Polycystic ovarian syndrome, aka PCOS, is the most common hormonal disorder among women of reproductive age, affecting up to 10 million women worldwide.
It is defined as a syndrome of hyperandrogenism and anovulation as it commonly presents itself with androgenic symptoms such as acne, hirsutism, and hair loss as well as irregular cycles (1).
Infertility is 10 times more common with PCOS women but this does not mean that pregnancy is not possible. PCOS is more of a sub fertility situation meaning it may take more work and time to conceive due to anovulatory cycles.
While there is no known cause for PCOS, genetics, environmental triggers, and exposure to androgens in utero seem to be the major triggers for developing PCOS. This means that though genes do play a role, environmental exposures may be even more influential in the development of PCOS and the severity of the phenotype (2).
The 4 main PCOS phenotypes include:
- Irregular cycles + polycystic ovaries + hyperandrogenemia
- Irregular cycles + hyperandrogenemia
- Hyperandrogenemia + polycystic ovaries
- Irregular cycles + polycystic ovaries
These phenotypes can change over time as they are strongly influenced by external factors such as diet and lifestyle.
How do you know if you have PCOS?
Contrary to popular belief, you do not need to display cysts to have PCOS. In fact PCOS cysts are actually not true cysts, but rather undeveloped follicles that did not reach ovulation and instead accumulate in the ovaries (3). Polycystic ovaries may be present but they do not alone confirm a PCOS diagnosis.
PCOS is a syndrome of exclusion therefore it’s important to rule out other conditions and get a proper diagnosis.
Presently, a PCOS diagnosis follows the Rotterdam Criteria and must include the presence of any two of the following three conditions : irregular or missing periods (fewer than 10 periods in one year or cycles of over 35 days), excess androgens, and polycystic ovaries on ultrasound (4).
It is important to seek professional guidance when diagnosing PCOS to ensure the proper treatment is followed.
So where can you start?
Okay so now you know that you have PCOS, so what do you do? You may feel overwhelmed with all of the diets, supplements, and medications thrown at you but it’s always best to start with the basics.
Clean up your diet
Nutrition is the foundation to reversing PCOS symptoms.
Certain foods can exacerbate hormonal conditions like PCOS and these include refined sugars, alcohol, coffee, processed foods, artificial sweeteners, and vegetable oils. In addition, many women don’t do well on dairy and gluten due to their insulin provoking and inflammatory properties. For those with insulin resistance (affecting up to 70% of PCOS women) added sugars should be avoided in order to stabilize the blood sugar response.
Whole foods should be your primarily focus with a wide variety of vegetables. I always recommend my clients fill up half their plate with non-starchy vegetables to boost their nutrient intake and load up on fibre which increases satiety and regulates blood sugar.
A mediterranean type diet has been shown to benefit PCOS due to its high anti-inflammatory content (5). Some of my favourite foods for PCOS include wild salmon, leafy greens, blueberries, turmeric, green tea, sweet potatoes, and avocado.
Manage your stress
Stress plays a significant role in PCOS. When we experience chronic stress the HPA axis (essentially the connection between the brain and the endocrine system) is thrown off balance, making our hormones go haywire. This can result in fatigue, weight gain, anxiety, depression, acne, and sleep problems. Women with PCOS may produce androgens from the ovaries, and to a lesser extent, the adrenal glands (6). Up to 30% of PCOS women are said to have Adrenal PCOS (7). As DHEA-S is an androgen only secreted by the adrenals it is a common marker that is used to assess adrenal androgen secretion (8).
PCOS women have not only been shown to be more sensitive to stressors but also produce higher cortisol levels than controls (9).
It’s important to remember that stress is not just emotional, but also physical and chemical. This could look like toxins from beauty products, household mold, accidents and injuries, over or under exercising, processed and inflammatory foods, and lack of sleep.
So it’s important to be aware of your day to day stressors so that you can make the necessary changes. Activating the parasympathetic system (the relaxed state of the body) is the best way to reduce stress hormones and balance Adrenal PCOS.
How can you do this? Mindfulness and grounding practices are an important addition to any PCOS protocol and can include activities such as spending time in nature, playing outside, meditation, reading, deep breathing, and journaling.
Work on your mindset
Strengthening your mindset is a crucial but often overlooked step in managing PCOS. Women with this syndrome are more likely to experience lowered self esteem, depression and mental health disorders (10). This is why focusing on a holistic approach that includes emotional healing can make a big difference.
Many neuroscience experts such as Joe Dispenza distinguish the link between our thoughts and emotions and how they can drive disease or health in the body. Once we realize that our thoughts can actually make us sick, we can learn how to use them strategically to support healing in the body.
Thought stopping is a great tool to become more aware of your thoughts, which involves recognizing disempowering thoughts and changing them to more empowering and positive ones instead.
I do encourage women to seek out additional support and to prioritize meaningful relationships in their lives because PCOS should not be navigated alone. Immersing yourself into a supportive community should be one of the first steps in your journey. This could be close friends, family, health care providers, or a PCOS community to find other women who can understand and support you.
Get adequate sleep
“Sleep is for the dead” is terrible advice to follow especially if you are female and have hormones… Sleep is the time for repair and regeneration. When our sleep is off we mess with our circadian rhythm which can throw off our energy levels during the day and dysregulate our hormones. Lack of sleep can increase hunger hormones, decrease satiety hormones, and promote an imbalance in cortisol levels. A single night of sleep deprivation has been shown to increase insulin resistance and glucose intolerance (11).
So how much sleep should you be getting? The sweet spot seems to be between 7-9 hours every night. Good sleep hygiene means getting to bed before midnight (by 10PM is ideal), eating at least 2 hours before bed, sleeping in complete darkness, and avoiding electronics at least 1 hour before bed.
Skip the stimulants
Caffeine is a common stimulant that is used among PCOS women to increase energy and even mood, but what many don’t know is that this can actually make things worse. Coffee acts as a central nervous system stimulant which can increase cortisol and insulin levels. This blood sugar rollercoaster ride can worsen anxiety, cravings, energy levels, and weight gain. Excess coffee consumption may also increase the risk of miscarriage and difficulty conceiving (11).
If you find yourself relying on coffee for energy or to “get through the day” you may need to reevaluate your relationship with your cuppa Joe. I recommend reducing to 1 cup before noon and enjoying your coffee with food, or substituting it for green tea instead which contains lower amounts of caffeine and the beneficial calming amino acid L-theanine.
Want more tips on how to manage PCOS?
Laurence Annez is a Certified Nutritional Practitioner and Health Coach. She specializes in PCOS, teaching women how to ditch the cystic acne, irregular cycles, and belly fat using nutrition and holistic strategies. She does this through guided nutritional coaching, personalized and sustainable diet and lifestyle recommendations, and mindfulness. No diets, no deprivation. Ever.