PCOS symptoms and background
PCOS -polycystic ovarian syndrome -is a collection of symptoms found in around 1 in 5 women and impacts periods. It is diagnosed when at least two of the following criteria (1) are met:
· Irregular or absent periods (oligomenorrhea or amenorrhea)
· Excess male hormones (androgens) such as testosterone. Diagnosed by blood test, excess body and facial hair or acne.
· Multiple cysts (immature, unreleased eggs) on the ovaries, seen on an ultrasound scan.
Fertility can be impacted by PCOS as you may be ovulating irregularly, but it does not guarantee that you are infertile or will have difficulty getting pregnant -it is highly variable and individual. Support is available for people with PCOS who wish to conceive, and this also means contraception is still needed if you don’t want to get pregnant!
Many cases of PCOS are linked to insulin resistance. Even though your body is likely producing enough insulin, your cells may not be particularly sensitive to this hormone, meaning you would need more insulin to have the same effect on lowering blood glucose (sugar) compared to someone without insulin resistance. This excess insulin drives the ovaries to convert oestrogen into testosterone, which prevents ovulation. Whilst there is no cure for PCOS, it can be managed by lifestyle interventions, dietary changes and medication.
Dietary management of PCOS
Managing PCOS has the benefit of potentially reducing your risk of conditions like cardiovascular disease and type 2 diabetes, so there are real advantages to making some lifestyle changes, even if you’re also taking medication.
One of the main recommendations you will hear for PCOS is weight loss. This is because even a small amount of weight loss has been associated with improvements in the physical symptoms, and in the chances of conceiving (3). However, weight loss can be challenging, not least with the presence of insulin resistance influencing hunger cues. Health-promoting behaviours may help to alleviate symptoms without weight loss being the primary focus (3).
Low carbohydrate diets including, at the strictest end, the ketogenetic diet are often suggested as part of PCOS management. As these diets tend to be lower in calories and produce a smaller insulin response, initial weight loss can often be seen along with alleviation of symptoms (4). Moreover, carbohydrate molecules are hydrophilic, and so with reduced carbohydrate comes reduced water retention, and appearance of weight loss. Some people find that these diets can be restrictive, especially the ketogenic diet, making them difficult to maintain long-term. However, other’s find success through adopting these dietary approaches. A more sustainable approach to adopt long-term could include being mindful of carbohydrate intake, choosing vegetables, fruit, wholegrains, nuts and seeds as the primary sources. A moderate amount of protein and “good” fats such as nuts, olive oil, avocado and Greek yoghurt are also helpful to include when building up an overall diet. It is important to find an approach that works for the individual when considering different dietary options.
Another reason not to go on a restrictive diet is stress. Cortisol is produced when we’re stressed, and whilst a little is okay, chronically high cortisol levels raise insulin and testosterone, increasing symptoms. So, if your diet or exercise regime as part of PCOS management is causing you stress, you might actually see more benefit from cutting yourself some slack.
There are several supplements and herbal remedies marketed at PCOS management. Most only have limited evidence, so it is entirely a personal choice as to whether or not to take them. Three reasonably accessible examples with some evidence behind them are listed here.
Inositol is a secondary messenger and insulin-sensitising compound. Myo-inositol is the main form sold in supplements, although d-chiro inositol is also available. This is the main supplement that is recommended for PCOS and it may help with ovulation and fertility (6).
Spearmint, brewed as a tea, has been shown to have a anti-androgenic effect in laboratory studies (7), although the evidence so far has not been strong enough to show reduced hirsutism (excess hair).
Cinnamon may help improve insulin sensitivity. Due to its sweet flavour, it can be used instead of sugar on top of meals such as porridge, helping to reduce sugar intake. Around half a teaspoon is a suggested amount to try (8).
PCOS varies between individuals, so a large part of managing the symptoms will involve learning your own body, cycle and reactions to different intervention. For further reading, I recommend The Gynae Geek by Dr Anita Mitra.
Thank you to this week's guest blog writer Eleanor Coales, she is currently completing a Masters in Nutrition at the University of Leeds, and has a special interest in women's health nutrition and sustainable nutrition. Eleanor is also a yoga teacher, and is the founder of Enlivening Elle, a virtual clinic and educational platform.
1. Boyle, J. and Teede, H.J., 2012. Polycystic ovary syndrome: an update. [Available from: https://search.informit.com.au/documentSummary;dn=805604754087626;res=IELIAC ]
2. Teede, H., Deeks, A. and Moran, L., 2010. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. [Available from: https://link.springer.com/article/10.1186/1741-7015-8-41]
3. Schillinger, M.O., 2014. Study of intuitive eating ratings and self-efficacy differences in women with Polycystic Ovarian Syndrome (PCOS). [Available from: https://commons.emich.edu/theses/588/]
4. Mavropoulos, J.C., Yancy, W.S., Hepburn, J. and Westman, E.C., 2005. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. [Available from https://link.springer.com/article/10.1186/1743-7075-2-35]
5. Eslamian, G., Baghestani, A.R., Eghtesad, S. and Hekmatdoost, A., 2017. Dietary carbohydrate composition is associated with polycystic ovary syndrome: a case–control study. [Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jhn.12388]
6. Unfer, V., Carlomagno, G., Dante, G. and Facchinetti, F., 2012. Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials. [Available from: https://www.tandfonline.com/doi/abs/10.3109/09513590.2011.650660]
7. Grant, P., 2010. Spearmint herbal tea has significant anti‐androgen effects in polycystic ovarian syndrome. A randomized controlled trial. [Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/ptr.2900]
8. Wang, J.G., Anderson, R.A., Graham III, G.M., Chu, M.C., Sauer, M.V., Guarnaccia, M.M. and Lobo, R.A., 2007. The effect of cinnamon extract on insulin resistance parameters in polycystic ovary syndrome: a pilot study. [Available from: https://www.sciencedirect.com/science/article/pii/S0015028206045559]