Polycystic ovarian syndrome is considered to be the most common endocrine disorder in women. In most cases, women with this condition have excess male hormones called androgens and irregularity in the menstrual cycle. Other symptoms include acne and excess of body and facial hair. One of the biggest challenges for women with this condition is a difficulty in getting pregnant. Women with diagnosed polycystic ovary syndrome are also at higher risk of other conditions, such as type 2 diabetes and cardiovascular diseases.
The main cause or why is this condition so highly prevalent among women is still unknown. Although the genes responsible for PCOS have not been identified, a genetic susceptibility to this disorder has been strongly supported. Lifestyle factors, such as high-caloric diets and reduced exercise, also play a major role in the occurrence of PCOS.
PCOS medical treatment depends on patient individual needs. For example, if a woman wants to get pregnant, then the treatment would focus on medication that would help the patient to conceive. On the other side, women who do not want to get pregnant will take birth control pills as a treatment for PCOS. The medication metformin is often used in PCOS treatment as it lowers insulin levels and it is also used in the treatment of diabetes. For other POCS symptoms, a different set of medicines will be used.
But the good news is PCOS is one of the conditions that can be very good managed with the change in a diet and exercise habits. It has been estimated at 40–80% of women with PCOS are overweight or obese. Women who have PCOS are also less sensitive to insulin (the body has difficulty to use this hormone in order to convert glucose to energy) and this causes high blood sugar levels. This imbalance causes an increase in the production of male hormones-androgens. High androgen levels are responsible for excess hair growth, irregular periods, skin problems and weight gain. So a proper diet and exercise can improve insulin sensitivity and reduce a risk of diabetes, heart disease, and other PCOS complications.
Although many women find hard to lose weight, especially if they suffer from the hormonal disorder, studies have confirmed that exercise and a healthy diet can improve fertility in women with PCOS.
Because of the risk of type 2 diabetes and insulin resistance, the most recommended diet for women who are diagnosed with PCOS is a low-glycemic index diet. The glycemic index is a rating system that helps us realize how slowly or how quickly foods cause increases in blood glucose levels. Low-glycemic foods (like wholegrain foods, vegetable, pulses, etc.) tend to release glucose slowly and steadily and by that keep the blood glucose levels stable. Foods high on the glycemic index (like white bread, sugar, and sugary foods) are broken down quickly by the body and cause a rapid increase in blood glucose.
However, not all foods with a low GI are necessarily considered healthy, for example, potato chips. Chips have a lower glycemic index then boiled potato because as fat slows digestion it tends to lower the glycemic index value of the food. On the other side, foods like watermelons and carrots have a high GI index and according to this system should be avoided. Therefore, relying on GI alone is not the completely reliable way if you want to lose weight. Because of this fact many nutritionists advice to rather be careful about the amount of carbohydrate we eat, than its GI rating, because both the amount and type of carbohydrate we choose to eat affects blood glucose levels.
Some experts advise following a low-carb-high-protein diet in order to lose weight and ease the symptoms of PCOS. Many studies have shown that low-carb diets have great potential when people want to lose weight. But following this type of diet for a longer period of time can lead to some health issues. More on this topic you can find in my previous blog “Low-Carbohydrates Diets”.
It doesn’t matter what kind of diet is chosen, according to studies, losing between 5% and 10% of body weight is often enough to ease the symptoms of PCOS.
Several studies have found that women with PCOS are more likely to have elevated levels of inflammatory markers in the blood compared to women without the condition. This means that the PCOS is associated with some kind of inflammation in the body. So it is also recommended to follow a Mediterranean style anti-inflammatory diet which is based primarily on plant-based foods, such as fruits and vegetables, whole grains, fish, legumes, and nuts. A study from 2015 showed following an anti-inflammatory diet can cause a moderate weight loss, significant improvements in body composition, hormones and menstrual cycle regularity in women with PCOS.
What about exercise? Should you exercise if you suffer from PCOS? Until now the exercise intervention studies in women with PCOS have generally been small. But although the number of studies is small, the results from studies showed regular, moderate-intensity aerobic exercise over a short period improves menstrual cycle regulation in addition to regulation of insulin resistance and weight loss in young, overweight women with PCOS. Those improvements were not dependant on the frequency, type of exercise or length of exercise sessions. But general recommendation is to engage in at least 90 min of aerobic activity per week at moderate intensity (60–70% VO2 max) to achieve these improvements.
Besides diet and lifestyle changes, the natural remedies/food supplements can also be very helpful as they might elevate the symptoms. Here is the list of some of the common natural remedies used to treat or reduce the symptoms of PCOS. If you take medicines, please consult with your doctor before using any of these supplements.
In the past, vitamin D was a concern because of its impact on calcium absorption and bone integrity. But recently, there is a lot of talk about the importance of vitamin D in overall health. Results of several studies did prove many women with PCOS are vitamin D deficient. The studies indicated that this low level of vitamin D in serum is related to a greater risk of diabetes and heart disease and other PCOS complications (because vitamin D plays important role in the regulation of insulin secretion, but it is also important for cell growth, immune system, and reduction of inflammation). And although the role of vitamin D in PCOS is still not completely understood, vitamin D supplementation might help with weight loss, menstrual regularity, and fertility.
Inositol is a vitamin-like substance that is also produced in the human body and is also found in many plants and animals. Inositol can be found in many forms (altogether 9 isomers of inositol are known) and the most common forms are myo-inositol and D-chiro-inositol. In our bodies, inositol is involved in cellular signaling and it is a component of cell membranes. It is known to increase the impact of neurotransmitters in the brain and that is why it may in some people cause some mood-boosting effect. In addition, it increases insulin sensitivity. Because of these properties, inositol is often recommended in PCOS treatment. A review from 2016 of 12 randomized, controlled trials found that inositol “is capable of restoring spontaneous ovulation and improving fertility in women with PCOS”. In addition, inositol is, according to available data, a fairly safe supplement. The side effects are associated with only very large doses and include gastrointestinal problems, headache, tiredness, and dizziness.
N-acetyl cysteine is a precursor of amino acid L-cysteine. N-acetyl cysteine (or simply NAC) is powerful antioxidant: it acts as a scavenger of free radicals, especially oxygen radicals. NAC is also a powerful mucolytic (breaks up mucus) and insulin regulator. It has many uses as medicine in the treatment of different disorders such as COPD, bronchitis, some forms of epilepsy, ear infections, etc. This supplement is often compared to medicine metformin (the medicine often prescribed for POCS) as it has demonstrated similar benefit in the management of PCOS. NAC supplementation improves ovulation and fertility in women with PCOS. However, NAC is not associated with better benefits then metformin for improving ovulation rates and menstrual regularity.
Fish oil is known to be rich in the beneficial omega-3 fatty acids. Two of the most important omega-3 fatty acids contained in fish oil are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), precursors of certain molecules in our bodies (eicosanoids) that are known to reduce inflammation in the body. Fish oil is often used by people as the supplement to lower blood pressure, triglycerides and cholesterol levels and to reduce the likelihood of heart attack and stroke. Studies on the use of omega-3 polyunsaturated fatty acids (fish oil) in PCOS found that supplementing with fish oil significantly lower testosterone levels and improve menstrual regularity in women with PCOS.
The medicine metformin is very often prescribed to women who are diagnosed with POCS. This medicine is also prescribed for diabetes type 2 patients. Studies performed with diabetes patients provided evidence that metformin is associated with vitamin B12 deficiency and anemia. Vitamin B12, also called cobalamin, plays important role in the normal functioning of the nervous system and in the maturation of developing red blood cells in the bone marrow. Metformin users with B12 deficiency also can develop a peripheral neuropathy, a common form of nerve damage. Researchers still haven’t found why exactly this B12 deficiency occurs in people who take metformin, but they recommend B12 supplementation and regular check for B12 deficiency.
Many women tend to use herbal medicines and supplements in addition to conventional pharmaceutical management to improve quality of life and to deal with some health issues. The list of herbs and natural remedies that are suggested for PCOS treatment is long. The most common herbs for PCOS treatment are Vitex agnus-castus tree (it is believed to have a normalizing effect on the menstrual cycle and has been used successfully to treat absence of menstruation), Saw palmetto (the plant is mostly used to treat hirsutism by decreasing the rate of secretion of testosterone), Maca root (stimulates the hypothalamus to activate pituitary gland for hormonal regulation) or Tribulus terrestris (this herb is used for regulation of ovulation).
A systematic review from 2017 found “there is no high-quality evidence to support the effectiveness of nutritional supplements and herbal medicine for PCOS symptoms and evidence of safety and is lacking”. However, you will find many women who can witness the traditional medicines or herbs have helped them with their PCOS problems and symptoms. But we should all be careful, as most herbs and supplements have not been thoroughly tested for interactions with other herbs, medicines or food supplements. So if you would like to try the effects of the herbal remedies, speak with a qualified healthcare provider before starting a new therapy.