PCOS - No Hype, Just the Science

A diagnosis of PCOS might feel confusing, or even stressful at first.

Did I do something wrong? Is this my fault? And what should I do now? Do I need to diet? Should I be trying to lose weight?

Understandably, the first place most folks turn is social media or the internet writ large. But these platforms are rife with misinformation and broad over-generalizations. So I asked our dietitian, Allison Rieck, who specializes in hormone health and lifecycle nutrition along with disordered eating, to clear up some of the confusion with a little actually-evidence-based-science.

Allison, take it away:

What is PCOS?

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders experienced by people with ovaries. A study published in 2023 by Yu et al. found a prevalence rate of 5.2%. PCOS is characterized by hormone imbalances, including excess production of androgens (particularly testosterone) and increased insulin production. Symptoms of PCOS can include irregular periods, depression and anxiety, excess hair growth (hirsutism), and acne.

What causes PCOS?

PCOS does not have one specific cause, though there is a genetic component. However, researchers have not identified a single gene causing PCOS; rather, they have identified some gene loci that may be involved in the development of PCOS, though more research is needed (Hoeger et al., 2020). Researchers have also hypothesized transmission during pregnancy as another factor in PCOS being passed from mother to daughter. Daughters of women with PCOS have a five times higher risk of developing PCOS themselves, raising the possibility that exposure to higher androgen levels during pregnancy may increase the likelihood of developing PCOS (Hoeger et al., 2020).

It's also possible that hormone irregularities contribute to the development of PCOS, rather than being just a result of PCOS; particularly, excess production of androgens can inhibit ovulation, and insulin resistance, which leads to high insulin levels in the blood, can also lead to increased androgen levels (Goodarzi et al., 2011).

Environmental factors such as endocrine-disrupting chemicals are likely another contributor to the development of PCOS (Palioura, & Diamanti-Kandarakis, 2015).

How is PCOS diagnosed?

There has been debate about the criteria for diagnosing PCOS, but since 2012 the recommended criteria (known as the Rotterdam criteria) is the presence of at least two of the following three conditions:

• Irregular or absent ovulation

• Clinical and/or biochemical signs of hyperandrogenism

• Polycystic ovaries

Note that despite the name, it is possible to have PCOS and not have polycystic ovaries.

Medical interventions for PCOS

One of the first-line interventions for PCOS is oral contraceptives to help regulate the menstrual cycle and decrease the availability of free testosterone. Metformin is also often prescribed to help decrease insulin and testosterone levels.

Weight loss is often recommended to patients with PCOS, which can be frustrating for many, as weight loss is often harder for those with PCOS. Excess insulin production can lead to increased weight as well as increased hunger. The hormones that regulate hunger and fullness may also be impaired, which can cause increased hunger. Even when weight loss attempts are successful, they rarely last long term, causing many to feel like they are in a constant battle with their body.

Difficulty losing weight can quickly become discouraging for many people in their attempt to support their health with PCOS, and it often leads to a more fraught relationship with food. However, there are plenty of ways to support one’s health with PCOS without making weight the focus.

Weight-Neutral Interventions

One of the most beneficial things is incorporating some physical activity into your day. Regular exercise has been shown to improve insulin resistance and ovulation in women with PCOS (Harrison et al., 2011). Many tend to think that for physical activity to “count” it must be high intensity and make you sweat profusely, but that is not the case. A walk after a meal can provide these same benefits.

Supplementation is another area to consider. While many people do not require supplements to meet their nutrient needs, those with PCOS may benefit from supplementation of certain vitamins and minerals. While there are several that can be helpful, I will mention only two here. The first is inositol (specifically myo-inositol and D-chiro-inositol), which has been shown to improve ovulation and insulin resistance in PCOS (DiNicolantonio & O’Keefe, 2022). Another supplement to consider is vitamin D. Studies have pointed to vitamin D as playing an important role in increasing insulin sensitivity in patients with PCOS (Mohan et al., 2023). Note that decisions about supplementation should be made with caution and in conjunction with a medical provider.

When it comes to nutrition support for PCOS, there is no specific diet that research has shown is optimal for PCOS. But, there are some nutritional strategies that can be helpful in managing PCOS symptoms. One of the most beneficial nutrition strategies for PCOS is to pair carbohydrates with protein, fat, and/or fiber. The protein, fat, and fiber slow the breakdown of the carbohydrates, moderating the impact on blood sugar levels and keeping us more satiated over time. Studies have also shown the benefits of unsaturated fats and omega-3 fatty acids for decreasing insulin resistance, triglyceride levels, inflammation, and androgen levels (Oner, 2013; Phelan, 2011). Increasing the proportion of low glycemic index foods (foods that release glucose more slowly into the bloodstream) in one’s diet has also been shown to be helpful in increasing insulin sensitivity and fertility (Saadati et al., 2021).

PCOS is a complicated disorder, but the right support can mitigate some of the stress in navigating the health challenges posed. We would love to come alongside you to help you make changes in an individualized and sustainable way. You don’t have to figure it all out on your own!

-Allison

Allison Rieck, MS, RDN, LDN

She/Her/Hers

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DiNicolantonio, J. J., & O’Keefe, H. O. (2022). Myo-inositol for insulin resistance, metabolic syndrome, polycystic ovary syndrome and gestational diabetes. Open Heart, March 2. https//:doi.org/10.1136/openhrt-2022-001989

Goodarzi, M., et al. (2011). Polycystic ovary syndrome: Etiology, pathogenesis, and diagnosis. Nature Reviews Endocrinology, 7, 219-31.

Harrison, C. L., et al. (2011). Exercise therapy in polycystic ovary syndrome: A systematic review. Human Reproductive Update, 17(2), 171-83.