How to manage your PCOS naturally

Polycystic ovary syndrome (PCOS), or Stein-Leventhal syndrome, is a hormonal disorder affecting women of reproductive age. The exact cause of PCOS is unknown, and whilst a genetic link is often present, the condition is thought to be related to abnormal hormone levels including elevated androgen, oestrogen and luteinizing hormone as well as decreased follicle-stimulating hormone levels.

The usual fluctuations or peaks of certain hormones that are observed during the menstrual cycle are missing. This hormonal imbalance causes the body to create higher-than-normal levels of androgens (the ‘male traits’ hormones i.e. often seen as more dark hair) and block both egg growth and ovulation (the release of a follicle).

Instead of travelling through the fallopian tubes for fertilisation or stimulation of a menstrual period, the undeveloped follicle forms a small ovarian cyst. Multiple, tiny ovarian cysts cause the ovary to enlarge and may become painful.

PCOS is also associated with insulin resistance (insulin is a hormone produced by the pancreas to control the amount of sugar in the blood). When insulin resistance is present, the body produces excessive insulin which in turns makes the ovaries produce more androgens. As we have seen, excessive androgens create a number of other problems, whilst insulin resistance can lead to weight gain. Excessive weight can make PCOS symptoms worse, as additional fat causes the body to produce even more insulin, making this a catch-22 situation.

How a diagnosis can be made

For a PCOS diagnosis to be made by your doctor, at least two out of three of the so-called 'Rotterdam criteria' must be met. These are:

• irregular periods (lack or irregular ovulation)
• high levels of ‘male traits’ hormones (assessed through a blood test and/or by observation of excessive growth of dark hair on the face, chest or back)
• the presence of polycystic ovaries (assessed through a scan)

Whilst current medical practice offers no cure for PCOS, symptoms can be successfully managed depending on what these are and your main goals (e.g. conception, reduction of male traits, weight management).  

What you can do to support your treatment

Considering your goals and symptoms, there are several things that can be done to support your treatment. If you are even mildly overweight, introduce a more balanced diet. The Mediterranean diet is a great model to follow as it is very varied and provides a good balance.

If insulin resistance is present or suspected, introducing foods such as whole-grain cereals, molasses, lean meats and yeast will ensure sufficient chromium intake, essential to counteract any insulin resistance. Vitamin D-rich foods such as fatty fish, cheese (if tolerated) and egg yolks alongside omega 3 rich foods (soybeans, walnuts, fatty fish, chia seeds, flaxseeds) would also be appropriate.

Research shows that modest reductions in energy intake can normalise insulin sensitivity and other hormone levels, increasing the frequency of spontaneous ovulation and menses. In conjunction with changes to the diet, aerobic exercise is also useful.

If you are not overweight, it would still be important to improve insulin sensitivity and normalise blood sugar levels with a low GL diet. Eating plenty of fibres and complex carbs (including vegetables, grains and fruits) while reducing the number of simple carbs (sugar, processed foods, fruit juice, white flour and packaged cereals) is an essential strategy. Try to make sure you include a source of protein with every meal (soy or vegetarian protein sources have been shown to be effective with PCOS) to make you feel fuller for longer.

If you are bothered by the male traits we mentioned earlier, be aware that these are linked to a hormonal imbalance. A balanced diet approach, including plenty of fibres and vegetarian proteins, is still your best bet to begin with. Research shows that the increased consumption of simple sugars and high-fat food brought about by Western-style diet and physical inactivity are the leading causes of the growing obesity epidemic and metabolic disorders we are facing.

As nutritional therapists, we advocate for a holistic approach, so don’t forget to consider your stress levels. Stress reduction, sleep hygiene and physical activity are also key to the successful management of PCOS. I would recommend at least 30 minutes a day of any enjoyable activity that might promote de-stress, relaxation and well-being such as meditation, yoga, reading, going for a walk, listening to music, etc.

Supplements that may help

In terms of supplementation, whilst there are several supplements and herbal remedies that are proven to help, I would consider whether or not you really need to take them (talk to your nutritionist or doctor first).

In my experience when insulin resistance is present, chromium or inositol supplementation might be appropriate.

Vitamin D is a pro-hormone so any insufficiencies should be addressed. In countries like the UK, a vitamin D supplement may be necessary for winter. Omega 3 needs to be considered too, but sufficient intake may be present if you eat fatty fish regularly for example.

Herbs that I have found useful include vitex angus-castus and cimicifuga racemosa. Preclinical and clinical studies have provided evidence that these herbal medicines may have beneficial effects for women with PCOS, however please discuss it with your healthcare provider before taking any herbal supplements.