One in 10 women live with PCOS, but very few of us know much about the condition. Here, two hormonal experts set the record straight on everything from fertility to food.
If you’ve ever had period problems, one of the first things your GP might suggest is getting checked for polycystic ovary syndrome (PCOS). While that can sound alarming (‘cysts’ and ‘ovaries’ are two words we don’t want to hear in the same sentence), it’s actually one of the most common issues affecting women of reproductive age – and it’s a condition that’s controlled largely by lifestyle tweaks.
One in 10 of us are living with PCOS, whether we know it or not. In fact, some experts believing that it may be doubly as common as official figures suggest. As a syndrome, PCOS is actually a collection of symptoms rather than an ‘illness’ per se, and many of them can be reduced by dealing with issues such as stress.
As with so much of women’s health, there’s a ton of misinformation out there on PCOS, with hundreds of blogs claiming huge diet overhauls are the way forward. That’s why consultant obstetrician and gynaecologist Dr Nitu Bajekal, and nutritionist Rohini Bajekal are busy putting the record straight on what exactly PCOS is and how to treat it. They claim that many people haven’t even heard of PCOS – let alone know how to deal with its symptoms. With that in mind, these are the nine things they want everyone to know about the syndrome.
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9 things everyone should know about PCOS
It’s incredibly common and most women living with PCOS haven’t been diagnosed
PCOS is the most common hormonal or endocrine disorder in women, with reproductive, metabolic and psychological consequences. It’s a complex condition with many potential symptoms, meaning up to three in four (75%) of those with PCOS remain undiagnosed.
You need to have 2 out of 3 symptoms to be diagnosed
To diagnose PCOS in adults, any two out of three of the criteria below have to be met (which is also known as the ‘Rotterdam criteria’):
- Ovulatory dysfunction (not producing eggs on a regular basis, which results in missed or irregular periods)
- Clinical or biochemical (lab) evidence of hyperandrogenism (think: acne or darker, thicker body hair)
- Evidence of cysts on one or both ovaries, as shown during a pelvic ultrasound scan
It (largely) comes down to insulin
The main driver of PCOS in the majority of people is insulin resistance. Insulin is a hormone produced by the pancreas that works to control blood sugar levels. If you become resistant to insulin, the body has to create more to compensate. That increase then causes the ovaries to produce too much testosterone in women with PCOS, which affects ovulation.
So if your PCOS is caused by insulin, the key is to work out how to make your body more sensitive to the hormone – and that’s best done via diet and lifestyle (particularly stress relief).
Missing periods are the most common symptom
Infrequent or missed periods are the most common sign of PCOS (also known as oligomenorrhea and amenorrhea respectively). That’s caused by anovulation – not producing or releasing that monthly egg. Then you’ve got excess facial/body hair (hirsutism), acne (often adult and/or cystic) and scalp hair loss (alopecia), which are all common signs of excess androgens like testosterone.
Symptoms can be physical and mental
Other signs include unintentional weight gain, insulin resistance, binge-eating disorders, sleep disturbances (like sleep apnoea and snoring), acanthosis nigricans (darkened skin: behind the neck, underarms, groin), depression and anxiety.
It’s a common cause of infertility but doesn’t make you infertile
PCOS is the most common cause of infertility because of the whole anovulation situation. If you’re not releasing an egg, it can’t get fertilised. But most women with PCOS do go on to get pregnant, whether that’s by making lifestyle tweaks or having fertility treatment.
There’s no cure but you can massively reduce symptoms
PCOS is a chronic condition, so while there is no ‘cure’, making positive lifestyle changes can go a very long way in managing PCOS and its symptoms, both in the short term and longer term. That’s why all national and international guidelines recommend lifestyle and behavioural changes to be the first line of management for PCOS before medications and supplements are prescribed.
Eating more soy can help
Consuming minimally processed soya regularly (edamame and mature soya beans, soya milk, tofu and tempeh) has been shown to help with the symptoms of PCOS. One study, published in the Journal of Clinical Endocrinology and Metabolism, found that after being fed soy isoflavone for 12 weeks, women with PCOS “significantly improved” markers of insulin resistance and biomarkers of oxidative stress.
Soya helps to counteract hormone disruption and improve many of the metabolic markers (insulin responses, insulin resistance, blood sugar levels and triglycerides) seen in the condition.
Self-care is key
PCOS can be managed successfully and women with the condition can live full and happy lives by making changes to their lifestyle, with or without medication. Self-care is very important to be able to take control of your PCOS.
6 core pillars everyone with PCOS should live by
Eating a fibre-rich plant-based diet promotes healthy gut bacteria and helps to reduce inflammation and oxidative stress. It also normalises blood sugars and lowers insulin resistance. People with PCOS should be advised to focus on a predominantly whole food, plant-based way of eating, including whole grains, beans, fruit, vegetables, nuts and seeds, herbs and spices. These foods are full of fibre and micronutrients that are nourishing and absorbed slowly, keeping blood sugars normal.
Regular movement in a form that you enjoy is key. Aerobic exercise and resistance training including high intensity interval training (HIIT) are all recommended to help improve insulin sensitivity in women with PCOS. Aim for 300 minutes of exercise per week (approximately one hour every weekday) and try to exercise outdoors in natural light. Can’t manage that much? Don’t stress – any amount of movement is beneficial.
Sleep and mood
Try to maintain a regular sleep routine with seven to nine hours of restorative sleep.
Exercise, meditation, mindfulness, community work, psychotherapy and/or yoga can all help to manage stress and lower cortisol levels (high levels of which makes insulin resistance worse).
Positive social connections
Build a community (online or offline) and ensure you have a support network or a friend you can trust. Loneliness is a source of chronic stress and is associated with increased risk of heart disease, high blood pressure and type 2 diabetes.
Avoid or limit tobacco and alcohol
People with PCOS are at higher risk of non-alcoholic fatty liver disease, so it’s important to drink in moderation and to avoid smoking if possible.
For more help and support, check out the Verity PCOS Charity.
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