• Alex Bovell

What is PCOS?

Updated: Apr 3, 2019



Polycystic Ovarian Syndrome (PCOS) is a pretty big and confusing word at the best of times. Let alone when you’re sitting in front of a doctor in a overly lit room and you’ve just been told you have PCOS. I’ve recently had quite a few women coming to me saying, “I’ve been diagnosed with PCOS, but I have no idea what to do”. I don’t blame you, I wouldn’t even know what the word meant if I wasn’t told I possibly had this condition by an endocrinologist a few years ago.


PCOS affects 12-21% of women of reproductive age in Australia [1]. That means almost 1 in 5 women are experiencing this overwhelming condition, many of them distressed, lost and unsure what they’re supposed to do. It’s concerning to me when I think about the many women out there who have and haven’t been diagnosed with PCOS, and have no idea what’s actually going on in their own bodies. With these statistics it’s possible many of you reading this will have PCOS without your knowledge.


PCOS

I was trying to think of a way to explain PCOS simply, because many definitions out there only state the symptoms. Whereas, I was trying to summarise what this is as straightforward as possible.


PCOS is a complex endocrine disorder affecting hormonal function in women, often characterised by abnormal ovarian function, hyperinsulinaemnia (high insulin levels) & hyper-androgenism (elevated androgen levels). Hold your horses, these are big fancy words for not so fancy things & I’m going to explain them a little further down. Buckle your seatbelts kids, you’re in for a ride!


ENDOCRINE?? HORMONAL… WHAT?!?!

Hormones are messengers that tell your body what to do. They communicate where to grow hair, where to store fat, how to ovulate & what mood you’re in. Men and women have the same hormones in their bodies, just different amounts. Think same ingredients, different cake. Men have more testosterone (typically) and women more oestrogen.

In women with PCOS, their hormonal cocktail becomes imbalanced and a domino affect occurs causing things to get out of order.


Symptoms?

It’s difficult with symptoms because each individual case presents in different ways depending on the person. Some women will have mild symptoms whilst others have severe symptoms. For example, some women don’t struggle with their weight & some don’t actually have cysts on their ovaries. So remember you don’t have to have ALL symptoms of the symptoms.


PERIODS & FERTILITY

No period or periods that are:Irregular – a regular cycle is between 21 and 35 days.InfrequentHeavyMultiple cysts on the ovariesDifficulty falling pregnant/ infertility

High levels of insulin and androgens disrupt the monthly cycle of ovulation (when mature eggs are released from the ovary) and menstruation. As a result, ovulation can stop or occur infrequently and spontaneously making it difficult to conceive. However, this doesn’t mean that you are infertile. Weight loss of around 5-10% amongst women with PCOS has been found to improve fertility [2].


BODY, HAIR & SKIN

Weight gain and/or difficulty losing weight

Insulin resistance and inflammation are behind the weight troubles due to the disruption of blood sugar levels and consequent fat storage. This is a very negative cycle that feeds one another.


Excess face and/or body hair (hirsutism)

Excess hair may occur due to high levels of androgens stimulating the hair follicles. The typical areas excess hair shows up include sideburns, chin, upper lip, nipples, lower abdomen, chest and thighs


Acne

PCOS increases testosterone production which causes the sebaceous glands to produce too much oily sebum contributing to acne.


MENTAL HEALTH

It’s difficult pinpointing why depression and anxiety is common among women with PCOS. However, coping with all these symptoms or even just a few of them would be extremely difficult and it’s no doubt that your self-esteem would be affected only adding to underlying mental illnesses. Additionally, if you’re having trouble conceiving, this is bound to impact your mood and mental health.


Depression

Research has found around 35% of women with PCOS have depression compared to the 10% of women without PCOS [3].


Anxiety

Research has found almost 57% of women with PCOS have anxiety compared to the 18% of women without PCOS [45].


Causes?

The cause of PCOS hasn’t been identified yet. However, there are definitely common factors playing a role in the development amongst many women.


HYPERANDROGENISM

Hyperandrogenism = High levels of androgens circulating in the bloodstreamAndrogens are male sex hormones, such as testosterone.Women naturally produce small amounts of androgens in their ovaries and adrenal glands however excess amounts can prevent ovulation and disrupt menstruation.


HYPERINSULINEMIA

Insulin is required in the body to control our blood sugar levelsInsulin resistance is a common driver in the development of PCOS.Insulin resistance = the body doesn’t respond to the hormone insulin and causes blood sugar levels to increase. When this occurs, more and more insulin is produced in an attempt to keep blood sugar levels stable.High insulin levels increase androgen levels (testosterone) in the ovaries which we discussed before contributes to hair growth, acne, irregular periods & trouble ovulating.Insulin resistance is present in around 80% of women with PCOS which is concerning due to the flow on symptoms as well as the increased risk of developing Type-2 Diabetes.Insulin resistance can be managed through diet and lifestyle


FAMILY HISTORY

Current research recognises there’s an increased risk of developing PCOS if an immediate female relative is affected such as your mother or sister. It’s important to talk with family members as this is an important factor when determining a women’s risk.


EXCESS WEIGHT

This is a tricky one because women with PCOS may have difficult losing weight yet their excess weight could be driving their PCOS. Being above a healthy weight worsens insulin resistance and therefore aggravates many PCOS symptoms. More and more research is coming out now showing an association between overweight/obese women and PCOS  [6]. This link highlights the importance of maintaining a healthy weight and overall lifestyle.


Diagnosis

A PCOS diagnosis can be made with any 2 of the 3 following criteria:

1. Menstrual dysfunctionlack of periodsmenstrual irregularityirregular/lack of ovulation

2. Hyperandrogenism – excess androgens in the bloodstreamclinical – excess hair, alopecia, acnebiochemical – raised free testosterone

3. Polycystic ovaries on ultrasound 12 or more follicles visible on 1 ovary increased size of 1 or both ovaries


Treatment

DIET

With nutritional awareness comes the ability to manage many symptoms of your PCOS and gain back some control in your life. Current research shows that diet and lifestyle changes are the MOST effective way of managing PCOS! Therefore, changing your diet should be the #1 FIRST thing you do if you’re diagnosed with PCOS. Unfortunately, I’m yet to hear of many doctors talking about this factor in PCOS treatment, often they’ll prescribe medication first which isn’t addressing the root cause.

So what should you eat???


LOW GLYCEMIC INDEX (GI) WHOLE FOODS

Whole foods are natural and unprocessed such as vegetables, fruit, nuts, seeds and legumes. These options are rich in dietary fibre and as a result take longer for the body to break down (they’re low GI). This means they’re absorbed into the blood stream slowly and require less insulin compared to high GI foods. Remember, less insulin = less testosterone.

ANTI-INFLAMMATORY FOODS

Inflammation can make women more resistant to insulin and prone to gaining weight. While managing those insulin levels will help with inflammation, making sure that your PCOS diet is rich in anti-inflammatory foods will help too. These anti-inflammatory foods include:

dark leafy greens – kale & spinachvegetables – broccoli, carrot, cauliflower, pumpkin, beetrootbeans & lentilsgreen teaavocadoextra virgin olive oilwalnuts, pistachios & almondscold water fish – salmon & sardinesspices and herbs – turmeric & cinnamon

BALANCE

I recently wrote a post all about nutrition which I’ll link here as it basically explains all you need to understand about eating a balanced diet in terms of macro nutrients carbohydrates, protein and healthy fats. Ensuring you balance your meals will assist reducing the glycaemic load of meals and consequently the blood sugar level stability.

AVOID

dairy – contains IGF-1 which mimics insulin in the body.gluten – creates general inflammation in the body increasing insulin resistance.soy – contains ‘phyto’ estrogen that acts like estrogen in the body. Eating too much confuses your body into thinking it has enough real estrogen already. This signals your endocrine system to slow down estrogen production, which slows the production of luteinizing hormone (LH), and halts ovulation.


EXERCISE

If you’re currently overweight, with a BMI of over 25, losing only 5% of your body weight can improve PCOS symptoms. I’m not a doctor, and i’m only a student in my final semester of nutritional medicine study, so I cannot recommend anything for you specifically. I know what exercise and physical activity works with me and my body and you have to discover what you enjoy and what helps you along your journey.


SUPPLEMENTS

The priority of supplement usage is to balance blood sugar levels which in turn assists with lowering insulin levels and lowering testosterone levels. It’s always a great idea to book a consult with a qualified practitioner and discuss your diagnosis as well as possible supplements to help you along the journey. The following are some great supplements:


INOSITOL – improves insulin sensitivity, ovarian health & lowers free testosterone

OMEGA-3 – lowers testosterone & regulates menstrual cycle

CHROMIUM – enhances the function of insulin


Thank you so much for reading, please message me ANY questions you have on this topic or if you’d like me to expand on certain areas. I’m trying my hardest to simplify complex issues for you but I completely understand it still can be extremely confusing so I apologise Xxxx