What is polycystic ovary syndrome (PCOS)?
Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens and can cause irregular menstrual cycles, infertility, and other symptoms. It is a common endocrine disorder that is characterized by menstrual irregularity and elevated serum androgens and is often accompanied by insulin resistance.
What is the main cause of PCOS?
The exact cause of PCOS is unknown, but it is believed to be related to an imbalance of hormones. It is also thought to be linked to genetics, as it tends to run in families.
What does PCOS do to a woman's body?
- Irregular menstrual cycles
- Excessive hair growth
- Weight gain.
- Period problems and weight gain are some of the issues that women experience.
- Those who are worried about being infertile reportedly experience psychological distress.
- Impact on day-to-day living related to self-esteem and self-confidence.
- Excessive hair
- Heavy/ missed/ irregular periods
- Weight gain
- Acne or oil skin
- Baldness or hair thinning
- Large ovaries or many cysts
- Skin tags
- Dark or thick skin patches on the back of the neck. In the armpits and under the breasts.
Long-term health risks of PCOS
- High risk of developing diabetes, especially if the woman is overweight.
- Insulin resistance
- Abnormalities in cholesterol and blood fat
- heart disease, heart attack and stroke - cardiovascular diseases
- endometrial cancer
How is PCOS diagnosed?
Polycystic ovary syndrome (PCOS) is typically diagnosed through a combination of physical examinations, medical history, blood tests, and imaging studies. Here is a more detailed look at the process:
- Pelvic Exam: A pelvic exam may be conducted to check for any abnormalities in your reproductive organs. An ultrasound may be used to examine your ovaries and the thickness of the lining of your uterus. In PCOS, the ovaries may be enlarged and contain follicles that surround the eggs, leading to the "polycystic" appearance.
- Physical Exam: Your doctor may conduct a physical exam that involves monitoring your blood pressure, body mass index (BMI), waist size and searching for signs of PCOS in you such as excessive hair growth, acne or skin discolouration.
- Blood test: A blood test can measure hormone levels (such as testosterone), insulin levels, and glucose tolerance, etc. High levels of androgens or signs of insulin resistance can support the diagnosis of PCOS.
If you are diagnosed with PCOS, your doctor may suggest additional tests to check for complications.
The first step towards PCOS management, it is important to understand your current lifestyle and what might be causing and/or aggravating your symptoms,
Step 1: Track your symptoms
Track what you are eating and drinking, exercise, stress levels, social life, and the symptoms you are experiencing. Understanding when symptoms occur can what is happening around them, can help start making some educated changes.
Step 2: Start making manageable changes
- Eating a healthy diet: Following a healthy nutrition plan that is low in processed foods and high in fruits, vegetables, and whole grains can help to regulate hormones and reduce symptoms. Additionally, avoiding foods that are high in sugar and saturated fat can help to reduce inflammation and improve overall health.
- Exercising regularly: It is also important to exercise regularly, as this can help to regulate hormones and reduce symptoms of PCOS.
- Managing stress: Stress can have a significant negative impact on female health. The increase in cortisol can negatively impact PCOS symptoms, as such finding ways to manage your stress levels can be beneficial.
Now that we have a rough idea about the 3 major pillars of PCOS management, namely - Diet, exercise & stress management, let us dive deeper into each section.
PCOS nutrition and diet
Some of the foods that may be beneficial for people with polycystic ovary syndrome (PCOS) include:
- lean proteins
- healthy fats
- fruits and vegetables.
For example: salmon, quinoa, nuts, avocados, leafy greens, and berries.
Check out our Guide: Diet Guidelines for PCOS
10 common foods that can make PCOS symptoms worse:
- Refined carbohydrates (pizza dough, pasta, pastries, white flour, white rice, sweet desserts, and many breakfast cereals)
- Trans fats (Commercial baked goods, such as cakes, cookies, and pies, Shortening, Microwave popcorn, Frozen pizza, Refrigerated dough, such as biscuits and rolls, Fried foods, including French fries, doughnuts and fried chicken, Non-dairy coffee creamer, Stick margarine)
- Processed meats ( sausages, bacon, ham, deli meats such as salami)
- Refined sugars (Table sugar and high-fructose corn)
- High-fat dairy products (Heavy Cream, Whole Milk Yogurt, Whole Milk, Butter (80% butterfat or higher), Full-Fat Cheese, Whole Milk Greek Yogurt, Whole Milk Cottage Cheese)
- Refined vegetable oils (soybean oil, corn oil, safflower oil, canola oil, and peanut oil)
- Artificial sweeteners (Aspartame, Sucralose, Acesulfame K, Saccharin, Xylitol)
- Processed foods (breakfast cereals, cheese, tinned vegetables, bread)
Which diet is best for PCOS?
Although there is no specific diet known to be the best for PCOS management, a study evaluated the effects of the "Dietary Approaches to Stop Hypertension (DASH)" diet on insulin resistance and serum hs-CRP in overweight and obese women with Polycystic Ovary Syndrome (PCOS).
In this randomized controlled clinical trial, 48 women with PCOS were divided into two groups. One group followed the DASH diet and the other group followed a control diet, both for 8 weeks.
The study found that adherence to the DASH diet led to a significant decrease in serum insulin levels, HOMA-IR score (a measure of insulin resistance), and serum hs-CRP levels (an inflammation marker), compared to the control diet. Additionally, significant reductions in waist and hip circumference were observed in the DASH group compared to the control group.
In conclusion, the study found that an 8-week DASH diet regimen in overweight and obese women with PCOS improved insulin resistance, reduced inflammation (as indicated by serum hs-CRP levels), and decreased abdominal fat accumulation.
What is the DASH diet?
"The Dietary Approaches to Stop Hypertension" (DASH) diet is a dietary pattern promoted by the U.S.-based National Heart, Lung, and Blood Institute to prevent and control hypertension. The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods; includes meat, fish, poultry, nuts, and beans; and is limited in sugar-sweetened foods and beverages, red meat, and added fats.
The DASH diet was traditionally used to treat high blood pressure and remains one of the healthiest diets science has studied.
Main characteristics of the DASH diet:
- Fruits and Vegetables: The DASH diet recommends 4-5 servings of both fruits and vegetables each day. These foods are high in fiber, potassium, and magnesium which are all important for regulating blood pressure.
- Whole Grains: Whole grains are recommended over refined grains because they have all parts of the grain — the bran, germ, and endosperm. Foods made from these grains are rich in fiber, protein, and multiple B vitamins.
- Lean Protein: Lean meats, such as chicken, fish, and pork, are preferred over red meats. The DASH diet also encourages the consumption of protein from plant sources, like beans and lentils.
- Dairy: Low-fat or non-fat dairy products are recommended because they are high in calcium and protein but low in fat and calories.
- Nuts, Seeds, and Legumes: These are good sources of protein, fiber, and healthy fats.
- Fats and Oils: The DASH diet recommends limiting saturated fats and trans fats. Monounsaturated and polyunsaturated fats, such as those found in olive oil and fish, are healthier choices.
- Sodium: One of the key aspects of the DASH diet is reducing sodium intake. The standard DASH diet recommends no more than 2,300 milligrams of sodium per day, and there's a lower-sodium version that recommends no more than 1,500 milligrams of sodium per day.
PCOS Exercise and workouts
Regular exercise can be incredibly beneficial for women with PCOS. A systematic review of the effects of exercise on hormones in women with polycystic ovary syndrome showed that, I quote "Vigorous aerobic exercise improves insulin measures in women with PCOS. Resistance or strength training may improve androgen levels, though additional studies are warranted. Studies with yoga are limited but suggest improvements in androgens".
As such, resistance or strength training may improve androgen levels(although additional studies are required to better support this). The study also suggested that exercises like yoga might help improve androgens.
The best exercise for PCOS
- Cardio exercises like brisk walking, jogging, cycling, swimming
- Strength training exercises like squats, push-ups, tricep dips
- High-intensity interval training (HIIT)
- Core training and pelvic floor exercises
Worst exercise for PCOS
There are no specific proven or worst exercises that can negatively affect PCOS management. That being said, too much of anything is bad for you. However, training vigorously and often can increase your cortisol hormone which can negatively impact your menstrual cycle.
Check out our article: How Cortisol Affects Women’s Health and the Menstrual Cycle, for more information on how cortisol impacts female hormones.
Supplements for PCOS management
Apart from focusing on the 3 major pillars of PCOS management, it is important to talk to a doctor about any medications or supplements that may be beneficial in managing PCOS.
Some medications, such as birth control pills, can help to regulate hormones and reduce symptoms - however, they could cause other side effects.
Additionally, supplements such as omega-3 fatty acids, vitamin D, and chromium can help to reduce inflammation and improve overall health.
Your journey towards PCOS management
PCOS can be a difficult journey, but there are many resources available to help you manage your symptoms and live a healthy life.
Remember - everyone is unique and what works for one person does not work for someone else. The more you track and understand your body, the better you will understand and manage your PCOS symptoms
Resources & Biography
- National Library of medicine (2009)- Hippokratia. - Long term health consequences of polycystic ovarian syndrome: a review analysis
- Pubmed (2014) - DASH diet, insulin resistance, and serum hs-CRP in polycystic ovary syndrome: a randomized controlled clinical trial
- Pubmed (2020) - A Systematic Review of the Effects of Exercise on Hormones in Women with Polycystic Ovary Syndrome
- Li K, Urteaga I, Wiggins CH, et al. Characterizing physiological and symptomatic variation in menstrual cycles using self-tracked mobile-health data. NPJ Digit Med. 2020;3(1):79. doi:10.1038/s41746-020-0269-8
- Orio, F. and Palomba, S., 2014. New guidelines for the diagnosis and treatment of PCOS. Nature Reviews Endocrinology, 10(3), pp.130-132.
- Hart, R., Hickey, M. and Franks, S., 2004. Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome. Best Practice & Research Clinical Obstetrics & Gynaecology, 18(5), pp.671-683.
About the Author:
This article was written by Menna Tallah El Masri, London Metropolitan Nutrition Graduate and reviewed by certified nutritionist Ashiklal Pyarilal.
Lena is a passionate nutritionist and soon-to-be dietician specializing in eating disorders. She takes a holistic approach to health and is dedicated to advocating for the importance of building a healthy relationship with food and exercise, free from guilt, shame, and restriction.