PCOS, which stands for polycystic ovary syndrome, is the most common endocrine disorder in women of reproductive age, with a prevalence rate of four to 12 percent. For a woman to be diagnosed with PCOS, at least two of the three below symptoms need to be present:
- Irregular or infrequent periods.
- Signs of having too many androgens either clinically (e.g. excess hair, cystic acne, male pattern baldness) or biochemically (e.g. raised testosterone and raised free androgen index).
- Polycystic ovaries.
The underlying hormonal disturbance in patients with PCOS is insulin resistance, which is present in nearly 50 to 80 percent of patients. Insulin resistance leads to high levels of insulin that stimulate the ovarian cells to make testosterone (a male hormone). This testosterone then stimulates your ovaries to make follicles, which do not rupture or allow you to ovulate, eventually causing a build-up of cysts in your ovaries. The result? High levels of the male hormone, low levels of progesterone, and estrogen dominance, all of which lead to a constellation of symptoms, including irregular periods, mood swings, acne, hair loss, male pattern baldness, and, later on in life, difficulty conceiving or infertility.
Some PCOS medical complications include an increased chance of cardiometabolic diseases — such as diabetes and heart disease — as well as an increased risk for endometrial cancer. Some women even experience poor bone health. National guidelines have consistently found that obesity and a higher BMI (body mass index) play a critical role in the development of PCOS.
If you’ve been diagnosed with PCOS, here are lifestyle changes that can really help manage your symptoms and improve your quality of life.
Estrogen dominance is present in people with PCOS. One of the ways estrogen gets excreted from our body is through our stool. A daily bowel movement is key to getting rid of excess estrogen in your body. Fiber is one of the best ways to keep your bowel movements regular.
The caveat: Many women who think their bowel movements are regular can actually attribute that to caffeine consumption. Caffeine acts as a laxative and stimulates bowel movements in a more artificial way than fiber does. You can get more fiber in your diet by consuming vegetables (especially leafy greens, broccoli, artichokes, and Brussel sprouts), fruits (especially raspberries, apples, bananas, pears, strawberries, and avocados), legumes, oats, and whole grains.
Choose Your Grains Wisely
Many women tend to utilize a “calorie in versus calorie out” technique to manage their weight. However, even if a piece of cake and a bowl of oats have the same amount of calories, they have an entirely different effect on your hormonal profile. A slice of cake spikes both your sugar and insulin levels, all of which propagate a higher testosterone level and increase the imbalance of male and female hormones. This, in turn, increases your cravings and sugar intake, further increasing your insulin levels and worsening PCOS symptoms.
Whole grains, on the other hand, tend to keep our insulin and blood sugar levels stable, reduce cravings, and allow for more balance between the male and female hormones. Whole grains also contain a higher quantity of fiber than refined grains, thus helping to make bowel movements regular. Whole grains come from brown rice, barley, buckwheat, millet, popcorn, oatmeal, and whole wheat sources of pasta and bread.
All reproductive hormones in your body are made of cholesterol. Therefore, it is important to make sure your diet incorporates a moderate quantity of healthy fats, such as olive oil, nuts, seeds, and avocados. Usually, low-fat packet foods tend to be high in sugar, which worsens your insulin resistance.
Hormonally, your body doesn’t know the difference between if you are stressed about your next meeting, have put yourself on an extremely calorie-restricted diet, or are running away from a tiger. In all these situations, your body reacts in the exact same way: cortisol levels (the stress hormone) will increase. When cortisol levels in your body increase, it has a domino effect on other hormones. First, an increased amount of cortisol will lead to increased blood sugar levels, which further increases your insulin levels. This will then increase your testosterone levels.
Next, when cortisol levels are high, your body preferentially produces cortisol as opposed to progesterone (a key female hormone), therefore reducing progesterone and creating an imbalance of male and female hormones. Then, when cortisol levels are high, your body tends to store fat to use as further fuel when required (remember, your body thinks it may be running away from a tiger and that you will need fuel for later). Furthermore, stress can switch off female hormone production in your brain. Therefore, it may be worth considering stress management tools, such as yoga, meditation, and other techniques.
Incorporate High-Intensity Interval Training (HIIT)
HIIT training has been shown to reduce insulin resistance and improve insulin sensitivity. Improved insulin sensitivity improves or reduces PCOS symptoms. The key to HIIT training? Start slow and stay slow. Aim for maybe 20 minutes of HIIT once or twice a week. Overdoing HIIT will have the opposite effect on your hormones and will cause an increase in your cortisol levels.
Lean muscle mass is much more insulin sensitive than adipose tissue, which is the tissue used to store fat, thus helping to reduce insulin resistance. Reducing adipose tissue is key as fat is the source of testosterone in women. For some women with PCOS, estrogen deficiency results from infrequent or irregular periods, which lead to poor bone health. Building muscle is important as the more traction and resistance you have on your muscles, the stronger your bones get.
Women with PCOS tend to have lower levels of zinc, which exacerbates the symptoms of hair loss and acne. Supplements can help with this. Zinc is needed for follicle development, as well as ovulation. Inositol — which is a B vitamin — is found in citrus foods and brown rice, in addition to supplements. Inositol helps fertility rates and decreases testosterone levels. It’s important for the dosage to be monitored as a moderate dose has been shown to be effective, while higher doses have been shown to be detrimental for women with PCOS.
Research and studies behind supplements are sparse, so their use has not yet been made universal. It is important to consult with your doctor before taking any supplements as each patient requires a thorough evaluation.
Stay Away from Endocrine Disruptors
In today’s society, we are surrounded by chemicals that can act as estrogen mimickers and disrupt the hormonal balance in our bodies. It is best to reduce your exposure to these by choosing glass containers, glass bottles, and BPA-free bottles and foods. It is also important to choose hormone-free meats when possible.
Here’s the deal: there’s no one “right” way and there’s no magical diet, nor is there any “super pill” that will magically make your PCOS disappear. What’s more frustrating is when your doctor tells you to “lose weight” without considering all of the physical, emotional, and logistical issues that go along with PCOS. When you are embarking on this journey, sustainability and customization are important. Some studies have found certain diets to be effective — such as the ketogenic diet or low-carb diet — but your end goal should always be sustainability. Each person’s body is different, and what helps one person may not help the other.
I sometimes have patients who come to me after a month or two of making lifestyle changes, complaining that they have seen no changes in their symptoms, and other times I see patients who, after a few months of resistance training and tweaks in their diet, now have regular periods. Each individual’s journey is going to be different. Patience is key. It will take approximately nine to 12 months for lifestyle changes to make a difference in your symptoms, but it is best to consult with your doctor to ensure you have a holistic approach to managing your life with PCOS.