Are you experiencing irregular periods, unwanted hair growth, infertility, skin issues, weight gain, or fatigue, but have no idea where to begin managing these symptoms?

While it can be scary and feel like you're alone when struggling with a medical condition, please know that you are not alone, and can live a full, healthy life if your PCOS is well managed!

Polycystic Ovary Syndrome (PCOS) is the most common reproductive endocrine disorder, affecting 9% to 18% of reproductive women. The exact cause of PCOS is unknown, but research shows that there are both genetic and environmental connections.

It’s also considered to be an inflammatory condition, meaning underlying chronic inflammation seems to drive much of the symptoms. While there is little to no cure, there is a lot of medical management and lifestyle changes that can reduce inflammation and decrease, or even eliminate symptoms.

The main hormones involved in PCOS are androgens, progesterone, and insulin. Women with PCOS have higher levels of androgens, which are often referred to as “male hormones,” however, all women make androgens in their bodies.

There are four types of PCOS known as insulin resistant PCOS, post-pill PCOS, inflammatory PCOS, and Adrenal PCOS.

• Insulin Resistant PCOS has been found to be the most common among women, affecting around 70%. In this type, you may struggle with your weight and have symptoms like fatigue or brain fog. The high levels of insulin drive up androgen levels which cause issues like excess hair (hirsutism) and acne.

• Post-Pill PCOS may occur in individuals after they stop taking the oral contraceptive pill. In this type, symptoms like acne, irregular periods, and excess hair growth were not present prior to starting the pill due to the increase in androgens.

• Inflammatory PCOS occurs when there is chronic inflammation (long-term) which can cause an increase in testosterone, resulting in physical symptoms and issues with ovulation. Symptoms may include irregular periods, acne, hirsutism, stress on the GI, fatigue, and skin issues like eczema.

• Adrenal PCOS may occur when there are higher levels of certain hormones that may be associated with stress and can influence our ability to cope with the negative effects of stress. DHEA is a hormone produced by the adrenal glands and is secreted in response to stress. High levels can lead to irregular periods, acne, trouble sleeping, lack of energy, and weight gain.

Despite the high prevalence, PCOS is commonly overlooked and undertreated. It is still not understood what causes PCOS, and the cause may vary for different people. Genetics, behavior, lifestyle, and environment may play a role in your individualized symptoms.

Signs and symptoms

There is a wide range of symptoms that women may experience, and often they have been pushed aside as normal woman problems or caused by too much stress. Because of this very reason, many women will struggle to get a real diagnosis, living for years with symptoms that they believe as a normal part of their body. Here are some common symptoms of PCOS:

• Acne

• Fatigue

• Irregular or absent periods

• Anovulatory period cycles

• Excessive hair growth

• Difficulty losing weight

• Insulin resistance

• Infertility

• Sugar cravings

• Anxiety

• Depression

• Digestive issues

 

How does PCOS affect metabolism?

It is not uncommon to see woman experiencing PCOS, also exhibiting metabolic comorbidities. This means that women with PCOS may have a slower metabolism compared to women without PCOS. This is because their body is burning fewer calories at rest.

Metabolic issues can lead to the development of cardiovascular disease, type 2 diabetes, obesity, and more. It is important to understand how PCOS is affecting your metabolism to avoid these long-term effects that are related to metabolic comorbidities.

Lifestyle interventions are first-line treatment for PCOS, and small lifestyle changes can improve metabolic dysfunction. These lifestyle changes can include making diet changes, which we will go more into detail about later. It may also be a good idea to speak with a dietitian about lifestyle modifications that may positively affect your metabolism.

 

How does PCOS affect fertility?

Most women struggling with PCOS may experience infertility. However, it is important to state that women with PCOS still have a chance at conception. It may take patience and dedication to allow adequate time to enhance fertility naturally, but it will be worth it in the end.

The absence of ovulation is the major difference between PCOS and a normal ovulation cycle. An imbalance in FSH and LH levels can impact ovulation. Abnormal FSH and LH levels lead to increased androgen levels in the blood, causing symptoms such as hirsutism, acne, etc.

When a woman has PCOS, this monthly cycle is interrupted. Although the follicles begin their growth, none of them becomes fully mature where they can be released, and so many small follicles remain on the ovaries. Without the presence of a mature egg, ovulation cannot take place, and therefore no possibility of a natural pregnancy.

There is still a chance you can ovulate with PCOS, and therefore it is possible to get pregnant on your own. However, some women with the syndrome will never ovulate spontaneously. Even if ovulation is occurring, the chances are much lower than for women without PCOS.

Although PCOS is one of the leading causes of infertility, many women with PCOS have successful pregnancies. They may just need some extra help from a specialist. Speak with a dietitian to begin making lifestyle modifications to enhance fertility naturally. When appropriate, seek the help of a fertility specialist for the initiation of medical therapy options.

 

Nutrition strategies

You’ve made it to the most requested topic that comes with PCOS diagnosis, what should I be eating? Now that you know what PCOS is, we can begin to explain how to improve the symptoms with nutrition! Whether it's inflammation, insulin resistance, or hormone imbalance, it’s important to be consuming a variety of nutrient-dense food using a balanced plate!

By having a balanced plate, we provide our bodies the nutrients they need to thrive. Balanced plates help us feel the most satisfied, can help to balance our blood sugars, and helps support our metabolisms.

As a guide, it is recommended for each meal to be balanced and full of protein (20-30 grams), carbohydrates (30-45 grams), fiber (8-10 grams), and healthy fats (20-30 grams). With that being said, this recommendation is created to be used as a guide, not a rule. Your carbohydrates requirements and energy needs will increase with activity level. For a better understanding of your nutritional needs, please speak with a dietitian.

The food we consume can be beneficial not only for PCOS, but for our overall well-being, improving insulin resistance, reducing inflammation, and balancing out hormones. The following information includes beneficial food to prioritize when creating your meals.

#1 Dark Leafy Greens

Dark leafy greens such as romaine lettuce, red leaf lettuce, kale, chard, spinach, collards, beet greens, dandelions, endive, basil, parsley, and arugula provide essential vitamins and minerals. Greens improve digestion and absorption of nutrients in the gut, improve glucose regulation and overall endocrine function, and reduce the risk of metabolic, cardiovascular, and autoimmune diseases, and cancer.

#2 Colorful Vegetables

Not only are vegetables packed with fiber, but they serve as an excellent source of vitamins and minerals. What makes them beneficial is the bioactive phytocompounds that maintain glucose regulation, reduce meta- inflammation and the dangerous effects of oxidative stress, and therefore, lower the risk of cardiovascular or any other chronic disease. Incorporate colorful vegetables such as bell peppers, carrots, sweet potatoes, eggplant, artichokes, asparagus, string beans, and potatoes!

#3 Berries

Berries such as blueberries, raspberries, blackberries, strawberries, currants, and cranberries are packed with immune-boosting, cancer- preventing, heart-protecting, obesity-preventing antioxidant components, including specific polyphenols, flavonoids, and other phytocompounds that fight inflammation and disease. Looking for a breakfast idea? Try making a smoothie with berries, or oatmeal topped with berries!

#4 Avocado

Avocados, known as the type of fruit, called a drupe, are a nutritional superfood, however, they have been villainized for their high saturated fat content, but they are packed with vitamins, minerals, and heart-healthy fatty acids that help reduce inflammation, promote healthy endocrine and immune system function. Adding an avocado per day to an already well-balanced diet has been shown to lower the risk of heart disease, lower LDL cholesterol, and reduce oxidative stress.

#5 Avocado and Olive Oil

Adding avocado or olive oil to your dishes can provide flavor and other health benefits. Use both these oils for sautéing vegetables and lean protein. Avocado oil has a high smoke point, so it won’t be damaged by the heat, tastes great, has a superior fatty acid profile, high antioxidant content, and contains cholesterol-blocking phytosterols.

Olive oil can be used to make your own salad dressings! It also can lower your risk of heart disease, type 2 diabetes, breast cancer, reduce inflammation, and help maintain vitamin E levels in breastfeeding mothers! Make sure you look for Extra Virgin Olive Oil at the grocery store.

#6 Nuts and Seeds

Brazil nuts, almonds, cashews, walnuts, macadamia nuts, flax, chia, and hemp seeds are protein-packed powerhouses that provide an array of minerals including magnesium, calcium, and selenium. When eaten in combination with fruit or carbohydrates, nuts and seeds help decrease the rate of blood glucose.

Try incorporating pumpkin seeds into your daily meals. They contain essential fatty acids (EFAs) that our bodies need. These EFAs help regulate hormone function, improve hair, skin, and nails, lower insulin levels, stabilize blood sugars, and help regulate periods. These little powerhouses may also help with hirsutism or male pattern hair growth.

#6 Wild Caught Fish

Fish such as salmon, tuna, mackerel, and sardines provide an excellent source of the essential, anti-inflammatory, and heart-healthy Omega-3 fatty acids DHA and EPA and other fat-soluble nutrients, including vitamins A & D. It’s recommended that you should consume these fish 3-4 times per week.

#7 Dark Chocolate

Yes, you can still have your chocolate! Research shows that dark chocolate containing 70% cacao or more reduces hypertension, increases circulation, aids in preventing atherosclerosis, improves glucose regulation by preventing blood sugar spikes, and may actually promote weight loss by controlling hunger and promoting satiety!

#8 Green Tea

Besides the comfort it brings, green tea also has many health benefits. Its high concentration of powerful antioxidants aid to improve blood flow, lower cholesterol, improve hypertension, and may prevent other heart- related issues, including congestive heart failure and stroke.

Nutrition lifestyle interventions

You’re probably wondering how much of the food listed above you should be eating, but there is no one size fits, especially for women with PCOS. We all have very, VERY different needs and following diet trends on social media may be more harmful than you think.

It’s recommended that you aim for 3 meals per day, 1-2 snacks in- between, if needed. Remember that nourishing your body will allow for it to function properly and provide you with the energy to show up for yourself each day. Skipping meals or restricting yourself will not bring the results you are searching for; it will only cause your body to produce more cortisol (a stress hormone) and high levels of this hormone can disrupt your digestive system and contribute to inflammation.

In addition, the hormones leptin, which signals fullness, and ghrelin, which signals hunger, become out of whack. When you cannot follow your own body’s cues in terms of hunger and fullness, it is hard to develop a healthy eating cycle.

This healthy eating cycle begins first thing in the morning with breakfast! It may be hard at first but beginning your day with coffee and not eating until 12 pm will only disrupt this cycle. The longer we do this, the more we suppress our appetite and allow cortisol to wreak havoc on our bodies.

Your body wants to feel safe and fed, so do it a favor, eat breakfast! Try whole-wheat toast with avocado slices and an egg on top, or greek yogurt with chia seeds and berries!

If you find yourself hungry in-between your main meals, try incorporating a high protein food option with fiber to prevent any blood sugar spikes!

Overall, it’s important that you prioritize nourishing your body with nutrient-dense food throughout the day, while still leaving space for your favorites. The best nutrition plan is sustainable and makes you feel your best.