Polycystic ovary syndrome (PCOS) is one of the most common problems affecting women of child-bearing age. Learn why PCOS is a serious problem for women and how dietary and lifestyle changes can help manage and potentially even reverse many health and fertility problems associated with this condition.
PCOS is a health problem that can affect a woman’s menstrual cycle, fertility, hormones, insulin production, weight, heart, blood vessels, and appearance. The condition is now one of the most common endocrine problems seen in women of child-bearing age, affecting 6-10 per cent of women in this group.
While the causes of PCOS are unknown, it can be aggravated by poor diet, obesity, and physical inactivity. The majority of women with PCOS are overweight and commonly carry much of the excess weight around the abdomen, rather than on the hips or thighs.
PCOS is a disease where insulin resistance lies at the heart of many of the problems so not surprisingly, PCOS is a major risk factor for developing diabetes and heart disease. By the age of 40, almost half of all women with PCOS will develop type 2 diabetes or a condition of pre-diabetes such as impaired glucose tolerance.
High levels of insulin precede many of the health problems in PCOS. It is thought that insulin acts on the ovary to disrupt the normal reproductive cycle. This results in the eggs not developing properly (underdeveloped eggs in the ovary are seen as cysts on an ultrasound) and not being released from the ovary, as would normally occur during ovulation. This also means that ovulation either does not take place or cycles are much longer than the ‘normal’ 28 days.
Women with PCOS typically have problems falling pregnant or are infertile, and this is by far the most common reason women are referred to fertility specialists. Increased levels of testosterone are also found, causing acne, excess body and facial hair and sometimes accelerated loss of scalp hair. Self-esteem and body image are often affected because of all these problems. Furthermore, issues of femininity and sexuality can contribute to depression, social isolation, decreased quality of life and other mood changes.
Treatment for PCOS will depend on the problems the woman has and may include weight loss, hormones or surgery. For example, if the woman is suffering from irregular, heavy periods, the oral contraceptive pill is often prescribed to regulate the cycle. Infertility can be treated by weight loss (which is very effective) and also medications that induce ovulation, or as a last resort, IVF.
The long-term focus of managing PCOS though is about a healthy sustainable lifestyle that keeps body weight in check. Reduction in body weight of as little as 5 per cent can improve the metabolic and reproductive problems seen in PCOS. Weight loss will also reduce the risk of developing diabetes and heart disease and help lessen insulin resistance.
Sometimes a diet high in protein and low in carbohydrate is recommended for women with PCOS and there is now some clinical evidence to support this approach. A dietary approach similar for people with diabetes that includes healthy low-GI foods that are naturally high in wholegrains and fibre combined with spreading meals over the day can also help.
Exercise is extremely important in PCOS management. Exercise can help with weight loss (especially by reducing the dangerous fat around the abdomen), improve self esteem and reduce cardiovascular disease risk. Even without weight loss, exercise can improve insulin resistance. For women with PCOS, something as simple as achieving 10,000 steps per day by using a pedometer is a very effective and cheap way of increasing activity during the day.
Advice for women with PCOS
- Become physically active and aim for at least 30 minutes of moderate activity on most days and aim to be fit and healthy whatever your size
- Including healthier food choices such as those recommended for people with diabetes and eating smaller more frequent meals and snacks can help manage blood sugar and insulin levels
- Some women eat for emotional reasons or out of habit, which leads to weight gain. Learn to listen to your body’s appetite signals such as feelings of hunger and fullness
- Be prepared to try different approaches to weight management depending on your needs at the time (but be well informed about the different options).
- Seek help with depression which is very common in women with PCOS.
Some women with PCOS may find weight management very difficult, especially if combined with body image problems so may benefit from specialist counselling. A dietitian with an interest in PCOS can help with this as well as food and lifestyle advice.