What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a condition that affects 10% of women of reproductive age and is the most common cause of female infertility. It is characterised by fluid-filled sacs which are found on both ovaries. Women with PCOS may also experience irregular or no periods and have excess androgens. Androgens (such as testosterone) are hormones responsible for male traits and reproductive functions and so women with an excess may experience additional facial or body hair; 60-80% of women with PCOS have a high androgen. That being said, half of women with PCOS do not experience any symptoms and so the condition can be difficult to diagnose in some cases. It can be diagnosed by looking at the family tree as PCOS commonly runs in families. The condition can affect girls as young as 11 but usually presents at the end of puberty (late teens and early 20s) and affects women often until menopause. PCOS is not a short-term condition and so a long-term approach to management and health is needed.

How does PCOS affect fertility?

The fluid-filled sacs that characterise PCOS are in fact where the egg develops and prepares for release. With PCOS, the sacs are unable to release the egg and so ovulation does not occur. This justifies the fertility issues that come with having PCOS; as ovulation cannot occur, the egg cannot be successfully fertilised. The result of this is irregular periods and difficulty falling pregnant.

How is PCOS related to diabetes?

Although the cause of PCOS is unknown, the condition results from a hormone imbalance (excess androgens). One hormone level which is abnormal in this case is that of insulin. In the condition of PCOS it is often elevated and is thought that PCOS and insulin resistance influence each other.

Increased levels of insulin are also encouraged by weight gain and central obesity, which over time leads to the development of type 2 diabetes. Alongside insulin resistance comes dyslipidaemia, which is the abnormal amount or elevation of lipids in the blood including cholesterol and other fats.

This is a common abnormality for women with PCOS and can be managed alongside other hormone abnormalities. From this, it’s concluded that PCOS increases the risk of developing type 2 diabetes later in life. The most effective and valuable method of combatting this correlation, for both PCOS and diabetes, is through diet.

How do you manage PCOS?

As there is no cure for PCOS, long-term lifestyle changes are taken to manage the condition. There are some medicines and surgeries that are used to manage the symptoms of PCOS, but the first port of call and most natural approach is adjusting the diet. With this, a dietitian or nutritionist can assist. Challenging the diet could be considered the most effective method as not only will it improve the condition at hand, but the effects of such an improvement will benefit overall health and improve life expectancy as well as reducing the likelihood of other conditions progressing. For example, if someone with PCOS is overweight, they are also at risk of developing type 2 diabetes and high cholesterol levels; conditions which are already associated with PCOS.

Losing weight by eating a healthy diet and exercising is what is first recommended to them. Not only will it improve PCOS symptoms but will ensure the body is in its optimum health to manage the condition and reduce the risk of other obesity-related conditions. When losing weight is prescribed for the management of PCOS, it can be frustrating for women who have been trying to lose weight for some time.

Women with PCOS often have insulin resistance, which encourages carbohydrate cravings and altered levels of appetite-driven hormones. The accumulation of effects suggests women with PCOS may have a slower metabolism, making the weight loss objective more difficult to pursue.

For the management of PCOS via the diet, a specialist dietitian can guide you through the process of managing your condition in a safe and tailored way. The guidance of a dietitian can help to prevent yo-yo dieting which is discouraging and promotes weight gain in the long run.

What is the best diet for managing PCOS?

As the primary treatment for PCOS, a healthy and adequate diet is essential for effective management. The word ‘diet’ implies a strict regime and set of rules that work for everyone, but this is not the case. No single diet will eradicate PCOS symptoms nor will a sole diet suit every woman, as each body is different. Instead, the diet for PCOS management is formed by a combination of beneficial foods; foods that benefit the female reproductive system and the production of hormones are influential. This includes whole foods, foods with anti-inflammatory properties, nutrient-dense foods, low GI (glycaemic index) carbohydrates. Furthermore, regular eating patterns play an important role. The two key patterns adopted in combat of PCOS is the Mediterranean diet and DASH (Dietary Approaches to Stop Hypertension). Both ‘diets’ have the same premise – consume lots of fruit and vegetables of variety, wholegrains and whole foods, lean protein and healthy fats.

Whole foods:

• Grains – wholegrain rice, oats, barley, whole wheat (wheat berries)
• Beans and legumes – beans, lentils, chickpeas, kidney beans, peas, soybeans, black beans
• Unsalted nuts and seeds – peanuts, pumpkin seeds, almonds, walnuts, sunflower seeds
• Low GI fruit and vegetables

Wholegrain options:

• Bulgar wheat
• Brown rice
• Oats
• Buckwheat
• Barley
• Wholewheat bread
• Wholewheat pasta
• Popcorn

Wholegrains provide complex carbohydrates, fibre for healthy bowels and help you feel fuller for longer and are associated with the reduced risk of diabetes and heart disease. Wholegrains provide more vitamins and minerals than refined grains.

Lean protein options:

• White, fleshy fish
• Chicken (without skin)
• Turkey
• Fortified tofu
• Soya products
• Seitan
• Lean protein options contain less unhealthy fats and reduced calories.

Sources of healthy fats:

• Avocados
• Nuts and seeds
• Salmon
• Mackerel
• Herring
• Trout
• Sardines
• Olive oil

Foods that contain healthy fats contain omega-3 fatty acids which are beneficial to heart health, as well as fat-soluble nutrients like vitamins A, D, E and K. No more than 2 portions of oily fish should be consumed per week due to harmful chemicals. It is important for women with PCOS to consider consuming less carbohydrates and favour carbohydrates with a low GI.

Low GI carbs are those which are broken down and absorbed more slowly by our bodies and so the risk of spiking our blood

glucose levels is decreased. Maintaining blood glucose levels within a healthy range is pertinent for reducing the risk of type 2 diabetes, in which our body becomes resistant to the actions of insulin. Many low GI carbs are within the food groups already mentioned.

Low GI carbohydrates sources:

• Bread – wholemeal, rye, high-protein
• Grains – basmati rice, brown rice, buckwheat, long-grain and wild rice
• Cereals – all bran, porridge oats, nut or seed-based muesli, shredded wheat
• Starchy veg – sweet potatoes, butternut squash, parsnips, pumpkin
• Fruit – apples, cherries, grapefruit, plums, kiwi
• Beans and legumes – chickpeas, kidney beans, black beans, lentils

Regular eating patterns such as three balanced meals a day or eating within the 8-10-hour window during the day, with occasional healthy snacks are encouraged. Being moderate on low GI carbohydrates and healthy fats and increasing lean protein courses is also recommended. It is important to balance meals to include all food groups (carbohydrates, fats, proteins and fibre) with a variety of fruit and vegetables. This will help to slow down sugar absorption from the meal.

Written by Beth Mulholland, Human Biology BSc Graduate, reviewed by Eugenia Grand, Specialist Fertility Dietitian Nutritionist.  

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