A diagnosis of Polycystic Ovary Syndrome, commonly known as PCOS, comes when many women least expect it. Related to hormonal imbalances, PCOS is an endocrine disorder in which a woman’s ovaries become enlarged and develop cysts. PCOS affects between 5-13% of women of reproductive age and is a leading cause of infertility.
The cause of PCOS is unknown but genetic and environmental factors are involved. Unfortunately, there is no cure for PCOS. Treatment involves a combination of medical intervention and lifestyle strategies. Diet can play a role in PCOS management.
Clinical Signs, Symptoms and Complications
Because women experience a range of symptoms, including skin issues like acne, many women do not associate their symptoms with a serious health condition. PCOS often goes undiagnosed until a woman experiences changes in her menstrual cycle or is having trouble getting pregnant.
Symptoms of PCOS include:
- Infertility
- Menstrual irregularities
- Obesity, weight gain, trouble losing weight especially around the abdomen
- Insulin resistance
- Hirsutism (excessive body hair, typically on the face, chest, abdomen, or upper thigh region)
- Acne
- Dyslipidemia (abnormal blood lipid levels)
- Pelvic pain
- Oily skin
- Acanthosis nigricans (patches of thick, dark skin)
To diagnose PCOS, a doctor will evaluate three main clinical features:
- absence of ovulation
- high levels of androgens (hormones produced in the ovaries)
- and the presence of ovarian cysts.
Due to the presence of hormonal imbalances, PCOS is associated with an increased risk of other conditions and diseases including low-grade chronic inflammation, hypertension (high blood pressure), dyslipidemia (abnormal cholesterol levels), overweight and obesity, type 2 diabetes, depression, anxiety, eating disorders, and pregnancy complications. A management plan for PCOS will consider these potential long-term complications.
Treatment Goals
Once PCOS is diagnosed, a woman will work with her practitioner to develop an individualized management plan. The treatment goals for PCOS are to improve hormonal imbalances, lose and/or maintain a healthy body weight, prevent complications, and improve quality of life.
Finally, if a woman with PCOS has had trouble getting pregnant, her management plan will address infertility. To achieve these goals, areas of focus include medications, eating patterns, exercise, and stress management.
PCOS and Diet
An eating pattern that is supportive of managing PCOS is like other anti-inflammatory eating patterns such as the Mediterranean Diet. The emphasis is on eating whole foods such as vegetables, fruit, legumes like beans and lentils, whole grains, nuts, and seeds. Pairing moderate portions of high-quality carbohydrates (starchy vegetables, fruit, legumes, whole grains) with lean proteins is encouraged. Select moderate portions of heart-healthy foods like avocado, olive oil, nuts, and seeds. Incorporate sources of omega-3 fatty acids including salmon, sardines, and seeds like flax, hemp, and chia. Drink water and other unsweetened beverages.
Limit or avoid foods that do not support an anti-inflammatory eating pattern such as foods with refined carbohydrates and added sugars. These include snack foods, white bread, white rice, baked goods, candy, soda, energy drinks, and sweetened cereals and yogurts. Limit high fat meats, processed meats, and full-fat dairy products. Avoid alcoholic beverages or limit to one per day.
Insulin Resistance and Blood Sugar Management
Insulin resistance is a common feature of PCOS that is exacerbated by excess weight and lack of physical inactivity. To better understand insulin resistance, let’s first describe how your body turns food into energy by producing insulin.
When you eat, your body breaks down food into glucose, also known as sugar, and your blood sugar level rises. Your pancreas makes the hormone insulin to help glucose enter muscle, fat, and liver cells, where it is used to generate energy. As insulin helps glucose enter your cells, your blood sugar level begins to fall into a normal range. Insulin resistance occurs when your cells do not respond as well to insulin. As a result, your pancreas makes more insulin, and your blood sugar level may remain higher than normal. Consistently having high blood sugar levels damages the body.
To reduce insulin resistance and manage blood sugar levels, focus on the types and amounts of macronutrients (carbohydrates, protein, and fat) in the foods you eat. Carbohydrate foods such as grains, starchy vegetables, and dairy affect blood sugar levels the most. Protein foods like fish, meat, poultry, and eggs have less of an effect on blood sugar. Fats like oils and butter have the least impact on blood sugar levels. Since a healthy diet is a balance of all food groups, do not try to avoid carbohydrate foods completely. The name of the game is moderation rather than restriction. Choosing high-quality, whole food carbohydrates in balance with lean protein and healthy fats at meals and snacks is best.
Physical Activity
A healthy way of eating is only one part of managing PCOS. It’s also important to get regular physical activity. Being active can help reduce insulin resistance and increase ovulation rates and menstrual cycle regularity. Plus, engaging in regular exercise is beneficial for overall physical and mental health.
Getting at least 150 minutes per week of moderate activity, including at least two full-body strength training sessions with weight-bearing exercises using dumbbells, weight machines, and/or bodyweight is recommended. Being less sedentary and more active overall can make a difference.
Weight Management
Some studies report that between 50-90% of women diagnosed with PCOS also have overweight or obesity. There is no one cause of overweight or obesity, but hormonal disturbances are involved.
Studies report that even losing just 5% of your current bodyweight can make a difference in PCOS symptoms by decreasing abdominal fat, androgens, and insulin resistance. Weight loss also improves blood lipid levels, menstrual cycle regularity, and fertility.
Weight loss is complicated. It’s not as simple as estimating calories consumed and burned. The main strategies used to lose or maintain weight are the same recommendations for managing PCOS – choose sensible portions of whole foods most often, have balanced meals and snacks, and exercise regularly including strength training.
General tips to support weight management include:
- Avoid restrictive diets, cleanses, or extreme exercise plans.
- Eat plenty of non-starchy vegetables. Choose lean proteins.
- Choose moderate portions of higher fat foods. Focus on healthy fats.
- Set goals for daily lifestyle habits.
- Enjoy fun foods like desserts occasionally.
- Avoid eating when bored or stressed.
- Choose unsweetened beverages most often.
- Exercise regularly.
- Improve sleep quantity and quality.
- Manage stress.
Mental Health and Eating Disorders
It is not surprising that the symptoms of PCOS impact quality of life for many women. PCOS can affect both the risk of mental health disorders and eating disorders. Between 28-64% of women with PCOS may have depression and anxiety. One contributing factor to the prevalence of mental health disorders in women with PCOS is weight and body image issues. In one study, women with PCOS had four times the risk of having an eating disorder compared to women without PCOS.
Addressing lifestyle habits should be part of a treatment plan for mental health and eating disorders. Seek professional support from qualified healthcare practitioners to discuss individualized care to deal with the many facets of PCOS.
Stress Management
Like many medical conditions, PCOS is linked to increased stress. Part of PCOS treatment should include coping with stress using tools such as self-care, reading, meditation, journaling, experiences in nature, and other stress reduction techniques.
Final Thoughts on Managing PCOS
The first step to managing PCOS is speaking with your doctor. A combination of medication, eating and exercise strategies, and stress management can improve symptoms. Seeing a fertility specialist is also a priority if your goal is to get pregnant. Following a PCOS treatment plan developed by you and your healthcare team and consistently practicing healthy lifestyle habits can enhance well-being and help you live a happy life with PCOS.
References
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