Polycystic Ovary Syndrome is a condition that our readers often write in about, and in some cases it can cause difficulties for couples trying to conceive. We turned to Wellbeing of Women to give us the low-down on exactly what it is, what can be done to treat the condition, and if you’re a sufferer, what you can be doing to alleviate the symptoms.
What is PCOS?
Polycystic ovary syndrome (PCOS) is the commonest hormone disorder in women, affecting between 5-10% of women of reproductive age and typically first manifesting itself during adolescence. It is a major cause of infertility and causes distressing skin problems (acne and unwanted body hair) that contribute to a negative impact on quality of life and often, overt depression. PCOS is also associated with risks to long-term health, and, in particular there is a 3-fold increase in the risk of developing type 2 diabetes in later life.
A woman is diagnosed with PCOS if she fulfils 2 of the 3 criteria:
- Polycystic ovaries (cysts in the ovaries), a common radiological finding seen in about 20% of women of reproductive age.
- Infrequent, absent or irregular periods.
- Clinical or biochemical signs of excess androgens (male hormones). Androgens are circulating hormones like testosterone, an imbalance of which can lead to acne, excess facial growth or alopecia.
How is PCOS Treated?
The precise causes of PCOS remain unclear to doctors but it is suggested that hormone imbalances including high levels of insulin cause an excess Luteinising hormone production, which in turn stimulates the ovaries to produce excessive amounts of testosterone. The importance of insulin imbalance to PCOS is why most doctors will treat patients by giving advice on healthy diet and exercise. Both have been proven to improve the symptoms of PCOS, improve fertility and may reduce the potential long-term complications.
Other more active treatment options for PCOS include the combined contraceptive pill to normalise periods, as well as metformin which can normalise periods (although less effective than the contraceptive pill), improve glycaemic control and fertility. A nutritional supplement called D-chiro-inositol is also found in some studies to improve insulin resistance and ovulation status in women with PCOS.
How Does Diet Improve PCOS?
Insulin is a very important hormone because it allows glucose to get into cells where it can be used as a source of energy and this prevents glucose levels from building up in the blood. The most important reason why women with PCOS are more prone to diabetes is that they are relatively resistant to the action of insulin in getting glucose into its target tissues such as fat and muscle. As a result, insulin levels in blood tend to be higher than normal and eventually blood sugar levels rise.
In order to balance blood sugar levels in your diet three things need to be addressed:
What types of food to eat?
- Eat fresh, whole foods and try to avoid packaged foods that have more than five ingredients listed
- Avoid simple carbohydrates including all white processed flour products, pasta, white rice, potatoes and sugar.
- Eat about a pound of colourful vegetables daily (raw or lightly steamed) and only a couple of portions of fruit (one apple or a handful of berries is a portion).
- Avoid fizzy drinks, fruit juices and alcohol.
- Restrict dairy consumption to two portions per day (a portion is a 200ml glass of milk, a 150g pot of yoghurt or 30g of cheese).
In what combination?
- Include a good source of plant or animal protein with every meal and snack; especially at breakfast. Good plant sources include quinoa, nuts and seeds as well as legumes (dried beans, lentils, chickpeas) whereas good animal sources are wild meats and fish, organic lean meats, lamb, organic chicken and eggs.
- Always aim to have ½ plate of vegetables, ¼ plate protein (listed above) and ¼ plate complex, low GI carbohydrates (e.g. a slice of rye or pumpernickel bread, wild rice or brown basmati rice, quinoa etc.).
- Always include a small amount of good fat in your meals (e.g. coconut oil, extra virgin olive oil, avocado, egg, oily fish, nuts, seeds) as it increases satiety and provides the raw materials for hormone synthesis, among numerous other benefits
When to eat?
- Always eat breakfast as it is the most important meal of the day; and it needs to be balanced with a good amount of good quality protein (as described above) for optimum blood sugar balance.
- Try to eat three main meals and one to two snacks per day, i.e. try not to leave your stomach empty for more than 4 hours, unless you are really not hungry. Make sure to always have snacks with you, such as a small bag of raw nuts, or an apple with some seeds, some vegetable cruditÃ© with a tablespoon of hummus.
Where is research needed for PCOS?
Significant research has been undertaken to investigate both the cause and treatment of PCOS such that women affected can manage symptoms effectively and minimise potential long term complications. Understanding of the complexity and systemic nature of PCOS has been key in providing accurate information and offering counselling to affected women.
Research is still needed to understand why women with PCOS are more likely to develop endometrial cancer as well as obstetric complications like pre-eclampsia and gestational diabetes compared to women without PCOS. Such understanding could potentially allow us to screen women with PCOS for the target condition (for example endometrial cancer) and therefore improve prevention and early treatment.
Wellbeing of Women is one of the few bodies in the UK funding work into the understanding and treatment of PCOS – if you would like to learn more about this, or indeed any of their other work into the health issues impacting women please visit www.wellbeingofwomen.org.uk or contact firstname.lastname@example.org
Huge thanks to Dr Nicolas Galazis, Professor William Atiomo, Professor Stephen Franks & Ms Mariliza Vassiliadou.