What is Polycystic Ovary Syndrome? What nutrition plan should I follow when facing this condition?

Definition: A few words about Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is a heterogeneous disorder, which means it has more than one root cause. It is characterized by a combination of symptoms of androgen excess. Androgens are male sex hormones, such as testosterone.

Symptoms of androgen excess:

• Hyperandrogenemia: a condition where a large amount of androgens are found in the blood
• Hirsutism: a condition where a female has thick, dark hair on their face, neck, chest, tummy, lower back, buttocks or thighs
• Polycystic ovarian morphology which concern various issues such as number, size and volume of follicles in ovaries
• Oligoovulation: a condition that causes irregular or infrequent periods

The prevalence of PCOS is about 8%-13%, making it the most common endocrine and metabolic disorder in women and individuals with a uterus of reproductive age, while it is estimated that 70% of people that have it remain undiagnosed.

Symptoms of Polycystic Ovary Syndrome (PCOS)

Those who suffer from PCOS have various symptoms that might be on:

• The psychological level: anxiety, dissatisfaction with body image, depression,
• The metabolic level: metabolic syndrome, insulin resistance, prediabetes, type 2 diabetes, cardiovascular risk factors
• The reproductive level: hirsutism, infertility, pregnancy complications, irregular menstrual cycles

It is characterized by three primary symptoms:

• Irregular Periods: This can mean periods that come infrequently, are irregular, or are absent altogether.
• Excess Androgen: Elevated levels of male hormones, such as testosterone, which can result in physical signs like excess facial and body hair, acne, and male-pattern baldness.
• Polycystic Ovaries: Ovaries may become enlarged and contain follicles that surround the eggs. These can appear as small cysts on an ultrasound.

However, it’s worth noting that not all women with Polycystic Ovary Syndrome will have all three features.

PCOS manifests in a variety of ways, with symptoms often beginning shortly after a woman first begins menstruating. Other symptoms can also be:

• Irregular periods
• Heavy bleeding
• Excess hair growth (hirsutism)
• Acne, oiliness, or dandruff
• Weight gain or obesity
• Male-pattern baldness or thinning hair
• Darkening of the skin, particularly along neck creases, in the groin, and underneath the breasts
• Skin tags
• Infertility

Polycystic Ovary Syndrome and Infertility

As explained, PCOS leads to a higher production of androgens. These high levels of androgens get in the way of the ovulation process. That means most likely a healthy egg is not being released because sperm cannot fertilise an unfertilized egg. 

Some doctors recommend hormonal birth control, such as the pill or a skin patch, if there is no wish for a pregnancy. If someone wants to get pregnant, the most effective and common method of dealing with the infertility associated with PCOS is IVF. Fertility treatments like those can encourage the release of eggs from the ovaries.

Causes of PCOS

While the exact cause remains unknown, several factors are thought to play a role:

• Insulin Resistance: Many people with PCOS have insulin resistance, where the body’s cells don’t respond as they should to insulin. This can lead to higher insulin levels, promoting increased androgen production in the ovaries.
• Inflammation: People with PCOS often have increased levels of inflammation, which can also contribute to higher androgen levels.
• Heredity: There is evidence to suggest that PCOS may run in families.
• Hormonal Imbalance: Elevated levels of androgens and imbalances in other hormones like progesterone can prevent the ovaries from releasing an egg regularly.

Diagnosis and treatment of PCOS

Even if PCOS is a very common disorder, diagnosis and treatment remain controversial. This is easily explained by the nature of the disorder, because there are different combinations of symptoms in different people but, also, with the same person across their lifespan.

Therefore, it has been difficult to establish specific diagnostic criteria that can be used among every health professional group. Unfortunately, the whole situation leads to dissatisfaction with the healthcare system and delayed diagnosis of many people with PCOS. As a result, PCOS remains one of the most poorly understood medical disorders, mainly because of its complexity, controversial definition and heterogeneous nature of its symptoms.

Helpful tips and nutrition guidelines for PCOS

The problem described above led to the development of the first international evidence-based guidelines for PCOS that was published in 2018 as an effort to raise awareness on the topic and suggest an international way to diagnose and manage PCOS, even though the evidence is still limited.

Among other topics, in the guidelines is the importance of nutrition in the management of PCOS, giving us an additional tool to face this condition. So, yes it is highly recommended that you follow a diet if you have PCOS!

According to the recommendations, there are two basic elements regarding nutrition: firstly, it is important to maintain a healthy body weight via a weight-loss intervention for overweight people or via a maintenance diet plan for those who have achieved weight loss; secondly, it is vital to follow a healthy and balanced diet.

However, science says that effective interventions to nutrition and exercise may improve cardiometabolic risk profile, endocrine characteristics and reproductive function, despite body weight loss. Any intervention to one’s diet should be individualized, according to their needs, beliefs and lifestyles, in order to optimize hormonal outcomes, general health and quality of life.

How exactly is nutrition related to PCOS?

Nutrition is related to PCOS in terms of overall health and via its direct effect on our metabolism and hormones. Let’s focus more on this.

1. Body weight and central obesity

The great majority of people seeking treatment for PCOS are overweight or obese. Obesity, in particular central obesity, increases insulin resistance and excess of androgens in the body, thus increasing PCOS prevalence and worsening its clinical features.

If we have central obesity this means that there is excess fat in the area of our abdomen, which has a negative impact on our abdominal organs’ functions and creates further metabolic risks. As a result, weight loss intervention is one of the most important steps to start managing PCOS.

2. Insulin resistance mechanism

Insulin resistance is a well-established mechanism to the underlying pathophysiology of PCOS and is present in 50%-70% of people with PCOS. If one has insulin resistance their body cannot use glucose properly for its functions. It is associated with oxidative stress and inflammation, procedures that both have a negative impact on our health.

It, also, contributes to hyperandrogenism linked with PCOS, as insulin stimulates production of androgens from ovaries. The whole PCOS condition may increase the risk for type 2 diabetes, gestational diabetes and impaired glucose tolerance. In this case, weight loss and careful food choices could help a lot.

3. Nutrients

Several nutrients affect PCOS:

• AGEs (Advanced Glycation End Products) are molecules that are created after a reaction (Maillard) between sugars and proteins or other components and this procedure happens normally in our bodies. However, it is possible to receive amounts of AGEs via nutrition, as they are created after thermal processing and modification of food. AGEs can cause damage to our cells and create problems with our glucose and insulin levels.
• Simple sugars and high GI (Glycemic Index) foods lead to impaired glucose management in the body, as they are rapidly absorbed, elevating blood glucose levels.
• Antioxidants found in various foods can help reduce inflammation and protect from oxidative stress.
• Saturated and trans- fatty acids worsen insulin resistance.
• Polyunsaturated (PUFAs) and monounsaturated (MUFAs) fatty acids can have a protective effect against insulin resistance.
• Vitamin D might be protective against PCOS features.

4. Eating disorders

Eating disorders can be common among people with PCOS. PCOS can be a tough condition, affecting different aspects of life and may include anxiety, low quality of life, depression, sexual dissatisfaction, psychological distress and low self-esteem. Via nutrition and dietitian’s assistance we can explore our body and its specific needs and take care of it the best way possible.

Applicable nutrition guidelines for PCOS

The nutrition plan has two directions: firstly, it should focus on a healthy body weight and fat percentage and, secondly, on nourishing the body. So, what can you do?

• Consume whole grain products, for example whole grain bread, pasta, cereal, rusks, etc, that have lower GI. Many people find it difficult to start preferring them, but it is important to keep in mind that any change needs time. So, you could start eating only whole grain pasta and gradually build a brand-new lifelong habit, rather than trying to change everything all at once.
• Consume 4-5 meals or snacks per day, preferably combining the carbohydrates with protein or lipids or both for better blood glucose levels. For example, try not to consume the fruit alone, but eat fruit with yogurt or fruit with cheese or, at least, fruit with a whole-grain, or high-fiber cracker.
• Eat a high-quality breakfast, like overnight oats, a whole-grain toast with low-fat cheese, healthy pancakes with fruit, omelet with vegetables, etc
• Opt for sugar-free and alcohol-free beverages, such as water, naturally-flavored water, tea, coffee, herbal tea, homemade iced tea, fruit and vegetable smoothies. Eliminate the consumption of alcohol as much as possible. Juices are not the best choice, as they lack fiber, in contrast to the whole fruit or the smoothie. Beverages like low-fat or free-fat milk and plant milk (like soy, almond, etc) can be consumed in moderation.
• Consume a variety of foods. This is a dietitians’ “cliché”, so I wouldn’t like to start giving examples of what variety is. I will give a practical tip, though: right now think of a healthy food you never consume even though you like it. Let’s assume it is fish. The time you will go to the supermarket this week you will buy one portion of the fish you like, preferably one with an easy recipe. It is your goal to cook and eat it this week. After trying for several times with the fish, till it is your new habit to eat it once a week, start working on your second nutrition goal for variety.
• Add foods rich in antioxidants, like spices, herbs, nuts, red fruits, a variety of vegetables and so on.
• Limit your total fat intake and saturated/ trans fats, like fats from red meat, margarine, butter, meat products like ham or bacon. Prefer low-fat versions of cheese, milk, yogurt.
• Limit AGEs in food by preparing it in low temperatures with high moisture and brief heating time or by using acidic marinades when cooking, such as lemon or vinegar. Also, keep in mind that high amounts of AGEs exist in processed foods like chips, crackers and cookies and in seasoned high-fat cheese like Parmesan. Finally, pasteurized products might contain greater amounts of AGEs.
• Consume avocado, olive oil, flaxseed oil, nuts, seeds, nut butters, chia seeds, hemp seeds, soybeans, whole-grain products and fatty fish to increase PUFAs and MUFAs.
• If you experience any difficulty with food or body image you could ask a dietitian and other health care providers for help, in order to build healthy habits and thoughts about food, body and nutrition!
• Exercise and physical activity are important to every individual and so is to people with PCOS. You could try different kinds of exercise and find the one that fits you best!

I hope that this article helped you understand more about the connection between PCOS and nutrition. Knowledge helps us get informed decisions for our health and body and choose what works best for us.

Katerina Magdalinou, Dietitian-Nutritionist and a partner of omgyno, gives us important information and quidelines regarding a much discussed and important issue.

If you have any questions regarding your diet or hormones, head to our telehealth page and book an online consultation with Katerina Magdalinou.Nutrition Guidelines for People with PCOS.