What Your Doctor Didn’t Tell You About PCOS
Written by Jenna Ray, Dietetics Student at the University of Wisconsin-Madison
If you or someone you know has been recently diagnosed with Polycystic Ovarian Syndrome (PCOS), then this quick guide is for you! Below I have highlighted what this condition is, common symptoms of PCOS, and how to help manage this condition. Make sure you read Part 2 to learn about our recommended diet patterns for PCOS, and Part 3 to learn about our most asked about PCOS supplements!
What Even Is PCOS?
If you are an individual of childbearing age in the U.S, it is highly likely that you or someone you know will have PCOS in their lifetime. In fact, this condition affects 10% of those with ovaries in the United States. Individuals with PCOS have high levels of androgens – male sex hormones – which are produced in ovarian cysts. These cysts develop when ovulation doesn’t occur due to imbalanced reproductive hormone levels. As a result, it’s one of the most common causes of infertility.
Those with PCOS have chronic low-grade inflammation and tend to be insulin resistant. Glucose intolerance and sensitivity is a common feature of this condition. Therefore, maintaining balanced glucose levels is extremely important for those with PCOS. Elevated glucose markers can trigger increased oxidative stress and inflammatory responses in the body. This can further enhance the symptoms of PCOS such as painful ovarian cysts and imbalanced reproductive hormones.
How is it Diagnosed?
To be diagnosed with PCOS, you must have at least two of the following:
Oligo-ovulation and/or anovulation
Aka irregular periods: infrequent, absent, and/or very heavy or very light periods
This is based on your description of your periods
This means your ovaries are not releasing eggs regularly
Polycystic ovaries
This is based on a transvaginal ultrasound
These cysts might appear like a “string of pearls”
Androgen excess
High levels of hormones like testosterone detected on blood tests
Some providers will use any physical signs of high testosterone they detect to meet this criteria if your lab values are normal (see below)
These labs are not reliable if you are taking birth control
We feel it’s important to establish a proper diagnosis if PCOS is suspected because it is commonly associated with other chronic diseases that you might be at a higher risk for. These include diabetes, heart disease, high blood pressure, sleep apnea, high levels of LDL, stroke, depression and anxiety, and endometrial cancer.
What Are the Symptoms?
Outside of the above features, symptoms of PCOS can include any of the following:
Hair balding or thinning
Hirsutism: excess hair on the face, back and chest
Periods that are irregular, painful, very heavy, abnormally long, or missed entirely
Easily gained weight and resistance to weight loss
Acne
Skin tags
Ovarian cysts
Acanthosis Nigricans: dark thick patches of skin on the back of the neck, in the armpits, and under the breasts
It’s important to note that none of these symptoms are diagnostic on their own. We hear far too often from our patients that they were diagnosed with PCOS based on their weight and the fact that they have acne. Neither of these things diagnose PCOS, and although they may be symptoms, they could also be completely unrelated (as in, you were genetically predisposed to acne and a higher weight).
While many of these symptoms are related to one’s outward appearance, there is no one “look” to PCOS! For example, some people don’t have the testosterone receptors in their skin that would cause excess facial hair. If you were told you have PCOS because you simply “look” like you might… that’s not a diagnosis, and requesting appropriate lab work and/or an ovarian ultrasound might be your next steps. On the other hand, if you feel like something isn’t right, but you aren’t being assessed because you don’t “look like you have PCOS,” then it’s also time to advocate for yourself.
Who is at Risk of Developing PCOS?
The cause of PCOS is currently unknown but researchers believe that genetics and environmental factors – such as chemical pollutants and hormone-disrupting skincare products – play a role in the onset of this condition. Individuals who are insulin resistant also have an increased risk for developing PCOS since these conditions are strongly correlated. If body cells become too resistant to insulin, this can cause insulin and androgen levels to build up in the body that elevates blood glucose levels and can overtime lead to prediabetes or Type 2 diabetes.
There is also a complex association between PCOS and higher weights. Being at a higher weight does not cause PCOS, rather it may be an outcome of the pathophysiology of PCOS (re: insulin resistance). More insulin resistance = a higher likelihood of weight gain, so the question becomes this: is a worsening of symptoms due to weight gain, or is the weight gain due to a worsening of symptoms? It is known that those who are at a higher weight are typically more associated with having developing reproductive abnormalities. Again, this correlation might make it feel easy to conclude that obesity causes PCOS, but correlation does not equal causation, friends! We’ll get off our soapbox (for now) and just say that the relationship between PCOS and weight is complex and it highlights the important interaction of both environmental and genetic factors that are associated with this condition.
I Have PCOS… What Should I Do Now?
Currently there is no cure for PCOS but that doesn't mean that there is no hope for individuals living with this condition. In Part 2, we’ll share all of our tips for a PCOS-supportive nutrition routine, and in Part 3 we’ll share the research on our most asked about PCOS supplements. But first, read on to learn about the typical medical management of PCOS.
Medical Management
The best medical treatment plan for PCOS often depends on whether or not an individual is planning to get pregnant. Either way, much of the focus of treating PCOS is on addressing blood sugar and insulin balance to decrease symptoms, improve fertility (if applicable), and manage the increased risk for additional chronic health concerns (so you can live a long, happy life!).
By balancing blood sugar, this can help regulate an individual’s ovulation and infradian rhythm – a 28-day biological clock that regulates the menstrual cycle and affects the brain, metabolism, immune system, microbiome, stress response, and reproductive system.
Aside from maintaining a balanced diet and overall lifestyle, oral medications such as Metformin have been used to manage PCOS symptoms like insulin sensitivity and anovulatory infertility. Metformin is an insulin-sensitizing agent that can be effective at inducing ovulation for those with PCOS. A study from the Annals of Translational Medicine on the analysis of Metformin’s effectiveness for treating PCOS showed that this medication was more effective than over the counter prescription drugs in decreasing one’s fasting insulin. This is incredibly important since individuals with PCOS experience an increased resistance to insulin. Metformin also has beneficial effects on restoring ovulation and a regular menstrual cycle for women with PCOS. However, there is still more information needed to conclude the relative efficacy of Metformin for preventing PCOS-related conditions like diabetes, endometrial cancer, and cardiovascular disease.
Another common medical treatment to help manage PCOS symptoms is birth control. Combined hormonal birth control pills – with estrogen and progestin – can be a long-term treatment plan for those with PCOS who are not looking to get pregnant in the near future. Oral contraceptive pills can help regulate one’s menstrual cycle so that their period comes about every 28 days instead of all over the place. This form of birth control can also help normalize your flow and lower androgen hormone levels, which would therefore help decrease abnormal hair growth, improve acne, and lessen the extent of menstrual cramping.
Weight Loss
Before you read on, here’s a spoiler alert: We will never prescribe weight loss for PCOS treatment (or any condition, for that matter). With that out of the way, here are our thoughts on weight loss as a central recommendation of many providers out there.
At Real Good Nutrition we firmly believe that finding an OB/GYN and/or endocrinologist (ideally both!) that treats from a weight-neutral standpoint is extremely important. Weight loss is often prescribed as a first-line treatment, often coming with recommendations for dangerously low calorie diets and excessive exercise plans (both of which are counterproductive to PCOS management and set you up for weight-cycling, which is even more damaging to your health in the long run). We strongly believe the focus should be on health-promoting behaviors, like balanced nutrition, good sleep patterns, regular movement, stress and mental health management, and addressing any related health conditions versus prescribing weight loss. Weight loss may or may not come as a result of these health-promoting behaviors we work on, but it’s not the main focus (more of a side effect if it happens vs. a goal!).
Healthcare providers that listen to your needs and focus on your overall health (including your mental health), and operate from a weight-neutral or Health At Every Size standpoint are not always easy to come by, so here are a couple of our favorite resources to find one in your area:
Thank you so much to Jenna Ray for helping with this post!
Wondering what our nutrition recs for PCOS are?
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