Polycystic ovary syndrome (PCOS)

What is PCOS?

First ‘discovered’ in 1935, polycystic ovary syndrome is a complicated hormonal condition in which women with polycystic ovaries experience one or more symptoms. In the UK, it is estimated that one in 10 women are affected by the condition.

Typically, women affected by PCOS have larger than normal ovaries (the organs in a female body responsible for producing eggs). The outer surfaces of these are covered by a large number of fluid filled sacks, otherwise known as cysts. In women without polycystic ovary syndrome, the ovarian cysts would usually be follicles, which are small swellings in which the egg should develop before ovulation.

However, when the follicles stop growing too early, instead of releasing the egg, they form cysts.

What causes PCOS?

Whilst the cause of polycystic ovary syndrome is unknown, a number of unproven theories have tried to establish the cause. One of the most popular explanations is that the condition is hereditary - although some studies suggest that the condition is related to abnormal hormone levels.

Some individuals favour the explanation that the condition can be attributed to one particular gene, whilst others think it is the role of several. It is believed that having a family history of type 2 diabetes can be an indicator of the condition.

Similarly, though not always the cause, many medical professionals have highlighted excess weight as a contributing factor in PCOS. Women who weigh above the healthy body mass index limit (BMI) stand an increased risk of hormonal abnormalities and have a lower rate of ovulation.

Diagnosing polycystic ovary syndrome

PCOS is usually diagnosed by your GP or healthcare provider. They will carry out blood tests at a suitable time during the menstrual cycle to determine whether or not you are affected.

Once the diagnosis has been made, options for management can then be discussed. If treatment is needed your GP or specialist may prescribe you medication and/or may recommend certain lifestyle changes.

For more complicated cases, you may be referred to a professional specialising in female reproductive health, such as a gynaecologist or endocrinologist.

Symptoms of polycystic ovary syndrome

Women will commonly begin to notice symptoms of polycystic ovary syndrome between their late teens and early 20s. Not all the PCOS symptoms will occur in all sufferers; for example some women may experience extremely irregular periods, whereas others may have normal cycles but find excess body hair.

Some sufferers will experience mild symptoms, while others may suffer more than one, these can include:

• Absent or irregular periods.
• Acne, usually on the face.
• Thinning hair.
• Excess body hair on the face, forearms, lower legs, around the nipples and lower abdomen - this is known as hirsutism.
• Miscarriage - women suffering PCOS usually have a raised level of the luteinising hormone. Sufferers with high levels of this stand a 65 per cent increased risk of pregnancy resulting in miscarriage.
• Weight gain - this is common in women with the condition. Cells are resistant to the insulin controlling sugar levels, this means the sugar isn’t used properly and is stored as fat instead.

Long-term risks

Polycystic ovary syndrome can over time, increase the risks of developing health problems later in life. PCOS is also a common cause for female infertility - with many women discovering the condition when trying to conceive.

Women with PCOS are at an increased risk of developing:

• type 2 diabetes
• sleep apnoea
• high blood pressure
• high cholesterol
• mood swings
• depression.

PCOS treatment

Despite there being no known cure for polycystic ovary syndrome, there are a variety of treatments available which can effectively control the symptoms.

Hormone treatment

Hormone therapy is often used as a PCOS treatment as a way of alleviating certain symptoms. In some cases, anti-male hormone drugs such as cyproterone acetate, spironolactone, flutamide and finasteride are used to block any unwanted hair growth, acne and high testosterone levels.

Diabetes medication

Metformin, a drug commonly used by diabetes sufferers has been found to be an effective PCOS treatment. It has been found to increase ovulation within women who have the condition. Experts believe it may reduce health risks linked to insulin resistance and the effect of abnormal hormone levels.

Clomiphene

This is a fertility drug occasionally offered to sufferers as a PCOS treatment. This is because clomiphene is capable of stimulating the ovaries if the woman is not ovulating.

Vaniqa cream

A PCOS treatment that slows down the growth of unwanted facial hair by blocking the action of an enzyme found in the follicles, which is needed for hair to grow. Whilst this is not a treatment that removes hair or cures unwanted facial hair, it has been found to be most effective when used with a hair-removal product.

Surgery

A treatment option for women with PCOS may be to undergo a minor surgical procedure. Laparoscopic ovarian drilling (LOD) is a treatment offered to women suffering with the fertility problems often associated with the condition. The ovaries are treated with either heat or laser, to target and break down the tissue producing the male hormone.

Does your weight make a difference?

Weight gain is one of the most common side effects of PCOS. Whilst it is essential that sufferers seek professional medical advice and treatment for the condition, a suitably qualified nutrition professional could provide individuals with extra support if they are struggling to manage their PCOS diet independently.

According to the NHS, individuals losing just five per cent of their body weight will experience an improvement in symptoms of polycystic ovary syndrome.

A PCOS diet

It is thought that a nutritious diet will also help to reduce the risk of developing symptoms of polycystic ovary syndrome, including weight management and helping to regulate insulin levels.

Finding the right diet to tackle the symptoms of PCOS is a complex process and highly individual. Contacting a suitably qualified nutrition professional will help you understand and manage the dietary and lifestyle changes.  

Following a low GI (glycaemic index) diet

The glycaemic index is a way to monitor how quickly the blood glucose rises after eating carbohydrates. Foods with a low GI can cause your blood levels to rise slowly. It is thought that these are helpful in reducing the symptoms of polycystic ovary syndrome.

Low GI foods can improve and help balance insulin levels; women with PCOS are often resistant to the effects of insulin, therefore have more insulin in their blood. This rise in insulin levels means the levels of testosterone are also increased. The increase in both insulin and testosterone upsets the natural hormone balance in the body, often causing symptoms to flare up.  

Women with the condition may find replacing high GI foods effective, even if they do not need to lose weight. It has also been found that when combined with weight-loss, a low GI diet can help regulate the menstrual cycle.

As well as the potential to help ease some of the symptoms worsened by being overweight, a nutritious diet will also help to reduce a woman’s risk of developing diabetes, heart disease and improve overall health and well-being.

Below are some of the foods to include in a PCOS diet:

Fruit - Fruit is rich in fibre and is a good source of essential vitamins and minerals. Whilst many women are reluctant to add fruits into their PCOS diet due to the sugar content, when eaten in the correct portions and as a whole fruit as opposed to dried or juiced, it can be an extremely healthy alternative to unhealthy snacks. Fruit is vital in providing the body with the nutrients needed to combat the symptoms of PCOS.

Fruits with a low GI include cherries, plums, apricots, prunes and grapes.

If concerned about the rise in blood sugar and insulin levels caused by fruit, enjoy a handful of seeds or nuts as a side snack - the protein in the seeds can help regulate the rising glucose levels. Aim for two to three portions of fruit per day and increase your vegetable intake for fibre, minerals and antioxidants.

Chromium is an important mineral involved in regulating blood sugar and insulin levels. This can sometimes be low in a highly refined diet; opting for more complex carbohydrates, such as whole grains, broccoli and nuts can help to provide this.

Healthy fats - Unsaturated fats are essential in managing the symptoms of polycystic ovary syndrome. Essential fatty acids (EFAs) are vital in a PCOS diet as they help maintain the cell wall, which absorbs the nutrients we need. EFAs also help to rebalance hormones, manage weight and can help fertility. ‘Healthy’ fats can include oily fish (salmon or mackerel), avocado and olive oil.

However, care should be taken - simply switch the fats you are already having to unsaturated fats, rather than adding extra into your diet in order to avoid weight gain.

Magnesium rich foods are also important to include. This is because a deficiency in magnesium has recently been linked with an increased risk of insulin resistance. Dark, leafy greens, nuts and seeds can help provide you with the mineral.

Organic meat - It is important to eat good quality, lean meat if you suffer with PCOS. Grass-fed meat often contains fewer hormones and the livestock are less likely to have been fed genetically modified foods. The GM foods fed to standard livestock will often contain pesticides, if consumed, it can be more difficult to manage hormone levels and treat symptoms of PCOS.

In addition to organic meat, organic dairy products, best in the form of live, natural yoghurt, (rather than cheese or milk) are advised as it contains bacteria beneficial in a diet for PCOS.

Pregnancy - If you are trying to get pregnant, it is particularly important to consider whether you are getting the right amount of nutrients in your PCOS diet. For support and advice on following a healthy PCOS diet, consult a suitably qualified nutrition professional.

It has been found that the sex hormone binding globulin (SHBG) is usually low in women with PCOS. Lignans, found in flax and sesame seeds, chickpeas and carrots are reported to increase this.

How can a nutritionist help you?

Whilst some individuals will feel comfortable devising their own nutrition and fitness programme, others may need extra support. Those who feel they don’t have the necessary knowledge and experience may benefit from consulting a suitably qualified nutrition professional.

If you do decide to seek professional support, your practitioner will usually begin by gathering information about your current diet and lifestyle.

They will also take certain body measurements to see if you are overweight, underweight or carrying excess weight around the middle. This is so they can build a realistic, effective nutrition programme including a tailored diet for PCOS, unique for you. This may involve you providing a food diary. You will be asked to record everything you have consumed over a period of time before or during the sessions, with details of your moods and menstrual cycle included.

At this early stage you will also have the opportunity to discuss any dietary requirements or related health conditions that will need to be considered when creating your PCOS diet.

A nutrition professional will not be able to cure the condition, but they can provide you with personal advice and support about simple changes to eating and exercise patterns. They will explain how these changes may help alleviate symptoms of PCOS and help manage the condition. In addition to making dietary adjustments, an essential factor in weight management is physical activity. Whilst exercising does support weight-loss, it can also improve how the body uses insulin.

When consulting a qualified nutrition professional, remember they are not just there to give you a kick-start to weight-loss. They are also there to monitor your progress and to provide ongoing motivation, support and advice.

Further help

• Verity - A PCOS Charity

Content has been reviewed by nutritionist, Anthea McCourtie. All content displayed on Nutritionist Resource is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional.