PCOS Awareness Month - Understanding PCOS: Managing Symptoms with Evidence-Based Solutions
PCOS Awareness Month - Understanding PCOS: Managing Symptoms with Evidence-Based Solutions
Polycystic Ovary Syndrome (PCOS) is the most common hormonal disorder affecting females of reproductive age. A leading cause of infertility, PCOS is responsible for approximately 70% of infertility issues in women who have difficulty ovulating. The condition can develop at any time after puberty, but many women are diagnosed in their 20s or 30s when they seek treatment for infertility.
Despite its prevalence, PCOS remains underdiagnosed and often misunderstood, leaving many women to grapple with its wide range of symptoms without proper guidance.
This article will introduce you to PCOS, exploring its symptoms, diagnostic criteria and causes. We will look at the link between the root cause of PCOS and how a low carb diet can offer hope to those struggling with the variety of symptoms associated with the condition.
What exactly is PCOS?
Polycystic Ovary Syndrome (PCOS) is a multifaceted endocrine disorder that disrupts the normal functioning of a woman's ovaries. The term "polycystic" refers to the presence of multiple small cysts that form in the ovaries. Though termed cysts, these are actually clumps of underdeveloped immature follicles. However, not all women with PCOS will have visible cysts, which is one reason why the condition can be challenging to diagnose.
PCOS is primarily characterised by three main features (also called diagnostic criteria):
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Irregular Ovulation: Women with PCOS may experience fewer periods (or oligomenorrhea), prolonged menstrual cycles, or an absence of menstruation altogether (also known as amenorrhea).
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Hyperandrogenism: Elevated levels of androgens (male hormones) can lead to physical symptoms such as hirsutism (excessive hair growth on the face and body), severe acne, and androgenic alopecia (thinning hair on the scalp).
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Polycystic Ovaries: On ultrasound, the ovaries may appear enlarged with numerous small follicles (often referred to as cysts), which can interfere with normal ovulation.
These hormonal imbalances can also affect other areas of health, contributing to issues such as insulin resistance, weight gain, and an increased risk of developing Type 2 diabetes and cardiovascular diseases as well as affecting the individual’s mental health through anxiety, depression, and affecting their day-to-day relationship with self-image and self- confidence.
Prevalence and Statistics
PCOS is the most common endocrine disorder among women of reproductive age, affecting approximately 10% of women worldwide. However, due to the variability in symptoms and the absence of a single diagnostic test, actual numbers could be even greater. Each woman’s experience with PCOS is unique, with many facing a range of symptoms that may go unrecognised as part of a single underlying condition.
According to the World Health Organization (WHO), PCOS affects an estimated 116 million women globally, or about 3.4% of the female population. The condition is also a leading cause of infertility, with many women first becoming aware of their diagnosis when they experience difficulty conceiving.
In addition to its reproductive implications, PCOS is associated with a higher risk of developing a host of serious health conditions, including Type 2 diabetes, cardiovascular disease, and metabolic syndrome. Research shows that up to 70% of women with PCOS have insulin resistance, and approximately 50% will develop Type 2 diabetes or prediabetes before the age of 40, if this insulin resistance is left untreated.
Symptoms of PCOS
The symptoms of PCOS can vary widely in severity and presentation but some of the most common symptoms include:
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Menstrual Irregularities: This is often the first noticeable sign of PCOS. Women may experience fewer than eight menstrual cycles per year, or their cycles may be longer than 35 days. Some women may experience heavy bleeding, while others may have very light or no periods at all. If you are unsure of your cycle regularity, there are lots of wonderful tracking apps available.
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Excess Androgen: High levels of male hormones (androgens) can result in physical symptoms such as hirsutism, which affects up to 60%- 70% of women with PCOS. Acne, particularly along the jawline and lower face, is also common. Some women may experience male-pattern hair loss (androgenic alopecia), which can be very distressing.
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Polycystic Ovaries: Many women with PCOS have ovaries that appear enlarged with numerous small follicles (cysts) that can disrupt normal ovulation. However, it’s important to note that not all women with PCOS will have visible cysts on their ovaries, and having cysts alone is not sufficient for a diagnosis of PCOS.
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Weight Gain and Difficulty Losing Weight: Women with PCOS are more likely to experience increased fat accumulation, particularly in the abdominal region, which heightens the risk of developing additional metabolic disorders.
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Insulin Resistance and Type 2 Diabetes: A significant number of women with PCOS have insulin resistance, a condition where the body’s cells become less responsive to insulin, leading to higher blood sugar levels. Over time, this can increase the risk of developing Type 2 diabetes.
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Fertility Issues: PCOS is one of the leading causes of infertility in women due to its impact on ovulation. However, with proper management, many women with PCOS can conceive and have healthy pregnancies.
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Mood Difficulties: Women with PCOS are at a higher risk for depression, anxiety, and mood swings, due partly to the mechanisms of hormonal imbalances and partly to the psychological impact of dealing with the symptoms.
Understanding Insulin Resistance and PCOS
Insulin resistance is the term given when the body’s cells become less responsive to the hormone insulin, which is crucial for regulating blood glucose levels. Normally, insulin helps glucose enter cells to be used as energy. However, in insulin resistance, the cells do not respond effectively to insulin, leading to higher levels of glucose in the blood. The pancreas compensates by producing more insulin, resulting in hyperinsulinemia, or high insulin levels.
Insulin resistance is prevalent in approximately 50% to 70% of women with PCOS, regardless of their body weight. The connection between insulin resistance and PCOS is significant because high insulin levels contribute to several of the hallmark features of PCOS, including hyperandrogenism (excessive androgen production), irregular menstrual cycles, and ovarian dysfunction.
Examining the role of insulin in the primary diagnostic criteria for PCOS:
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Hyperandrogenism: Insulin acts directly on the ovaries to increase the production of androgens, such as testosterone. Elevated androgens lead to symptoms like hirsutism (excess hair growth), acne, and male-pattern baldness. The excess insulin also reduces the production of sex hormone-binding globulin (SHBG), a protein that normally binds to androgens, making them inactive. Lower SHBG levels result in more free and active androgens in the bloodstream, exacerbating PCOS symptoms.
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Menstrual Irregularities and Anovulation: Insulin resistance and the resulting hyperinsulinemia disrupt the normal regulation of the hypothalamic-pituitary-ovarian (HPO) axis. This disruption can impair the regular release of hormones that control ovulation, leading to irregular menstrual cycles or anovulation (lack of ovulation). Without regular ovulation, women with PCOS may experience infertility and other reproductive issues.
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Ovarian Dysfunction: The ovaries in women with PCOS are often described as being "polycystic," meaning they contain many small, undeveloped follicles that do not mature properly. Insulin resistance contributes to this by creating a hormonal environment that is not conducive to regular follicular development and ovulation. The excess insulin and androgens disrupt the normal growth of follicles, leading to the characteristic polycystic ovaries seen in many women with PCOS.
Insulin Resistance and Mental Health in PCOS
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Impact of Insulin Resistance on Neurotransmitter Function
Insulin resistance affects the brain's ability to regulate neurotransmitters, such as serotonin and dopamine, which play crucial roles in mood regulation. Serotonin, often referred to as the "feel-good" neurotransmitter, is particularly important for maintaining a stable mood. Insulin resistance can impair serotonin function, leading to lower levels of this neurotransmitter in the brain, which is associated with symptoms of depression and anxiety.
2. Hormonal Imbalances and Psychological Distress
High androgen levels are linked to mood swings, irritability, and a higher prevalence of anxiety and depression in women with PCOS. These hormonal changes can also contribute to body image issues and reduced self-esteem, further affecting mental health.
3. Impact of Insulin Resistance on Sleep and Mental Health
Insulin resistance is also associated with sleep disturbances, including poor sleep quality and sleep apnea. Poor sleep has been linked to a range of mental health issues, including increased stress, anxiety, and depression.
Above we can see the direct impact of insulin resistance on PCOS and the host of problems that it is causing our systems.
Given that insulin resistance is the underlying issue, what strategies can be employed to address it?
To effectively manage insulin levels and their impact on PCOS symptoms, it is crucial to first understand the role of food in this process.
Our diet is composed of three primary macronutrients: proteins, fats, and carbohydrates. Carbohydrates are found in foods such as rice, potatoes, pasta, bananas, porridge, bread, as well as sugary items like cakes and sweets.
These carbohydrates are converted into glucose in the bloodstream. As previously discussed, insulin is released to regulate elevated glucose levels.
With this understanding, we can now explore the most effective strategies for managing insulin levels and addressing the symptoms of PCOS.
Introducing: A Low Carb Diet
How Does a Low-Carb Diet Help?
Adopting a low-carbohydrate (low-carb) diet is a particularly effective approach for managing PCOS symptoms and enhancing overall metabolic health.
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Enhances Insulin Sensitivity: By reducing carbohydrate intake, insulin levels—which are often elevated in women with PCOS—can be directly influenced. Lowering these levels helps decrease androgen production, alleviating symptoms such as acne, hirsutism, and irregular menstrual cycles.
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Promotes Sustainable Weight Loss: Weight management is a significant challenge for women with PCOS, largely due to insulin resistance. A low-carb diet may be more effective for weight loss than other approaches by reducing hunger and stabilising blood sugar levels. As insulin, a hormone that promotes fat storage, decreases, weight loss becomes more achievable, allowing the body to overcome the signals to store fat.
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Reduces Inflammation: Chronic low-grade inflammation is common in women with PCOS and can exacerbate symptoms. A low-carb diet, focused on whole, unprocessed foods and the elimination of sugars and refined carbohydrates, can help lower inflammation, leading to improvements in overall health.
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Balances Hormones: Stabilising blood sugar levels through a diet low in refined carbohydrates and sugars can help balance hormones such as insulin and androgens. Achieving hormonal balance is crucial for reducing PCOS symptoms and improving fertility. Balanced hormones can also significantly enhance day-to-day well-being, particularly for those experiencing mood fluctuations due to hormonal imbalances.
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Improves Fertility: For women with PCOS who are trying to conceive, a low-carb diet may enhance ovulation frequency and menstrual regularity, thereby increasing the likelihood of a successful pregnancy.
Practical Tips for Adopting a Low-Carb Lifestyle
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Focus on Whole Foods: Structure your diet around nutrient-dense whole foods, such as lean proteins, healthy fats, and an abundance of non-starchy vegetables. These choices help maintain low insulin levels while providing essential nutrients.
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Limit Refined Carbohydrates: Minimise consumption of foods that cause rapid spikes in blood sugar, such as bread, pasta, sugary snacks, and sweetened beverages. Instead, opt for low-glycemic fruits like berries and increase your intake of above-ground vegetables.
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Incorporate Healthy Fats: Include healthy fats, such as those found in avocados, nuts, seeds, and olive oil, as a key part of your diet. These fats promote satiety and offer a steady source of energy without causing insulin spikes.
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Monitor Carbohydrate Intake: Begin by reducing your daily carbohydrate intake to under 100 grams, and consider lowering it further to around 50 grams per day for more significant weight loss or improved blood sugar control.
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Stay Hydrated and Manage Electrolytes: As your body adjusts to a low-carb diet, you may experience changes in fluid balance and electrolyte levels. Drink plenty of water and consider supplementing with electrolytes to prevent symptoms like fatigue and headaches.
Polycystic Ovary Syndrome (PCOS) is a prevalent and complex condition that can significantly impact a woman’s quality of life.
No two women will experience the PCOS in the exact same ways. In addition to the very challenging primary symptoms, many women struggle from the impacts that these symptoms can have on their self-confidence, self-image and overall mental health.
However, there is reason for optimism. While the symptoms of PCOS can be challenging, they can be effectively managed with appropriate lifestyle changes. Adopting a low-carbohydrate diet has been shown to significantly improve insulin sensitivity, support sustainable weight management, reduce inflammation, and help balance hormones. By focusing on addressing the underlying root cause—insulin resistance—rather than just alleviating symptoms alone, targeted dietary adjustments can have a profound and lasting impact on both mental health and physical well-being.
