September is PCOS Awareness month, and I couldn’t let the month go by without taking a moment to recognize this very common diagnosis that so many women live with.
What is PCOS?
Polycystic ovary syndrome is a genetic, hormone, metabolic, and reproductive disorder that affects up to 15% of women in the U.S. It is one of the most common endocrine or hormonal disorders and cause of infertility among women of childbearing age. Common symptoms include missed or irregular periods, unwanted hair growth, acne, mood changes, sleep problems, weight gain and difficulty losing weight, and fatigue.
For a disorder that impacts so many women research on it is grossly under-funded, therefore it remains poorly understood and under-diagnosed. One statistic from the National Polycystic Ovary Syndrome Association states that in addition to the 1 in 10 women with the diagnosis, “a staggering 50% of the women living with PCOS are going undiagnosed.”
How is PCOS diagnosed?
PCOS is diagnosed based on two of the following three criteria:
1. Presence of ovarian cysts – Some women with PCOS may have fluid-filled sacs called cysts on the ovaries, found by ultrasound.
2. High levels of androgens – Blood tests can be done to measure androgens and other reproductive hormonal levels, diagnosis can also be made based on symptoms of excess androgens, such as facial hair and hormonal acne.
3. Irregular periods – If you’re experiencing missed periods or irregular periods this could indicate PCOS, but your doctor will also want to first rule out any other causes.
What PCOS Is NOT
Simply put, PCOS is not your fault. If you know someone with this diagnosis, please pass this message along. I have had many conversations with clients who feel a lot of blame and shame around their diagnosis of PCOS and harbor a belief that somehow, they caused the disorder. Those with PCOS often feel like if they had just eaten better, moved more, or take care of their body better they could have avoided the issues and symptoms related to their PCOS.
This is especially true because PCOS often impacts women’s weight and can lead to weight gain. The advice many women with PCOS are given is to “just lose weight.” The common rhetoric is that weight gain somehow causes PCOS, and that weight loss can get rid of the disorder and its symptoms. This just simply isn’t the case. Not only is this advice not helpful, it can be harmful and send women down paths of trying to lose weight through unsustainable and miserable methods that in the long run don’t work and wreak havoc on the body in the process.
Although the exact cause isn’t known, genetics – something completely out of our control – likely plays a significant role. Weight gain, if it occurs, is caused by the disruptions in the body’s systems involved with PCOS, not the other way around.
If you are someone with PCOS please know you didn’t to this to yourself and your body is not broken. You have a condition that, while often frustrating and not ideal, is treatable and manageable. There are many ways to manage and improve symptoms and help you feel better in your body.
How to Care for Yourself with PCOS
The best treatment for PCOS is one that is multifactorial and involves lifestyle modifications, psychological treatment, supplements, and medications. All of these different factors when addressed properly can give relief to symptoms and make living with PCOS more manageable. PCOS is a complex disorder and impacts each individual differently. In this post I will focus on lifestyle modifications.
The root cause of issues and symptoms related to PCOS are often related to insulin resistance and chronic inflammation. Lifestyle changes that are geared towards both balancing insulin levels and blood sugars and decreasing inflammation in the body can be extremely helpful as part of the treatment for managing symptoms. If you have PCOS (or even if you don’t) and want to hear advice outside of “just lose weight”, the following tips around food and nutrition are for you.
Eat consistently and balanced.
For so many of the clients I see, whether they have PCOS or not, eating consistently and in a balanced way is one of the main things we work on. Because insulin resistance is often a major factor with PCOS this one is particularly important. With insulin resistance, cells become less responsive to insulin doing it’s main job, which is to allow glucose from the bloodstream and into the cells to be used for energy.
Many people with PCOS turn to low carb diets to manage blood sugars and to lose weight. Between the low carb diets and the cells not getting the energy they need due to the insulin resistance this results in our bodies clamoring for glucose in the form of cravings and often an out of control feeling with carbs. Instead of low carb, the answer is consistent carbs. This means meals and snacks that are at regular intervals, about 3-4 hours apart. Balancing those carbs along with some protein and fat can also help to stabilize blood sugars and insulin levels, in addition to making meals and snacks more satisfying and long lasting. Some balanced meal examples include:
- Oatmeal with a handful of walnuts
- Avocado toast with an egg
- A mixed green and veggie salad with grilled salmon and avocado
- One-pan meal with roasted veggies, sweet potatoes, and sausage (look for this one in a future blog post!)
Choose High Fiber Carbs Often
When we are dealing with out of whack lab values or a chronic condition like PCOS it can be really tempting to take the extreme approach – like keto or low carb. Unfortunately, these diets aren’t sustainable or healthy long-term for most people.
Switching up carbs to higher fiber sources – like whole grains, fruit, starchy vegetables, beans, and peas – more often can be a better, more beneficial, and sustainable approach than cutting them out all together. Carbs provide our body with a much-needed energy source. The higher fiber carbs are broken down and therefore enter the bloodstream more slowly which is helpful with insulin resistance. Think of it as allowing for glucose to trickle in over a longer period of time versus opening up the flood gates all at once, which makes it easier for insulin to do its job and your body to more efficiently use that source of energy.
This doesn’t mean you can never again have white pasta or a roll, or whatever you might eat that isn’t whole wheat or complex. Instead, it is about exploring in a more moderate and doable way what it would look like to include more complex, high fiber carbs when you can and in ways that you enjoy. A great example of this is recently I recommended Dave’s Killer Bread – one I recommend often and my favorite yummy whole grain bread – to a client, and she got it and is loving it.
Eat More Omega-3 Fats
Foods high in omega-3 fats can be helpful in reducing inflammation in the body. So often when we want to make changes in how we eat we come at it from a restrictive, “what do I need to take out or not have” approach. This feeling of restriction doesn’t feel good and often doesn’t last. Instead, when we can think about it in terms of what can I add in, this feels much better psychologically and as a result is more sustainable.
Omega-3s are found in fish like salmon, tuna, mackerel, herring, trout, and sardines and can also be found in grass-fed beef, red lentils, navy beans, fortified eggs, walnuts, chia/hemp/or flax seeds, spinach, and winter squash. Which one of these do you like? How could you include it more?
Take Charge of Your PCOS and Your Health
The above recommendations are focused on food, and while yes nutrition is important, it is definitely not the only factor that can impact our health and the symptoms of PCOS. Finding ways to move your body that you enjoy, getting good quantity and quality sleep, and learning how to manage and cope with stress and emotions are all really important factors in reducing inflammation and stabilizing blood sugars too.
There are many things you can do to take charge of your health with PCOS and hopefully this post empowers you and helps you understand that more fully. Making changes in your habits in order to better support your health doesn’t have to be confusing or stressful. If you need someone to walk alongside you in your PCOS diagnosis I would love to help.