- Healthy Living with Lean PCOS
- Meal planning for lean PCOS
- Exercise for Lean PCOS
- Lifestyle advice for managing lean PCOS
- Important Natural Health Tips for Women with Lean PCOS
- Why Does PCOS Happen?
- The Lean PCOS Diet and Lifestyle
- Overweight Women Are More Likely To Face Polycystic Ovary Syndrome (PCOS)
- Polycystic Ovarian Syndrome (PCOS) and Obesity
- Link between obesity and polycystic ovary syndrome may be exaggerated
- Do women with PCOS have a greater risk of being overweight?
- Benefits of weight loss with PCOS
- Medical management & surgery for weight loss
- Surgery to assist weight loss
- Weight loss medications
- Actions you can take
- Does weight gain make PCOS symptoms worse?
- Does PCOS cause weight gain or stop you losing weight?
- What should I do if I have PCOS?
- Without further ado, the best ways to lose weight with PCOS:
- Limit refined carbs and sugar
- Fill up on protein and healthy fats
- Understand the difference between hunger and cravings
- Prioritize a consistent exercise routine
- Ask your doctor about metformin or going on birth control
- Practice self-care to reduce stress
- Bottom line: You can lose weight to improve your PCOS symptoms, but it doesn’t just go away.
- Related posts:
Healthy Living with Lean PCOS
Many women with PCOS (Polycystic Ovary Syndrome) are overweight. However, it is possible to have PCOS and be a healthy weight or even underweight. This is known as lean PCOS. Women with lean PCOS may struggle with irregular periods, blood sugar control, fertility problems, and other symptoms caused by elevated androgen (testosterone) levels such as excess facial hair and acne.
Some strategies for handling these symptoms were discussed in our previous article About Lean PCOS: Symptoms and Supplements. This article will focus on diet and lifestyle tips to help keep these symptoms under control.
Meal planning for lean PCOS
Meal planning is essential for women with lean PCOS because it can help manage symptoms of lean PCOS. Here are some specifics to consider when planning what to eat.
Make breakfast the biggest meal of the day
A study shows that for women with lean PCOS, having the highest calorie meal at breakfast and the lowest calorie meal at dinner improves insulin resistance and ovulation and reduces testosterone levels.
The glycemic index, or GI, is a system of measuring how much a carbohydrate-containing food increases your blood sugar and insulin levels. Choosing lower GI foods may be beneficial for PCOS, especially to help manage insulin resistance.
Studies have shown improved insulin sensitivity and more regular menstrual cycles in women with PCOS who incorporate low glycemic index foods such as chickpeas and lentils into their meals in place of high glycemic index foods such as white rice and white flour bread.
The GI ranks foods on a scale from 1-100. Foods that have a low GI, less than 55, promote a slower rise in blood sugar levels. Eating low GI foods also results in less insulin secretion by your body.
Health experts recommend planning meals to include low GI foods, but encourage us to also consider the overall glycemic load, GL, of a meal to avoid sudden spikes in blood sugar.
Here’s the skinny on GL. Each food has a unique effect on blood sugar. GL considers both the number of carbohydrates in a food and the GI of the food. This measurement gives you a more precise estimate of the effect a food has on your blood sugar level. Simply put, to best use GL you’ll want to control portions of carbohydrate-rich foods, such as brown rice or a sweet potato. Then, be sure to pair them with foods containing protein and fat such as fish or chicken. Add a salad to complete your meal.
It makes sense for women with PCOS to use both GI and GL. Using both measurements is optimal for helping to manage insulin resistance. Some simple rules to follow are to know the GI of the foods you’re eating. . Also, choose whole grains, limit foods made with refined grains such as white rice or white bread, eat fruits and vegetables but limit fruit juice, and include beans and legumes. This PCOS Nutrition Center article explains how including protein-rich foods at each meal can help temper the rise of blood glucose.
Include healthful omega-3 fats, especially fatty fish
There are three main types of omega-3 fats: ALA (alpha-linolenic acid), found in canola oil, walnuts and flax seed oil, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). EPA and DHA are both found in fatty fish such as salmon, herring, sardines, tuna, trout, and mackerel. All are essential polyunsaturated fatty acids, but EPA and DHA are particularly beneficial for women with PCOS.
Some women with PCOS have a gene impairment leading to a reduced ability of D6D, delta-6 desaturase, to convert ALA into EPA and DHA. This gene impairment may also lead to insulin resistance and elevated blood lipid levels. It’s still recommended for women with PCOS to consume foods rich in ALA because they are essential fatty acids, may help reduce inflammation, are low in saturated fat, and foods such as flax seeds are also rich in fiber. It’s important, though, to also consume EPA and DHA omega-3 fats from fish.
Research has shown that including fatty fish more than twice per week may be beneficial for women with PCOS by helping manage symptoms. For recipes and more information to help you add fish to your weekly meals, consider reading The Pescetarian Plan, by Janis Jibrin, MS, RD.
Plate portions for PCOS
PCOS fitness expert Erika Volk recommends cooking with unsaturated fat such as olive oil and portioning food according to this simple plate method. In this method, you fill one half of your plate with low-starch veggies such as brussels sprouts or zucchini. Then, you fill one-quarter of your plate with protein-rich food such as fatty fish or chicken. Finally, you can include a handful of carbohydrate-dense foods such as oats, beans, fruit, or root vegetables.
Exercise for Lean PCOS
Although all types of exercise are beneficial for different reasons, women with lean PCOS can benefit from including strength training and high-intensity interval training as these exercises improve insulin resistance and decrease body fat percentage.
Strength training for PCOS
To get started, set some goals around the types of exercise and body parts that you plan to work. An excellent strength-training workout includes chest, back, shoulders, biceps, triceps, abdomen, hamstrings, and quadriceps. You can work out two to three non-consecutive days per week using weights, plate-loading machines or medicine balls. You can even use your own body weight or exercise bands.
Start with 3 sets of 10 repetitions (reps) for each body part. If you are using resistance, the weight should be challenging to move by the tenth rep. This plan will ensure that you strengthen your major muscle groups and challenge your muscles to help you decrease body fat percentage. If you need help getting started, consider enlisting the help of a personal trainer. And, as always, consult your healthcare professional before you begin.
High-intensity interval training, HIIT, for PCOS
According to the American College of Sports Medicine, HIIT cardiovascular workouts may include a one-minute high-intensity interval and a one-minute moderate-intensity interval. This is called a 1:1 interval since the intervals are the same length. The workout usually includes a short warm up and cool down period for a total of at least 32 minutes.
The intervals may vary and may be one, two, even up to eight minutes long. The moderate-intensity interval length may vary as well, deviating from the 1:1 ratio. If you’re used to a steady intensity workout, start with just a few high-intensity intervals before you acclimate to the HIIT routine.
Lifestyle advice for managing lean PCOS
To eat healthfully with PCOS, pair low-glycemic carbohydrates (eg. whole grains, fruit, sweet potatoes) with protein-rich foods to help manage your glycemic load. Eat fatty fish at least twice per week, plenty of vegetables, and healthful fats such as nut butter, nuts, seeds, and olive oil.
Consider including HIIT cardiovascular workouts and strength-training exercise to improve insulin resistance and lower body fat percentage.
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Weight loss can improve insulin sensitivity. That will reduce your risk of diabetes, heart disease, and other PCOS complications.
To lose weight, start with a visit to your doctor. The doctor will weigh you and check your waist size and body mass index. Body mass index is also called BMI, and it is the ratio of your height to your weight.
Your doctor may also prescribe medication. Several medications are approved for PCOS, including birth control pills, anti-androgen medications and Metformin (Glucophage). The anti-androgen medications block the effects of male hormones. Metformin is a diabetes drug that helps the body use insulin more efficiently. It also reduces testosterone production. Some research has found that it can help obese women with PCOS lose weight.
In addition to taking medication, adding healthy habits into your lifestyle can help you keep your weight under control:
- Eat a high-fiber, low-sugar diet. Load up on fruits, vegetables, and whole grains. Avoid processed and fatty foods to keep your blood sugar levels in check. If you’re having trouble eating healthy on your own, talk to your doctor or a dietitian.
- Eat four to six small meals throughout the day, rather than three large meals. This will help control your blood sugar levels.
- Exercise for at least 30 minutes a day on most, if not all, days of the week.
- Work with your doctor to track your cholesterol and blood pressure levels.
- If you smoke, get involved in a program that can help you quit.
Important Natural Health Tips for Women with Lean PCOS
In the U.S. alone it is estimated that 6% to 12% (as many as 5 million) women of reproductive age suffer from Polycystic Ovary Syndrome (PCOS) according to the Centers For Disease Control. PCOS is a female fertility health disorder that impacts the body’s endocrine system. Typically, women with PCOS are overweight, and as a result of insulin resistance, struggle to lose weight, but there is an increasing number of women with PCOS for whom being overweight is not an issue.
Many women with PCOS regularly reach out to us for support. A large portion of these women do not fit what has become the stereotypical image of a woman with PCOS – overweight/obese with acne and facial hair. In fact, they are the opposite, they share that they are skinny or lean, not overweight, and some have no signs or symptoms at all (but many do), yet they have been diagnosed with PCOS. They are wondering why they don’t fit the typical profile of a woman with PCOS and how they can naturally heal themselves when most of the information on PCOS speaks to those who are overweight.
Why Does PCOS Happen?
Why PCOS happens is still somewhat of a mystery; this is especially true for lean women. PCOS could be a genetic condition, yet is believed to be a result of hormonal imbalance and the body’s inability to properly regulate insulin, which is made worse by poor diet, excess body fat, and an inactive lifestyle.
It is common to hear from a doctor that the chances of conceiving naturally with PCOS are slim to none. Medical solutions for women with PCOS wanting to conceive can include: hormone replacement therapy (most commonly oral contraceptives), blood sugar-regulating medications, IVF, egg donor, or adoption.
We want women with PCOS to know that these are not the only options! Many healthcare providers of all schools of thought now believe that dietary and lifestyle changes are foundational for all women with PCOS. Countless women with PCOS are successfully supporting their health, seeing dramatic changes to their health and getting pregnant by simply eating a PCOS-specific, nutrient-dense, whole food diet.
First, the Symptoms of PCOS…
Both lean and overweight women with PCOS can experience many of the same symptoms associated with PCOS, to varying degrees, which are:
- hormonal imbalance causing irregular menstrual cycles
- elevated levels of male hormones called androgens (testosterone), estrogen and luteinizing hormone (LH)
- low levels of follicle-stimulating hormone (FSH)
- heavy menstrual blood loss or absent periods
- cysts on one or both ovaries
- ovarian pain or enlarged ovaries
- severe acne
- male pattern facial and body hair growth (hirsutism)
- anxiety and depression
- weight gain and difficulty losing weight with no known cause (even if just slight gain)
- insulin resistance
More About Insulin…
Insulin is instrumental in helping glucose (blood sugar) travel to cells to give them energy. Whether eating a clean, whole food diet or eating a diet high in refined sugars and grains, processed foods, saturated fats, etc., insulin goes to work. It is when the unhealthy foods are indulged in too often, or are the basis of a diet (coupled with an inactive lifestyle), that the cells may become resistant to insulin. Resistance means that they don’t recognize insulin. Glucose is then forced to the liver where it is converted into body fat instead of being used as energy (excess adipose tissue, or fat, also contributes to estrogen dominance).
The organ that produces the hormone insulin and keeps blood sugar and salt levels balanced within the body is the pancreas. An imbalance of insulin and salt within the body, especially when the pancreas is not able to make enough insulin to meet the body’s needs, may lead to diabetes (a serious health condition).
Researchers from Prince Henry’s Institute of Medical Research, Australia, believe there is another cause for the development of insulin resistant PCOS, beyond poor diet and inactivity, – some women’s bodies have an excess of androgens (male hormones) (Diabetes/Metabolism Research and Reviews). Elevated androgen levels in women cause the ovaries to make more estrogen which, in turn, stops ovulation.
For women with lean PCOS, androgens levels may be low
If you are living with PCOS, ask your doctor to evaluate your body’s ability to regulate and control insulin, to know if insulin resistance is a concern for you. Even a lean woman’s body may not be able to produce and regulate insulin properly.
Whether lean or overweight, regardless if insulin resistance is a factor or not, it has been determined by science that PCOS impairs the body’s ability to properly process glucose and insulin-producing cells may not function properly. Another factor of concern is that the insulin-producing cells of women who were once overweight do not change after weight loss, they stay impaired.
So, while being lean may make conquering PCOS a bit easier, being lean does not mean insulin resistance is not a factor according to Dr. Sari Cohen in PCOSA Today Newsletter, September/October 2007. All of this being said, no matter which variation of PCOS you have, hormone levels, including insulin, can be managed through specific dietary changes, lifestyle changes, regular exercise, herbs, nutritional supplements, and natural therapies.
The Lean PCOS Diet and Lifestyle
It will, from the start, be easiest to implement and stick to lifestyle and diet changes if you make a routine! Sure, it’s great to have variety from day to day, but planning out meals, exercising around the same time each day and taking time for self-care and stress-reduction practices will help make this healthy lifestyle a habit.
The following steps will be beneficial for lean women with PCOS, who are not insulin resistant. Lean women with PCOS who struggle with insulin resistance would be best served by following our guide Learn to Eat a PCOS Fertility Diet. Here is a PCOS Fertility Diet Tip – Simple Food Choices to Stabilize Blood Sugar to help as well.
The PCOS Fertility Diet
The foundation of the PCOS Fertility Diet is really about going back to basic healthy, clean-eating principles. Clean eating means filling your plate with real, whole foods, eating a variety of fruits, vegetables, moderate amounts of lean (organic/grass-fed/free-range) animal products and seafood, legumes, nuts and seeds, healthy fats, and limited amounts of whole grains. Eating clean also means limiting processed foods, salt, added sugar, and saturated fats.
Diet Dos: Eat whole, fresh foods that are organic and non-GMO when possible, and:
- incorporate dark leafy greens, cruciferous and sea vegetables, a variety of vegetables daily – 5-6 servings a day
- cook with womb warming, anti-inflammatory herbs and spices – cinnamon, turmeric, cayenne, paprika, etc.
- balance your daily carbohydrate intake with an equal amount of lean protein (animal or vegetable; remember that beans, though high in protein, also contain carbohydrates)
- limit fruits to 1-3 servings per day, choose low glycemic-index fruits, and avoid fruit juice
- eat 5 smaller meals each day to keep blood sugar stable throughout the day
- incorporate fertility superfoods into your diet – Maca, Royal Jelly, quinoa, greens powders and wheatgrass are just a few
- eat fermented foods to boost gut health – a healthy gut helps the body assimilate nutrients
Diet Don’ts: Avoid eating processed, pre-packaged foods, as well as:
- processed carbohydrates (white flour – breads and pastries) and sugar
- soda and alcohol
- fried foods and any oil besides coconut and olive oils
- and limit gluten (inflammatory) and dairy (congesting)
The PCOS Lifestyle
Most of all, remain positive! Believe in your ability to kick this syndrome to the curb! Think about the exercises and self-care practices you enjoy and make them a part of your daily routine.
- Exercise even if you are lean – participate in moderate daily exercises like Fertility Yoga, light jogging and long walks, Pilates, leisurely bike riding and swimming are great too. The goal is to stay lean and if needing to put on weight, working to increase lean muscle mass rather than fat.A 2016 Brazilian study in the journal Medicine and Science In Sports and Exercise enlisted “45 sedentary women with PCOS and 52 without (non-PCOS), 18-37 yr of age, with body mass indexes (BMI) of 18-39.9 kg·m(-2) of all races and social status” to performed progressive resistance training three times a week for 4 months. The women with PCOS using resistance training saw a decrease in abdominal “visceral” fat (the fat that increases risk factors for insulin resistance), decrease in androgen levels, and improvements in irregular menstrual cycles and ovulation issues, as well as increased lean muscle mass.
- Acknowledge stress and learn ways to effectively manage it – work, family, fertility, body image, etc., can all cause stress. Some thoughts are to enlist a friend to go on a daily walk, learn the Emotional Freedom Technique (EFT) or Circle and Bloom. There are more short- and long-term stress reduction tips in our guide to Stress and Your Fertility.
- Avoid xenohormones – Xenohormones are environmental toxins known to contribute to endocrine system disruption and hormone imbalance. Examples of everyday ways we are exposed to xenohormones are plastics (avoid drinking water from plastic bottles and storing food in plastic), conventional cleaning products, personal and body care products, and non-organic foods.
- Cut out caffeine because caffeine increases estrogen levels.
PCOS Herbs & Nutritional Supplements
Supplements That Are Beneficial for PCOS… are complementary to the dietary and lifestyle changes you will be making with the goal to support the body in re-learning balance by promoting healthy hormonal balance, a healthy uterine lining, regular ovulation, improved estrogen metabolism and ultimately a healthy pregnancy if that is your wish. So, consider learning more about:
- vitamins and minerals like calcium and vitamin D
- herbs that promote hormonal balance and support regular ovulation like Vitex (Vitex agnus-castus) and Maca (Lepidium meyenii), Licorice root (Glycyrrhiza glabra) and White Peony (Paeonia lactiflora)
- nutritional supplements like DIM, essential fatty acids like Evening Primrose Oil and Cod Liver Oil, Saw Palmetto (Serenoa repens), and D-chiro inositol and Myo-Inositol
Your health begins with you! Your condition does not define who you are as a woman! If you chose health, you will achieve health!
Elizabeth Willett is the Senior Herbalist and Lead Educator at NaturalFertilityInfo.com. She holds a BS in Mass Communications (2000) from Minnesota State University, and a Master of Arts degree (MA, 2010) in Holistic Health Studies with a specialization is herbalism from St. Catherine University in St. Paul, MN. Liz has written over 200 articles on women’s fertility and brings a vast wealth of knowledge and expertise in holistic health and healing to Natural Fertility Info.com
Dr. Christine Traxler M.D., OB/GYN
Dr. Traxler is a University-trained obstetrician/gynecologist, working with patients in Minnesota for over 20 years. She is a professional medical writer; having authored multiple books on pregnancy and childbirth; textbooks and coursework for medical students and other healthcare providers; and has written over 1000 articles on medical, health, and wellness topics. Dr. Traxler attended the University of Minnesota College of Biological Sciences and University of Minnesota Medical School, earning a degree in biochemistry with summa cum laude honors in 1981, and receiving her Medical Doctorate degree (MD) in 1986.
Overweight Women Are More Likely To Face Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Being overweight is one of the risk factors of the condition, as it causes insulin resistance and abnormal level of hormone. Polycystic ovary syndrome is common in women of childbearing age, 25-35 years. If left untreated, PCOS can lead to infertility, endometrial hyperplasia, and cancer of the uterine lining (endometrial cancer).
What is polycystic ovary syndrome (PCOS)?
Polycystic ovary syndrome (PCOS) is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance causes the ovaries to develop numerous small collections of fluid and fail to regularly release eggs. With PCOS, the egg may not develop as it should or it may not be released during ovulation as it should be. The exact cause of PCOS is unknown, but it often runs in families. It is related to abnormal hormone levels in the body and abnormality of multiple system in the body such as pituitary gland, ovaries, and adrenal gland.
Obesity and PCOS
Obesity leads to abnormal estrogen hormone production especially in people with excess belly fat. Fat cells produce extra estrogen and this can affect your ovaries and their ability to ovulate. Women with PCOS may have infrequent or prolonged menstrual periods.
See your doctor if you have these symptoms.
- Prolonged menstrual cycles: fewer than 6-8 perioids a year or more than 35 days between periods
- Missed period: more than 3 cycles in women who have regular periods or more than 6 cycles in women who have irregular periods.
- Heavy period or spotting due to thick uterine lining
- Excess androgen: elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), severe acne, oily skin and male-pattern baldness.
- Overweight: leads to insulin resistance and abnormal ovulation.
Complications of PCOS
Complications of PCOS can include:
- Infertility: caused by abnormal ovulation, miscarriage in first trimester, gestational diabetes, preeclampsia, slow growth of the baby
- Increased risk of endometrial hyperplasia, endometrial cancer, and breast cancer
- History taking: family history, menstrual cycle, contraceptive use, hormonal drug use
- Physical examination: blood pressure, height, weight, general appearance
- Body mass index (BMI)
- Pelvic examination
- Losing weight: Weight loss can reduce insulin and androgen levels and may restore ovulation.
- Medication: To regulate menstrual cycle for women who are not trying to become pregnant. For women who wish to become pregnant, the doctor will prescribe the medication to help you ovulate.
- Preventing complications: insulin resistance treatment, reduce risk of diabetes, cardiovascular diseases, and endometrial hyperplasia
How to prevent PCOS?
- Maintain healthy weight
- Eat healthy diet – plenty of fruits and vegetables, reduce carbohydrate and fat intake
- Regular exercise
- Reduce stress
PCOS is the most common hormonal disorder in women of childbearing age and can lead to issues with fertility. Most women at some point have to struggle with weight gain. However, for women with polycystic ovary syndrome (PCOS), losing weight can become a constant struggle. For obese women, it is best to consult a doctor for a proper management such as medications and bariatric surgery.
Reference: Dr. Suthep Udomsawaengsup, laparoscopic and bariatric surgeon, Bariatric surgery center, Bangkok hospital
For more information:
Bariatric Surgery Center
1st floor, D Building, Bangkok Hospital
Call 0 2310 3788 or 1719
Polycystic Ovarian Syndrome (PCOS) and Obesity
by William Hignett, MPH and Ted Kyle, RPh, MBA
To view a PDF version of this article, click here.
Most individuals are familiar with the common health risks linked to obesity, including type 2 diabetes, sleep apnea, coronary artery disease (CAD), high blood pressure and cancer; however, fewer know that women affected by obesity are also more likely to face reproductive problems like polycystic ovarian syndrome (PCOS).
What is PCOS?
PCOS is one of the most common hormonal disorders in women of reproductive age, affecting 5 to 10 percent. Women with PCOS have irregular menstrual bleeding and often have difficulty getting pregnant. The syndrome occurs when levels of hormones are abnormal. The name “polycystic ovarian syndrome” refers to the appearance of small cysts along the outer edge of the enlarged ovaries of women with this condition.
What Causes PCOS?
The exact cause of PCOS is unknown, but experts believe it is related to the production of an excess amount of androgens, a group of male sex hormones. Although all women produce some androgens, too much of this type of hormone prevents ovulation. Excess androgens also disrupt the normal menstrual cycle. They may cause infertility, acne and abnormal hair growth, such as excess facial hair or male pattern baldness. But, what causes a woman to produce excess androgens?
Many factors may play a role in the production of androgens, and thus the development of PCOS. For instance, excess insulin (the hormone that allows cells to use sugar) may be a factor in developing PCOS. Excess insulin leads to insulin resistance, which in turn decreases your ability to use insulin effectively. When the body cannot use insulin properly, it secretes more insulin to make glucose available to cells. The resulting excess insulin is thought to additionally boost androgen production by the ovaries.
Low-grade inflammation is another potential factor leading to PCOS. Research has shown that women with this condition often have low-grade inflammation. Heredity is also a factor. If your mother or sister has PCOS, you may have a greater chance of having PCOS.
Finally, even conditions before birth in the mother’s womb can be a factor contributing to PCOS. Excessive exposure to male hormones (androgens) in fetal life may permanently prevent normal genes from working normally. These androgens can promote a male pattern of abdominal fat distribution, which increases the risk of insulin resistance and low-grade inflammation. Because many factors can lead to the development of excess androgens, which is related to the development of PCOS, it is impossible to name a single, exact cause of this condition.
Does being Overweight Cause PCOS or Does PCOS Result in Obesity?
Both are possible. The link between PCOS and obesity is complicated. Signs and symptoms of polycystic ovarian syndrome begin for some females soon after they start having periods. Women with PCOS produce too much insulin, or the insulin they produce does not work as it should. The inability of insulin to function normally is one reason why women with PCOS tend to gain weight or have a hard time losing weight. For others, PCOS develops later on, following substantial weight gain. What is clear is that women affected by obesity have a greater risk for PCOS and women with PCOS have a greater risk for obesity.
What are the Symptoms of PCOS?
Although the symptoms vary from individual to individual, a diagnosis is usually made after two of the three following symptoms are found: menstrual irregularity, excess androgen and polycystic ovaries. Since there is no definitive test for PCOS, a doctor diagnoses this condition by ruling out other possible disorders. The physician’s diagnosis is based on findings from your medical history, physical and pelvic exam and pelvic ultrasound. Women diagnosed for PCOS also undergo blood tests that measure levels of several hormones in order to exclude potential causes of menstrual abnormalities or androgen excess.
Addressing Your Overall Health as Part of the Treatment for PCOS
Quitting smoking is generally the most positive action you can take to improve your health, and related to PCOS, it may lower the higher levels of androgens.
Birth control pills and androgen reducing therapies can address the symptoms of PCOS, such as menstrual cycle problems, male-type hair loss and hair growth and acne. For women who wish to get pregnant, fertility drug treatment may also help start ovulation. For some women, a doctor might also prescribe the anti-diabetic drug metformin, or the fertility drug gonadotropins, to address insulin resistance.
And importantly, even modest weight-loss of 5 to 7 percent of body weight throughout six months can lower your insulin and androgen levels. Such a reduction, according to Dr. Huang and associates in the 2007 edition of Berek and Novak’s Gynecology, restores ovulation and fertility in more than 75 percent of women with PCOS.
Why is Early Diagnosis and Treatment of PCOS Important?
As with any chronic disease, finding it early helps a lot. That’s because PCOS makes a number of other diseases more likely. These include high blood pressure, type 2 diabetes, sleep apnea, abnormal uterine bleeding, cholesterol abnormalities, metabolic syndrome, heart disease, cancer of the uterus and complicated pregnancies. With early diagnosis and treatment of PCOS, doctors can reduce risk of these long-term complications.
What Treatments Can Help with PCOS?
No simple cure for PCOS exists. Fortunately, it can be controlled, decreasing the risk of long-term complications. Engaging in regular exercise, keeping a healthy diet, losing excess weight, quitting smoking and using medications to control hormones are all important parts of treatment for PCOS.
Because PCOS is a complicated condition, seeing a knowledgeable physician who has experience treating the condition is essential. A good source for locating a medical endocrinologist with expertise in the field of PCOS is the American Association of Clinical Endocrinologists Physician Finder Web site: www.aace.com/resources/memsearch.php. There you can enter information about your location and select “PCOS” as a specialty from the drop-down list to obtain a list of doctors near you.
Daily exercise improves the body’s use of insulin, and many of the symptoms of PCOS may improve with at least 30 minutes of exercise a day. Furthermore, it is important to fuel your body with a healthy diet – one that includes many complex carbohydrates and is low in animal fats. The more fiber in a food, the slower it is digested, which has the advantage of causing your blood sugar levels to rise slower. Examples of high-fiber complex carbohydrates include whole-grain breads and cereals, whole-wheat pasta, brown rice, barley and beans.
PCOS is a common hormonal disorder that affects women of reproductive age. PCOS challenges the quality of life of the women who suffer from it. Yet with proper treatment, PCOS can be managed and symptoms can be relieved. In addition, early diagnosis and treatment of PCOS can help reduce the risk of long-term complications such as type 2 diabetes, heart disease and stroke. For more information on PCOS, visit the Polysystic Ovarian Support Association at www.pcosupport.org.
About the Authors:
Ted Kyle, RPh, MBA, is a pharmacist and health marketing expert. Ted has worked for more than 10 years on programs and products to help people quit smoking and lose weight. Ted is a member of the OAC National Board of Directors.
William Hignett, MPH, is a disease management expert with a master’s degree in public health from the University of Pittsburgh. He has years of experience as a health educator for universities, hospitals, Fortune 100 companies and health insurers. He has seen first-hand how obesity contributes to many chronic diseases and how weight bias stands in the way of effective solutions.
Link between obesity and polycystic ovary syndrome may be exaggerated
PCOS affects about 10 percent of women and is characterized by excess male hormone, irregular ovulation and menstruation as well as increased risk of metabolic diseases often associated with being overweight.
The study in the Journal of Clinical Endocrinology & Metabolism looked at what have long been considered indicators of the disease, including obesity, high testosterone levels and excess body hair, in women actively seeking care for PCOS as well as those identified with PCOS through a general pre-employment health screening.
They found that the women with PCOS identified through the screening had about the same obesity rates as those who didn’t have PCOS, said Dr. Ricardo Azziz, reproductive endocrinologist and PCOS expert at the Medical College of Georgia at Georgia Regents University. However, obesity rates in patients actively seeking treatment were about 2.5 times higher than in women identified with PCOS through the screening of the general population.
“The women actively seeking care had higher male hormones, more hair growth, more severe ovulation problems, which was not surprising because patients who have a more severe condition are more apt to seek medical care,” said Azziz, the study’s corresponding author. “What is surprising to us is that the rate of obesity in women with PCOS who we found in the general population is nowhere near as high as we expected from studying women with PCOS who did seek care.”
“This finding indicates that while obesity is a major problem for everyone who has it, we should treat obesity as obesity and probably not try to link obesity as a sign of PCOS,” Azziz said. He notes that obesity has been considered a hallmark of the condition since it was first described in 1932 and that the ongoing association likely is perpetuated by a bias resulting from patients who self-refer for care.
A more accurate picture of PCOS likely would emerge if studies of the condition also included patients identified through screening the general population, Azziz said. “A lot of patients believe PCOS leads to obesity and we really don’t have strong data to support that. In fact, our evidence suggests that is not the case.”
“We do know that the more fat you have, the more metabolic dysfunction you have, regardless of whether you have PCOS,” Azziz said. Growing evidence also suggests that — regardless of how much they have — the fat in women with PCOS behaves differently.
Fat, a huge organ even in thin individuals and a literal hormone factory, is a major site where the body uses insulin to convert glucose consumed in food to energy. Azziz and his colleagues reported in another recent study in the journal Diabetes differences in the fat of women with PCOS, showing that several tiny RNA molecules, called microRNA, were overexpressed in the fat of those who also were insulin-resistant, resulting in decreased expression of GLUT4, a key protein that regulates fat’s use of glucose for energy.
The new studies were done on 64 women being treated for PCOS and 688 women seeking pre-employment physicals at the University of Alabama at Birmingham. Dr. Uche Ezeh, Department of Obstetrics and Gynecology and Center for Androgen-Related Disorders at Cedars-Sinai Medical Center in Los Angeles, is the study’s first author. Dr. Bulent O. Yidiz, Department of Internal Medicine and the Endocrinology and Metabolism Unit, Hacettepe University School of Medicine in Turkey, is co-author.
Loss of excess weight may reduce the severity of some symptoms and will reduce the risk of developing further complications associated with PCOS. Even a small weight loss can reap large benefits.
Do women with PCOS have a greater risk of being overweight?
It is currently not clear if there are any biological factors that could lead to women with PCOS having more difficulties with weight management. However, research has suggested that hormones involved in controlling appetite and hunger aren’t regulated properly in some women with PCOS. If this is the case, it may mean that some women with PCOS are more likely to gain weight and have more difficulty losing weight.
Benefits of weight loss with PCOS
Modest weight loss will not cure PCOS, but it will help. Weight loss can restore the normal function of the ovaries and result in normal hormone production. This may in turn lead to improvements in symptoms of PCOS, such as excess facial and body hair growth, acne or scalp hair loss.
A large number of research studies have shown it only takes a modest amount of weight loss of 5-10 kg or 5-10% of initial body weight to:
- reduce insulin resistance by about 50%
- restore ovulation
- regulate menstrual cycles
- reduce pregnancy complications
- improve fertility
- improve health during pregnancy
- improve the health of a child during pregnancy
- improve emotional health (self-esteem, anxiety, depression)
- reduce risk factors for diabetes and heart disease
Weight loss is best achieved through a combination of lifestyle changes – a healthy diet and physical activity. It is not always easy to make changes to your lifestyle so that you eat more healthy foods and make exercise a regular part of life. Learning and understanding about goal setting can be helpful along with how to make changes to your behaviour. For further information and advice, talk to an accredited practising dietitian (APD) and/or your doctor.
Medical management & surgery for weight loss
Some women with PCOS may need medical assistance to help with weight loss.
Surgery to assist weight loss
The effect of obesity surgery has been assessed in women who have PCOS. Weight loss surgery is generally only considered if you meet certain criteria including:
- You have a BMI (body mass index) over 40 (or over 35 and a related condition such as diabetes, high blood pressure or arthritis)
- You have been unsuccessful at losing weight with alternative treatments
- You are aged between 18 and 65
There are two main types of surgical procedures:
- Gastric bypass – where a smaller stomach pouch is made from the stomach and the intestine joined to it (a fairly major operation)
- Gastric banding – where the size of the stomach is reduced by a band around the upper part of the stomach (a minor procedure done via keyhole surgery)
Surgical procedures improve many of the symptoms of PCOS however there are some things to consider including:
- the risk of vitamin and mineral deficiencies – since food intake is reduced and food absorption is affected, vitamin and minerals can become deficient (eg iron, folate and iodine)
- timing and pregnancy – it is not recommended for women to become pregnant until 12-18 months after weight loss surgery
- appropriate contraception: effective contraception after surgery is important as fertility may improve but pregnancy is not recommended until 12-18 months after surgery
- potential post-operative complications
- cost – the procedure is expensive and it is very rarely available in public hospitals in Australia. Costs may be partly covered by private health insurance.
Weight loss medications
As yet, there is no evidence that weight loss medications are any better than having a healthy lifestyle. They are generally expensive, only work whilst being taken, lead only to small weight loss and have side effects. Sibutramine (sold as Reductil) has been withdrawn from the market in many countries including Australia due to concerns about it increasing the risk of stroke or cardiovascular disease. Liraglutide (Saxenda) is an injectable medication that has recently been approved by the Therapuetic Goods Administration, but is expensive and so far there is limited information about long term use.
Actions you can take
Talking with your doctor and also understanding what influences weight change for you will help you to make decisions about what is the best way of managing your weight. You may like to speak with a psychologist, dietitian or exercise physiologist who may be able to help you with changes to the way you think about eating and activity. Further information on managing a healthy weight is also available here.
Last updated 24 April 2018 — Last reviewed 20 April 2017
** Currently under review **
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at April 2017.
Women with polycystic ovary syndrome (PCOS) are more likely to be overweight or obese and their symptoms worsen the heavier they are.
What causes this weight gain? How can losing weight help? And how can women shed the extra kilos to improve what they describe as distressing symptoms?
Read more: Explainer: what is polycystic ovary syndrome?
PCOS is the most common hormonal disease in women of childbearing age. Symptoms include irregular periods, or signs of high male hormone levels, such as excessive hair growth or severe acne.
Women find it distressing to deal with these symptoms as they feel their feminine identity is challenged. They also report a lack of support from health professionals and peers, and worry about long-term risks, such as developing type 2 diabetes.
Women with PCOS are two to three times more likely to be overweight or obese (having a body-mass index of 25 kg/m² and above) compared to women without the condition. And they gain more weight a year (260g more) than women without PCOS of the same age. Many women with PCOS also have trouble losing weight or keeping it off.
Read more: Explainer: overweight, obese, BMI – what does it all mean?
Does weight gain make PCOS symptoms worse?
Heavier women with PCOS tend to have worse symptoms. The question is whether gaining weight worsens symptoms or PCOS itself causes women to gain weight.
To prove gaining weight worsens PCOS symptoms, we need studies in which women are made to gain weight and their symptoms monitored for changes. We doubt if such a study has been done because of ethical issues relating to the potential harm to participants. That’s not to mention the challenges in recruiting women for a study where they would gain weight. So we need to look for other forms of evidence.
An observational study in Finland found an increase in BMI in women from the age of 14 to 31 was associated with greater likelihood of having irregular periods, excessive hair growth or being diagnosed with PCOS.
Read more: In defence of observational science: randomised experiments aren’t the only way to the truth
And when women with PCOS lost weight through lifestyle changes such as eating less or increasing physical activity, a Cochrane review showed a reduction in male hormones and excess hair growth.
Given the above evidence, we could conclude that weight gain is likely to make PCOS symptoms worse.
Does PCOS cause weight gain or stop you losing weight?
Many women with PCOS say they find it very hard to lose weight, but we don’t fully understand why that is.
Women with PCOS have the same metabolic rates as women without PCOS. They eat a few more calories (about 200 kilojoules a day, or the equivalent of one cube of cheese) than women without PCOS. This could lead to putting on an extra 2-3kg over a year.
Women with PCOS may have different levels of hormones that control appetite, and the high levels of male hormones could increase cravings for high-fat foods.
But when provided with similar levels of support, women with and without PCOS lose the same amount of weight.
When provided with similar levels of support, women with and without PCOS lose the same amount of weight. from www..com
Looking beyond PCOS, all women of childbearing age seem to put on small but persistent amounts of weight. Women, on average, gain up to 600g a year from the age of 18. Women who are married or partnered, start work or have children are more likely to gain weight.
The reasons women gain weight could relate to challenges maintaining a healthy lifestyle due to lack of time, energy, motivation and supporting family and friends.
These reasons tend to be similar for women with and without PCOS. However, women with PCOS may face additional challenges as they describe ongoing stress living with PCOS symptoms such as unpredictable periods.
Read more: How to choose the right contraceptive pill for you
Women with PCOS also have higher levels of anxiety and depression and lower quality of life, all of which may compromise their ability to adopt a healthy lifestyle.
Recent focus groups we conducted revealed women with PCOS reported “a lifetime of yo-yo dieting” with repeated cycles of weight loss followed by weight regain. Often these cycles result in an overall weight gain over the years.
What should I do if I have PCOS?
Instead of going on unsustainable diets, which could lead to weight cycling and a sense of defeat, aim for small (and therefore sustainable) changes in diet and exercise.
Find something you enjoy. Set yourself the overarching goal to maintain your weight and improve your health, whatever that is now.
Keeping track of your weight by weighing yourself regularly (say, once a week) can help. If you have regular medical appointments, having your doctor monitor your weight changes between visits can also help you maintain your weight.
If you are 25 years old now, simply holding on to your current weight would be equivalent to permanently losing more than 20kg when you are 50. We know that is next to impossible. Staying the same weight is a far more achievable goal, and just as beneficial.
This article was medically reviewed by Rekha Kumar, MD, a board-certified physician in internal medicine, endocrinology, diabetes, and metabolism and member of the Prevention Medical Review Board, on May 15, 2019.
Losing weight is hard, but it’s especially challenging for women with polycystic ovarian syndrome (PCOS)—a health condition that affects 1 in 10 women between the ages of 15 and 44. Women with PCOS have a hormonal imbalance, which causes problems with the way they metabolize food, and therefore, affects their ability to lose weight. But before we dive into the best ways to lose weight with PCOS, it’s important to know what the condition exactly is.
What is PCOS, anyway?
“PCOS is really a syndrome because it’s not just one disease. It’s a constellation of symptoms,” says Rekha B. Kumar, MD, MS, an endocrinologist who specializes in weight and metabolism at New York-Presbyterian Hospital.
And because PCOS affects many hormones (example: estrogen) that are responsible for a variety of bodily functions, women with PCOS may also find it hard to become pregnant. PCOS is actually the leading cause of infertility in women because the condition may cause women to stop ovulating.
What are the symptoms of PCOS?
Dr. Kumar says women are diagnosed with PCOS if they meet two out of the three classic symptoms of the condition. These symptoms include having an irregular menstrual cycle, experiencing ovulatory dysfunction, showing signs of hyperandrogenism, and developing cysts in the ovaries. However, it’s important to note that you don’t necessarily have to have cysts in your ovaries to have PCOS. According to the U.S. Department of Health & Human Services, other common signs of PCOS include:
- Hirsutism, aka having too much hair on the face, chin, and areas of the body where men usually have hair. Up to 70 percent of women with PCOS have hirsutism.
- Cystic acne on the face, particularly the chin area, chest, and upper back
- Thinning hair or hair loss
- Darkening of the skin, especially around the neck, groin, and underneath the breasts
- Skin tags in the armpits and neck area
Okay, so why does having PCOS make it hard to lose weight?
“The main cause of the problem with PCOS has to do with insulin resistance. Insulin resistance is a condition in which you’re not processing carbohydrates normally, which can interfere with weight regulation and cause fat storage,” Dr. Kumar explains. Basically, your body doesn’t respond to insulin properly or it takes more insulin to move glucose into cells.
MORE ABOUT PCOS
Many women with PCOS struggle to drop the pounds because the condition creates an imbalance in hunger hormones, causing blood sugar levels to spike and crash throughout the day. “As a result, it is not uncommon for women with PCOS to develop an eating disorder, such as binge eating and yo-yo-dieting,” Dr. Kumar says.
The good news is there are plenty of safe and effective ways to lose weight while improving your insulin resistance and keeping your symptoms under control.
“The most effective way to look at weight loss for women with PCOS is as a personal journey and lifestyle change,” says Lisa Samuels, RD, founder of The Happie House. “We want to foster habits that will last a lifetime by making small gradual changes that seem doable and enjoyable and that we know we’ll be able to stick with.”
Without further ado, the best ways to lose weight with PCOS:
Limit refined carbs and sugar
Refined carbohydrates, such as white bread and pasta, can cause your blood sugar to rise and fall quickly, making you only hungrier for more.
“Where many women with PCOS get into trouble is when they give into the carbs they crave. Then, their blood sugar crashes, causing a vicious cycle of eating and wanting more carbs,” Dr. Kumar explains. “The best approach is a low-glycemic diet to stabilize insulin.”
In fact, a 2019 study from Food Science & Nutrition suggests that low intakes of fiber and magnesium are associated with PCOS and hyperandrogenism. That means you should go for foods that are sources of complex carbs, such as vegetables and fruits, whole grains, and legumes. These better-for-you carbs take longer to digest because of their high-fiber content, helping to stabilize your blood sugar and keep you fuller longer.
Go for foods that are sources of complex carbs, such as vegetables and fruits, whole grains, and legumes.
So the next time you’re craving noodles, go for one of these low-carb pasta alternatives. Instead of white rice, choose the brown variety, quinoa, or farro. At the same time you want to avoid added sugars you’ll find in many packaged foods, pre-made smoothies and meal replacement shakes. And if you must use a sweetener, go light on honey or pure maple syrup.
Fill up on protein and healthy fats
You already know that protein and fat are essential for satiety, so be sure you enjoy a little bit of both with every meal and snack. “Eat consistently throughout the day and keep snacks on hand that have good amounts of protein and carbohydrates in them, for example, peanut butter and an apple, string cheese, or nuts and seeds with some dried fruit mixed in,” Samuels says. Moreover, having plenty of healthy fats from avocados, fatty fish, and olive oil can also help curb hunger. “It’s a good excuse to get creative with your cooking: Use less salt and try other seasonings like lemon juice, fresh herbs, and other various spices,” Samuels adds.
Understand the difference between hunger and cravings
While they might feel similar, cravings and hunger are completely different. Samuels explains that hunger is a more general feeling, while cravings are usually geared toward one specific food, texture, or taste. “Cravings are more emotional or psychologically driven. They can also be driven by feelings of boredom, loneliness, or anxiety,” Samuels says. On the other hand, “hunger is a physiological response to the stomach being empty,” Samuels notes. If your stomach is rumbling, you have a headache or experience irritability, light-headedness, or nausea, or have trouble focusing, these are signs that you’re hungry.
MORE ABOUT WEIGHT LOSS
Prioritize a consistent exercise routine
Following a workout routine can help you stabilize blood sugar and reduce your risk for heart disease and diabetes—two conditions women with PCOS are at high risk for. Research suggests that more than half of women with PCOS will have diabetes or prediabetes before the age of 40. Studies also show that there’s a strong link between having PCOS and cardiovascular disease.
Be sure to incorporate cardio and strength training into your routine, alternating days between walking, running, or kickboxing with lifting weights or doing bodyweight exercises. Aim to exercise for at least 30 minutes every day and remember to take walks throughout the day to get your blood flowing and your heart rate up. Having trouble sticking to a routine? “Take a new exercise class with a new friend, walk or job around a track, or try a new sport,” Samuels says. Adding in movement you love, whether that’s walking, dance, or yoga, makes it easier for you to make it a part of your lifestyle.
Ask your doctor about metformin or going on birth control
Aside from making healthy lifestyle improvements, Dr. Kumar says that PCOS is often treated with a variety of medications, including metformin, hormonal contraception, and spironolactone. You might be familiar with metformin, a prescription medication for treating type 2 diabetes. Metformin works to decrease the amount of glucose you absorb in your food and improves your body’s response to insulin. On the other hand, hormonal birth control can help stabilize sex hormones and lower androgen levels that can cause symptoms like excess hair growth and cystic acne. Spironolactone is actually a diuretic with anti-testosterone properties that’s also often used to treat PCOS.
“The main thing I think about when prescribing medications for PCOS is what is the most important thing to treat for this person. For some women it’s infertility, so I wouldn’t prescribe birth control but metformin or Clomid (clomiphene) to help induce ovulation,” Dr. Kumar explains. Moreover, Dr. Kumar says that metformin can also induce weight loss, so it’s not appropriate for lean women with PCOS.
“If the acne and excess hair is the bigger problem, then I would prescribe birth control with spironolactone,” she says, but it all depends on the patient’s health profile and what they’re looking to achieve.
Practice self-care to reduce stress
Outside of diet, exercise, and medication, the best way to prevent weight gain with PCOS is to manage stress. By practicing some self-care, such as meditation, exercise, and yoga, you can help clear the mental roadblocks that are preventing you from losing weight and build willpower to overcome challenges. Reducing stress also puts you in better mind frame to make healthier decisions.
Bottom line: You can lose weight to improve your PCOS symptoms, but it doesn’t just go away.
Dr. Kumar says that while losing weight can greatly improve your symptoms and reduce your risk of other health conditions, it doesn’t mean that PCOS goes away once you drop the pounds.
“Well-managed PCOS after weight loss can help improve symptoms, but under severe stress, women with this condition are predisposed to developing the condition again, along with being at risk for gestational diabetes, type 2 diabetes, heart disease,” Dr. Kumar says.
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Tiffany Ayuda Tiffany Ayuda, a senior editor at Prevention and certified personal trainer through the American Council on Exercise, has specialized in fitness, health, and general wellness topics in her previously editorial roles at Life by Daily Burn, Everyday Health, and South Beach Diet.
Photo Credit Shannon Freshwater
Jane Brody on health and aging.
Sometimes medical syndromes are named long before they are fully understood.
Take polycystic ovarian syndrome, or PCOS, which affects as many as 10 percent of women of childbearing age, often impairing their fertility.
But not all of these women have polycystic ovaries, a fact that can result in misdiagnosis. As it turns out, cysts — sacs of fluid on the ovaries — are just one manifestation of a complex hormonal condition.
First described in 1935, PCOS was initially called Stein-Leventhal syndrome, for the two American gynecologists who identified it, Dr. Irving F. Stein Sr. and Dr. Michael L. Leventhal. They recognized that ovarian cysts can interrupt ovulation and cause infertility in significant numbers of women.
Irregular menstrual cycles and difficulty conceiving are among the most common symptoms, the result of ovarian follicles that fail to mature fully and to release eggs. Affected women often have enlarged ovaries and, when menses does occur, prolonged bleeding.
Over time more cysts — swollen follicles, really — may form. On an ultrasound exam, they resemble a string of pearls stretched over the surface of the ovary. Yet some experts believe cysts are a result, rather than the cause, of the syndrome.
“Whether the condition starts in the ovaries is not certain,” Dr. R. Scott Lucidi, an expert on PCOS at Virginia Commonwealth University, said in an interview.
Indeed, women with few or no ovarian cysts may be diagnosed with PCOS. According to the so-called Rotterdam criteria, a woman with any two of the following conditions may have the condition:
■ Symptoms of elevated levels of androgens, or male sex hormones, which can include acne, excessive hairiness and sometimes male-pattern hair loss.
■ Irregular menses, with prolonged periods between cycles.
■ Twelve or more follicular cysts on the ovaries, as seen on an ultrasound.
Dr. Lucidi and others have suggested that insulin resistance could be the underlying factor responsible for the disparate symptoms of PCOS.
In people resistant to insulin, the hormone does not effectively transfer glucose from blood to body cells to be used for energy. As blood levels of glucose build, more insulin is produced to try to lower it.
Excess insulin promotes fat storage and can result in weight gain and obesity. About half of American women with PCOS are obese. Insulin also can stimulate the ovaries to produce androgens.
But just as some young women with a lot of ovarian cysts do not have PCOS, some women with metabolic syndrome and insulin resistance are thin.
PCOS tends to cluster in families, with predisposing genes passed from either parent to both daughters and sons. In affected males, early balding or excessive hairiness can be a sign that the genes have been inherited. In women, symptoms can vary from being very mild to extensive.
Some experts believe that the fundamental defect may not be insulin resistance, but hormonal dysregulation by or of the hypothalamus. This small region at the base of the brain produces hormones that stimulate the pituitary gland, which in turn affects organs throughout the body.
In most women with PCOS, the pituitary gland produces excessive amounts of luteinizing hormone, which, like insulin, can stimulate the ovaries to secrete androgens, according to a practice guideline written by Dr. Robert L. Barbieri, head of obstetrics and gynecology at Brigham and Women’s Hospital in Boston.
When ovarian follicles are enlarging, women with PCOS also produce high levels of estradiol but low levels of progesterone, resulting in a thick uterine lining and over time an increased risk of endometrial cancer.
There is no cure for PCOS, and the best approach to treatment is individualized, depending on the goals of each patient, Dr. Lucidi said.
For women with prolonged intervals between menses or excessive hairiness, or both, contraceptives containing estrogen and progestin are used to regulate the menstrual cycle and suppress the production of androgens.
Often, the blood pressure drug spironolactone is also given to counteract androgen-caused acne or hirsutism in adult women.
For a woman trying to become pregnant, a different regimen is needed. Two drugs, clomiphene and letrozole, are commonly prescribed to stimulate ovulation. Both these drugs prompt the pituitary to secrete follicle-stimulating hormone (FSH), which enhances the growth of small follicles and thus can trigger ovulation.
Dr. Barbieri noted that “most women with PCOS who undergo ovulation induction go on to conceive and bear children.” Perhaps the most challenging therapy involves weight reduction. Losing 10 percent of body weight can result in more regular menstrual cycles and reduced levels of testosterone, Dr. Barbieri wrote.
For women with PCOS, the most effective diet for achieving and maintaining weight loss is low in carbohydrates, rather than low in fat.
Without being extreme, women with PCOS should reduce their carbohydrate intake overall and in particular avoid sugars and refined carbohydrates (white bread, white rice and anything stripped of its natural fiber or made with refined white flour).
They should instead select foods high in fiber made from whole grains, as unprocessed as possible. They are also advised to avoid eating carbohydrate-rich foods by themselves, and space them out during the day to keep insulin levels from spiking. Consuming four or more small meals instead of a few large ones each day is also helpful.
Regular moderate or vigorous exercise done five or more times a week is an important part of the regimen.
by Dr. Sari Cohen
From PCOSA Today Newsletter, September/October 2007
Are you confused about your diagnosis of PCOS because you are thin? Many people think that everyone with PCOS is overweight, but this is not the case. In fact, at least half of women diagnosed with PCOS are of normal weight or lean. Some women with PCOS are even underweight.
While insulin resistance is generally thought to be the underlying cause of most cases of PCOS, there is disagreement in the medical community about whether thin women with PCOS suffer from the same degree of insulin resistance as their heavier counterparts.
Some studies support the presence of insulin resistance in both lean and obese women with PCOS. Furthermore, lean women with PCOS do seem to struggle with insulin-glucose regulation, even though it is not classified strictly as “insulin resistance.” Thin women with PCOS have higher insulin levels in their blood than thin or normal weight women without PCOS, according to researcher Vrbikova and associates in the 2004 article “Insulin Sensitivity in Women with Polycystic Ovary Syndrome” published in The Journal of Clinical Endocrinology and Metabolism.
Moreover, even if the serum insulin levels are normal, the ovaries of women with PCOS tend to be over-sensitive to the effects of insulin, thereby leading to increased ovarian androgen output.
Oral contraceptives are commonly prescribed to women with PCOS, regardless of whether they are overweight or of normal weight. However, using oral contraceptives in women with “lean PCOS,” as it is termed, may increase the risk of weight gain in this population and put them more at risk for insulin resistance or other negative effects on insulin and glucose metabolism.
Women with lean PCOS have much in common with their heavier counterparts. For example, lean women with PCOS may still have the same risk factors for cardiovascular disease as overweight women, according to a study conducted by Kravariti and colleagues and reported in the September 2005 issue of The Journal of Clinical Endocrinology and Metabolism. They conclude that all women with PCOS, regardless of weight or BMI, should work to prevent cardiovascular complications.
Another article by Tarkun et al published in The Endocrinology Journal in October 2004 suggests that lean women with PCOS were at higher risk of cardiovascular disease and anovulatory infertility compared to age-and weight-matched healthy women without PCOS. Therefore all women with PCOS should work to prevent complications like hypertension and diabetes mellitus. This can be accomplished through a whole foods, low carbohydrate diet, an exercise plan tailored to you, and certain nutritional and herbal supplements.
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About the author
Dr. Sari Cohen received her doctorate in naturopathic medicine with High Honors from the Southwest College of Naturopathic Medicine, and graduated cum laude from Dartmouth College. A clinical practitioner in New Hampshire, where she sponsors a PCOS support group, Dr. Cohen is the author of the prize-winning article “Melatonin, Menstruation and the Moon” published in The Townsend Letter for Doctors and Patients. A contributing author of the Board Review Study Materials for the Naturopathic Physicians Licensing Examination, she is also a member of Insulite Laboratories’ Medical & Advisory team where she undertakes research and provides professional guidance to individuals with insulin-related disorders. Dr. Cohen has developed the company’s 52-week Customer Protocol and has co-authored The Insulite Guide to Reversing Insulin Resistance and its Related Conditions.