Polycystic ovary syndrome (PCOS) is an endocrine condition that can impact on how well the ovaries work. It can affect around 1 in every 10 women in the UK, with more than half of women not experiencing symptoms. Having PCOS can significantly impact on quality of life for some women (1). 

Many females will have large number of follicles (or cysts) on the ovary, which can be harmless. These follicles are underdeveloped sacs where eggs will develop overtime, before releasing an egg during ovulation. With PCOS, the sacs are unable to release the egg, which will prevent ovulation. 

This lack of ovulation can lead to an imbalance of hormones, such as a high oestrogen level. The presence of follicles alone isn’t enough for diagnosis. 

To be diagnosed with PCOS, at least two of these three diagnostic criteria need to be met (4): 

  • Irregular periods 
  • Polycystic ovaries (the presence of follicles on the ovaries)
  • Excess androgen levels (hyperandrogenaemia). These are higher level of ‘male’ hormones in the body such as testosterone, which can lead to excess facial/body hair as a symptom.

Symptoms of PCOS (5) 

  • Irregular periods/absence of periods
  • Fertility issues 
  • Acne
  • Inflamed/oily skin
  • Hair loss
  • Excess body or facial hair
  •  Weight gain/difficulty to lose weight 

What causes PCOS? 

There is no exact cause known, but a variety of factors such as genetics, environment and lifestyle factors can influence the development of PCOS. It can also run in the family (3).  

High levels of insulin (the hormone that controls blood sugar levels) is common in those with PCOS. This can mean their body is more resistant to the action of insulin, which can lead to the overproduction of insulin to try to combat this. This can lead to the body becoming insulin resistant. In turn, this higher output of insulin can lead to rises in male hormones (2). PCOS can also increase the risk of developing type 2 diabetes mellitus and gestational diabetes (6). 

Insulin resistance is also linked to an increase in weight, which can further effect symptoms. However, whether obesity leads to PCOS or PCOS leads to obesity is still unknown (4). 

Having PCOS can also increase the risk of developing high cholesterol or high blood pressure, however there are some influences to our diet and lifestyle that can be looked at, to reduce the risk of developing these conditions. 

Management of PCOS 

Whilst there is no cure for PCOS, there are various areas of health and wellbeing that can be looked at when it comes to controlling the related symptoms of PCOS to help improve lifestyle outcomes.

Weight loss:

Excessive weight is associated with adverse health outcomes in women with PCOS. Research has shown that a 5% body weight loss can help regulate menstrual cycle, reduce insulin and testosterone levels, improve fertility, decrease acne and body/facial hair as well as improve overall health and wellbeing (1).

Nutrition:

Focusing on increasing your intake of fruits and non-starchy vegetables can help create a more balanced diet, including lean sources of protein, complex carbohydrates and a moderate intake of healthy fats.

Choosing complex carbohydrates (lower GI foods) can help keep the blood sugar more stable, as well as providing a source of fibre, that keeps you fuller for longer. An increase in fibre can also help the body remove excess oestrogen via stool (7). 

Regular meals throughout the day can help prevent dips in blood sugar, which can regulate insulin levels. 

Exercise:

Trying to keep active and incorporate some sort of movement can help with regulating insulin and blood sugar levels. Having a mixture of both cardiovascular and strength exercises in the week is ideal. Choosing something you enjoy doing can make such a difference! 

 Stress management:

Those with PCOS may be more prone to higher stress levels due to higher cortisol and other stress hormones. Managing stress can be an important way to help control this.

Examples may include journaling, practicing breathing techniques/meditation, calling a friend or going for a walk.

Medical management:

There may be cases where medical treatment can be added for better management of PCOS symptoms. Speak to your GP or doctor to find out how they can support you with this. 

PCOS is a complicated metabolic disorder but having the guidance from a Registered Dietitian can help ensure you are working on making some positive changes to your health and lifestyle that can improve your symptoms. 

By Reema Patel, Dietitian, MSc 

References

  1. El Hayek, S., Bitar, L., Hamdar, L. H., Mirza, F. G., & Daoud, G. (2016). Poly Cystic Ovarian Syndrome: An Updated Overview. Frontiers in physiology7, 124. https://doi.org/10.3389/fphys.2016.00124
  2. Dunaif A. (1997). Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocrine reviews18(6), 774–800. https://doi.org/10.1210/edrv.18.6.0318
  3. Chen, Z. J., Zhao, H., He, L., Shi, Y., Qin, Y., Shi, Y., Li, Z., You, L., Zhao, J., Liu, J., Liang, X., Zhao, X., Zhao, J., Sun, Y., Zhang, B., Jiang, H., Zhao, D., Bian, Y., Gao, X., Geng, L., … Zhao, Y. (2011). Genome-wide association study identifies susceptibility loci for polycystic ovary syndrome on chromosome 2p16.3, 2p21 and 9q33.3. Nature genetics43(1), 55–59. https://doi.org/10.1038/ng.732
  4. Kamangar, F., Okhovat, J. P., Schmidt, T., Beshay, A., Pasch, L., Cedars, M. I., Huddleston, H., & Shinkai, K. (2015). Polycystic Ovary Syndrome: Special Diagnostic and Therapeutic Considerations for Children. Pediatric dermatology32(5), 571–578. https://doi.org/10.1111/pde.12566
  5. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and sterility81(1), 19–25. https://doi.org/10.1016/j.fertnstert.2003.10.004
  6. Randeva, H. S., Tan, B. K., Weickert, M. O., Lois, K., Nestler, J. E., Sattar, N., & Lehnert, H. (2012). Cardiometabolic aspects of the polycystic ovary syndrome. Endocrine reviews33(5), 812–841. https://doi.org/10.1210/er.2012-1003
  7. Victoria L. Holt, Britton Trabert, Kristen Upson, Chapter 18 – Endometriosis, Editor(s): Marlene B. Goldman, Rebecca Troisi, Kathryn M. Rexrode, Women and Health (Second Edition), Academic Press, 2013, Pages 271-284, ISBN 9780123849786, https://doi.org/10.1016/B978-0-12-384978-6.00018-2 (https://www.sciencedirect.com/science/article/pii/B9780123849786000182)
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