Managing PCOS: The Role of Diet and Lifestyle Interventions

Polycystic Ovary Syndrome (PCOS) is the most common chronic endocrine disorder among women of reproductive age, affecting an estimated 5 to 15 percent of women, depending on the diagnostic criteria used. Despite its high prevalence, PCOS often goes undiagnosed, with many individuals seeing multiple healthcare professionals over the course of a year or more before receiving a diagnosis. This delay can be frustrating and emotionally draining.

While PCOS was once thought of primarily as a reproductive disorder, growing research now shows it’s a complex condition with far-reaching effects on metabolic, hormonal, and even gut health. As our understanding of PCOS evolves, so too does the way we approach diagnosis and treatment. In this post, I’ll break down the latest science-backed insights and what they mean for managing PCOS more effectively through personalised lifestyle strategies.

PCOS: More Than Just Ovarian Cysts

Despite the name, PCOS isn’t primarily about ovarian cysts. The so-called "cysts" are actually immature follicles, and not all individuals with PCOS have them. Diagnosis is typically based on the Rotterdam Criteria, which requires two of the following three features:

• Irregular or absent periods (ovulatory dysfunction)

• Signs of high androgens (e.g. acne, unwanted hair growth, elevated testosterone)

• Polycystic ovaries on ultrasound

Recent research has highlighted that metabolic and hormonal imbalances like insulin resistance and elevated androgens are central to PCOS. As a result, ultrasound findings are becoming less important in diagnosis, and more emphasis is placed on the underlying metabolic drivers. This shift is important because it means treatment is no longer just about managing reproductive symptoms as nutrition, movement, sleep, and stress play a key role in improving hormonal balance, metabolic health, and long-term wellbeing.

What Causes PCOS?

PCOS is a complex condition with no single cause. Instead, it’s thought to arise from a combination of genetic, environmental, and metabolic factors.

• Genetics: PCOS often runs in families, and recent studies have identified multiple genes involved in hormone regulation, insulin signalling, and inflammation that may increase risk.

• Environmental influences: Early life factors such as exposure to endocrine-disrupting chemicals (like BPA) or in-utero conditions may also play a role in triggering PCOS in genetically predisposed individuals.

• Gut health: Research suggests that imbalances in gut bacteria may contribute to insulin resistance, inflammation, and hormone disruption in PCOS. While still an emerging field, supporting gut health could become part of a more personalised approach to managing symptoms.

These risk factors highlight why lifestyle strategies like nutrition, exercise, and stress management are key to improving symptoms and long-term health outcomes in PCOS.

Long-Term Health Risks of PCOS

While it's important to note that not everyone with PCOS will experience these issues, untreated PCOS can increase the risk of several long-term health conditions, including:

• Heart disease

• Endometrial cancer

• Type 2 diabetes

• High cholesterol and high blood pressure

• Central obesity (fat around the abdomen)

• Obstructive sleep apnoea (a condition that disrupts breathing during sleep)

Hormones and PCOS: The Insulin-Androgen Loop

Many PCOS symptoms stem from hormonal imbalances, particularly high levels of insulin and androgens (“male” hormones like testosterone).

Insulin helps move sugar (glucose) from the blood into your cells where it is used to create energy. In PCOS, insulin has a harder time carrying out this task because your cells are more resistant to its effects i.e., they are “insulin resistant”. This leads the body to produce more insulin to compensate, however, this elevation in insulin levels can signal the ovaries to make more testosterone, which can lead to symptoms like acne, excess hair growth, and irregular periods.

The good news. Improving how your body responds to insulin through diet, exercise, sleep, stress management, or medication can lower insulin levels. As insulin sensitivity improves, testosterone levels will likely come down too, helping to break the cycle and ease symptoms.

Image sourced from: https://www.imaware.health/blog/insulin-resistance-and-pcos

Managing PCOS: How Diet and Lifestyle Can Help

While there is no single "PCOS diet", the right lifestyle changes can significantly reduce symptoms and improve overall health. Here’s a breakdown of the key dietary and lifestyle interventions recommended for managing PCOS:

• Choose Low Glycemic Index Carbohydrates:

  • Foods with a low glycemic index (GI) cause a slower, steadier rise in blood sugar levels, which is beneficial for managing insulin resistance.

  • Low GI foods include whole grains, vegetables, legumes, and certain fruits.

  • Swapping high-GI foods (like white bread or sugary snacks) for low-GI alternatives can help improve insulin levels and regulate menstrual cycles.

• Balance Your Meals:

  • Combining protein and healthy fats with low-GI carbs can help further stabilise blood sugar levels and improve insulin sensitivity. This also helps with appetite control, reducing food cravings.

  • Example of a balanced meal: a portion of lean protein (e.g., chicken, fish, or tofu), healthy fats (e.g., avocado or olive oil), and a serving of low-GI vegetables (e.g., leafy greens or cauliflower).

• Include Omega-3 Fats:

  • Omega-3 fatty acids, found in oily fish (like salmon or sardines), chia seeds, flaxseeds, and walnuts, have anti-inflammatory properties that can help manage the chronic inflammation often seen in PCOS.

• Prioritise Fibre:

  • High-fibre foods (such as vegetables, fruits, whole grains, and legumes) help manage blood sugar levels and promote digestive health.

  • Fibre also helps you feel fuller for longer, which can support weight management.

The Role of Weight Management in PCOS

PCOS can affect people of all body sizes. However, those with overweight or obesity may find that even modest weight loss (5% of body weight) can significantly improve symptoms. Weight loss can help reduce insulin resistance, lower testosterone levels, and restore more regular menstrual cycles.

However, managing weight can be particularly challenging for many people with PCOS, often due to factors like insulin resistance, increased cravings, and difficulties with appetite regulation. While not everyone experiences the same symptoms, these challenges can make traditional weight loss approaches feel frustrating or ineffective. It’s essential to focus on sustainable, healthy eating habits and avoid restrictive diets that can lead to nutrient deficiencies or worsen symptoms. This is where working with an experienced dietitian can be especially helpful. A dietitian can support you in making tailored, realistic changes that fit your lifestyle, while ensuring you meet your nutritional needs and manage your symptoms effectively.

Using Physical Activity to Manage PCOS

Exercise plays a vital role in improving insulin sensitivity and managing weight. Regular physical activity helps the body process insulin more effectively and reduces the risk of metabolic diseases like diabetes. Here are some effective forms of exercise for managing PCOS:

• Strength training: Improves muscle mass and metabolic function, which can boost insulin sensitivity.

• Cardiovascular exercise: Activities like walking, running, or cycling help with weight management and improve heart health.

• High-Intensity Interval Training (HIIT): Short bursts of intense activity followed by periods of rest can improve insulin sensitivity and metabolic health.

• Yoga: Reduces stress and promotes overall well-being.

Guidelines recommend 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity per week, plus strength training twice a week.

Supplements and Medications for PCOS

In addition to lifestyle changes, certain supplements and medications may support hormone balance, insulin sensitivity, and ovulatory function in people with PCOS.

Dietary and Nutritional Supplements:

Research suggests that some supplements can help reduce insulin resistance, improve ovulation, and lower inflammation in those with PCOS. These include:

• Inositols (myo- and d-chiro-inositol): Inositols are a type of naturally occurring sugar alcohol related to the B-vitamin family. Research suggests they can help improve insulin sensitivity, support regular menstrual cycles, and promote ovulation.

• Vitamin D and omega-3 fatty acids: These nutrients may support hormonal balance and reduce inflammation.

• Zinc, magnesium, selenium, and chromium: These may help improve insulin action and antioxidant status.

Medications:
While not always needed, medications may be recommended by your doctor in some cases:

• GLP-1 receptor agonists (e.g., semaglutide): Originally used for diabetes and weight management, these medications are being studied for PCOS. Early research shows potential benefits including weight loss, better blood sugar control, and reduced androgen levels.

• Metformin: Originally developed for type 2 diabetes, metformin is commonly used in PCOS to help lower blood glucose and insulin levels.

It's important to remember that supplements and medications are not one-size-fits-all. Speak with your healthcare provider or dietitian before starting anything new to ensure it's appropriate for your individual needs.

Additional Lifestyle Tips for PCOS Management

• Prioritise sleep: Aim for 7-9 hours of sleep per night to support hormonal balance and stress management.

• Manage stress: Chronic stress can exacerbate hormonal imbalances in PCOS. Try techniques like meditation, deep breathing, or mindfulness.

• Seek professional support: A dietitian can help you develop a personalised eating plan that aligns with your specific needs, while a doctor can guide you on medication options such as metformin to improve insulin sensitivity or hormonal treatments to regulate periods.

Final Thoughts

Our understanding of PCOS is rapidly evolving. What’s clear is that PCOS is not just a reproductive condition it’s a complex, systemic syndrome that requires a whole-person, individualised approach. As new therapies and strategies emerge, the future for PCOS management looks more hopeful with a strong focus on empowering individuals to understand and manage their condition with science on their side.

If you'd like to explore how personalised nutrition can support your PCOS journey, you can book a consultation with me.

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