What is PCOS, and who is affected?
Polycystic Ovary Syndrome, or PCOS, is a hormonal condition that affects females of child-bearing age. It is the most common hormonal condition in pre-menopausal women. As it is a syndrome rather than a disease, PCOS is characterised by a set of symptoms that cluster together.
This means that it might show up differently in different people and that not all possible symptoms are required for a person to be diagnosed.
Current guidelines for diagnosis are based on the modified Rotterdam criteria, which state PCOS may be diagnosed if:
- any two of the following three criteria are present:
- clinical or biochemical hyperandrogenism – signs of excessive testosterone in the body, which could be found via a blood test or by assessing modified Ferriman–Gallwey score, which looks at the presence of body hair;
- evidence of oligo-anovulation – essentially irregular or no periods, e.g., cycles are at least 35 days apart, or there are less than eight periods per year; and/or
- polycystic appearing ovarian morphology on ultrasound – e.g., having at least 20 follicles on at least one ovary;
- AND at the exclusion of other relevant disorders.
That last part is important, as other disorders can appear similar to PCOS, and having them ruled in or out can change treatment options.
PCOS and your long-term health
PCOS can affect your long-term health in different ways.
In general, we see an increase in the risk of certain conditions co-occurring with PCOS, such as obstructive sleep apnoea and depression, as well as those listed below.
Infertility
Due to the impact PCOS can have on regularity of periods and ovulation, this can make it more difficult to conceive.
Diabetes
Due to the hormonal imbalances that occur in PCOS, specifically insulin and testosterone, women with PCOS have an increased risk of pre-diabetes and type 2 diabetes.
One way to keep this risk low is to monitor for these issues so that they can be managed as soon as possible. To do this, it is recommended that ‘glycaemic status’ is established at diagnosis of PCOS and every 1-3 years after that, depending on the presence or absence of other risk factors for diabetes. The gold standard for this is using an oral glucose tolerance test. Fasting blood sugar levels can also be taken instead in some cases.
Cardiovascular health
There is some evidence to suggest that the risk of cardiovascular disease (e.g., heart problems) is higher in individuals with PCOS. For this reason, it is recommended that a blood test looking at cholesterol, also known as a full lipid profile, is done at time of diagnosis of PCOS, as well as a yearly blood pressure check to keep an eye on heart health.
PCOS and insulin resistance
What is insulin resistance and how is it related to PCOS?
Insulin resistance refers to a condition where the body has trouble regulating blood sugar levels. Insulin is a hormone released by the body when blood sugar levels rise after eating. Insulin triggers the muscle, fat and liver cells to take glucose out of the blood and use it, thus bringing blood sugar levels back down again. Insulin resistance is when the muscle, fat and liver cells don’t listen to insulin and so the body has to produce high levels of insulin to control blood sugar levels. To make complex biochemistry as simple as possible, these high levels of insulin can lead to long-term health problems.
Insulin resistance often occurs in PCOS as PCOS can involve imbalances in the hormones insulin and testosterone. Insulin resistance is seen as a driver of PCOS in a large number of cases, altering ovarian function, causing central weight gain, and driving up testosterone, which in turn leads to other symptoms of PCOS. Many diet-based treatments for PCOS involve dealing with insulin resistance.
Goal of a dietary strategy for managing PCOS
It’s always important to consider the end-game when it comes to making changes to your diet. When it comes to PCOS there are some key factors with your diet that are worth focussing on to improve your long term health:
- Nutritional adequacy and satisfaction – a well-balanced diet that includes all five core food groups is vital, as is choosing foods that will adequately satisfy you (physically and mentally!).
- Address binging and overeating – your dietitian can coach you through a personalised strategy.
- Stabilise blood sugar levels and manage insulin resistance – this is often done by manipulating (not excluding!) carbohydrate intake.
- Decrease chronic inflammation – increasing foods that help the body deal with the inflammatory nature of PCOS.
- Supporting fertility – optimising nutrient intake to help with egg quality, ovulatory function, and implantation.
Focus on health not weight
The latest keto or fasting diet is not what your body with PCOS needs. Any kind of drastic dietary restriction will not achieve the health that you want.
An interesting point to note is that latest recommendations make a point of saying that the increased risk of complications or associated issues that cluster with PCOS happens regardless of BMI. So focussing on your weight isn’t the best use of you efforts.
We understand your desire to lose weight and that lot of information online says that weight loss is how you improve your PCOS, however, if weight loss diets and restrictions lead you to restriction/binge cycles, or follow unhealthy patterns of eating then this is not the right path!
We recommend focussing on what you can directly control and that is your daily behaviours, routines and food habits. Take the time to unpack unhelpful mindsets and beliefs. Address underlying issues that impact your food choices and find balance so that your diet both nourishes and satisfies you.
Key lifestyle changes to focus on
We recommend the following lifestyle improvements:
- Eat regularly: avoid skipping meals or going too long without food
- Choose smart carbs: these are high fibre, minimally processed foods of moderate portions evenly distributed across the day
- Whole protein rich foods: eaten regularly across the day
- High plant volume and variety: vegetables, fruit, nuts, and seeds
- Healthy fats: fatty fish, nuts and seeds
- Regular resistance exercise
Overcome the barriers
One of the problems with modern nutrition information and online programs is that they are all about WHAT to eat and rarely about HOW. They especially don’t help with many of the common challenges faced by individuals such as:
- Poor hunger and fullness cues
- Binge eating
- Emotional/stress eating
- Boredom/social eating
- Constantly dieting/restricting
When it comes to the lifestyle management of PCOS, getting evidence-based help and support to help you overcome these barriers and build a healthy relationship with food, exercise and your body is a key part of the process.
The benefits of nutrition coaching
It’s vital any kind of one-on-one support is delivered by appropriately qualified and experienced individuals. Our nutrition coaches are APDs and RNutrs with extra training in specialty areas like women’s health and PCOS. Not only should your coach understand the evidence when it comes to managing PCOS and insulin resistance they also need to have experience and training to help you with other aspects of eating as well. How and why you eat is just as important as what. We are able to help you with disordered eating, binge eating, emotional and stress eating, as well as non-hungry eating behaviours like boredom or eating just because it’s there.
We believe that focusing on building intuitive eating skills, food and cooking skills and learning is just as important about learning what to eat and will help form a foundation for you to eat well long-term and have the ability to put what you learn into practice.
Nutrition coaching can help you know where to start, find the strategies that work for you and overcome any barriers you might be facing. All in a non-judgmental, supportive environment that has your long-term health both physically and mentally at the centre.
If you’d like to find out more about how individual nutrition coaching can help you manage your PCOS symptoms and thrive, then let’s connect.
