Polycystic Ovary Syndrome (PCOS) is the most common female hormone condition and manifests differently in each woman.
PCOS can be incredibly devastating to a woman’s self esteem and quality of life.
Polycystic Ovary Syndrome is an endocrine disorder, whereby polycystic ovaries are one of several possible symptoms caused by an underlying hormone imbalance.
The term polycystic ovaries describes ovaries that contain many small ‘cysts’ (about twice as many as in normal ovaries), usually no bigger than 8 millimetres each, located just below the surface of the ovaries. The ‘cysts’ in polycystic ovaries are not true cysts. They are not full of liquid, they do not get bigger or burst, they do not require surgical removal and do not lead to ovarian cancer.
They are actually follicles that have not matured to be ovulated, hence the name of the condition is confusing.
It was originally thought that these follicular cysts caused the condition but we now know they are one of the symptoms and not everyone will get them.
Polycystic ovary syndrome (PCOS) is very common, originally thought to affect 1 in 10 women (10%) but has recently been found to be as many as 1 in 5 (20%).
Polycystic ovary syndrome (PCOS):
- affects millions of women in the UK and worldwide
- runs in families
- is one of the leading causes of fertility problems in women
- if not properly managed, can lead to additional health problems in later life
- can affect a woman’s appearance and self-esteem.
What causes PCOS
The exact cause of PCOS is unknown however there are a variety of different hormone imbalances that impact the severity and range of symptoms. At first it was thought to be caused by sex hormone imbalances, but we now know that the condition is caused by insulin resistance.
Insulin stimulates secretion of testosterone by the ovaries, and inhibits hepatic sex-hormone binding globulin (SHBG) production leading to increased circulating testosterone. Testosterone is often thought of as a ‘male hormone’, but this is not the case – it is just that men produce 10 times as much testosterone as women.
Women with PCOS usually have a testosterone measurement that is either slightly above the female range or at the upper end of the normal range for women. Testosterone is a normal and essential product of the ovary because most of it is converted, within the ovarian follicle, to oestrogen, which is the main female hormone.
Not to over-simplify, but PCOS is due to an imbalance in the relationship between our sex hormones, in this case testosterone and oestrogen, our stress hormones, especially cortisol (which loves to encourage weight gain around the middle of our bodies, as well as cause cravings for food high in fat and sugar as part of our stress response) and insulin (which is of course designed primarily to help us balance blood sugar, but is also a potent fat storage hormone).
Increased testosterone can cause influence some of the more physical symptoms of PCOS, such as acne, facial hair, and male-pattern hair loss in many women with PCOS.
PCOS is also considered to be a harbinger of metabolic syndrome and Type 2 Diabetes.
The dysfunctional hormone relationship can lead to a variety of symptoms, grounded in inflammation, reproductive dysfunction, abdominal obesity, excess hair growth and insulin resistance
How is it Treated
1. Nutrition: Focus on whole, real, fresh foods
Eat regular, blood sugar balanced meals that include good quality protein, healthy fats, and vegetables (especially the dark green leafy cooked cruciferous – broccoli and cauliflower).
A Mediterranean style diet, mostly plant based, with oily fish a couple of times a week and plenty of nuts and seeds (and avoiding processed carbs and added sugar) is going to do a couple of things for women with PCOS
- It can help avoid the blood sugar spikes
- Women who eat a primarily plant-based diet tend to have bigger better bowel movements – which helps our bodies excrete excess hormones.
- A diet rich in colourful fruit and vegetables provides an anti-inflammatory, anti-oxidant, nutrient powerhouses that
- Healthy fats are essential building blocks for reproductive health – so avocados, extra virgin olive oil, nuts and seeds all provide the building blocks for restoring healthy hormone production, especially progesterone, which is an essential component of reproductive health for women.
2. Manage your Stress
There will always be stress to be managed, but with PCOS we might also be dealing with the added stressors of facial hair, weight gain around the middle and infertility. Optimising our stress response – taking a deep breath instead of giving in to cortisol telling us to inhale chocolate ice cream, practising mindfulness based meditation instead of allowing the rage and fear and panic to overtake us…these strategies may be useful, or going for a walk outside, or putting on a favourite piece of music.
We want to start re-directing our hormonal production away from cortisol and adrenaline, which can feed into inflammation and insulin resistance and instead focus on allowing the hormonal building blocks to be directed towards progesterone rather than stress hormones.
There are two main exercise strategies that have been shown to be specifically helpful for PCOS.
HIIT or High Intensity Interval Training:
Almenning et al did a study in 2015 to assess the effects of high intensity interval training and strength training on metabolic, cardiovascular, and hormonal outcomes in women with PCOS.
They found that HIIT for ten weeks improved insulin resistance & body composition improved significantly after both strength training and high intensity interval training.
The beauty of HIIT is that almost any exercise can be made into a HIIT type exercise – walking/ running fast for 60 seconds, then walking slowly for 30 seconds, could just as easily be replaced by squats or star jumps.
High energy HIIT training will ideally be balanced out by a more restorative and digestive system friendly strategy such as Yoga
Yoga is beneficial for constipation and IBS, so it is hardly surprising that we would see evidence in the literature that it is good for PCOS too.
Ratnakumari’s 2018 study along with many others show the benefits of including yoga as part of a movement strategy to improve the symptoms of PCOS – is it the twists and stretches that improve digestive function? The breathing and pelvic floor connectivity that helps centre the person? The emphasis on breathing and relaxation that helps decrease cortisol production and improve the stress response? Or all of the above?