Nutrition for Polycystic Ovary Syndrome (PCOS)
What is PCOS and how is it diagnosed?
Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine (hormone-related) disorders amongst women of childbearing age. In Australia, an estimated 8-13% of women in this age group are affected by PCOS.
Genetics, hormones and lifestyle factors all play a role in PCOS. In accordance to the International Evidenced-Based Guideline for PCOS, only two out of three Rotterdam diagnostic criteria need to be met to be diagnosed with PCOS:
Oligo- or anovulation i.e. missed or irregular menstrual cycles
Clinical and/or biochemical signs of hyperandrogenism such as excess hair growth, acne or high level of androgens (male-type hormones) e.g. testosterone
Polycystic ovaries where many small cysts (follicles) are found in the ovaries
How can PCOS affect health and wellbeing?
In women with PCOS, two hormones i.e. insulin and androgens are produced in higher levels. This imbalance can result in signs and symptoms including:
Excess hair growth on face, stomach and back
Loss or thinning of scalp hair
Acne (pimples)
Weight gain
Symptoms of PCOS can vary from woman to woman, and also change over time.
Scientific research has also shown links between PCOS and various health issues:
Weight
Many women with PCOS have difficulty managing their weight
Increased weight can lead to higher level of androgens and insulin, resulting in worse physical symptoms
Measurement of waist circumference to monitor central adiposity should also be considered, particularly for South East Asians and Indigenous Australians
Diabetes: Prediabetes, Type 2 Diabetes and Gestational Diabetes (GDM)
Increased risk of diabetes in women with PCOS is related to ‘insulin resistance’. When the body is ‘resistant’ to the hormone insulin, blood sugars are not controlled properly and this can lead to diabetes.
Women with PCOS are recommended to see their GP for regular diabetes screen via a test called the ‘Oral Glucose Tolerance Test’ and/or HbA1c test
Cardiovascular disease (CVD): heart disease, heart attack and stroke
Women with PCOS may develop high cholesterol and high blood pressure more easily than the general population, which increases their risk of developing CVD.
Women with PCOS are recommended to have regular check-ups of their blood pressure, cholesterol levels, weight and blood sugars levels.
Infertility
High levels of androgens and insulin in PCOS can affect the menstrual cycle and ovary functions, making it difficult for women with PCOS to conceive naturally and become pregnant without assistance.
PCOS may limit fertility but this can be treated. Hence, early family planning including referral to a fertility specialist is encouraged.
Other factors such as maintaining a healthy weight and an active lifestyle can improve fertility.
Mental and emotional wellbeing
Research shows women with PCOS have higher levels of anxiety and depression
It may be due to both hormonal influences as well as dealing with PCOS symptoms such as hirsutism and acne which can often impact of a woman’s body image and self-esteem
Counselling and psychological support is important to maintain good quality of life
Management of PCOS
PCOS cannot be cured but can be managed and management should be individualised and considered across the lifespan.
The 1st line of treatment for women with PCOS and BMI >25 is lifestyle management which encompasses:
Healthy weight management
Healthy eating
Regular physical activity
Lifestyle changes can significantly improve symptoms of PCOS including cycle regularity, increase chance of fertility, reduce risk of long-term health effects such as diabetes and cardiovascular disease and optimise quality of life.
Using individualised behavioural strategies such as SMART goal setting, problem solving, assertiveness training, reinforcing changes and relapse prevention can help improve the success and maintenance of lifestyle changes.
Other effective treatments include ‘pharmacological treatments’. Some medications help to manage the symptoms of PCOS, while some have more targeted effects, such as treating infertility. Commonly prescribed medications include:
Combined oral contraceptive pills (COCPs) such as the pill, Implanon or Mirena
Letrozole or clomiphene (used to treat infertility)
Metformin is an insulin-sensitising medication commonly used to manage diabetes
Why is healthy eating so important for management of PCOS?
The high levels of androgens, which are responsible for the effects and symptoms of PCOS, thrive when there are large amounts of fat in the abdominal area. Central adiposity has also shown to worsen insulin resistance. Therefore, reducing excess abdominal fat can help with management of PCOS symptoms.
Achievable goals such as 5-10% weight loss in women with excess weight has been shown to significantly:
Improve hormone levels and menstrual cycle regularity
Improve symptoms of PCOS such as acne and hirsutism
Increase fertility
Reduce risk of chronic diseases such as diabetes and CVD
However, evidence-based guideline advises against restrictive, unsustainable and nutritional unbalanced diets. Instead, women with PCOS are encouraged to have a balanced diet and follow healthy eating principles:
Limit high intake of processed foods which are high in refined sugar and saturated fats
Choose healthy fats and oils such as extra virgin olive oil (EVOO)
Include moderate amount of lean protein including plant sources like lentils and legumes
Have a high fibre diet with plenty of colourful vegetables and fruits – eat the rainbow!
Go for low glycaemic index (GI) carbohydrate such as grainy bread, rolled oats (instead of instant oats), long grain rice (rather than medium grain variety)
A high quality, well balance diet with healthy fats, lean protein, high fibre and low GI can help manage your weight.
Who can help if you have PCOS?
A multidisciplinary approach is very important to help you manage this condition and your team could include:
GP
Dietitian
Physiotherapist/Exercise Physiologist
Psychologist
Gynaecologist
Endocrinologist
How can Holistic Dietetics help if you have PCOS?
We are a team of Accredited Practicing Dietitians who:
have clinical training to understand medical conditions such as PCOS
can help you achieve your weight loss goal to manage your PCOS symptoms, reduce your risk of diabetes, cardiovascular disease and increase your chance to conceive
provide advice on how to incorporate more fibre and low-GI foods into your diet to improve your blood sugar control
recommend individualised and tailored advice that suits your unique lifestyle and circumstances while taking into account your personal preferences and cultural background
offer dietary counselling to keep you motivated and on track to achieve your goals
Holistic Dietetics is here to help support you through your PCOS journey!