Everything You Need to Know About Polycystic Ovarian Syndrome (PCOS)

What is Polycystic Ovarian Syndrome (PCOS)? 

Polycystic Ovarian Syndrome (or PCOS) is a hormonal disorder that affects how the ovaries work. It affects around 1 in every 10 women in the UK, usually of reproductive age.

Symptoms of PCOS often begin in adolescence and can fluctuate during adulthood. Most women find out that they have PCOS in their 20s or 30s.

What are the symptoms of PCOS?

PCOS is a 'syndrome' - a group of symptoms that occur together. But PCOS does not affect everyone in the same way. Symptoms vary from person to person. 

Common symptoms of PCOS include:

• Irregular or absent periods
• Excessive hair growth (called hirsutism), often in a male-like pattern. For example on the face and back.
• Acne
• Weight gain around the tummy
• Fatigue
• Sleep disturbances
• Low libido
• Dark patches on the skin (known as acanthosis nigricans)
• Skin tags
• Hair thinning or balding
• Reduced fertility
• Mental health challenges such as anxiety and depression

How is PCOS Diagnosed?

Doctors use guidelines called the Rotterdam criteria to diagnose PCOS. To be diagnosed, a person needs to have at least two of the following three signs or symptoms:

• Ovulatory problems: When ovulation (the release of an egg) doesn't occur or is irregular, it leads to menstrual irregularities. For example light periods, irregular or absent periods due to follicles not maturing and being released.
• Raised Androgen Levels: High levels of androgens (a group of hormones) like testosterone. These can be seen on blood tests or evaluated by a doctor. For example elevated levels can manifest as male-pattern hair growth, acne, or hair thinning.
• Polycystic Ovaries: The presence of many follicles around one or both ovaries, as shown on a vaginal ultrasound scan.

What causes PCOS, is it hereditary? 

PCOS is a complex condition and the exact causes are not understood. Research shows there are both genetic and environmental factors that can play a role. For example PCOS often runs in families. If your mother or sister has PCOS, your risk of developing the condition may be higher.

Other factors that can contribute to the development of PCOS symptoms include:

• Insulin Resistance: Insulin is a hormone that helps convert sugar and starches from food into energy. When the cells in your body don’t respond normally to insulin, the body releases more insulin to try and correct the problem. This can lead to higher insulin levels, increasing the production of androgens. This exacerbates symptoms like hair growth, acne, and ovulatory dysfunction.
• Inflammation: Chronic low-level inflammation is common in many women with PCOS. This inflammation may prompt the ovaries to make androgens which can disrupt the menstrual cycle.
• Changes in the Gut Microbiome: Imbalances in the gut microbiome (the community of bacteria living in your gut) may play a role in how PCOS develops. Gut microbes play a role in regulating oestrogen and androgen metabolism in the body. They can also impact insulin sensitivity, contributing to the hormonal imbalances seen in PCOS.

Are there any health issues linked with PCOS?

PCOS is a leading cause of infertility but it also increases the risk of long-term health conditions like heart disease and type 2 diabetes. PCOS has a huge impact on a person's quality of life, body image and self esteem too.

However, with the right management and support, many people with PCOS lead healthy and fulfilling lives.

How is PCOS treated? 

There's no cure for PCOS but it can be managed effectively with lifestyle changes. Lifestyle changes can also improve energy levels and reduce the risk of developing related conditions like heart disease and diabetes.

Supplements and medications like hormonal contraceptives can benefit some people with PCOS too.

What Lifestyle Changes Help?

1. A Healthy Diet:

Aim for a healthy balanced diet rich in whole foods can help to manage insulin levels. Try to build your meals around:

• fruits and vegetables
• lean proteins
• healthy fats (for example from nuts, seeds and oily fish)
• low-glycemic index (GI) carbohydrates like oats, wholemeal bread and wholegrain cereals

2. Regular Exercise:

Making exercise a regular part of your lifestyle can improve how your cells respond to insulin. It can also help you reach and maintain a healthy weight and support your mental health.

3. Get Enough Sleep:

Poor sleep can make insulin resistance worse and can increase stress hormones. Both of these things can aggravate PCOS symptoms. Taking steps to help you get enough good quality sleep helps regulate hormones and supports your health.

Some simple strategies include creating a calming bedtime routine and avoiding screens in the hour before bed.

4. Manage Stress:

Chronic stress can lead to raised cortisol levels. In turn this can disrupt hormone balance and worsen PCOS symptoms. Exploring stress-reducing techniques like yoga, meditation, or deep-breathing exercises to help balance hormones.

Managing stress is also important for your mental wellbeing, so finding coping tools that work for you is really worthwhile.

5. Include Foods to Support Your Gut Microbiome:

Aim to include foods like yoghurt, kefir, and fermented vegetables. These can support the beneficial bacteria in your gut, which can in turn help regulate inflammation.

6. Consider Supplements:

There are two well-researched dietary supplements that can help with symptoms of PCOS:  

1. Inositol: Inositols are small molecules which are structurally like glucose. Your body makes inositols but they're also found in foods like fruit, grains and beans. Studies show inositol supplements can improve how the body responds to insulin and regulate menstrual cycles in PCOS. The recommended dose for inositol is 4000 milligrams daily, split into 2 doses morning and night. 

• Omega-3 Fatty Acids: There's some evidence omega-3 may help with symptoms of PCOS. They can also play a role in reducing inflammation and supporting heart health. The recommended dose is 500 milligrams of DHA per day.

The Power of Small Steps in Managing PCOS

Living with PCOS can be challenging, so it’s important to have a strong support system and work with healthcare professionals who are knowledgeable about the condition. Taking steps to better understand PCOS and how to manage it can lead to big improvements in symptoms and your quality of life. It can also reduce the risk of related health issues

If making changes feels overwhelming, start with one or two small steps to build your confidence and motivation. For additional support, consider reaching out to organisations like the charity Verity or speak to your GP to learn about what support services are available.

References:  

• Fauser BCJM, Tarlatzis, Fauser, Chang, Aziz, Legro, et al. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Hum Reprod. 2004;19(1):41–7. 
• International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Monash University, Melbourne Australia, 2018. http://www.monash.edu/medicine/sphpm/mchri/pcos  
• Rasquin LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease. [Updated 2022 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459251/ 
• Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013 Dec 18;6:1-13. doi: 10.2147/CLEP.S37559. PMID: 24379699; PMCID: PMC3872139. 
• U.S. Department of Health and Human Services, Office on Women's Health. (2014). Polycystic ovary syndrome (PCOS) fact sheet. Retrieved June 28, 2024. from http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html (PDF 126 KB)