Polycystic ovary syndrome (PCOS) and Health! What are you doing about it?

Polycystic ovary syndrome (PCOS) is a multi-layered, endocrine disorder that affects ~ 5 – 10% of women of reproductive age in the Indian subcontinent. In India, it is approximated that nearly two thirds of women with PCOS remain undiagnosed (2008). Given this, it is hardly surprising that several women have either not heard of this syndrome, or have glaring misconceptions about it.

Dismantle 5 common misconceptions surrounding it.

PCOS and Ovary – The basics:

Although there are varying criteria used to define PCOS, the expert consensus for the diagnosis of PCOS requires the presence of AT LEAST two of the following three criteria:

Chronic anovulation – infrequent or prolonged menstrual periods, which is fewer than nine periods a year, or more than 35 days between periods.
Hyperandrogenism – It is simply the secretion of excessive androgens in our bodies. The levels are often measured using blood tests (free testosterone), but also diagnosed clinically when the patient has excess facial and body hair (hirsutism), and occasionally (treatment resistant) severe acne and baldness (hair loss).
Polycystic ovaries – As the name suggests, the ovaries may develop numerous small follicles, and fail to release eggs. This is usually identified using ultrasound imaging of the ovaries, in conjunction with measurement of 17-hydroxyprogesterone and anti-Müllerian hormone (AMH).

Now what causes PCOS? There is no one known cause for PCOS. Several factors implicated in PCOS include genetic predisposition, excess insulin secretion (insulin resistance), increased androgen production, and sedentary lifestyle. Not every woman with PCOS exhibits the same set of symptoms! Therefore, there is a strong need for accurate and detailed clinical assessment and diagnosis to prevent further complications, and manage the condition.

Can Low Iron Cause Acne? Indeed, Low iron levels could indirectly contribute to acne in individuals with PCOS. PCOS is commonly associated with hormonal imbalances, including elevated androgen levels, which can trigger excess sebum production and subsequently lead to acne. Moreover, iron deficiency can exacerbate these imbalances. Iron is crucial for synthesizing hemoglobin, which is responsible for oxygen transportation throughout the body, including to the skin cells. Insufficient iron may lead to suboptimal skin cell function and renewal, contributing to clogged pores and fostering an environment conducive to acne. Therefore, maintaining balanced iron levels can be an essential part of managing acne in people with PCOS

Now that we have a basic understanding of PCOS is, here are 5 common misconceptions surrounding PCOS –

“PCOS is not a serious illness. It’s simply irregular periods”

PCOS is often dismissed as merely a menstrual cycle issue. However, it is so much more complicated than that. Some of the potential health complications from PCOS include –

Infertility
Nonalcoholic fatty liver disease (NAFLD)
Increased risk of cardiovascular disease
Type 2 diabetes or prediabetes
Depression, anxiety and eating disorders
Abnormal uterine bleeding
Endometrial cancer

The earlier we diagnose PCOS, the earlier we begin the interventions, the better for the woman.

“Insulin resistance? Go low carb, or keto!”

One of the most common issues with PCOS is presence of insulin resistance (IR). In IR, one develops decreased sensitivity to insulin (a hormone that helps us to regulate the level of glucose in the body). As a result, the person ends up producing increasing amounts of insulin to maintain normal levels of glucose in the blood. IR is often thought as a precursor to Type-2 diabetes.

So given that glucose (carbs!) is the issue, and the solution to the above issue is “low carb”, or “keto” diets right? Not so fast! In a low carb diet, you are often required to eat less than 50- 100 g of carbs per day. While reduction in our overall consumption of carbohydrates may have some merit, restricting carbohydrate intake to meagre amounts, and thereby eliminating healthful carbs such as wholegrains, legumes, vegetables and fruits is not smart. Additionally, it is important for women with PCOS to regulate the amount and type of fats their diets (Limit sources of saturated fat and trans fats – red meat, processed meat, butter, margarine, etc..).

So what does a healthy diet look like?

Plenty of fruit and vegetables (including green leafy vegetables)
Moderate amounts of wholegrains (such as whole wheat bread, oatmeal and brown rice)
Legumes
Raw nuts (almonds, walnuts)
Lean meat (fish and chicken) and eggs.
Healthy fats such as sesame and olive oil
Green tea

You can also consider consulting your nutritionist or healthcare provider regarding supplementation with folic acid, vitamin D, B12 and calcium (depending on current gaps in your diet and requirement).

“You have to eliminate gluten and dairy, if you have PCOS”

There is no evidence that eliminating gluten and dairy from your diet helps alleviate symptoms of PCOS, especially if you have had no trouble digesting them. A gluten-free/ dairy-free diet removes healthy food options such as wholewheat bread and pasta, rotis, oatmeal, rye bread, milk, cheese and yogurt from your plates, for no reason whatsoever. These foods help with satiety, and happen to valuable sources of micronutrients, ranging from B vitamins, to calcium and magnesium.

“Use of medication to manage PCOS is unnecessary.”

One of the most commonly perpetuated myths regarding reproductive health is that “an all-natural approach” is the best option. This could not be further from the truth! Oral contraceptives/ birth control pills can be prescribed by your physician to regulate your menstrual cycle and address the excess androgen secretion. Metformin (a commonly prescribed oral medication for type 2 diabetes) is shown to improve insulin resistance and slow the progression to diabetes (in case, you are prediabetic). While nutrition and lifestyle changes are great, it is important to consider the benefits of medication when your healthcare provider recommends it.

“Exercise makes PCOS worse”.

Obesity has often been correlated with worsened symptoms of PCOS, and even small reductions in weight (5%) could help restore menstrual cycle regularity and ovulation, reduce the risk of diabetes in high risk groups and help prevent future cardiometabolic risk. It therefore makes sense as to why exercise is recommended as one of the primary management strategies for PCOS – Increased physical activity in combination with energy restriction has been shown to reduce insulin resistance, abdominal fat, blood glucose and blood lipid levels, and improve reproductive features of PCOS, and body image.

However, it is worth noting that women of all sizes and shapes can have PCOS. Instead of fixating on your weight, focus on infusing your life with more activity. Overwhelmed and unsure where to begin? Start with regular, moderate paced walking. Even 30 minutes of walking per day is solid start! For those who are not new to exercise, combining aerobic and resistance training can be more efficacious for improving insulin sensitivity and reducing abdominal fat, compared with either form of exercise alone.

Conclusion:

Navigating hormonal and reproductive health challenges can feel intimidating, to say the least. Relying on a support network comprised of healthcare providers, nutrition and mental health experts, and choosing to educate oneself about lifestyle interventions is essential.

When it comes to nutrition and PCOS, it is particularly important to be mindful of restrictive diets – these can exacerbate anxiety surrounding food, or cause disordered eating. Focusing on eating healthy for the most part, getting plenty of sleep and physical activity, and finding positive ways to cope with stress is a solid start.

Writer :

Aarathi Shanmugam, a certified Nutrition Coach working at The Quad, Chennai. A lifelong science enthusiast, she majored in Biotechnology and later pursued her Master’s in Stem cell biology from University of Minnesota. She worked in the pharmaceutical sector for three years, before switching gears to nutrition science.

References :

https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/
Roe AH, Dokras A. The diagnosis of polycystic ovary syndrome in adolescents. Rev Obstet Gynecol. 2011;4(2):45–51.
Neil F. Goodman, Rhoda H. Cobin, Walter Futterweit, Jennifer S. Glueck, Richard S. Legro, and Enrico Carmina (2015) AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ANDROGEN EXCESS AND PCOS SOCIETY DISEASE STATE CLINICAL REVIEW: GUIDE TO THE BEST PRACTICES IN THE EVALUATION AND TREATMENT OF POLYCYSTIC OVARY SYNDROME – PART 1. Endocrine Practice: November 2015, Vol. 21, No. 11, pp. 1291-1300.
Conte F, Banting L, Teede HJ, Stepto NK. Mental health and physical activity in women with polycystic ovary syndrome: a brief review. Sports Med. 2014;45(4):497–504. doi:10.1007/s40279-014-0291-6
Szczuko M, e. (2016). Quantitative assessment of nutrition in patients with polycystic ovary syndrome (PCOS)

Available at: https://www.ncbi.nlm.nih.gov/pubmed/27925712

Cinar N et al. (2019). Depression, anxiety and cardiometabolic risk in polycystic ovary syndrome. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21984577
Thomson RL e. Exercise for the treatment and management of overweight women with polycystic ovary syndrome: a review of the literature.

Available at: https://www.ncbi.nlm.nih.gov/pubmed/20546140

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