Polycystic ovary syndrome (PCOS) is a common health issue for women of childbearing age. It is characterized by higher levels of male hormones, irregular periods, and cysts on the ovaries. Symptoms can include menstrual cycle changes, excess hair growth, acne, weight gain, and problems with insulin, which could potentially lead to complications like diabetes and heart issues. Managing PCOS involves several approaches: making lifestyle changes, taking medications, and adjusting your diet. Regular exercise and a balanced diet with low-glycemic foods, high fiber, low carbs, and lean proteins can help, while medications like metformin or birth control pills can also help manage symptoms and improve insulin sensitivity in the body. Regular health assessments by a healthcare provider are essential for comprehensive management of PCOS.

While we at Chiyo are passionate about nutritional solutions, please note that this information is for educational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. 

 

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If you are navigating the complexities of polycystic ovary syndrome (PCOS), know that you’re not alone. PCOS is a common condition, but understanding its causes and treatments can sometimes feel overwhelming. This guide will dive into what PCOS is, how it impacts women’s health, and what steps you can take to manage it effectively.

PCOS is a multifaceted disorder that requires a comprehensive approach to diagnosis and management, focused on addressing both reproductive and metabolic concerns. The diagnosis of PCOS involves a combination of clinical history, physical examination, and blood tests.

Managing PCOS often includes a combination of lifestyle changes, medications, and dietary adjustments. Nutrition plays a crucial role in this process, with a focus on low glycemic index foods, high fiber intake, and balanced meals to help regulate insulin levels and reduce symptoms.

Join us in exploring the causes and symptoms of PCOS, and practical strategies to help manage this condition.

 

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PCOS 101

What Is It?

Polycystic ovary syndrome (PCOS) is a common health condition in women of childbearing age. It can cause a range of health issues like irregular periods, excess hair growth, male pattern baldness, acne, and weight gain. PCOS can make it more difficult to get pregnant, and the condition is connected to problems with metabolism, like insulin resistance, type 2 diabetes, and abnormal cholesterol levels. The causes of PCOS are complex, involving a mix of genetics, environmental factors, and hormones. [1-8]

Symptoms & Complications

PCOS can present with a range of symptoms that affect multiple systems of the body. The most common symptoms include:

• Menstrual Irregularities: This can manifest as oligomenorrhea (infrequent periods) or amenorrhea (absence of periods). [9-11]
• Hyperandrogenism: This is the excess presence of androgens, a group of sex hormones that includes testosterone. Clinical signs include hirsutism (excessive hair growth in a male pattern), acne, and androgenic alopecia (male-pattern baldness). [9-12]
• Polycystic Ovarian Morphology: The ovaries may have multiple small follicles, often described as having a "string of pearls" appearance on ultrasound. [9][11][1]
• Obesity: Approximately half of women with PCOS are overweight or obese, which can compound symptoms and metabolic complications. [9-12]
• Insulin Resistance: Many women with PCOS have insulin resistance, which means their bodies don't use insulin properly. This can lead to elevated insulin levels and a higher chance of developing type 2 diabetes. [9-11][13]
• Pregnancy-Related Complications: Problems like gestational diabetes, preeclampsia, and preterm birth are associated with PCOS, and these can have lasting effects on both maternal and neonatal health. These complications necessitate vigilant postpartum monitoring and management to mitigate long-term health risks. [62-64]
• Infertility: Because they don’t ovulate regularly, women with PCOS may have trouble getting pregnant. [11-12]
• Metabolic Syndrome: This includes problems like high cholesterol, high blood pressure, and a greater chance of heart disease. [10-11][13]
• Psychological Symptoms: PCOS can influence cortisol levels, and cortisol can exacerbate the biological processes of PCOS, potentially creating a feedback loop. As a result, women with PCOS are at increased risk for depression, anxiety, and other mood disorders. [13][14]

Diagnosis

The diagnosis of Polycystic Ovary Syndrome (PCOS) is primarily based on the Rotterdam criteria, which require the presence of at least two of the following three features:

1. Oligo-ovulation or anovulation, identified through a history of irregular menstrual cycles, such as infrequent or absent periods;

2. Hyperandrogenism, assessed clinically by observing physical symptoms or biochemically by measuring elevated levels of androgens like total testosterone;

3. Polycystic ovarian morphology, defined as the presence of multiple small follicles on the ovaries, or a large ovarian volume, seen on ultrasound. [3][15]

The Endocrine Society recommends using this criteria to diagnose PCOS and stresses the importance of ruling out other conditions that can look like PCOS — including congenital adrenal hyperplasia, Cushing's syndrome, and tumors that produce androgen hormones. [3][17]

Common Misconceptions

There are several misconceptions about PCOS that can lead to misunderstandings in diagnosis and management of the condition, including:

• That PCOS always involves ovarian cysts: Despite the condition’s name, not all women with PCOS have visible cysts on their ovaries. The diagnosis can be made based on other criteria like testosterone levels and ovulatory dysfunction. [5][3]
• That PCOS is solely a reproductive disorder: PCOS is often perceived as primarily affecting reproductive health, but it also has significant metabolic implications, including increased risks for insulin resistance, type 2 diabetes, and heart disease. [5][18]
• That obesity is a requirement for PCOS: While obesity can be involved in symptoms and metabolic complications of PCOS, it is not a prerequisite for the diagnosis. Non-obese women can also have PCOS, presenting with other symptoms. [19]
• That PCOS is caused by poor lifestyle choices: Although lifestyle factors such as diet and exercise can influence the severity of PCOS symptoms, this condition has a strong genetic component and is not solely caused by lifestyle choices. [18][20]
• That PCOS can be cured: There is currently no cure for PCOS. Management focuses on symptom relief and reducing the risk of long-term complications through lifestyle changes and other treatments. [3][21]
• That all women with PCOS have the same symptoms: PCOS can show up in many different ways, with symptoms that can be mild or severe. [5][22]

 

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Causes of PCOS

Understanding the causes of PCOS involves looking at a mix of different factors — including how genetics, lifestyle, and environmental influences contribute to the development of the condition. The key risk factors and biological mechanisms underlying PCOS help to highlight how these complex interactions affect the body's functions and overall health.

Risk Factors

Polycystic Ovary Syndrome (PCOS) is influenced by a variety of risk factors, including:

• Family History: Family history plays a significant role in the risk of developing PCOS. Women with a first-degree relative (mother or sister) with PCOS have a higher likelihood of developing the condition themselves. [23-24]
• Insulin & Obesity: Insulin resistance and high insulin levels are closely linked to PCOS, potentially making hormonal and menstrual problems worse. Obesity, especially excess fat around the belly, is also a risk factor — women with higher BMI and significant weight gain are at increased risk of PCOS. [25-28]
• In-Utero & Early Life: The development of PCOS can be influenced by things that happen before and shortly after a person’s birth. For example, if a baby is exposed to high levels of stress hormones in the womb, they might be more likely to develop PCOS later in life. In early infancy, factors like gaining weight quickly, inadequate nutrition, and limited physical activity can also increase the risk of PCOS. Exposure to certain chemicals in the environment, like endocrine disruptors, might contribute to the development of PCOS as well. [34-35] Maternal obesity and smoking during pregnancy have also been associated with a higher risk of PCOS in children. [24][29]
• Lifestyle & Environment: A sedentary lifestyle and poor dietary habits can increase the risk of PCOS, particularly in people with a genetic predisposition. [30] Exposure to certain chemicals in the environment, like endocrine disruptors, might contribute to the development of this condition as well. [34-35]
• Other Health Conditions: Conditions like metabolic syndrome, pre-diabetes, and type 2 diabetes are more common in women who develop PCOS. These conditions are both risk factors and consequences of PCOS. [27][31]

Biological Mechanisms

PCOS arises because of a mix of factors, including genetics, problems with how the body processes food and energy, and inflammation.

• Genetic Factors: Genetics play a big role in PCOS. Several genes are involved, and some of them affect hormone levels and how the body handles insulin. For example, changes in genes like LHCGR, THADA, and DENND1A have been linked to PCOS, disrupting how the ovaries produce hormones and other functions. [32][5]
• Metabolic Pathways: In PCOS, the body often has trouble using insulin properly, leading to higher levels of insulin in the blood (insulin resistance). This extra insulin worsens PCOS symptoms by causing the ovaries to produce more male hormones, and by limiting a protein that normally helps balance these hormones. For people who are overweight, the dysfunction of adipose tissue (mainly composed of fat cells) can also worsen insulin resistance and other metabolic issues. [5][33]
• Inflammatory Responses: Chronic low-grade inflammation is increasingly recognized as a significant contributor to PCOS. This chronic inflammation is characterized by elevated levels of pro-inflammatory molecules (called cytokines) which can disrupt ovarian function and impact egg development and hormone production. [36-38] Inflammatory molecules like lipopolysaccharide (which is found on the outer surface of certain bacteria) can also promote the production of androgen hormones, which underpins the symptoms of hyperandrogenism in PCOS. [39] Chronic inflammation is also closely linked to insulin resistance, which is a common feature of PCOS. [40-41]

 

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Managing PCOS

Managing PCOS involves tackling inflammation, hormone imbalances, and insulin resistance using a mix of lifestyle changes, nutrition, and medications.

Lifestyle Changes

• The cornerstone of PCOS management is lifestyle adjustments, including increased physical activity and dietary changes. Exercising regularly can help your body handle insulin better and lower inflammation, which can lead to improved health and reproductive outcomes. [44]
• A balanced diet — including carbohydrates with a low glycemic index, and reduced intake of saturated and trans fats — is recommended, while making sure you get enough important nutrients like vitamin D, chromium, and omega-3s. [42-43] See the following section, Nutrition for PCOS, to learn more.

Pharmacological Interventions

• Several pharmacological approaches are used to manage PCOS. Metformin (which lowers blood sugar levels) can help with insulin resistance and thus improve ovulatory function and reduce symptoms like excess hair and acne. Birth control pills also help regulate periods and control some PCOS symptoms by balancing hormones. Medications like spironolactone (which blocks a hormone called aldosterone) are sometimes used to help reduce issues caused by high androgen levels. Additionally, while not a standard treatment, some studies suggest that anti-inflammatory medications might also help with PCOS by reducing overall inflammation. [45-48] Your doctor will help you determine what course of treatment is right for you.

Monitoring Complications

• Women with PCOS will need to be regularly screened for metabolic problems, by checking blood sugar levels and cholesterol, because of the higher risk of diabetes and heart disease associated with PCOS. [47]
• Since depression and anxiety are commonly seen in people in PCOS, getting psychological support and screening for mood disorders is essential. [13]

Complementary Therapies

• While not as extensively studied, mindfulness practices and yoga have been suggested to reduce mental health problems and improve overall wellbeing in women with PCOS. These practices may have beneficial effects the central and autonomic nervous systems, hypothalamic-pituitary-adrenal axis, and immune system — to help reduce stress, blood pressure, and inflammation. [49][54]
• Acupuncture might help with PCOS by reducing high androgen levels and improving how often periods occur. It’s believed to work by stimulating nerves that affect both the nervous system and hormone levels, which in turn helps with overall metabolism and endocrine functions. [49]

Supplements

• As a complement to nutritional strategies (see below), several supplements have been studied for their potential benefits in PCOS. Inositol may help with insulin sensitivity, lower androgen levels, and improve ovulation, in levels of 2-4 grams per day. [50-51] N-acetylcysteine (NAC) may help with insulin sensitivity and ovulation and act as an antioxidant, in doses of 600-1800 mg per day. [51]
• Some formulations from Traditional Chinese Medicine (TCM) like Jia-Wei-Xiao-Yao-San, which contains a mix of herbal components, are thought to help with PCOS by balancing hormones, reducing insulin resistance, and making periods more regular. [52-53]

 

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Nutrition for PCOS

Dietary interventions are considered a first-line treatment for PCOS, aiming to improve insulin resistance, reduce androgen levels, and improve reproductive function. [43][55-56]

• Low Glycemic Index: Eating foods with a low glycemic index (like leafy greens, whole grains, and legumes) is recommended for managing insulin resistance and high insulin levels in PCOS. This approach help keep blood sugar levels steady and prevent insulin spikes, which can lead to better metabolic health and reproductive outcomes. [55-57]
• Fewer Simple Carbohydrates: Reducing intake of simple and refined carbohydrates have shown to be helpful with PCOS, and choosing complex carbohydrates containing fiber can help stabilize blood sugar and promote health health. [60-61]
• Monounsaturated Fats & Omega-3s: Eating more foods with monounsaturated fats (like olive oil, avocados, almonds, and pumpkin seeds) and omega-3 fatty acids (like fatty fish, flaxseeds, chia seeds, and walnuts) can help facilitate this and improve the balance between omega-6 and omega-3 fatty acids, which is often disrupted in PCOS. [56][58] Omega-3 fatty acids can also reduce inflammation and improve cholesterol levels, in quantities of 1-3 grams per day. [50-51]
• High-Fiber Foods: These are beneficial for improving insulin sensitivity and promoting satiety. High-fiber foods include chia seeds, lentils, apples (with skin), broccoli, oats, black beans, sweet potatoes (with skin), almonds, quinoa, and raspberries. [59][56]
• Lean Proteins: Fish, poultry, and plant-based proteins (like tofu, beans, lentils) are recommended to support metabolic health and reduce excess insulin production. [59][56]
• Vitamin D & Chromium: These are both important for metabolic health and insulin sensitivity. Foods high in vitamin D (like shiitake mushrooms, beef liver, cod liver oil, and egg yolks) can help support people who are deficient in this vitamin, the same is true for chromium (found in cooked broccoli, almonds, cashews, oats, and green beans). [43][56]
• Inositol: B vitamins, particularly  myo-inositol, support healthy ovulation by promoting estrogen production and increasing follicular sensitivity to follicle-stimulating hormone. Sources include citrus fruits, brown rice, almonds, lentils. [65-66]
• Cinnamon: Specific ingredients like cinnamon can also support PCOS management. Cinnamon may help with insulin sensitivity and regular menstrual cycles, in doses from 1-6 grams per day. [50]

• Assessing Total Energy Intake: For women struggling with PCOS and obesity, assessing total energy intake and making changes to reduce calories in needed areas of their diet would be recommended. This approach can help improve insulin sensitivity, reduce high androgen levels, help make periods more regular, and boost fertility. [43][56-57] It’s important to talk with your healthcare provider to find the approach that is right for you.

 

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Conclusion

Managing PCOS can be challenging, but with the right approach, you can take control of your health. By understanding the condition, adopting a comprehensive management plan that includes lifestyle changes, medications, and dietary adjustments, you can effectively address both the symptoms and the underlying issues of PCOS. Regular exercise, a balanced diet, and medical treatment play crucial roles in improving insulin sensitivity and reducing symptoms. While PCOS does not currently have a cure, proactive care can help you achieve your health and fertility goals.

 

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FAQs

What is Polycystic Ovary Syndrome (PCOS)?

PCOS is a common condition in women of childbearing age that can lead to irregular periods, excess hair growth, acne, male-pattern baldness, weight gain, and difficulties with pregnancy. It is associated with metabolic problems such as insulin resistance and type 2 diabetes.

What are some common symptoms of PCOS?

Common symptoms include menstrual irregularities (infrequent or absent periods), excess hair growth, acne, male-pattern baldness, multiple small ovarian follicles, obesity, insulin resistance, and potential infertility.

How is PCOS diagnosed?

PCOS is typically diagnosed using the Rotterdam criteria, which require the presence of at least two of the following: irregular ovulation, excess androgen levels (clinically or biochemically), and polycystic ovarian morphology on ultrasound. Other conditions must be ruled out.

Are ovarian cysts always present in PCOS?

No, not all women with PCOS have visible cysts on their ovaries. The diagnosis can be based on other criteria such as hormonal levels and menstrual irregularities.

Can PCOS affect women who are not overweight?

PCOS can affect women of any weight. While obesity can exacerbate symptoms, it is not a prerequisite for PCOS.

What role does lifestyle play in managing PCOS?

Lifestyle changes, such as regular physical activity and a balanced diet, are crucial in managing PCOS. These changes can improve insulin sensitivity, reduce inflammation, and help with symptom control.

What dietary adjustments are recommended for managing PCOS?

A diet focusing on low glycemic index foods, high fiber intake, monounsaturated fats, omega-3 fatty acids, and lean proteins is recommended. Reducing simple sugars and refined carbohydrates can also help manage insulin levels.

How does insulin resistance relate to PCOS?

Many women with PCOS have insulin resistance, which means their bodies do not use insulin effectively. This can lead to higher insulin levels and exacerbate symptoms of PCOS, such as high androgen levels and menstrual irregularities.

How can psychological support be beneficial for women with PCOS?

Women with PCOS are at higher risk for depression and anxiety. Psychological support and screening for mood disorders can be crucial in managing the emotional aspects of the condition and improving overall wellbeing.

 

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