PCOS (Polycystic Ovary Syndrome) is a commonly misunderstood condition that impacts millions of women. PCOS Awareness Month is an opportunity to build understanding and awareness around what is a complex medical condition. If you or someone you know and love has PCOS, read on to learn what PCOS is, what causes it, what the symptoms are, how it is diagnosed. Plus, some suggestions on lifestyle habits to help manage symptoms.
- 1 in 10 women of childbearing age are affected by PCOS (according to the Office of Women's Health of Health and Human Services)
- PCOS is one of the most common causes of female infertility, affecting 6% to 12% (as many as 5 million) of US women of reproductive age (according to the CDC).
- 50 to 75 percent of people with PCOS don’t know they have it (according to a November 2018 paper in the ‹International Journal of Environmental Research and Public Health‹).
What is PCOS?
PCOS is a condition in women caused by an imbalance of hormones. It is both a hormonal and reproductive disorder characterized by high levels of androgens (male sex hormones that females also have) and problems with ovulation and insulin resistance.
A big part of PCOS and its symptoms is insulin resistance. Insulin is a growth hormone that we all need to survive. Insulin is responsible for transporting glucose (a breakdown product of carbohydrates and our body's main source of fuel) from our blood into our cells so that it can be used for energy. Imagine it this way, there are locked doors on our cell walls, and the only way for glucose to leave the bloodstream to be used as energy is by opening those locked doors.
Insulin acts as the key to open those doors. With insulin resistance, a common occurrence with PCOS, the key (insulin) doesn't fit well or work properly to open the cell door walls. To compensate, your body produces more insulin ultimately leading to too much insulin along with higher levels of glucose in the bloodstream neither of which are able to be used properly.
To give you an example of how this process works, when you eat an apple (or any carbohydrate food), your body breaks it down into glucose that enters your bloodstream. In response, insulin is released from the pancreas which when working normally unlocks the cells and carries the glucose in to be used for energy. With insulin resistance this normal processing of insulin and glucose is disrupted.
Insulin resistance can then lead to imbalances in reproductive hormones. When insulin levels become elevated in women with PCOS, the ovaries are stimulated to produce more androgens (male sex hormones). All women have androgens, just like all men have estrogen. This imbalance in hormones can cause disruptions in the menstrual cycle and ovulation.
What Causes PCOS?
The exact cause of PCOS is unknown, but if you are one of the 1 out of 10 women with this condition, the most important thing to understand is that you are not to blame and nothing you did caused you to have PCOS. There are many theories as to what causes the condition, with genetics playing a role.
Symptoms of PCOS
Some of the symptoms of PCOS include:
- Irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Some women with PCOS stop having menstrual periods.
- Excessive hair on the face, chin, or parts of the body where men usually have hair.
- Acne on the face, chest, and upper back
- Thinning hair or hair loss on the scalp; male-pattern baldness
- Weight gain or difficulty losing weight
- Darkening of skin, particularly along neck creases, in the groin, and underneath breasts
- Skin tags, which are small excess flaps of skin in the armpits or neck area
How is PCOS Diagnosed?
Diagnosis of PCOS is based on whether someone has two of the following three criteria with exclusion of other possible conditions:
- Irregular periods (fewer than eight menstrual cycles per year) or no periods.
- Blood tests or physical signs that indicate high androgens (elevated testosterone, excessive hair growth, balding, acne)
- The presence of tiny fluid-filled follicles surrounding the ovary – ovarian cysts – found on ultrasound (not all women with PCOS have ovarian cysts)
Weight and PCOS
A common refrain heard by many women who are dealing with PCOS is to just lose weight. While in the short term, weight loss may temporarily relieve some symptoms, in the long run, purposeful weight loss does more damage. Many women with PCOS describe it being “impossible” to lose weight, not for lack of trying, but because of biology. With PCOS, slower metabolism paired with high insulin levels causes the body to store more fat. On top of that, carb cravings caused by insulin resistance can make it more difficult for someone with PCOS to stick to a diet. Because often, mistakenly, weight is viewed as the cause and weight loss as the cure women with PCOS often go on essentially starvation level diets for a significant length of time to end up barely losing any weight and ultimately feeling more frustrated.
Women with PCOS are six times more likely to develop an eating disorder, and dieting is a common trigger for eating disorders, with binge eating disorder being especially common. High levels of insulin and insulin resistance both lead to intense carbohydrate cravings. Dieting, especially the low carb diets commonly recommended for PCOS, further contribute. Paired with anxiety, depression, and the stress of living with PCOS, it only makes sense that binge eating and feeling out of control with food could result.
Ultimately, PCOS is not caused by weight gain or being at a higher weight, so weight loss isn’t the cure. There are plenty of thin women who have PCOS. Doesn't it make sense that all women, regardless of weight, shape, or size should be given similar advice and/or medications for PCOS management (or any condition for that matter)? There are many things you can do to manage and live with PCOS without just losing weight.
Three Ways to Manage PCOS
While medications and specific supplements can also be helpful, nutrition and lifestyle changes can be an immensely important part of PCOS symptom management. The main goal with managing PCOS is to decrease inflammation and keep blood sugars steady. Women with PCOS have been shown to have higher levels of inflammatory markers and persistent and chronic low-grade inflammation associated with high insulin levels, an imbalance in gut bacteria, not getting enough good quality sleep, and living a high stress life.
When we hear the word inflammation most people's minds automatically go to restrictive type anti-inflammatory diets and what they need to avoid or cut out. Lowering inflammation is a big part of treating PCOS and while including anti-inflammatory foods and focusing on nutrition is part of the equation, there are also many other lifestyle changes we can make that are effective in both lowering inflammation and keeping blood sugars in check.
Here are a few nutrition and lifestyle strategies to implement to improve mental and physical health with a diagnosis of PCOS.
Eat Consistently and Enough
A common strategy to control PCOS and its symptoms and resulting weight gain is to restrict food and overall calories. Not eating enough backfires leaving all of us, but especially women with PCOS, feeling depleted, lacking energy, and experiencing intense and impossible to ignore cravings. Our bodies need adequate fuel and nutrients to function. Fat and protein support hormonal functions and consistent carbs at regular intervals throughout the day help to give us energy and help keep blood sugars steady.
Choose High Fiber Carbs
Instead of no carbs, choosing carbs high in fiber, like whole grains, beans, fruits, and starchy vegetables can also help to regulate and keep blood sugars steady. Carbs with fiber are broken down more slowly than carbs without fiber resulting in smaller amounts of glucose over a longer period. Making it easier for a body experiencing insulin resistance to manage and use that glucose or sugar in the blood. You don't have to NEVER have a white carb again or ONLY eat high fiber carbs, but some thought around switching it up and including them more can help with symptoms. Having some protein and fat along with your carbs can also help stabilize blood sugars too.
Get Enough Sleep and Manage Stress
Chronic stress and not getting enough sound restful sleep can both trigger the body's stress response and negatively impact our body's ability to regulate inflammation. Sleep deprivation and chronic stress also have hormonal consequences and can affect glucose metabolism and insulin levels. Sleep and stress are interrelated, with lack of sleep only making stress worse, and vice versa. If you are chronically sleep deprived and stressed to the max finding ways to cope and better manage sleep can go a long way in helping to manage PCOS. Practice good sleep hygiene by doing things like avoiding caffeine after about 2 pm, getting in bed about the same time each night, turning off the TV and iPhone an hour before bed, and keeping the temperature cool in your bedroom. Getting some movement in during the day, preferably outside in the sunshine, can also help with both stress and sleep.
Better understanding PCOS and knowing how best to treat and manage symptoms with a well-rounded approach can empower us to better care for ourselves and live healthier and happier lives. Want to learn more? An excellent resource full of practical information and one that I work through with clients, is The PCOS Workbook: Your Guide to Complete Physical & Emotional Health by Angela Grassi and Stephanie Mattei. The website PCOSnutrition.com is full of great information too.