Polycystic Ovary Syndrome, known as PCOS, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility.
Women are born with all their eggs stored in their ovaries. As these eggs mature past puberty, the ovaries release an egg every month. In Polycystic Ovary Syndrome, however, it’s thought the egg is not properly expelled from the ovary, and it forms into a fluid-filled cyst rather make into down into into the uterus as normal.
For some women, they may not even know they have PCOS until they find they can’t fall pregnant and begin to investigate the reasons why. Also, the symptoms and severity can vary greatly between women.
causes of PCOS
PCOS had long been known to affect between 5-10 per cent of women of childbearing age, regardless of race or nationality.
There can be many causes of PCOS, such as eating disorders (anorexia and bulimia), excessive exercise, extreme stress and brain fertility disturbances. Generally, though, the most common cause tends to be insulin resistance, or having high levels of insulin in the blood.
Insulin resistance is the underlying basis for many of today’s diseases – obesity, type 2 diabetes, heart disease, hypertension (high blood pressure) and pre-eclampsia.
Every time we eat food our blood glucose and blood insulin levels rise over the following few hours. Insulin mops up glucose and moves it to the cells where it is used for energy. Insulin also suppresses the use of fat as a fuel. The fat cells in our abdomen and around our waists are particularly sensitive to insulin. Too much insulin in the blood stream causes accumulation of fat around the waist and this is the most obvious sign of insulin resistance and PCOS.
symptoms
Medical tests such as blood tests, ultrasounds or laparoscopic investigations are vital to determine the problem for sure, but there are some symptoms which a woman may notice:
- Delayed, or early onset of puberty (normal puberty begins about 12-13 years of age)
- Irregular periods or none at all (amenorrhea)
- Excess body fat around the waistline
- Excess body and facial hair (hirsutism)
- Acne
- Hypoglycaemia after meals (low blood sugar)
- Hot flushes (heat intolerance or excessive sweating)
- Unexplained fatigue
- Mood swings
- Infertility
- Recurring spontaneous miscarriages
- Drop in blood pressure on standing or with exercise
Too much insulin in the blood stream causes an accumulation of fat around the waist and this is the most obvious sign of insulin resistance and PCOS. Women with a waist circumference of 80cm are considered to have an increased health risk, while those measuring more than 88cm have a substantial health risk. However, you can still be very thin and still have PCOS.
Very high insulin levels can cause the excessive production of testosterone and oestrogen which create PCOS symptoms and the vicious cycle of hormonal imbalance.
Insulin resistance also naturally rises at puberty, which is why PCOS is often seen in 10-12 year old girls. And it doesn’t necessarily stop at menopause!
You are also PCOS probable if you were born under 2.5kg (5.5lbs), and then put on weight quickly within the first two years of life.
If you have one or more of these symptoms, it’s a good idea to discuss your concerns with your doctor or health professional. The risks involved with this condition include an increased likelihood of developing diabetes, heart disease, strokes and uterine and breast cancer.
I have PCOS, what can I do?
Watch your diet
Changing to a low carbohydrate diet may work in the short-term because it lowers blood glucose and insulin levels. But the restrictiveness and relatively high saturated fat content may cause long-term health consequences as women with PCOS tend to have elevated homocysteine levels – a condition associated with heart disease.
New nutritional guidelines by the American Institute of Medicine suggest that 45 to 65 per cent of energy coming from carbohydrates will minimise the risk of chronic disease. It recommends the following daily minimum intake of carbohydrates, fat and protein for an average woman.
Carbohydrates: 45 per cent: That’s between 158g (1400kcal) and 225g (2000kcal). However, do note that not all carbohydrates are created equal. The Glycemic Index (GI) describes how the carbohydrates in food affect blood sugar levels.
- Low GI = 0-55
- Moderate GI = 56-69
- High GI = >70
Ideally you want to aim for Low GI carbohydrate foods because foods in this category cause lower insulin levels, making fat easier to burn and less likely to be stored. They also help lower blood lipids, are more satisfying and reduce your appetite, and reduce the risk of developing diabetes and heart disease.
A good low GI eating plan would include:
- 2-3 pieces fruit daily
- >5 serves vegetables daily
- At least 1 low-GI food at each main meal (at least 4 wholegrain cereals daily)
- Plenty of fibre
Fat: 30 per cent: Based on the calculated energy needed that would be 67g (2000kcal) – 47g (1400kcal). The best foods in this category are oily fish, walnuts, almonds, cashews, avocado and olives.
Protein: 25 per cent: This should consist of lean protein, 125g (2000kcal) – 88g
(1400kcal). Foods include lean meat and chicken, fish, low-fat dairy (milk, yoghurt and cheese), nuts and eggs.
Exercise is vital
A Canadian study has showed that non-dieting women (consuming 2000 kcal per day) who exercised moderately caused a reduction in abdominal obesity and an improvement in insulin resistance without weight loss.
Exercise intensity could be the key to PCOS management. An Otago University study looked at two groups of women. The ‘modest group’ exercised 30 minutes, five times a week and maintained a low-GI diet. The ‘intense group’ exercised for at least 20 minutes, five times a week at 80 to 90 per cent of their maximal heart rate and maintained a low-GI diet.
There was a significant difference between the two groups in their reduction in insulin resistance. In the intense group there was a 23 per cent drop compared with a 9 per cent drop in the modest group. The intense group also showed an 11 per cent increase in aerobic fitness compared with a 1 per cent increase in the modest group.
The implications of this study are especially relevant for lean women with PCOS. It means a low-GI diet coupled with intense exercise reduces insulin resistance and improves PCOS symptoms, and thereby chances of increasing fertility.
Remember, the cornerstone of managing PCOS is about diet and exercise. By modifying your lifestyle so you’re eating the right foods and ensuring you keep active, you are far more likely to be able to effectively manage the symptoms of PCOS.
Nikki Hart, Nutritionist
