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  • Aryane Oar, MS, RDN, CD

PCOS at a glance series {part 1}

Updated: Aug 24



PCOS, or polycystic ovary syndrome, is the most common hormonal disorder in women that can cause menstrual irregularities and infertility [1]. If you don’t have PCOS, chances are you know someone who does.

Dietary and lifestyle changes are the primary approaches to manage PCOS symptoms [2]. So, as expected, you just need a quick online search to find numerous promising diets out there. However, not all the information we find is evidence-based, and some advice may even be harmful. 

To set the stage, let’s better understand this complex hormonal disorder.

Background

The cause of PCOS is unknown, but genetic and environmental factors play a role [3]. The disorder causes reproductive and metabolic symptoms [4]. Please note that not all women have all symptoms.


- Reproductive symptoms: cysts in the ovaries (or immature follicles that are often mistaken as cysts), menstrual irregularity, infertility, and excess sex hormones (namely androgens, such as testosterone). High sex hormones may cause severe acne; hair on unwanted areas (such as face, chest, back, lower abdomen, or upper shoulders); or, on the flip side, loss of scalp hair. 


- Metabolic symptoms: insulin resistance (insulin being less effective, resulting in high levels of insulin in the blood), weight gain in the mid-section, and elevated cholesterol levels in the blood (dyslipidemia). High insulin levels are associated with weight gain, which can occur even with good nutrition and an active lifestyle. 


Psychological consequences, such as anxiety and depression, are also common among women with PCOS [5]. The disorder can be seen throughout the size spectrum – in women from smaller to larger bodies.

How is it diagnosed? 

To be diagnosed with PCOS, the woman needs to present at least two of the following three criteria [4]: 


* Irregular or no menstrual periods (ovulatory dysfunction);

* Symptoms of high sex hormones as described above (or blood work showing elevated androgens);

* Polycystic ovaries confirmed by ultrasound.

Note that not all women with PCOS present cysts in the ovaries or ovulatory dysfunction, which is surprising given the name of the disorder. Also, if blood values are obtained to verify sex hormone levels, the patient should not be on contraceptive pills for at least six weeks. 

Medical treatment

Oral contraceptive pills are commonly used to treat PCOS as they induce regular periods, improve acne, and reduce both the excessive hair growth on unexpected areas and hair loss from the scalp.

Metformin, a medication that improves insulin effectiveness, is commonly prescribed and helps normalize insulin levels in the blood and induces ovulation.

Nutrition and PCOS

Turning to the internet for nutrition advice will likely make you feel overwhelmed with all the do’s and don’ts - not to mention all the diets that are suggested. Losing weight is a very common recommendation after being diagnosed with PCOS and, consequently, restrictive dietary patterns are suggested, such as low-carb, gluten-free, or dairy-free diets. But is it really necessary to deprive yourself of certain foods or food groups if you have PCOS? 

Luckily, the answer is no; you don’t have to torture yourself with diets! Instead, you can connect to your body to determine what works and does not work for you as you follow healthful eating patterns. 

Be aware that specific dietary recommendations have not been determined for PCOS [6]. Since higher than normal insulin levels seem to be an important aspect of this disorder, starchy and sugary foods, i.e, carbohydrates, are often demonized – again. However, there is no need to avoid them. You may benefit from some nutrition shifts, but you don’t have to deprive yourself. 

Also, it is normal to have food cravings if you have PCOS. This is explained by the high insulin levels that act as an appetite stimulant and increase food cravings, particularly for sweets. So, an important initial step is to make sure you are eating enough and not restricting. It is very counterproductive to cut on calories when your body’s physiology is increasing your drive for food.

Lifestyle

Look for ways to move your body regularly as it has been shown that both aerobic and resistance training can improve insulin levels, body composition, and reproduction in women with PCOS [7]. 

If you would like help learning how you can manage PCOS through your nutrition, you can make an appointment by clicking here.

Suggested resources: 

- Love Food podcast and the Food Peace website by Julie Duffy Dillon.

References

1. Chittenden BG, Fullerton G, Maheshwari A, Bhattacharya. Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review. Reproductive BioMedicine Online. 2009;19(3). https://www.rbmojournal.com/article/S1472-6483(10)60175-7/pdf. Accessed June 25, 2020.

2. Phelan N, O’Connor A, Tun TK, et al. Hormonal and metabolic effects of polyunsaturated fatty acids in young women with polycystic ovary syndrome: results from a cross-sectional analysis and a randomized, placebo-controlled, crossover trial. The American Journal of Clinical Nutrition. 2011;93(3). doi:10.3945/ajcn.110.005538.

3. Ovalle F, Azziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertility and Sterility. 2002; 77(6). doi:10.1016/S0015-0282(02)03111-4.

4. Evidence-based Methodology Workshop Executive Summary. Washington D.C.: National Institutes of Health; December 2012. https://prevention.nih.gov/research-priorities/research-needs-and-gaps/pathways-prevention/evidence-based-methodology-workshop-polycystic-ovary-syndrome-pcos. Accessed June 25, 2020. 

5. Deeks AA, Gibson-Helm ME, Teede HJ. Anxiety and depression in polycystic ovary syndrome: a comprehensive investigation. Fertility and Sterility. 2010;93(7). doi:10.1016/j.fertnstert.2009.09.018. 

6. Moran LJ, Ko H, Misso M, et al. Dietary Composition in the Treatment of Polycystic Ovary Syndrome: A Systematic Review to Inform Evidence-Based Guidelines. Journal of the Academy of Nutrition and Dietetics. 2013; 113(4). https://jandonline.org/article/S2212-2672(12)01925-9/fulltext. Accessed June 25, 2020.

7. Thomson RL, Buckley JD, Brinkworth GD. Exercise for the treatment and management of overweight women with polycystic ovary syndrome: a review of the literature. Obesity Reviews. 2011;12(5). doi:10.1111/j.1467-789X.2010.00758.x.

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