Author: Amy Cottrell (DipCNM, mBANT, rCNHC, mANP)
September is PCOS (Polycystic Ovary Syndrome) awareness month, so we thought it was the perfect time to help you understand more about this complicated condition and how to alleviate its symptoms.
Firstly, you might be wondering, what is PCOS exactly? Let’s begin by breaking down the name – it stands for Polycystic Ovary Syndrome. A polycystic ovary is a growth of follicles (fluid-filled sacs) in one or both ovaries. Despite the name, there are no “cysts” present, but believe it or not, you can have PCOS without even having polycystic ovaries (you can also have polycystic ovaries (PCO) without having PCOS). A “syndrome” is a collection of symptoms characterising a condition.
Despite PCOS being one of the most common hormonal conditions affecting women of reproductive age, many women remain undiagnosed, haven’t received information about the condition, or are simply unaware that they have PCOS [a].
Since PCOS can present itself in various ways depending on the individual, there is a specific diagnostic criterion [b] in the UK, whereby if you have at least two of the following three features, you may receive a diagnosis of having PCOS:
- Irregular periods, which is when the ovaries do not regularly release eggs (ovulation)
- If you have excess androgens (so-called “male” hormones such as testosterone) is identified via a blood test. Symptoms associated with excess androgens include male pattern hair growth.
- Polycystic ovaries (as described above)
As you can see, the name PCOS doesn’t encapsulate the full extent of this condition.
What are the possible causes?
Although the exact reason women develop PCOS is unknown, various factors seem to contribute to this condition. For that reason, different possible causes affect the development of PCOS. Let’s take a look at a few:
- Genetics – even though the specific genes associated with PCOS have not yet been identified, it has been noted that PCOS sometimes runs in families and thus appears to have a genetic link [c].
- Insulin resistance, when our cells stop responding to insulin and become less effective at taking up the glucose from the blood, is often implicated with PCOS. Many women with PCOS are insulin resistant and have hyperinsulinemia (high levels of insulin in the blood), which can cause the ovaries to produce excess amounts of testosterone. This can result in weight gain and hirsutism [d]. If you’re interested in learning more about how our genetics can influence our insulin secretion, check out our recent blog article.
- Diet and lifestyle also play a part in PCOS – women who are overweight or obese do not eat a healthy diet or get enough exercise. Those with a family history of type 2 diabetes are generally more prone to developing insulin resistance [e].
- Hormonal imbalances: many women with PCOS are found to have raised levels of testosterone, luteinising hormone and in some cases prolactin, and low levels of sex hormone-binding globulin, and although it’s unclear why these hormonal changes happen, it might be caused by insulin resistance, problems in the ovaries or in the glands that produce the hormones [f].
- Chemicals such as the chemical Bisphenol A (BPA) have been linked to the development of PCOS, owing to its endocrine-disrupting qualities [g].
- Since Vitamin D plays a role in several metabolic pathways, such as insulin resistance, deficiency has the potential to influence the development of insulin resistance in PCOS [h].
Think you might have Polycystic Ovary Syndrome?
Some common signs and symptoms of PCOS can include:
- Irregular or short cycles (this is because PCOS interferes with ovulation)
- Mood swings or low mood
- Cravings for sweet foods
- Hair loss
- Weight gain and difficulty losing weight
- Hirsutism (male pattern hair growth, with coarse dark hair)
- Fertility problems /difficulty conceiving
- Low mood
- Breakouts/Acne
- Sleep apnoea
PCOS symptoms might cross over with other conditions and might not be PCOS-related. So it’s important to talk to your doctor so that the necessary investigatory tests can be carried out, such as blood tests (looking at various hormones and sometimes blood glucose) and an ultrasound of the ovaries [i].
The impact of PCOS can be far-reaching
Menstruation disorders, such as irregular periods or no periods, are common in women with PCOS. Since ovulation might not occur regularly or not at all in women with PCOS, it’s, therefore, a common reason for fertility problems.
In addition to menstruation and fertility concerns, PCOS is also linked to the following complications [j]:
- Metabolic disorders, including insulin resistance and type 2 diabetes
- Cardiovascular disease
- Cancer (specifically endometrial cancer)
- Psychological and behavioural disorders, such as depression, anxiety and eating disorders
- Obstructive sleep apnoea
- Pregnancy complications
How can we manage Polycystic Ovary Syndrome?
Although there is no cure for PCOS, there are various ways that you can manage its symptoms. Everyone is unique; therefore, individual approaches are necessary.
When it comes to Western medicine, the symptoms or goals will define the treatment path. Commonly, women with PCOS are offered a contraceptive pill to “regulate” cycles. Other women having difficulty conceiving might be prescribed specific medications to help. Additional advice may include to lose excess weight, but not all women with PCOS are overweight yet still experience symptoms [k].
You can also do plenty to support the condition via nutrition, lifestyle and supplements. Don’t believe that medication is the only option or that there is little you can do to alleviate debilitating symptoms.
Regarding nutrition, focus on a wholefood diet – think lots of fruit, veg, healthy fats (nuts, seeds, avocado), legumes, and good quality protein, such as lean grass-fed meat and wild fish. Eat organic food wherever possible to avoid nasty pesticides and chemicals that can interfere with our delicate hormone balance. At the very least, avoid the “dirty dozen” [l].
Blood sugar management is often vital for PCOS (see our recent blog article for some tips). Aim to reduce intake of simple and refined carbohydrates, instead focussing on low GI foods (this is a rating system for foods containing carbohydrates [m]), as well as reducing saturated and trans fatty acids and addressing possible deficiencies, such as vitamin D [n].
Although there is not enough evidence supporting the success of a specific diet for patients with PCOS, studies have demonstrated that a low glycaemic index diet improves insulin sensitivity compared to a conventional healthy eating diet [o].
Lifestyle modifications will support overall health and wellbeing regardless of whether you have PCOS, but paying them extra attention could genuinely help you to see an improvement in your symptoms:
- Incorporate regular movement and exercise into your day, which is even more important if you have a sedentary job.
- Prioritise your sleep, aiming for 7-8 hours a night, and practice good sleep hygiene. Lack of sleep can exacerbate cravings and mood swings and worsen insulin resistance over time.
- Stress management is also key – chronic stress has numerous adverse effects on our body and can negatively impact our hormones [p].
- Reduce exposure to BPAs and endocrine disruptors by avoiding plastic water bottles, food containers, and clingfilm. Don’t reheat food in plastic containers, either. Opt for glass bottles and storage containers, and steer clear of any liquids in plastic bottles!
Many supplements have been looked at in clinical trials when investigating the management of PCOS. These include Myoinositol (a sugar made in the human body and found in foods) [q], Chromium [r], Omega 3 fatty acids [s], Probiotics [t] and Vitamin D (if deficient) [u] and Magnesium [v]. Talk to a qualified practitioner to see what might be right for you!
Polycystic Ovary Syndrome is not only physiologically and physically challenging, but it can also be emotionally difficult for many women. Prioritising a healthy lifestyle plays a key role in managing PCOS, maintaining a healthy weight and optimising metabolic health and overall health and quality of life [w].
Please share this article with others, and let’s give Polycystic Ovary Syndrome the attention it deserves.
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Disclaimer: This article is for educational purposes only – always talk to your doctor before making any changes to your medications or diet.
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