PCOS 101: Everything You Need to Know

What is PCOS?

Polycystic Ovary Syndrome or Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder that causes menstrual cycle disruptions, including abnormal patterns of ovulation and irregular cycles.

It is the most common endocrine disorder among people with a uterus of reproductive age and is a chronic health condition that occurs from adolescence to post-menopause. It cannot be cured or reversed and requires management strategies and support, as symptoms can fluctuate and change over time.

How is PCOS diagnosed?

Diagnosis of PCOS can generally be done by a qualified healthcare provider through a detailed medical history, physical examination, and basic laboratory testing. Ultrasound or other imaging is not always a requirement for diagnosis, and polycystic ovaries may or may not be present in PCOS (1).

The most widely used diagnostic criteria for PCOS are the Rotterdam Criteria, which require at least two of the three findings:

1. Irregular ovulation – cycles longer than 35 days or fewer than 8 periods per year.

2. High androgen levels – either in blood tests or seen through symptoms such as excess facial or body hair, acne, or hair thinning.

3. Polycystic ovaries – visible on an ultrasound.

There is currently very little high-quality evidence in PCOS research, and women internationally experience a significant delay in diagnosis and dissatisfaction with care (2). One international study of over 1000 participants found that a diagnosis of PCOS took at least one year and involved ≥3 health professionals (3). There is a great need for more research in this area and for improvement in education and awareness of healthcare providers.

Does PCOS only matter if I want to get pregnant?

No, this is a common misconception about the condition. While having PCOS can impact fertility, it is a complex condition with a wide range of symptoms and related conditions. Symptom presentation can be highly variable among people, and some may not have noticeable symptoms at all.

 

Common Symptoms and Related Conditions

Metabolic and Physical (2):

• Chronic fatigue or low energy

• Insulin resistance and elevated insulin levels (hyperinsulinemia)

• Unexplained weight gain or difficulty losing weight

• Male pattern hair growth (hirsutism)

• Female pattern hair loss (androgenic alopecia)

• Acne

• Cardiovascular disease

• Type 2 Diabetes

• High blood pressure

• High blood lipids (triglycerides, LDL cholesterol, etc.)

• Poor sleep or sleep disturbances, such as obstructive sleep apnea

Psychological (2):

• Mood disorders, such as depression or anxiety

• Poor body image

• Disordered eating patterns or eating disorders

Reproductive (2):

• Menstrual abnormalities, such as irregular, long, heavy, or skipped periods

• Infertility, irregular ovulation

• Increased risk of endometrial cancer

• High risk pregnancy: increased risk of developing gestational diabetes, hypertension, or preeclampsia in pregnancy, miscarriage

Because PCOS can have such a wide range of symptoms and effects on the body, early diagnosis and intervention are important to improve the quality of life for individuals (2).

I’ve been diagnosed with PCOS—what now?

Many people are told simply to “lose weight and eat healthy.” Unfortunately, this advice is often vague, and these recommendations can be quite problematic for several reasons that we will discuss below.

Understanding PCOS Beyond Weight Loss

You do not need to be overweight to have PCOS. Its clinical features are largely the same regardless of body type; however, a larger proportion of those with the condition are considered overweight or obese (4). This is only correlative and is not the cause of PCOS.

Due to the metabolic disruptions like insulin resistance and high insulin levels, when the condition is unmanaged, these can lead to unexplained weight gain and difficulty losing weight.

Many of the related conditions listed above (Type 2 Diabetes, obstructive sleep apnea, etc.) have a higher prevalence in individuals with PCOS and occur regardless of the body mass index (BMI) (2).

The inherent weight stigma in our culture and health care system may place a large emphasis on weight loss for treatment; however, PCOS occurs in all body sizes. Weight-inclusive, evidence-based management strategies should be offered to people in larger bodies, other than just weight loss, which can be very challenging for people with PCOS and can have adverse medical, metabolic, and psychological health impacts (2,5).

Weight Cycling and Chronic Dieting

With the advice to lose weight, one might resort to social media or the internet. We might look up “PCOS diet plans” as one example. These usually involve some form of restricting Carbohydrate foods (starch and sugar) to reduce insulin resistance, which in theory can help to reduce insulin levels and reduce symptoms, but can be very difficult to maintain long-term.

We may be “on” the diet and be very strict with our eating, limiting certain foods and calories, but this level of restriction and control can be very hard to maintain, especially with the blood glucose dysregulation seen in PCOS, which can cause strong cravings for carbohydrate-rich foods.

When we are “off” the diet, we may feel unhinged around certain foods and feel out of control with them, which can lead to binge eating behaviours. This tends to result in feelings of guilt or shame around our body size and our inability to “just follow the diet”.

These cycles of weight loss and weight gain can happen over years and sometimes decades, and are called weight cycling.

Weight cycling can be problematic as there is a vast amount of evidence supporting its negative impacts on:

• cardiovascular health;

• metabolism (the body’s ability to burn energy);

• body composition (muscle and fat mass);

• mental health (negative body image, increased risk of developing an eating disorder) (2,5).

  
  

So, what can we do to manage PCOS if weight loss is not the answer?

Treatment and Management

Diet and Food Relationship

There is no evidence to support one dietary pattern over another in managing PCOS (2). The best way to reduce the insulin resistance commonly seen is to eat enough and eat balanced meals and snacks regularly.

As we have already discussed, less is not more. We tend to have a more chaotic eating pattern when we are “on” and “off” diets, which has detrimental effects on insulin levels and other symptoms of PCOS.

Balanced eating and eating regularly also increase variety and adequacy in our diet.

When we eat more often, we have the opportunity to include foods of differing

nutritional value. This increases our intake of essential nutrients like vitamins, minerals,

and antioxidants, which are necessary for our bodies to function optimally.

A history of dieting and/or disordered eating is common for most of us and can be difficult to navigate when trying to manage a chronic condition like PCOS. A Registered Dietitian who has experience in working with PCOS can help you come up with a plan that this right for you for managing your symptoms.

Physical Activity

Movement is also an important management piece. Not only does it offer health benefits to our cardiovascular system and metabolic function, like blood glucose regulation and body composition, but it can have benefits for our mental and emotional health as well(2). Like diet, there is no evidence to support one type or intensity of physical activity over another in the management of PCOS. (2)

Our relationship with movement is just as important as our relationship with food. If we are using movement (aka exercise) as form or punishment, or feel as though we need to do “x” amount of movement for “x” amount of time, and we have little flexibility with our fitness routines, we may have an unhealthy relationship with movement.

To get the physical and mental benefits of movement, it should be flexible, enjoyable, and fit into our lives in a realistic way. It can be anything from walking or riding a bike to lifting weights at the gym, and it does not have to be the conventional forms of movement we might think of. Things like gardening, housework, dancing, swimming, playing with our kids, etc., are all forms of movement. The more we enjoy what we are doing, the more sustainable it can be for us throughout our lives.

Other Lifestyle Factors

Other factors like smoking, alcohol use, cannabis use, sleep, hydration, and stress management/reduction can be important considerations as well in managing PCOS (2).

Medications and Supplements

There are several medications that can be prescribed to help manage the underlying issues of PCOS (insulin resistance, excess androgen production, and irregular cycles). Speak to your doctor about these options.

Some popular supplements you may see in the media for PCOS management are Inositol, Vitamin D, and Omega-3. A Naturopathic Doctor (ND) or Registered Dietitian (RD) can help you to choose the best, evidence-based option for you.

Mental Health Support

Finally, there is a high prevalence of moderate to severe depression and anxiety in people with PCOS (2). Health professionals should be aware of this and screen for it and refer to mental health specialists when appropriate.

Due to the nature of the condition, weight gain, difficulty losing weight, and strong cravings for certain foods can have a negative impact on body image. This can lead people to a diet that can put them at an increased risk of developing an eating disorder. Working with a therapist (psychologist, counsellor) on body image can be beneficial if you are struggling. Also, working with a Registered Dietitian who specializes in PCOS, body image, disordered eating, or eating disorders can be helpful.

Conclusion

Managing PCOS is a lifelong journey. Symptoms and needs can change over time, but with the right knowledge, support, and healthcare team, it’s possible to feel empowered and in control of your health.

If you’d like support with diet and lifestyle changes for PCOS, you can book a free virtual 15-minute Nutrition Meet and Greet with Megan Hoffman, RD.

*Disclaimer: The information contained within this post is for general educational and information purposes only; no doctor-patient relationship is formed. It is not professional medical advice, diagnosis, treatment, or care, nor is it intended to be a substitute therefore. If you have any concerns or questions about your health, always seek the advice of a qualified healthcare professional.

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References:

1. Williams, T., Mortada, R., & Porter, S. (2016). Diagnosis and Treatment of Polycystic Ovary Syndrome. American family physician, 94(2), 106–113.

2. Teede, H. J., Tay, C. T., Laven, J. J., Dokras, A., Moran, L. J., Piltonen, T. T., ... & Joham, A. E. (2023). Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. European journal of endocrinology, 189(2), G43-G64.

3. Gibson-Helm, M., Teede, H., Dunaif, A., & Dokras, A. (2017). Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 102(2), 604-612.

4. Toosy, S., Sodi, R., & Pappachan, J. M. (2018). Lean polycystic ovary syndrome (PCOS): an evidence-based practical approach. Journal of Diabetes & Metabolic Disorders, 17(2), 277-285.

5. Tylka, T. L., Annunziato, R. A., Burgard, D., Daníelsdóttir, S., Shuman, E., Davis, C., & Calogero, R. M. (2014). The weight‐inclusive versus weight‐normative approach to health: evaluating the evidence for prioritizing well‐being over weight loss. Journal of obesity, 2014(1), 983495.