Polycystic ovarian syndrome (PCOS) sadly is all too common in modern day life, with recent estimates placing as many as 5-15% of all women affected at some point during reproductive age. 

It is a complex syndrome characterised by irregular periods, or no periods at all, and the production of excess androgens which can, but not always, lead to polycystic ovaries. 

Other common symptoms of PCOS include:

• difficulty getting pregnant (because of irregular ovulation or failure to ovulate)
• excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks
• weight gain
• thinning hair and hair loss from the head
• oily skin or acne

The cysts (clinically referred to as follicles) themselves are harmless fluid filled sacs containing the egg that fail to discharge for fertilisation. However, that failure to discharge can kickstart a domino-like set of hormonal and biological changes that can severely impact a woman’s quality of life.

“While the exact cause of PCOS is unclear, insulin resistance plays a central role”

Diagnosis as well as treatment can be a daunting prospect and typically requires testing to assess a number of biomarkers, such as:

• Sex hormone binding globlin (SHBG) which may be decreased
• Thyroid markers to rule out any thyroid dysfunction 
• Lutinizing hormone (LH) which can display as elevated
• Follicle stimulating hormone (FSH) measured as a ratio to lutinizing hormone
• Oestrodiol and oestrone can be normal to low
• Testosterone and other androgens, which can be raised
• Prolactin which can also be raised
• Blood glucose markers to isolate the presence of insulin resistance

Depending on the results, an ultrasound and referral to a specialist may be required. 

While the exact cause of PCOS is unclear, insulin resistance plays a central role. 80% of women with PCOS suffer with hyperinsulinemia – in other words, elevated levels of insulin circulating throughout the body. 

So how and why would elevated levels of insulin, a hormone central to blood sugar regulation, exert such a marked impact on sex hormone imbalance and ovarian function?

“PCOS is a complex hormonal disorder that requires a holistic approach for its management”

The excess of insulin causes cells within the ovaries (theca cells) to essentially amplify the production of androgens, namely; testosterone and DHEA amongst others. Just as men produce a small amount of female sex hormones for a number of beneficial reasons, women also produce androgens in small amounts. It’s when this fine balance becomes imbalanced that it disrupts the menstrual cycle leading to many of the aforementioned symptoms. 

PCOS is a complex hormonal disorder that can benefit from an integrative approach for its management.

Therapeutically, lifestyle interventions (e.g. diet and exercise) have shown to positively impact those suffering with PCOS. Mild weight loss of 5 – 10% (or as little as 2 – 3kgs) is considered significant enough to improve metabolic, reproductive and psychological symptoms. 

A low carbohydrate diet has shown very high efficacy in PCOS patients by reducing body mass index, increasing follicle stimulating hormone, sex hormone bindng globlin and reducing testosterone. A low carbohydrate diet is proven to lower insulin levels, improve insulin resistance and support a wide variety of disorders. 

Specifically, the Mediterranean Diet can support a notable reduction in inflammatory biomarkers such as CRP (c-reactive protein) and IL-6 (interleukin-6). By lowering systemic inflammation, it is possible to beneficially regulate ovulation.

“Exercise and its influence on PCOS support should not be under-estimated”

For most, alcohol consumption does nothing to help the overall symptom picture. Alcohol inhibits our ability to use fat as fuel, adding to the increased fat accumulation and weight gain experienced by many with PCOS. It also dysregulates blood sugar balance and exacerbates the hyperinsulinemia present in those diagnosed with PCOS.

Often, PCOS needs to be approached from multiple angles, so engaging with an acupuncturist can have a profound impact in long-term management. In fact, the latest research indicates that acupuncture can promote the recovery of the menstrual cycle as well as down regulate the levels of lutinizing hormone and testosterone in trials.

Exercise and its influence on PCOS support should not be underestimated, however the research is, by and large, contradictory. What is relatively clear is that intensity vs dose is important, with vigorously intense exercise having the most favourable outcomes for those with PCOS. What’s “vigorous” you ask? According to the International Physical Activity Questionnaire Short Form, it includes: “activities that take hard physical effort and make you breathe much harder than normal” e.g. heavy lifting, digging, aerobics, and fast bicycling are cited as examples. On dose, the jury is out, but the general ballpark is 120 – 150 minutes spread evenly throughout the week. 

If you are looking for an indispensable resource relating to almost everything associated with women’s health, the book Women’s Bodies, Women’s Wisdom is a must for anyone wanting to connect more deeply with their physical as well as emotional health. 

Should you be experiencing any of the symptoms listed above or suspect that you may be suffering with PCOS, speak to your GP or other qualified healthcare practitioner. 

References

Frydenberg, H. Flote, V. Larsson, I. et al (2015) ‘Alcohol consumption, endogenous estrogen and mammographic density among premenopausal women’ Breast Cancer Research, 17 (1), pp 103

Gaskins, A. Mumford, S. Zhang, C, et al. (2009) ‘BioCycle Study Group. Effect of daily fiber intake on reproductive function: the BioCycle Study’ American Journal of Clinical Nutrition, 90 (4), pp. 1061-9

Greenwood, E. Noel, M. Kao, C. et al. (2016) ‘Vigorous exercise is associated with superior metabolic profiles in polycystic ovary syndrome independent of total exercise expenditure’ Fertility and Sterility, 105 (2), pp. 486–493

Hodges, R. & Minich, D. (2015) ‘Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application’ Journal of Nutrition & Metabolism. Unknown

Morenga, L, Docherty, P. Williams, S, et al. (2017) ‘The Effect of a Diet Moderately High in Protein and Fiber on Insulin Sensitivity Measured Using the Dynamic Insulin Sensitivity and Secretion Test (DISST)’ Nutrients, 9 (12), pp. 1291

NICE UK (2018). Polycystic ovarian syndrome: what investigations should I arrange? [Online]. Available at: https://cks.nice.org.uk/topics/polycystic-ovary-syndrome/diagnosis/investigations/ 

Nordio, M. Basciani, S. & Camajani, E. ‘The 40:1 myo-inositol/D-chiro-inositol plasma ratio is able to restore ovulation in PCOS patients: comparison with other ratios’ European Review for Medical and Pharmacological Sciences, 23 (12), pp. 5512-5521

Patel, S. (2019) ‘Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy’ Journal of Steroid Biochemistry and Molecular Biology, 182, pp. 27-36

Patten, R. Boyle, R. Moholdt, T. et al. (2020) ‘Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis’ Frontiers in Physiology, 11, pg. 606

Silvestris,E. Lovero,D. & Palmirotta, R. (2019) ‘Nutrition and Female Fertility: An Interdependent Correlation’ Frontiers in Endocrinology, 10, pg.346   

Richards, C. Meah, V. James, P. et al. (2021) ‘HIIT’ing or MISS’ing the Optimal Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of High- Versus Moderate-Intensity Exercise Prescription’ Frontiers in Physiology, 12.

Sirmans, S. & Pate, K. (2013) ‘Epidemiology, diagnosis, and management of polycystic ovary syndrome’ Clinical Epidemiology, 18 (6), pp. 1-13

Stepto, N. Patten, R. Tassone, E. et al. (2019) ’Exercise Recommendations for Women with Polycystic Ovary Syndrome: Is the Evidence Enough?’ Sports Medicine, 49, pp. 1143–1157 

Wu, J. Chen, D. & Liu, N. (2020) ‘Effectiveness of acupuncture in polycystic ovary syndrome’ Medicine, (99) 22

Zhang, X. Zheng, Y. Guo, Y. et al. (2019) ‘The Effect of Low Carbohydrate Diet on Polycystic Ovary Syndrome: A Meta-Analysis of Randomized Controlled Trials’ International Journal of Endocrinology, Unknown

DISCLAIMER: The information provided on this website is for informational purposes only and should not be used for diagnosis. It is not intended as a substitute for advice from your GP or other qualified health practitioner.

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