Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders, affecting 9% to 18% of reproductive-age women.
Despite the high prevalence, PCOS is commonly overlooked and undertreated. A recent international study showed that nearly 50% of women saw three or more health professionals and one-third waited for more than two years before receiving a PCOS diagnosis.
Lack of education in medical schools and underfunding for increasing awareness and clinical trials (currently PCOS receives less than 0.01% of funding from the National Institutes of Health) are two main reasons PCOS doesn’t receive more attention. Some professionals suggest that the name of the condition itself is misleading and adds confusion.
Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain. Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two of these signs:
- Irregular periods. Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS Polycystic . For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods.
- Excess androgen. Elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
- Polycystic ovaries. Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.
The exact cause of PCOS isn’t known. Factors that might play a role include:
- Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar, your body’s primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your body might produce more insulin. Polycystic Excess insulin might increase androgen production, causing difficulty with ovulation.
- Low-grade inflammation. This term is used to describe white blood cells’ production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems.
- Research suggests that certain genes might be linked to PCOS.
- Excess androgen. The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne.
Complications of PCOS can include:
- Gestational diabetes or pregnancy-induced high blood pressure
- Miscarriage or premature birth
- Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver
- Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease
- Type 2 diabetes or prediabetes
- Sleep apnea
- Depression, anxiety and eating disorders
- Abnormal uterine bleeding
- Cancer of the uterine lining (endometrial cancer)
Obesity is associated with PCOS and can worsen complications of the disorder.
Diet and lifestyle modifications are the primary treatment approaches for women with PCOS, yet the optimal diet hasn’t yet been determined. A systematic review and meta-analysis published in the Journal of the Academy of Nutrition and Dietetics found that the type of diet didn’t matter as much as weight loss. Losing weight improved both metabolic and reproductive parameters associated with PCOS. This review, however, only included six articles from five studies.
Eating plans that include foods with a lower glycemic index and glycemic load, Polycystic or modifying carbohydrate, fat, or protein amounts have been shown to reduce metabolic markers associated with PCOS, even without weight loss
Compared with women without PCOS, women with the condition have higher levels of insulin and inflammatory markers. In a 2015 study, researchers investigated the use of an anti-inflammatory diet in women with PCOS. In this study, 100 overweight women with PCOS ate a reduced-calorie diet for 12 weeks.
The diet consisted of five small meals with 25% proteins, 25% fat, and 50% carbohydrates. The diet was designed to include moderate to high amounts of fiber with an emphasis on anti-inflammatory foods such as fish, legumes, green tea, and low-fat dairy. Chicken, red meat, and added sugars were limited.
The results were encouraging. The mean weight loss was 7.2% with significant reductions in cholesterol, blood pressure, and fasting blood glucose. Levels of C-reactive protein (CRP) were reduced by 35%, and 63% of the women regained menstrual cyclicity.
The DASH (Dietary Approaches to Stop Hypertension) diet, which also is designed to be rich in antioxidants, has been investigated in women with PCOS as well. Women who followed the DASH diet for eight weeks saw significant reductions in insulin and CRP levels, along with improvements in waist circumference measurements.
Studies on PCOS show an inverse relationship between vitamin D and metabolic and hormonal disorders. A systematic review published in Nutrients, however, found no evidence that vitamin D supplementation reduced or mitigated metabolic and hormonal dysregulations in women with PCOS.
Vitamin D receptors have been located on oocytes, immature ova, or egg cells involved in reproduction. Vitamin D supplementation (100,000 IU/month) has been shown to improve fertility in women with PCOS by increasing the number of mature follicles and improving menstrual regularity, but the results weren’t statistically significant.
Fish oil offers many benefits to women with PCOS, including helping to reduce elevated triglyceride levels, improving the fatty liver, and decreasing inflammation. Omega-3 oil also has been found to lower testosterone and regulate menstrual cycles in both overweight and lean women with PCOS.
Results from the Diabetes Prevention Program Outcomes Study show that metformin affects the absorption of vitamin B12 by causing alterations of the vitamin B12-intrinsic factor complex in the ileum. Vitamin B12 deficiency is progressive over time in metformin users. Consequences of decreased vitamin B12 concentrations—such as macrocytic anemia, neuropathy, and mental changes—can be profound.
Since the average dose of metformin in the PCOS population is high (1,500 mg to 2,000 mg per day), it’s recommended that patients who take metformin have their vitamin B12 levels checked annually and supplement with vitamin B12. The sublingual methylcobalamin form is best absorbed.