10 things you want people to know about PCOS

Article by Gynaecologist Dr Nitu Bajekal and Nutritionist Rohini Bajekal.

Polycystic Ovary Syndrome (PCOS) affects at least 1 in 10 women of reproductive age and those assigned female at birth.

It almost certainly affects someone you know and care for. Despite this, most people have never heard of this common condition. Here are 10 things to know about PCOS:

1. PCOS is the most common hormonal or endocrine disorder with reproductive, metabolic, and psychological consequences. Depending on how hard one looks for the condition, up to 3 in 4 (75%) of those with PCOS remain undiagnosed. Think of PCOS as a close cousin of Type 2 diabetes.

2. To diagnose Polycystic Ovary Syndrome in adults, any two out of three of the criteria below have to be met (Rotterdam criteria).

• Ovulatory dysfunction (Oligo or anovulation: not producing eggs on a regular basis)
• Clinical or biochemical (lab) evidence of hyperandrogenism (Androgen excess)
• Polycystic ovarian morphology in one or both ovaries on pelvic ultrasound scan

3. The main driver of PCOS in the majority of people is insulin resistance with diet and lifestyle playing a pivotal role in women who are predisposed to developing the condition.

4. Infrequent periods or missed periods are the most common sign of PCOS (oligomenorrhoea/amenorrhoea) because of anovulation with excess facial/body hair (hirsutism), acne (often adult and/or cystic) and scalp hair loss (alopecia) being the signs of excess androgens (testosterone).

5. Other signs include unwanted weight gain (8 out of 10), insulin resistance, binge eating disorders, sleep disturbances (sleep apnoea, snoring), Acanthosis nigricans (darkened skin: behind the neck, underarms, groin), depression and anxiety.

6. PCOS is the most common cause of infertility because of a failure to release eggs regularly (anovulation) but most women will go on to get pregnant, with lifestyle changes and fertility treatment.

7. 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 including insulin resistance, both in the short term and longer term. Lifestyle modifications can tackle the underlying insulin resistance. All national and international guidelines recommend lifestyle and behavioural changes to be the first line of management for PCOS, even before medications and supplements which may have a role to play in individual cases.

8. Here are the six core pillars that everyone should follow if they have PCOS.

• Nutrition: Eating a fibre rich plant-based diet helps promote healthy gut bacteria and helps to reduce inflammation and oxidative stress, and normalises blood sugars, and lowers insulin resistance. Given the commonality of PCOS among those with type 2 diabetes, and the higher risk of long-term consequences such as gestational diabetes, Type 2 diabetes, metabolic syndrome, increased cardiovascular risk factors, and womb cancer, 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.
• Exercise: 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 a day) and try and exercise outdoors in natural light. However, any physical movement is good.
• Sleep and mood: Ensure a regular sleep routine with seven to nine hours of restorative sleep.
• Stress management: Consider exercise, meditation, mindfulness, community work, psychotherapy or yoga to help manage stress and lower cortisol levels which makes insulin resistance worse.
• Positive social connections: Build a community (online or offline), 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 risky substances such as tobacco and alcohol: Avoid risky substances such as drugs and tobacco and limit alcohol (people with PCOS are at higher risk of non-alcoholic fatty liver disease).

9. Consuming minimally processed soya regularly (edamame and mature soya beans, soya milk, tofu and tempeh) has been consistently shown to help with the symptoms of PCOS including weight loss and reduction in waist circumference. 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.

10. PCOS can be managed successfully with women living a full and happy life with the help of lifestyle changes with or without medication. Self-care is very important to be able to get control of your PCOS.