Being diagnosed with Polycystic Ovarian Syndrome (PCOS) can be disorienting and frustrating. Especially when you’re not given any real guidance on how to manage it and just told to lose weight (which is extremely difficult with PCOS). The truth is, many healthcare providers don’t understand PCOS enough to fully educate and guide you in regards to PCOS for pregnancy. When you turn to Google, you’re presented with lots of conflicting information and unsure of which path would be appropriate for you. As the name states, PCOS is a syndrome, which means it presents differently in every woman. Therefore, management will also be individualized. If you were just diagnosed with PCOS, here are 5 things to know before starting your journey towards PCOS management.
Disclaimer: This information is to be used for educational purposes only. It is not intended to be medical advice. Please discuss with your healthcare provider before engaging in any lifestyle changes or taking any supplements/medications.
1. PCOS Affects More Than Just Fertility
Most womxn living with PCOS are diagnosed when they seek out help with fertility. It is one of the most common causes of female infertility, but it is a lifelong condition that can affect many other areas of the body. Womxn with PCOS can have:
This means that their body cannot break down and use insulin adequately, which results in insulin buildup in the body. Unfortunately, this is a risk factor for developing type 2 diabetes or gestational diabetes during pregnancy. Increased insulin levels also cause the ovaries to produce androgens (male sex hormones), which brings us to our next point.
Elevated androgen levels
All womxn have androgens in their body, but womxn with PCOS have a greater amount than what is needed. Their ovaries produce too many androgens and may not produce enough female hormones needed for ovulation. When immature eggs fail to mature and result in ovulation, they can turn into many small cysts (hence the name polycystic ovaries). These small cysts create even more androgens, which turns into a vicious cycle. These elevated androgen levels manifest as excessive hair growth on the face, chest, or back (hirsutism), acne, and/or male pattern hair thinning/loss.
Increased risk for endometrial cancer
Due to irregular periods (or no periods for some womxn), the lining of the uterus, or endometrium, can become thick as it builds up every month without shedding. When the endometrium becomes thick and has an overgrowth of tissue, this is called endometrial hyperplasia, which can develop into cancer if left untreated.
Increased risk for depression and anxiety
Womxn living with PCOS are 3x more likely to have depression or anxiety, though the exact reason why is still unknown. The symptoms of PCOS, such as infertility or hirsutism can be distressing and hormonal imbalances can also play a role.
This is why it’s critical to start PCOS management right away, even if you are not actively trying to conceive to later increase your PCOS pregnancy chances. Some providers will tell you not to worry about it or to come back when you’re ready to get pregnant, but this is truly a disservice.
2. Treatment Options for PCOS
Medications have a role in PCOS management, BUT it should not be viewed as a solution for long-term management. What does Metformin do? Remember, womxn with PCOS are resistant to insulin, which increases their risk for type 2 diabetes. Metformin, which is actually used to treat diabetes, helps your body break down and use insulin more effectively. The most effective way to treat insulin resistance is through sustainable lifestyle changes, but this could be helpful as you work on those changes. Like all medications, Metformin has its side effects, such as nausea, vomiting, diarrhea, hypoglycemia (low blood sugar), and even serious complications that could be more life-threatening.
Recently, research has shown that inositol, a type of sugar that our bodies make, can effectively manage insulin resistance. A systematic review in 2019 found that Myo-inositol in particular was comparable to Metformin without the downfall of unfavorable side effects. Additionally, research has found that a 40:1 ratio of myo and d-chiro inositol helps to balance hormones, stimulate ovulation, improve fertility and egg quality, and decrease insulin resistance.
When should birth control be considered? As mentioned above, the absence of periods over time could lead to endometrial hyperplasia and even cancer. This is because every month the endometrium (lining of your uterus) builds up in preparation for a potential pregnancy. When ovulation fails to occur, the lining stays thick instead of shedding. Sometimes the tissue that is built up on the endometrium can change into cancer cells. So, it’s important to shed your lining at least every 3 months. Birth control keeps your endometrium thin or you can use progesterone every 3 months to shed the lining.
However, if your ultimate goal is to conceive, birth control will not help you achieve that. Slow, sustainable lifestyle changes are the most optimal way to manage PCOS long-term and to improve fertility and your PCOS pregnancy success rate. By healing your body through food (and supplements as needed), you can balance your hormones and restore normal ovulation. You want to make changes that feel authentic to your lifestyle and will not add stress to your life, as elevated levels of stress can exacerbate PCOS symptoms. This brings us to our next topic.
3. What to Eat When You Have PCOS
Dieting and restrictive eating do more harm than good when it comes to PCOS. It can lead to obsessing over food, disordered eating, a cycle of restricting and binging, slow down your metabolism, and cause further hormonal imbalances. It’s not sustainable and can cause you to give up altogether. Making gradual changes over time will prove to be more beneficial in the long term because consistency is more valuable than perfection. These are great foods to ADD to your diet:
Protein is critical for keeping you full throughout the day, stabilizing blood sugars, and curbing cravings. Chicken, lean beef, turkey, tofu, nuts, peanut butter, almond butter, lentils, and fish are all great options.
Substituting whole grains (brown rice, whole wheat bread, whole wheat pasta, sweet potatoes) for white, refined carbohydrates helps to reduce spikes in blood sugar and improves digestion as they are high in fiber.
Healthy fats, such as avocado, olive oil, cheese, whole eggs, fatty fish like salmon, nuts, and full fat yogurt help to balance hormones and reduce inflammation. They are also high in folate, which improves egg quality, aids in implantation, and promotes fetal growth and organ development.
Green, leafy vegetables (spinach, kale, collard greens), asparagus, broccoli, cauliflower, Brussels sprouts, berries, citrus fruits, and bananas are rich in B12, folate, and Coenzyme Q10 (CoQ10). CoQ10 protects ovarian reserve, counteracts ovarian aging, improves fertilization rates, and promotes genetically normal embryos.
Garlic, oregano, black pepper, paprika, turmeric, cinnamon, and olive oil are all great ways to season your food and reduce inflammation simultaneously.
Consuming at least 64 ounces of water daily will keep you hydrated, which is critical for proper organ functioning and naturally decrease consumption of sugary drinks/soda
Shifting your mindset to focus on what to HAVE instead of thinking of what to NOT HAVE, makes it easier to stick to changes. Just remember this is a lifestyle change, so if you crave something, eat it! Indulging in your favorite foods when you desire helps to rebuild trust in your body and to ensure that your relationship with food remains healthy.
4. PCOS and Pregnancy
PCOS is the most common cause of female infertility, but it’s also the most treatable. How does PCOS affect your ability to conceive? Ovulation is critical for fertility, but many womxn with PCOS fail to ovulate every month, which decreases their chances of conceiving. A woman with normal, regular periods has 12 chances to get pregnant throughout the year. If you have your period every other month, your chances are already cut in half to 6. If you have your period every 3 months, your chances are even slimmer at 4. So, the goal is to have you ovulating every single month if you desire to be pregnant.
The nutritional changes discussed above are extremely effective at balancing hormones, restoring regular ovulation, and improving fertility. Many womxn with PCOS can conceive through lifestyle changes alone. If you’ve tried lifestyle changes and still haven’t been able to regulate your period, you may want to consider fertility medications, such as Clomid or Femara. Femara has actually been proven to increase PCOS pregnancy success rates, so your provider will probably start with that one. This medicine works by reducing estrogen levels in order to stimulate ovulation, and you usually take it for 5 days every month while you are on your cycle. Common side effects include headaches, fatigue, dizziness, bloating, hot flashes, breast pain, and spotting.
Many womxn are able to get pregnant once they start ovulating regularly, but if not, they move on to more advanced fertility assistance, such as Intrauterine Insemination (IUI) and In-vitro Fertilization (IVF).
You can also consider supplements to improve fertility. As discussed earlier, a 40:1 ratio of myo and d-chiro inositol helps to balance hormones, stimulate ovulation, improve fertility and egg quality. A 2020 review also found that a 3-month daily supplementation regimen of vitamin D and calcium regulated the periods of womxn with PCOS. Fish oil helps in regulating your hormones, increasing blood flow to the uterus, reducing inflammation in the body, and improving implantation of an embryo in the body. It’s also critical for fetal brain and nervous system development. Many times, it takes a combination of lifestyle changes, supplements, and medications/procedures as needed to conceive. Don’t forget to have your partner evaluated as well, as it takes two to create a baby.
5. Stress and PCOS Management
The impact of stress on PCOS is often overlooked. How does stress play a role? Stress stimulates the production and release of cortisol. Cortisol is an essential hormone but too much of it can weaken the immune system, increase insulin resistance, stimulate the secretion of male sex hormones (results in hirsutism), and disrupt the secretion of female sex hormones responsible for menstruation (results in irregular/absent periods). It’s important to find healthy ways to release stress, such as meditation, mindfulness, yoga, reading, listening to music, journaling, taking a warm bath, getting a massage, etc. Sleep is also imperative to balance your hormones and adopting a calming, bedtime routine can aid if you suffer from insomnia.
As mentioned above, focusing on adding to your diet and making gradual, sustainable lifestyle changes is less stressful than dieting or engaging in restrictive eating. When it comes to moving your body, engage in the type of movement that you truly enjoy and can do consistently. Walking is a great option that is less stressful on the body and mind. Dealing with PCOS symptoms can be overwhelming, so it’s important to take note of how stressed you are and to actively work on releasing that stress.
Managing PCOS is truly a lifelong journey, but being aware of these 5 things is a great starting point to understanding the syndrome, as well as the various treatment options that are available. It’s also critical to feel supported by your healthcare provider. If you leave your healthcare visits feeling shamed or believing that your weight is to blame, then I highly encourage you to seek out a size-friendly provider who will treat you with respect and evidence-based care.
About the Author: Katrina Rollins, CNM, ARNP, MPH is a Nurse Midwife/Nurse Practitioner with 7 years of experience diagnosing and treating womxn with PCOS. She has PCOS herself and has spent the last 4 years learning how to manage her symptoms holistically and sustainably. After the birth of her son, she developed a passion for helping other womxn with PCOS on their wellness and fertility journeys. She owns a holistic telemedicine Womxn’s Health practice that serves womxn in Florida, Arizona, and Colorado. You can find out more here: https://globalwomenscare.com
To reach even more womxn, she also provides holistic virtual health consultations worldwide, which you can learn more about here: https://www.katrinarollins.com