Polycystic ovarian syndrome (PCOS) is a condition that predominantly affects women during their childbearing years. Current statistics show that PCOS affects up to 10% of women in North America and is often undiagnosed. In PCOS a woman will develop multiple small cysts on their ovaries (hence the name). These cysts secrete hormones which over time start to disrupt your natural hormonal balance. You may start to have an increase in male hormones called androgens as well as an irregular menstrual cycle. When androgens increase or we see an imbalance of estrogen to progesterone, you could experience any or all of the following symptoms:
- Anovulation (not ovulating) or irregular ovulation
- Longer menstrual cycle
- Heavy periods
- Weight gain
- Facial or body hair growth
- Concerns with blood sugar regulation and cholesterol
PCOS is diagnosed based on a combination of presenting symptoms, a hormonal panel performed via a blood test and a transvaginal ultrasound to look at your ovaries. It is a condition that often isn’t diagnosed until a woman presents at her doctor struggling to get pregnant.
The good news is that there are several diet and lifestyle changes that can improve the symptoms associated with PCOS. In addition, diet and lifestyle changes can reduce your risk of heart disease and diabetes both of which are common in women with PCOS.
The 3 best places to start to make an impact on your PCOS symptoms include:
- Dietary changes
Part of the concern with PCOS is healthy blood sugar regulation. There are some significant changes you can make to your diet to more effectively help you regulate your blood sugar and hormones.
Ensure every meal you eat has a protein source. Some options include eggs, poultry, fish, beef, seeds, nuts or nut butter and beans. Protein takes longer to digest and absorb into the blood, resulting in a steady state of fuel which prevents large increases in blood sugar levels.
Eliminate refined carbohydrates. These include sugar, white rice, and any processed grains - wheat, rye, corn etc. These refined grains and sugars cause quick spikes in blood sugar levels. When blood sugar goes up, your pancreas must secrete a hormone called insulin to move the sugars out of the bloodstream into your cells. Insulin promotes inflammation in the body which can make your PCOS symptoms worse. Many women with PCOS have a difficult time with regulating their blood sugars so making this change to your diet will also help reduce sugar cravings.
Stop snacking. Contrary to widespread belief eating frequent small meals does NOT give you more stable blood sugar levels. Eating 3 balanced meals per day will help allow your insulin levels to drop between meals and maintain a healthy blood sugar level. When your insulin level drops, this allows your other hormones including cortisol (your stress hormone) and estrogen, progesterone and testosterone to resume their natural rhythm. You may also consider intermittent fasting with eating over an 8 hour period 2 meals and one snack instead of spaced out through the whole day. This often can help more effectively regulate blood sugar levels as well as your stress and female hormones.
There is a B vitamin called myoinositol that has a wealth of research supporting its benefits in women with PCOS. The typical dose in the most studies is 4g per day. Studies have shown that in 8 weeks, women taking this dose begin to ovulate regularly, have fewer sugar cravings, better blood sugar regulation, improved acne, and higher pregnancy rates, in women who had been previously infertile.
Myo-inositol is a widely available supplement that is best taken in a powdered form to be able to dose at the 4 gram per day (the alternative is multiple capsules daily). It is a slightly sweet powder that is easily mixed into a smoothie or water.
CoQ10 is an antioxidant that is essential for proper energy metabolism in the body. It has been shown to support healthy egg quality in women and is also a support for energy production. CoQ10 supplementation has been studied in women with PCOS and in one 12 week trial by Samimi et al. (20017), women with PCOS were given 100mg of CoQ10 daily with beneficial effects on glucose metabolism, serum cholesterol levels (both total and LDL-cholesterol).
CoQ10 is an important antioxidant that can improve the environment that your egg develops in, increase your viable follicles, improve ovulatory function, endometrial tissue and results in higher pregnancy rates in women with PCOS.
Regular daily movement is one of the most important ways to manage symptoms of PCOS long term. This doesn’t mean you must go to the gym every day if you are someone that doesn’t like this type of exercise. If you enjoy the gym then great, please make it part of your regular routine. I encourage women to find an activity they really enjoy because this will be sustainable and easier to maintain in their regular routine. This could be as simple as daily walks in your neighbourhood, dancing in your living room to your favourite music or enjoying a bike ride with a friend.
High-intensity exercise a few days per week can also be very helpful to regulating your hormonal balance. High intensity means choosing an exercise and doing as many repetitions as you can for a brief period. As a starting point, I find most women can easily commit to 5 minutes per day. An example of what this looks like can be doing push-ups or lunges for 40 seconds taking a 20-second break and repeating that 5 times. There are several distinctive styles of high-intensity training. Some classes available can be called HITT (high-intensity interval training) or Tabata. There are apps you can download to your phone to time the intervals for you.
In a review article by Cameron and Hakimi (2016) that looked at the impact of exercise on ovulation, researchers found that vigorous exercise between 30-60minutes per day could prevent anovulation. When they looked specifically at studies including exercise and PCOS, they found that even without making dietary changes women who exercised regularly often resumed ovulating regularly. Exercise helps to improve ovulation by helping to balance your HPA (hypothalamus pituitary axis). Your HPA axis controls your sex hormones, cortisol (your stress hormone) and your thyroid. Exercise helps to lower your cortisol, this allows the androgens to drop and progesterone to increase to balance your progesterone to estrogen ratios.
The key is to move your body every day. The more you move the easier it is for your body to regulate your hormonal balance.
PCOS is a combination of both a metabolic and hormonal dysregulation. Starting the above mentioned lifestyle and dietary changes will go a long way to help you regulate both ovulation and symptoms you may be experiencing.
By: Dr. Jodie Peacock ND
Chief Medical Officer at Enhance Fertility