What you need to know about Polycystic Ovarian Syndrome

Do you think that you might suffer from Polycystic Ovarian Syndrome? PCOS can cause irregular periods, acne, unwanted hair growth and weight gain and it affects women in different ways: some women may have only mild symptoms, while others may have a wider range of more severe symptoms.

So what is PCOS?

PCOS is defined by

1) few or no periods

2) high “male” hormones like testosterone – this can either be high levels in the blood picture or clinical symptoms of acne or hirsutism (which is the term used to describe what happens when the light fine vellus hairs that are normally found on places like the face and shoulders are transformed into coarse thicker terminal hairs which are normally found on eyebrows and scalp).  Women may have increased production of testosterone, or increased sensitivity to testosterone, or an imbalance between oestrogen and progesterone versus testosterone.

3) Multiple cysts on their ovaries at ultrasound scan (12 follicles measuring 2-9mm diameter)

Having regular periods is critical because left untreated, PCOS is associated with an increased risk of endometrial cancer, due to the unopposed oestrogen causing thickening of the endometrial lining.[1]  However, whilst birth control pills may override the ovaries and induce a regular monthly withdrawal bleed,  they don’t actually address the root cause, nor help women who are keen to get pregnant or worried about their fertility to become more confident that they will be able to fall pregnant naturally.

In fact, women with the polycystic ovarian syndrome tend to have good egg quality and egg reserve (the anti-mullerian hormone, which is a marker of egg reserve, is often high in polycystic ovarian syndrome): the problem is that they are not ovulating regularly.  Therefore, it is important to make the relevant diet and lifestyle changes to try to correct the underlying problem.

Polycystic ovarian syndrome is linked in about 70% of cases with insulin resistance, meaning that more insulin is being produced, but the cells aren’t listening. However, at the level of the ovary, this increasing insulin floating about causes overproduction of testosterone and worsens symptoms! For insulin resistance, prescribing the anti-diabetic medication metformin can help by reducing insulin resistance, but diet changes have to be made as well.

Metformin alone only helps to a degree – it increases the number of cycles where ovulation takes place from 13% to 23%. Following a low GI diet is really important, because eating foods that cause insulin to be released will worsen the condition. Therefore, eating lots of carbs and sugar which cause insulin release should be avoided; eating a low GI diet with good amounts of protein and fresh vegetables which will not cause insulin to spike is an important part of the treatment plan.

If you are overweight, it is important to lose weight as this will decrease insulin resistance. Also, get your thyroid checked – women with PCOS are four times more likely to also have autoimmune hypothyroidism ( otherwise called Hashimoto’s Disease).

The aims in managing PCOS are:

1.   To lower androgens such as testosterone

2.   To induce regular ovulation

3.   To reduce insulin resistance

5 things you can do to help achieve these goals are:

1)  Lose weight if overweight

2)   Do daily aerobic exercise –  one hour per day

3)  Follow a low GI diet. That means choosing carbohydrates with a low glycaemic index, which means they are ‘slow-releasing and less likely to spike your blood-sugar levels. Avoid white carbs, sugary drinks, concentrated sweets, fast food and processed foods.  If it comes in a package with a label, limit it! Eat good fats containing omega 3’s (salmon, mackerel, herring, sardines) and omega 9 (olive oil, olives, almonds, hazelnuts, avocados) and avoid hydrogenated vegetable oils and fried foods. Eat protein with each meal – think of eggs and smoked salmon for breakfast. Choose lean, clean, quality protein at each meal such as chicken breast, turkey breast, lean beef, fish (especially salmon and sardines) and eggs. Avoid hydrogenated vegetable oils and fried foods. Snack on vegetables and small amounts of nuts, olives or avocado. Eat 5-9 servings of vegetables daily (fruits must be limited to 1 -2 per day due to sugar content)

4)  The following supplements may help:

  • Flax seeds: these increase sex hormone-binding globulin and so lower testosterone levels – take 1-2 tbsp per day
  • Vitamin D: Supplementing with vitamin D has been shown to improve glucose tolerance and insulin resistance if vitamin D levels are low.
  • Chromium: in one study, taking 1,000 mcg per day of chromium for as little as two months was able to improve insulin sensitivity by 30% and by 38% in overweight women with PCOS.
  • Green tea: this is thought to work by increasing sex-hormone-binding globulin, helping some free testosterone to be bound up and thereby reducing some of the testosterone- related problems seen in women with PCOS. Consume  300mg-500 mg per day or 3 cups of tea per day.

[1] Polycystic ovary syndrome and endometrial cancer