Managing polycystic ovary syndrome

What is PCOS?

Polycystic ovary syndrome (PCOS) is possibly the most common hormonal imbalance in women of reproductive age. It is thought to affect between 6-10% of this age group and as many as 70% of those with the condition remain undiagnosed. This is because there are differing medical opinions on the diagnostic criteria. The predominant hormone disruption seen in PCOS is higher than normal levels of androgen (male) hormones in women. Androgens are hormones such as testosterone and DHEA which women do need but not at high levels.

Polycystic ovaries contain a large number of harmless follicles that are up to 8mm (approximately 0.3in) in size. The follicles are underdeveloped sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means ovulation does not take place. PCOS is considered a hormonal and metabolic condition but the driving mechanisms aren’t completely clear. What is known is that insulin resistance, hormone and immune imbalance and inflammation are involved. Insulin is the hormone that helps to control the amount of sugar in the blood. Many factors can contribute to PCOS such as environment, diet, lifestyle and genetic predisposition.

PCOS signs and symptoms

It's quite possible to not have symptoms but most often symptoms appear in the late teens to early twenties. The most common symptom to bring this condition to light is the absence of, or the infrequency of periods. If a couple are trying for a baby it can make it difficult to get pregnant. Other common symptoms include oily skin and acne, excess weight gain and hair growth or thinning of hair on the scalp and temples. Another sign is insulin resistance which can manifest in energy slumps, fatigue, weight gain, depression, mood swings and changes in blood pressure.

Stress

Over-activation of the stress response can increase the production of stress hormones and result in HPTAG axis dysfunction (hypothalamic-pituitary-thyroid-adrenal-gonadal). What this means is that extreme stress can disrupt a number of the linked hormone systems between the brain, thyroid, adrenals and ovaries, and therefore the balance of sex hormones. This is likely to be a contributing factor to PCOS.

What are the options to support PCOS?

There is no universal drug therapy for PCOS or any approved drugs specifically for this condition. Dependant on the presenting symptoms, drugs are often prescribed to lower androgen levels, for insulin resistance and/or to prevent ovulation. The contraceptive pill may be prescribed but this only regulates bleeding and masks the symptoms of PCOS, as with the former medications mentioned, this does not work on the root cause of the issue. The first line of therapy should be dietary and lifestyle changes but often patients are not referred to a nutritional therapist.

Nutrition, lifestyle and environment

It's important to understand there is not one specific eating regime for PCOS. Each and every case is different and management is dependant on the presenting symptoms and lab test results. However, steps can be taken to improve insulin sensitivity, reduce inflammation and support hormone balance.

I recommended to remove foods in plastic packaging from the diet, plastic such as bisphenol A (BPA) can mimic hormones inside the body. Higher BPA levels in cases of PCOS have significantly correlated with excess androgens, insulin resistance and reduced ovarian function. Eat organic. Traces of pesticides have been associated with insulin sensitivity and hormone disruption. Dietary intervention studies have shown a reduction in both types of disrupters after following an organic diet and reducing exposure to plastic.

Exercise and intermittent fasting are known to greatly improve insulin sensitivity. The exercise doesn’t need to be excessive because this can be an added stress on the body but regular cardio and weights can be of benefit. Stress management is essential because raised cortisol levels can cause blood sugar swings and add to the risk of insulin resistance. Try meditation, an Epsom salts bath, going for a walk, spend time doing something you love.

There are mixed results in studies as to eating regime for this condition but it seems a moderate to low carbohydrate diet or paleo diet (without excessive levels of protein, too much can be turned into sugar inside the body) may be of benefit. Some studies have shown that by restricting dairy products it possible to increase insulin sensitivity and reduce levels of testosterone.

An eating regime is recommended with a regular intake of Omega 3s from oily fish or supplements and foods such as legumes, vegetables and fruits that are low on the glycaemic index. A moderate to low carbohydrate diet does not mean removing fibre from your diet, fibre has an important role to play in improving insulin sensitivity. Studies have shown that some herbal teas may help to support PCOS. Spearmint tea has shown to increase levels of oestrogen and follicle stimulating hormone required for regular cycles and fertility, and marjoram tea has shown to decrease levels of testosterone.

Supplementation

Magnesium glycinate is a useful tool to support this condition it can support the thyroid, insulin sensitivity and the hormone leptin which inhibits hunger. Vitamin D has shown in studies to support the immune system and inflammation, insulin sensitivity, reduce the levels of androgens and regulate menstrual frequency. Taken alongside a probiotic, it has also shown to reduce stress and anxiety. Always remember to take vitamin K2 with vitamin D to ensure the extra absorbed calcium goes to the bone and not the soft tissue. I recommend having your vitamin D levels checked before supplementing. Zinc has shown to regulate monthly cycles and support follicle development. You may need more if you are taking the contraceptive pill because this can deplete zinc from the body.

A B vitamin complex is important and in particular B12 if taking medications such as metformin which can deplete this vital nutrient. Myo-inositol has shown in studies to improve insulin sensitivity, support follicle development and restore ovulation. Chromium is involved in blood glucose regulation and reduces the levels of androgens. Cinnamon can also help to balance blood sugar. Finally, NAC N-acetyl cysteine has shown to reduce testosterone and improve menstrual regularity. Please do always check with your nutritional therapist and/or doctor before taking nutritional supplements.

If you have been diagnosed with PCOS you can see that there are steps you can take to support your symptoms and work towards healthy and functioning ovaries.

References:

https://academic.oup.com/humrep/article/31/12/2841/2730240
https://www.nature.com/articles/nrendo.2018.24
https://www.fertstert.org/article/S0015-0282(17)30344-8/fulltext
https://academic.oup.com/humrep/article/25/2/544/673002
https://www.ncbi.nlm.nih.gov/pubmed/25200687
https://www.ncbi.nlm.nih.gov/pubmed/28416368
https://www.ncbi.nlm.nih.gov/pubmed/29734548
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516387/
https://academic.oup.com/jcem/article/96/3/E480/2597282
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488802/
https://www.ncbi.nlm.nih.gov/pubmed/17310494

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Written by Deborah Condon DipION, mBANT, CNHC

My name is Deborah and I am a registered nutritional therapist. I qualified after 4 years of study with a DipION at the Institute for Optimum Nutrition.

I provide nutritional and lifestyle coaching online and in clinic at Deborah Lee Nutrition. Please see my website for more information www.deborahleenutrition.com.… Read more

Written by Deborah Condon DipION, mBANT, CNHC

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