hormone disruptors
There are chemicals and compounds that can be found in our environment that can interfere or block your body’s natural hormonal system.
These disruptors can mimic the effects of sex hormones in the body and further contribute to hormonal problems (28).
Common hormonal disruptors include:
- BPA found in plastics
- Phthalates also found in plastics and cosmetics
- Environmental toxins (eg. exhaust fumes)
Oral contraceptive pill (OCP)
The combined oral contraceptive pill (OCP) is the most common treatment for symptoms of PCOS. The OCP interferes with testosterone production that helps to regulate menstrual cycles that can have significant beneficial effects in reducing face and body hair growth, acne, and oil (sebum) production in the skin (29).
Unfortunately, side effects such as fatigue, reduced libido, mood disturbances and changes in liver function are common (30).
This may be due to the OCP causing multiple nutrient deficiencies that include B vitamins, vitamin C, magnesium and zinc that are involved in the proper function of many of these bodily systems (31).
Metformin is a drug that is used to treat type 2 diabetes and may also help to manage PCOS through its effects on improving insulin resistance.
A 2010 study conducted concluded that “The long-term use of metformin to prevent remote complications of PCOS is uncertain and a significant amount of work is needed before a decision can be made on this front.”. Suggesting that metformin may not be as effective as once thought (32).
While metformin may be still have a potential role in treating PCOS, it might not be a preferred treatment method for PCOS.
Side effects can also occur with metformin use that include gastrointestinal symptoms such as nausea, abdominal pain, diarrhoea, bloating and flatulence (33).
Speak to your doctor
If you believe that you suffer from PCOS based on signs and symptoms discussed in this article speak to your doctor before trying to manage symptoms on your own.
If you have any questions or need support with your health, feel free to email our head nutritionist Ben at firstname.lastname@example.org
This article does not constitute medical advice and does not take into consideration your personal circumstances. Please see your medical professional before implementing the above.