Written by Natasha Gilbody, Second Nature Health Coach (ANutr)
What is PCOS?
Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects approximately 5-10% of females at reproductive age.
In females with PCOS, it's common to have a large number of follicles or cysts on the ovary, which can impact how well the ovaries work. A follicle is a sac where the egg develops during the menstrual cycle. Normally these follicles will mature and develop before releasing an egg during ovulation. However, in those with PCOS, these follicles don't grow and mature in the same way, which means the egg doesn't get released. Instead, the egg gets ‘trapped’ in the surface of the ovary which leads to an accumulation of follicles on the ovary. If the egg isn't fully released from the follicle, ovulation doesn't take place. The lack of ovulation can lead to continually high oestrogen levels and an imbalance of hormones.
However, the presence of follicles on the ovary alone isn't enough for a diagnosis, as many females can have these follicles without necessarily having PCOS.
For a diagnosis of PCOS, two out of the three following diagnostic criteria must be met:
- The presence of follicles on the ovaries
- Irregular periods or ovulation
- The presence of 'male' hormones, known as androgens, in the body
Symptoms of PCOS
- Irregular or no periods
- Irregular or no ovulation
- Fertility issues
- Hirsutism (the presence of dark facial or body hair)
- Oily skin or acne
- Thinning hair or baldness
- Weight gain or difficulties losing weight
- Mood changes, depression, and anxiety
These symptoms can consistently occur together, but present differently from person to person. In some cases, there might not be any obvious symptoms at all.
If you're concerned about any symptoms you're experiencing, please speak to your GP.
What causes PCOS?
There's no known 'cause' of PCOS, but genetic, environmental, and certain lifestyle factors are known to play a role in the development of the condition.
Those with PCOS often have increased levels of inflammation in their body which is typically triggered by the presence of androgens (or 'male' hormones). Increased body weight can also contribute to inflammation which can then feed into this cycle.
Research suggests there's a link between insulin resistance and PCOS. Around 70% of females who have PCOS are also insulin resistant. High levels of insulin cause the ovaries to produce too much testosterone, which interferes with the development of the follicles (the sacs in the ovaries where eggs develop) and prevents normal ovulation.
Insulin resistance can also lead to weight gain, which can exacerbate some PCOS symptoms.
PCOS is also a familial condition, meaning you're more likely to have this if another member of your family also has it.
Long term complications of PCOS
There are some risks of long-term health problems associated PCOS, including type 2 diabetes, heart disease, certain types of cancer, sleep disturbances, and mental health issues.
However, the good news is there are many ways you can reduce the risk of these long-term health problems. Following a healthy lifestyle is one way to reduce your risk, alongside visiting your GP for regular check ups.
What can I do to manage the symptoms of PCOS?
1. Weight loss
Some weight loss (~5% of your body weight) can be beneficial in managing symptoms of PCOS. However, we know there are a number of mechanisms involved in PCOS that can make it more challenging to lose weight, including insulin resistance, problems with sleep, and high stress levels.
Focusing on following a healthy and balanced diet, and including regular exercise, can help manage symptoms whilst also contributing to weight loss.
Eating a well-balanced diet can have a positive impact on symptoms of PCOS:
- Timing of meals is really important. Make sure you're spacing your meals evenly throughout the day, both for blood glucose control and to improve insulin action. Skipping meals and getting too hungry can increase the likelihood of eating more food than your body needs at the next meal.
- Aim to build your meals using our healthy plate model
- Opt for complex carbohydrates as these can help to reduce the overall glycaemic load of the meal (i.e. the overall effect on your blood sugar levels). Complex carbs will also provide more fibre, which helps to keep you feeling fuller for longer and slow down the release of glucose into your bloodstream. Choosing foods high in fibre can also help remove excessive oestrogen from the body via the stool. High, unbalanced levels of oestrogen are often seen in those with PCOS.
- Make sure you're including enough protein at mealtimes. A good rule of thumb is to aim for 1/4 of your plate to be made up of protein at main meals, or a serving size equivalent to the size of the palm of your hand.
- Some types of healthy fat may also play a role in helping to address the inflammation that underlies PCOS. Try including extra virgin olive oil or servings of oily fish such as salmon and mackerel in your diet.
- Finally, some early research suggests that including 1-2 tsp of cinnamon each day could help to manage PCOS symptoms.
Engaging in some form of regular activity or movement can help to balance out the levels of key hormones involved in PCOS, including reducing insulin resistance and helping to manage blood sugar levels.
- Find a type of exercise or a way of moving your body that you actually enjoy. For inspiration, you can check out the Exercise Toolbox in the Second Nature app.
- It's believed that anaerobic exercise, in particular, can help to reduce insulin resistance
4. Stress management
People with PCOS can be more sensitive to the impacts of stress and tend to have higher levels of cortisol and other stress hormones.
Here are a few ways to help manage your stress levels:
- Breathing exercises
- Mindfulness and meditation
- Calling a friend or family member
- Keeping a stress journal. Next time you're experiencing a stressful period, write down what caused this, how you felt emotionally and physically, how you responded at the time, and how you'd like to respond in the future.
- Exercising and moving your body in a way that feels good for you
- Getting a good night's sleep
- Spending time outdoors
Problems with sleeping are more common in women with PCOS, and we know that getting adequate amounts sleep is important for overall health.
Some ways in which you might improve the quality of your sleep are:
- Being mindful of your caffeine intake and trying to reduce your intake of caffeinated drinks after midday
- Reducing screen time 1-2 hours before bed
- Trying to keep to a regular sleeping pattern. This means going to bed and getting up and the same time each day and avoid afternoon napping.
You can find more tips on how to sleep better here.
Take home message
- PCOS is common condition affecting 5-10% of females at reproductive age
- In those with PCOS, the follicular sacs in the ovary are undeveloped, which means they're unable to release an egg and ovulation doesn't take place
- This leads to an accumulation of these follicles on the ovary, which is one of the diagnostic criteria for PCOS
- Making changes to your lifestyle can help to manage PCOS symptoms, including eating a balanced diet, exercising regularly, reducing stress levels, and getting a good night's sleep
- If you're experiencing some of the symptoms described in this article or are concerned about the management of your PCOS, we'd recommend making an appointment with your GP