Polycystic ovary syndrome (PCOS) is a perplexing hormonal disorder affecting women of reproductive age. It is estimated that 5% to 10% of women in their reproductive years have PCOS, but only up to 30% of those with the disorder have symptoms. Many times, women present with an isolated complaint, such as an inability to conceive or weight gain.
A common diagnostic criterion for PCOS is clinical and/or biochemical signs of hyperandrogenism, the etiology of which is not completely understood. This hormonal imbalance results in the symptoms of PCOS, which include infertility, menstrual irregularities (oligomenorrhea, amenorrhea, anovulation), ovarian cysts, weight gain and/or difficulty losing weight, thinning or loss of scalp hair, and excessive growth of body hair (eg, face, chest).
Women with PCOS also are at increased risk for diabetes, heart disease, and uterine cancer, which makes good nutrition a very important part of PCOS management.
The correlation between PCOS and insulin resistance has been well established. In fact, nearly all overweight women with PCOS have high insulin levels. Many women with PCOS have been treated with reasonable success with metformin, but the drug’s adverse effects, which can include gastrointestinal discomfort, respiratory issues, and musculoskeletal pain, can be intolerable for some patients.
Recently, there has been much attention given to minimizing PCOS through diet and weight loss. Up to 80% of PCOS patients are obese, and weight loss is a mainstay of treatment. Since nearly all of these women have high levels of insulin, managing insulin levels and reducing weight can lead to significant symptom improvements.
A weight loss of only 5% can reduce androgen levels which, in turn, can result in improved menstrual function and cholesterol levels and other related cardiovascular benefits. The reduced symptoms experienced by many of my patients with PCOS who have committed to lifestyle changes for weight loss are evidence that this option does work.
A sustainable weight loss program includes both a healthy diet and exercise. Women with PCOS should engage in some form of rigorous exercise for up to 1 hour daily most days of the week. Your patients must be motivated by, committed to, and educated about the benefits of a regular exercise routine. For some patients, the idea of going from sedentary to exercising 1 hour a day can be overwhelming, so a less daunting short-term goal may be more reasonable. Prescribing 15 minutes of exercise per day initially may be more effective than overwhelming a patient with an exercise goal of 1 hour.
Women today are busy, with more that 50% juggling the demands of careers, children, and home life. Along those lines, most women consider their ob/gyn to be their primary care doctor. Therefore, it is imperative that we start the conversation about initiating these healthful lifestyle changes.
Lobo RA. The complexities of polycystic ovarian syndrome. In: Advances in Gynecology. New York, NY: New York–Presbyterian; Oct/Nov 2013.
Redfern J. Combating polycystic ovary disease through diet. March 23, 2012. Available here. Accessed February 12, 2014.
Thompson J, Manore M. Nutrition for Life. 3rd ed. Upper Saddle River, NJ: Pearson Education, Inc; 2012.