Polycystic ovary syndrome (PCOS) is thought to affect one in 10 women. How might nutrition and lifestyle help manage symptoms?

PCOS is thought to be one of the most common hormonal conditions, but is often overlooked and under-managed.

Registered nutritional therapist Lauren Lovell didn’t know she had PCOS until her late twenties.

As a teenager, she began taking a birth control pill to treat testosterone-induced acne, but it was only when her sister was diagnosed as an adult that she decided to get tested, and was diagnosed ­­­­herself.

“It took some convincing to get a referral for an ultrasound but I eventually did, and multiple cysts were found on my ovaries,” she says.

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An anti-inflammatory, Mediterranean-style diet with plenty of colourful fruits and vegetables for fibre, micronutrients and antioxidants, plus good quality protein and healthy fats can support PCOS

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A survey of 1,385 women from 48 di­fferent countries who had been diagnosed with PCOS revealed that it had taken a third (33.6%) more than two years to receive a diagnosis.

Mimi Hawary, 28, told Optimum Nutrition that it took her five years.

“I didn’t get my first period until I was around 15,” she says. “When it started, it was so erratic and horrendously painful.”

She was eventually sent for blood tests six months after her 20th birthday. When these were inconclusive, she had an ultrasound done privately.

“The technician literally said, ‘I’ve lost count of how many cysts are on your ovaries’,” she says.

“He said that judging by the amount of cysts I had it was ‘slim to no chance of conceiving without medical assistance’. But he couldn’t say for definite because that’s just one symptom.”

She was referred to a hormone specialist, then to a gynaecologist who o­ffered her the contraceptive pill or coil. But in 2018, she started to lose weight.

“By November my periods had become regular,” she says. “By April 2020, I had lost about 35kg in total and also fell pregnant for the first time.” Hawary now has a daughter.

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Symptoms of PCOS

Possible symptoms to look out for include:

• Hair loss
• Hirsutism (more hair)
• Pelvic pain
• Infertility
• Weight gain
• Irregular periods
• Fatigue
• High testosterone levels
• Acne

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Managing symptoms of PCOS

Dr Caroline Overton, a spokesperson for the Royal College of Obstetricians and Gynaecologists, says: “We would always encourage women to speak to their doctor if they are having symptoms and ask to have a second opinion or be referred to a gynaecologist if they feel that they are not getting answers.”

Whilst there is no cure for PCOS, she adds there are ways to manage symptoms.

“Medical treatments aim to manage and reduce symptoms which, when coupled with a healthy lifestyle, can reduce any long term health risks,” she says.

Overton adds that eating a balanced and healthy diet, exercising, and maintaining a healthy weight, can all help manage PCOS symptoms and reduce the risk of further problems.

Insulin resistance and PCOS

According to research, between 50 to 70% of women with PCOS have insulin resistance. – See this article to learn about insulin resistance.

With PCOS, insulin resistance can impair ovulation, causing the ovaries to produce more androgens and resulting in associated symptoms such as acne and hair thinning.

“High insulin also reduces sex hormone binding globulin (SHBG),” Lovell says.

SHBG is like a sponge for excess hormones, so if there are lower amounts in the body then there will be more androgen hormones running free.

According to Lovell, balancing blood sugar and insulin levels are therefore key to managing PCOS.

“Avoiding refined carbohydrates and too much sugar is helpful,” she says. “An anti-inflammatory, Mediterranean-style diet with plenty of colourful fruits and vegetables for fibre, micronutrients and antioxidants, plus good quality protein and healthy fats can support PCOS.”

When it comes to specific nutrients, she says that omega-3 fatty acids, vitamin D, zinc, vitamin A and adequate protein can support inflammation, skin and gut health, to better manage PCOS symptoms.

Gut health and PCOS

Increasingly, research highlights the importance of gut health. According to Lovell, imbalances in bacteria within the gut microbiome can contribute to inflammation and associated metabolic disorders.

The growth of so-called ‘bad’ bacteria can also “impede the proper excretion of hormones from the body”, she says, worsening PCOS symptoms.

Researchers from the University of California’s San Diego School of Medicine, USA, found that women with PCOS had less diverse populations of gut bacteria than those without the condition.

This lack of diversity in gut bacteria, the researchers said, was also linked to elevated testosterone levels, suggesting that testosterone and other androgen hormones may help to shape the gut microbiome and influence the development of PCOS.

Eating a wide range of fibrous fruits and vegetables, and including probiotic rich foods such as sauerkraut and kefir in the diet can help to support the gut.

Stress and PCOS

Whilst the ovaries are the main source of androgen excess in PCOS, research also suggests that 20-30% of individuals with the condition have adrenal androgen excess.

When we are under a lot of physical or psychological stress, our adrenal glands produce the stress hormones adrenaline, noradrenaline and cortisol.

At the same time, they also produce androgens such as DHEA-S and androstenedione, excess levels of which are thought to contribute to PCOS symptoms.

Lovell says that managing stress is therefore “crucial” for those with PCOS.

Epigenetics and PCOS

Individuals with a family history of PCOS are at an increased risk of developing the condition, but diet, environment and lifestyle can all impact the expression of these genes. This is known as epigenetics.

“[Nutritional therapists] can use genetic testing to find out which areas associated with PCOS we may need to support more,” she says.

Overton also stresses the importance of consulting a doctor if you think you may have PCOS.

“Women are encouraged to have regular health checks with their doctor or gynaecologist, where they can discuss any of their concerns,” she says.

“PCOS puts women at greater risk of developing diabetes, high blood pressure and cancer, so these check-ups are also to monitor for any early signs of health problems.”

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