What is Polycystic Ovarian Syndrome (PCOS)?

I personally struggle with polycystic ovarian syndrome (PCOS), so I know first hand how challenging it can be! I treat many clients with PCOS and work with them to manage symptoms, including infertility, weight management, insulin sensitivity and acne. If you are struggling with PCOS-related symptoms, contact me to set-up an initial consultation where we can create a customized plan including targeted nutrient supplementation and diet intervention.

What is Polycystic Ovarian Syndrome? 

PCOS is an endocrine disorder that is caused by an imbalance of reproductive hormones. 

How is PCOS diagnosed? 

PCOS diagnosis is made by combining symptoms, laboratory results and imaging. If the individual has cycles >35 days, or are irregular, and she has PMS symptoms, and/or hirsutism, and/or weight challenges they usually meet PCOS criteria. 

Prevalence: 

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders, affecting ~10% of reproductive age women. However, diagnosis is often missed. 

What causes PCOS? 

The exact etiology of PCOS remains unknown, but the two primary factors that are believed to play a role include: 

• High levels of androgens, a reproductive hormone. 
• High levels of insulin. Many women with PCOS have insulin resistance. 

Symptoms of PCOS: 

Some of the symptoms of PCOS include: 

• Irregular menstrual cycle 
• Acne 
• Thinning hair 
• Hirsutism – increased facial hair 
• Darkening of the skin – particularly along neck creases, in the groin, and underneath breasts 
• Skin tags 

Note: many women with PCOS will experience some symptoms, but not necessarily all symptoms. 

Connection with Mood and Eating Disorders: 

• Women with PCOS have higher rates of anxiety and depression, potentially due to hormone imbalance. 
• Women with PCOS have a significantly higher risk of disordered eating behaviors. High insulin levels have been associated with increased cravings and binge-eating behaviors. 

Medical Treatment of PCOS: 

• Hormonal birth control (including the pill, IUD, patch, vaginal ring etc). Birth control can suppress excessive androgen secretion by the ovaries, regulate your menstrual cycle and help improve acne and hirsutism. 
• Anti-androgen medicines. These medications can block the effect of androgens and improve acne, thinning hair and hirsutism symptoms. 
• Metformin. Traditionally a medication used in the treatment of diabetes, metformin is an insulin-sensitizing agent and can lower both insulin and androgen levels. Metformin may help restart ovulation and improve weight loss and cholesterol levels. It usually has very little effect on acne and excessive body hair. 

Lifestyle Management of PCOS: 

Diet and lifestyle modifications are often the primary treatment approach for women with PCOS. 

• Weight loss (as little as 5% of body weight) is associated with improved metabolic and reproductive symptoms 
• Recommended dietary approaches include a low glycemic index/glycemic load diet with a focus on consuming anti-inflammatory foods and high antioxidants 
• Women with PCOS have increased levels of insulin and inflammatory markers. An anti-inflammatory diet, with a focus on high fiber intake and anti-inflammatory foods such as fish, legumes, green tea and omega-3 fatty acids. Recommend limiting red meat, processed foods and added sugars. 

Nutritional Supplements: 

• N-acetylcysteine (NAC): a powerful antioxidant and amino acid. NAC is involved in fighting oxidative stress and inflammation. NAC also has been shown to protect insulin receptors and influence insulin receptor activity and insulin secretion from pancreatic cells. 
• Inositol: Both myo-inositol (MYO) and D-chiro-inositol (DCI) have been well studied in women with PCOS and are showing promising results as first-line treatment. MYO in particular has been shown to improve insulin sensitivity as well as egg quality and ovulation. Newer research is showing that a combination of MYO and DCI in the ideal 40:1 ratio that mimics the body’s own tissue levels works better than inositol alone for improving metabolic aspects and restoring hormone balance. Inositols are pseudovitamins found in foods such as fruits, beans, cereals, and buckwheat. MYO and DCI help to regulate hormone activity including follicle-stimulating hormone, thyroid-stimulating hormone, and insulin. It’s believed women with PCOS have a defect in their ability to use inositol properly, which could perhaps be a reason why they have higher insulin levels. 
• Vitamin D: Studies on PCOS show an inverse relationship between vitamin D and metabolic and hormonal disorders. Vitamin D supplementation (100,000 IU/month) has been shown to improve fertility in women with PCOS by increasing the number of mature follicles and improving menstrual regularity, but the results weren’t statistically significant. 
• Fish Oil: Fish oil offers many benefits to women with PCOS, including helping to reduce elevated triglyceride levels, improving fatty liver, and decreasing inflammation. Omega-3 oil also has been found to lower testosterone and regulate menstrual cycles in both overweight and lean women with PCOS. 
• Vitamin B12: Metformin affects the absorption of vitamin B12 and therefore Vitamin B12 deficiency is common in metformin users. It is recommended that patients who take metformin have their vitamin B12 levels checked annually and supplement with vitamin B12. The sublingual methylcobalamin form is best absorbed. 

Is PCOS associated with other health problems? 

Women with PCOS have increased risk of the following health problems: 

• Diabetes 
• High blood pressure 
• High cholesterol 
• Sleep apnea 
• Depression and anxiety 
• Endometrial cancer