Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS)

February 18, 2017 | by | No Comments

Polycystic ovary syndrome (PCOS) is a common condition that affects how the ovaries work.

If you have at least two of these features you may be diagnosed with PCOS [1]:

  • irregular periods – which means the ovaries don’t regularly release eggs (ovulation)
  • excess androgen – high levels of testosterone, which may cause physical signs such as excess facial or body hair
  • polycystic ovaries – ovaries become enlarged and contain many fluid-filled sacs (follicles) which surround the eggs (it’s important to note that, despite the name, if you have PCOS you don’t actually have cysts)

Polycystic ovaries contain a large number of harmless follicles that are up to 8mm (approximately 0.3in) in size. The follicles are under-developed sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means that ovulation doesn’t take place [1].

It’s difficult to know exactly how many people have PCOS, but it’s thought to be very common affecting about one in every five people who menstruate in the UK. More than half of these people don’t have any symptoms [1].

The exact cause of polycystic ovary syndrome (PCOS) is unknown, but it’s thought to be related to abnormal hormone levels:

Resistance to insulin- Insulin is a hormone produced by the pancreas to control the amount of sugar in the blood. It helps to move glucose from blood into cells, where it’s broken down to produce energy. Insulin resistance means the body’s tissues are resistant to the effects of insulin. The body therefore has to produce extra insulin to compensate [1].

High levels of insulin cause the ovaries to produce too much testosterone, which interferes with the development of the follicles (the sacs in the ovaries where eggs develop) and prevents normal ovulation. Insulin resistance can also lead to weight gain, which can make PCOS symptoms worse, because having excess fat causes the body to produce even more insulin [1].

Many people with PCOS are found to have an imbalance in certain hormones, including [1]:

  • raised levels of testosterone – a growth hormone found in all people, although at higher levels in males
  • raised levels of luteinising hormone (LH) – this stimulates ovulation, but may have an abnormal effect on the ovaries if levels are too high
  • low levels of sex hormone-binding globulin (SHBG) – a protein in the blood, which binds to testosterone and reduces the effect of testosterone
  • raised levels of prolactin (only in some people with PCOS) –  hormone that stimulates the breast glands to produce milk in pregnancy

The exact reason why these hormonal changes occur isn’t known. It’s been suggested that the problem may start in the ovary itself, in other glands that produce these hormones, or in the part of the brain that controls their production. The changes may also be caused by the resistance to insulin [1].

Genetics- PCOS sometimes runs in families. This suggests there may be a genetic link to PCOS, although specific genes associated with the condition haven’t yet been identified.

Main symptoms [1]:

PCOS is also associated with an increased risk of developing health problems in later life, such as type 2 diabetes and high cholesterol levels [1].

Note: See your GP if you have any typical symptoms of polycystic ovary syndrome (PCOS).

Your GP will ask about your symptoms to help rule out other possible causes and they’ll check your blood pressure. They’ll also arrange for you to have a number of hormone tests to find out whether the excess hormone production is caused by PCOS or another hormone-related condition.

You may also need an ultrasound scan, which can show whether you have a high number of follicles in your ovaries (polycystic ovaries). The follicles are fluid-filled sacs in which eggs develop. You may also need a blood test to measure your hormone levels and to screen for diabetes or high cholesterol.

Treatment options can vary because someone with PCOS may experience a range of symptoms, or just one. This NHS information page outlines the different medications available for treating different aspects of PCOS.

Managing PCOS through diet and lifestyle approaches:

The good news is that PCOS symptoms respond well to the four steps outlined on our ‘all symptoms‘ page, so it might be worth trying some of these options before turning to medication, or in combination with it:

Try a hormone-balancing diet– As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet can significantly improve PCOS symptoms;

1. Eat lots of fresh fruit and vegetables

2. Eat lots of fibre (and drink water with it)

3. Eat oily foods (mainly unsaturated fats- avoid saturated fats [2])

4. Reduce meat and dairy products

5. Avoid sugary foods and drinks– Since insulin resistance is one of the main symptoms of PCOS, it is critical that you avoid sugary foods and drinks, to avoid gaining excess weight- which, in turn, worsens insulin resistance [3]. There are different types of ‘sugars’, so to make things clear- the sugars to avoid completely (if at all possible) are fructose and sucrose.  These are the sugars used in desserts, fizzy or syrup-based drinks, biscuits, snack bars, or chocolate- basically anything that tastes ‘sweet’.

Note – The small amount of natural sugar found in fresh fruits and vegetables is OK- so freshly squeezed fruit juice is fine, but those made from concentrate are not… 

TOP TIPS! Lara Briden offers some handy advice for quitting sugar in her book, ‘Period Repair Manual‘ pp 141 [4]: Get enough sleep; eat satisfying meals with all three macro-nutrients: protein, starch, and fat; do not attempt any other type of diet restriction while quitting sugar; go cold turkey (eliminate sugary foods completely) for four weeks; pick a start date during a low stress time of your life; know that intense craving will subside after 20 minutes; know that cravings generally subside after 2 weeks of withdrawal; supplement magnesium to reduce cravings; and love yourself!

6. Avoid caffeine

7. Avoid alcohol– It’s full of sugars! If you are going to have a drink, anyway, choose a beer or wine- rather than a spirit with sugary mixer, or cider/ other sweet tasting drink.

8. Take nutritional supplements; Magnesium deficiency may be a contributing factor to insulin resistance (and supplements may help improve it) [5], and folic acid & vitamin B12 (both found in vitamin B complex supplements), vitamins C and D, calcium, potassium, and zinc have all been found to help reduce the symptoms of PCOS [2].

TOP TIP! In overweight women, the symptoms and overall risk of developing long-term health problems from PCOS can be greatly improved by losing excess weight. Weight loss of just 5% can lead to a significant improvement in PCOS [1].

Exercise regularly–Regular exercise, particularly aerobic exercise, may help you to lose excess weight [1].

Research has shown that regular exercise, (more specifically cardio-respiratory fitness), and a healthy BMI (Body Mass Index), significantly reduces the symptoms of PCOS [6].

Boost self-esteem- Losing weight is difficult to do at the best of times, but it is even harder when you are insulin-resistant. You are more likely to experience cravings, and feel inclined to eat sugary foods for emotional reasons [7]. So, high self-esteem can help you to resist sugary temptation- and feel good about your decision to improve your diet.

Cognitive behavioural therapy (CBT) is one of the most effective treatments for building self-esteem, and is available on the NHS. Research shows that the benefits of CBT may last longer than those of medication, although no single treatment is best for everyone. CBT helps you to understand how your problems, thoughts, feelings and behaviour affect each other. It can also help you to question your negative and anxious thoughts, to improve the way you see yourself, and reduce damaging internal thought processes. CBT usually involves meeting with a specially trained and accredited therapist for a one-hour session every week for 10-12 weeks.

Note: The Oxford Cognitive Therapy Centre produces a highly effective (and cheap!) CBT booklet; ‘Building self-esteem‘.

Reduce stress- People who have PCOS are at increased risk for psychological distress, body dissatisfaction and reduced quality of life due to obesity, hirsutism (excess hair), acne, irregular menses and possible infertility [8]. A couple of clinical research studies have found that mindfulness training can significantly improve stress, depression, anxiety and the quality of life in people living with PCOS, and ultimately lead to favourable changes in blood pressure, and blood glucose levels [9] [10].

Mindfulness works by focusing your awareness on the present moment and by acknowledging and accepting certain feelings. Being mindful can teach you how to overcome negative thoughts – for example, being able to challenge hopeless feelings.

This practice has been found to reduce ‘stress reactivity’, stopping the vicious cycle of low mood and anxiety constantly triggering the ‘fight or flight’ HPA (Hypothalamic Pituitary Adrenal) stress response- leading to further anxiety (and, therefore, worsening hormone-related symptoms) [11]. MCBT usually involves meeting with a therapist for a one-hour session every week for three to four months.

You may also find relaxation and breathing exercises helpful, or prefer activities such as yoga or pilates to help you unwind.

Further information:

Page last reviewed and updated: June 2018

References:

1. NHS. (2016) Polycystic Ovary Syndrome. [ONLINE] Available at: http://www.nhs.uk/Conditions/Polycystic-ovarian-syndrome/Pages/Introduction.aspx. [Accessed 4 August 2017].

2. Szczuko M, Skowronek M, Zapałowska-Chwyć M, Starczewski A. Quantitative assessment of nutrition in patients with polycystic ovary syndrome (PCOS). Rocz Panstw Zakl Hig. 2016;67(4):419-426. PubMed PMID: 27925712.

3. Kahn, B. B., & Flier, J. S. (2000). Obesity and insulin resistance. Journal of Clinical Investigation, 106(4), 473–481.

4. Briden, L. (2015) Period Repair Manual; Natural Treatment for Better Hormones and Better Periods Amazon: pp 131-153

5. Hruby A, Meigs JB, O’Donnell CJ, Jacques PF, McKeown NM. (2014) Higher magnesium intake reduces risk of impaired glucose and insulin metabolism and progression from prediabetes to diabetes in middle-aged americans. Diabetes Care. Feb;37(2):419-27. doi: 10.2337/dc13-1397.

6. Panidis D, Tziomalos K, Papadakis E, Vosnakis C, Chatzis P, Katsikis I. (2013) Lifestyle intervention and anti-obesity therapies in the polycystic ovary syndrome: impact on metabolism and fertility. Endocrine. Dec;44(3):583-90.
doi: 10.1007/s12020-013-9971-5. Epub 2013 Apr 27. Review. PubMed PMID: 23625194.

7. Hirschberg AL, Naessén S, Stridsberg M, Byström B, Holtet J. (2004) Impaired cholecystokinin secretion and disturbed appetite regulation in women with polycystic ovary syndrome. Gynecol Endocrinol. Aug;19(2):79-87. PubMed PMID: 15624269.

8. Barnard L, Ferriday D, Guenther N, Strauss B, Balen AH, Dye L. (2007) Quality of life and psychological well being in polycystic ovary syndrome. Hum Reprod. Aug;22(8):2279-86.

9. Raja-Khan N, Agito K, Shah J, Stetter CM, Gustafson TS, Socolow H, Kunselman AR, Reibel DK, Legro RS. (2015) Mindfulness-based stress reduction for overweight/obese women with and without polycystic ovary syndrome: design and methods of a pilot randomized controlled trial. Contemp Clin Trials.  Mar;41:287-97. doi:10.1016/j.cct.2015.01.021.

10. Stefanaki C, Bacopoulou F, Livadas S, Kandaraki A, Karachalios A, Chrousos GP, Diamanti-Kandarakis E. (2015) Impact of a mindfulness stress management program on stress, anxiety, depression and quality of life in women with polycystic ovary syndrome: a randomized controlled trial. Stress. Jan;18(1):57-66. doi: 10.3109/10253890.2014.974030.

11. Hoge, E. A., Bui, E., Marques, L., Metcalf, C. A., Morris, L. K., Robinaugh, D. J., … Simon, N. M. (2013). Randomized Controlled Trial of Mindfulness Meditation for Generalized Anxiety Disorder: Effects on Anxiety and Stress Reactivity. The Journal of Clinical Psychiatry, 74(8), 786–792. http://doi.org/10.4088/JCP.12m08083