Understanding PCOS and the role of nutrition

By Amber Charles-Alexis, MSPH, RDN

June 7, 2021


Polycystic ovary syndrome (PCOS) is the most common cause of infertility in women of childbearing age. This blog describes the impact of PCOS on women’s health and the role of nutrition in PCOS management.


What is PCOS | Symptoms | Diagnosis | Risk factors | Health impact | Nutrition | Takeaway

Picture: Canva, stock image


What is PCOS?

PCOS is a disorder of the female endocrine system – the network of glands responsible for producing the female reproductive hormones – estrogen and progesterone (1, 2).


Hormones are chemical messengers that control bodily functions, including metabolism, blood sugar, blood pressure and reproduction (3).

Women with PCOS produce higher levels of the male hormone, testosterone, and have lower levels of estrogen, the hormone responsible for female fertility (1, 4).


PCOS can affect up to 20% of women, depending on the criteria used for diagnosis (5).


Signs and symptoms of PCOS

The symptoms of PCOS are mainly due to the presence of excess testosterone – aka male androgens – a condition also called hyperandrogenism.


However, not all women with excess testosterone levels have PCOS, but they may share similar symptoms (5).


Common signs and symptoms of PCOS include (1, 5, 6, 7, 8):

  • Hirsutism or excessive body hair on the face, neck, back, chest and thighs

  • Acne occurs in 15-30% of women with PCOS

  • Increased abdominal fat/obesity

  • Weight gain or obesity

  • Irregular menstrual cycles or lack of a menstrual cycle

  • Insulin resistance and pre-diabetes

  • Chronic, low-grade inflammation and poor gut health

  • Hair loss (alopecia)

  • Non-alcoholic fatty liver disease (NAFLD)

How is it diagnosed?

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PCOS is a diagnosis of exclusion.


This means that your medical team will determine if there are other underlying health conditions responsible for your symptoms before diagnosing PCOS (5, 7).


You can expect a combination of lab work (blood) and ultrasounds of your ovaries to confirm the presence of PCOS.


While there are several diagnostic frameworks for PCOS, the Rotterdam criteria is quite common and PCOS can be diagnosed if any 2 of the following are present (8):

  • Hyperandrogenism

  • Symptoms caused by hyperandrogenism, such as androgenic baldness, hirsutism

  • Menstruation and ovulation disorders

  • Enlarged (ovary volume > 10 cm3) or polycystic ovaries (at least 12 follicles) visible in an ultrasound image.

As you can see, you do not actually need cysts to be present on your ovaries to be diagnosed with PCOS.


Risk factors for PCOS

You are more likely to develop PCOS if you have (5):

  • A family history of PCOS

  • A history of weight gain

  • Epilepsy

  • Diabetes – type 1, type 2 or gestational

How does PCOS affect women’s health?

Excess testosterone is responsible for a myriad of negative health outcomes in women with PCOS.


The high levels of testosterone trigger inflammation which leads to the development of insulin resistance - a condition where your cells become less responsive to the action of insulin, the hormone that regulates blood sugar (1, 4, 8).


Approximately 50-70% of women with PCOS have insulin resistance (IR) (5).

Scientists believe that inflammation and IR play key roles in the development of metabolic syndrome and increases your risk for diabetes, high blood pressure, heart disease, high cholesterol, and some cancers, like breast and ovarian cancer (1, 2, 3, 4, 7, 8).


Furthermore, IR is also believed to cause increased visceral fat - the fat around the organs - and an expanding waistline.


Although there isn't a cure for PCOS, if left unmanaged it may lead to the development of many chronic, non-communicable diseases and a reduced quality of life.


Can I have PCOS if I am not overweight?

In short - yes.


As highlighted above, body weight is not a diagnostic criterion for PCOS (3, 8).


Furthermore, up to 75% of lean women with PCOS have insulin resistance (2).


This simply means that you can have a BMI within the normal range and still develop PCOS and its many side effects. However, women with higher body fat have more aggravate forms of PCOS and insulin resistance (2).


What is the role of nutrition in PCOS management?

While there isn't a specific diet for PCOS, nutrition and lifestyle changes are the first-line treatment for PCOS (2).

The elimination of gluten and dairy are generic recommendations made by referring physicians, but there is limited evidence to support this approach.


Nutrition is effective at improving metabolic markers, hormonal balance, and symptoms of PCOS (1, 2, 6, 9). Get enough:

  • healthy fats - nuts and nut butters, seeds, olive oil, coconut oil

  • lean protein - fish, poultry, low fat cuts of meat

  • complex carbohydrates - whole grain, ground provisions

  • fruits - fresh, dried, frozen or canned

  • vegetables - raw or cooked

  • low-fat dairy products - milk, yogurt, cheese

Dietary supplements such as myo-inositol and D-chiro-inositol have been rigorously studied for their impact on PCOS management. Read more about inositol.

Women with PCOS naturally have lower levels of omega-3, B-vitamins including folic acid and vitamin B-12, calcium and vitamins C and D and may be required to take supplements (3, 8, 9).


Other lifestyle factors to include are exercise to improve blood sugar control, reduce blood pressure, reduce body fat, and increase muscle mass, as well as stress management and activities to nurture your mental health (stress = cortisol).


Overall, nutrition plays an essential role in the management of PCOS and can improve your quality of life.


Takeaway


PCOS is a disorder of the female endocrine system and it is the most common cause of infertility.


Although there isn't a cure for PCOS, nutrition and lifestyle serve as the first-line approaches for the effective and successful management of PCOS.


A tailored treatment plan will help to reduce your risk for developing type 2 diabetes, high blood pressure, high cholesterol, heart disease and some cancers.

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The information provided in this blog is for general knowledge and is not intended to diagnose, cure or treat your medical condition. This information does not replace your need for personalized medical and nutritional expertise and intervention.


References:

1. Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS) - PubMed (nih.gov)

2. Correlation Between Daily Energy Intake from Fat with Insulin Resistance in Patients with Polycystic Ovary Syndrome (nih.gov)

3. Nutritional management in women with polycystic ovary syndrome: A review study - PubMed (nih.gov)

4. Targeting Metabolic Consequences of Insulin Resistance in Polycystic Ovary Syndrome by D-chiro-inositol and Emerging Nutraceuticals: A Focused Review (nih.gov)

5. Epidemiology, diagnosis, and management of polycystic ovary syndrome (nih.gov)

6. Diet and nutrition in polycystic ovary syndrome (PCOS): pointers for nutritional management - PubMed (nih.gov)

7. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment - PubMed (nih.gov)

8. A Properly Balanced Reduction Diet and/or Supplementation Solve the Problem with the Deficiency of These Vitamins Soluble in Water in Patients with PCOS - PubMed (nih.gov)

9. Quantitative assessment of nutrition in patients with polycystic ovary syndrome (PCOS) - PubMed (nih.gov)