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All You Need To Know About PCOS
- Heka Nutrition
- Oct 2, 2022
- 4 min read
Polycystic Ovary Syndrome (PCOS) is an endocrinological disorder causing metabolic, hormonal and reproductive issues in 8-20% of reproductive age individuals with a uterus. This is why PCOS is known as a complex condition characterized by enlarged ovaries and/or presence of numerous cysts (fluid filled sacs) in ovaries. It has been observed that few people with PCOS do not have cysts formed in their ovaries and there are few people who do not have the syndrome but still do develop cysts. This shows that the pathogenesis and diagnosis of PCOS is quite ambiguous; and it has been observed that a high percentage of individuals who have PCOS remain undiagnosed.
What causes PCOS?
A definite cause for PCOS has not yet been found however, there are few factors that it can be linked to.
Genes - First-degree relatives of people affected with PCOS have a high inheritance rate and there are certain genomic variants that may trigger the dysregulation of androgen synthesis in the body. These genomic variants are related to hyperandrogenism and environmental factors like dietary habits and leading a sedentary lifestyle.
Obesity - Excessive weight gain and obesity play a huge role in the development of PCOS. Imbalanced energy expenditure, dietary habits, genetic factors, emotional and mental well-being are underlying causes of weight gain/obesity. Obesity also contributes to metabolic dysfunction and aggravates insulin resistance.
Insulin Resistance - Every individual produces the hormone insulin to utilise the glucose for energy. In usual cases, the dysfunction of metabolic action of insulin occurs in the muscle and adipose tissues causing the insulin to not function well which increases the glucose levels leading to diabetes, but in PCOS mitogenic and steroidogenic actions of insulin taking place in the ovaries are maintained causing elevated levels of insulin (hyperinsulinemia). High levels of insulin triggers the ovaries to produce more androgens like testosterone which has an adverse effect on the development of the follicles and prevents ovulation.
Inflammation and Oxidative stress - Research has implied that individuals with PCOS always have elevated levels of a protein called C-reactive protein (CRP) which indicates inflammation. There are also high levels of other markers for inflammation like oxidative stress, inflammatory cytokines, and white blood cells called lymphocytes and monocytes which connote a weak immune system. This low-grade chronic inflammation associated with PCOS is also a risk factor for diabetes, infertility, and heart disease.
What are the symptoms of PCOS?
Hirsutism (excessive hair on the face, chest, back)
Weight gain
Acanthosis (dark discolouration of skin in body folds and creases)
Seborrhea (oily skin)
Acne
Thinning hair, alopecia
Irregular periods, infertility
Heavy bleeding
Pelvic pain
Insomnia, sleep apnea
Fatigue, mood swings
Anxiety, depression
How is PCOS diagnosed?
According to the Rotterdam criteria (2003), any two out of three of the following diagnostic markers should be present to meet the diagnosis criteria:
Excess Androgens (Hyperandrogenism)
Irregular periods or lack of ovulation (Oligo anovulation)
Polycystic Ovaries
How can PCOS be treated?
Presently, there is no cure for PCOS and the treatment depends on several factors and severity of the symptoms. The first line of defense for PCOS is to opt for diet and lifestyle correction and to get a medical consultation from a healthcare provider; here are a few common medical treatments:
Birth-control pills - A daily dosage of progestin would help balance the hormones, regulate ovulation, help relieve the PCOS symptoms (acne, hirsutism) and protect against endometrial cancer. These can be administered in the form of IUD’s, pill, shots, patch or vaginal rings.
Metformin - A biguanide drug that is used to help treat type 2 diabetes and in case of PCOS, it helps by improving the sensitivity of peripheral tissue against insulin and lowering insulin resistance. It also lowers the androgen levels and helps in reducing fatty acid oxidation.
Spironolactone - A steroid that acts as an antiandrogen helps to reduce androgen levels by blocking its synthesis to some extent.
Clomiphene - It is a fertility drug that can aid women with PCOS to get pregnant. It stimulates the process that triggers the ovulation and often comes with risks of hyperstimulation of ovaries increasing the chances of multiple births and/or increasing the release of hormones.
What about Nutrition and lifestyle?
It is always better to manage a healthy weight range so as to help relieve PCOS symptoms. Losing just about 5 to 10 percent of excess body fat can help regulate the menstrual cycle, improve cholesterol levels and improve insulin sensitivity. A minimum of 40 minutes of exercise for at least 5 days a week is recommended.
As evidence suggests, a Mediterranean-style diet is beneficial as it is a low-calorie, low-saturated fat diet with a low-glycemic index and moderate to high fiber intake. It accentuates the intake of anti-inflammatory foods such as fish, legumes, nuts, olive oil, herbs, spices, and green tea.
The practice of seed cycling is another method to add into the routine to help regulate the hormones and reduce the PCOS symptoms. It requires the consumption of seeds in different phases within an individual’s menstrual cycle. One tablespoon each of flaxseeds and pumpkin seeds are to be consumed in the follicular phase (first phase) of the cycle which are days 1-14; One tablespoon each of sesame seeds and sunflower seeds are to be consumed in the luteal phase (second phase) of the cycle. This entire cycle would nudge the body into a normal rhythm as the seeds are rich in fibre, omega 3 fatty acids and antioxidants.
References
Mykhalchenko K, Lizneva D, Trofimova T, Walker W, Suturina L, Diamond MP, et al. Genetics of polycystic ovary syndrome. Expert Rev Mol Diagn. 2017;17(7):723-33.
Crespo, Raiane P. et al. An update of genetic basis of PCOS pathogenesis. Archives of Endocrinology and Metabolism [online]. 2018, v. 62, n. 3 https://doi.org/10.20945/2359-3997000000049
Barber, T. M., Hanson, P., Weickert, M. O., & Franks, S. (2019). Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies. Clinical medicine insights. Reproductive health, 13, 1179558119874042. https://doi.org/10.1177/1179558119874042
Livadas S, Anagnostis P, Bosdou JK, Bantouna D, Paparodis R. Polycystic ovary syndrome and type 2 diabetes mellitus: A state-of-the-art review. World J Diabetes 2022; 13(1): 5-26. DOI: https://dx.doi.org/10.4239/wjd.v13.i1.5
Peker, N., Turan, G., Ege, S., Bademkıran, M. H., Karaçor, T., & Erel, Ö. (2021). The effect of clomiphene citrate on oxidative stress parameters in polycystic ovarian syndrome. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 41(1), 112–117. https://doi.org/10.1080/01443615.2020.1719052
Unluturk, U., Harmanci, A., Kocaefe, C., & Yildiz, B. O. (2007). The Genetic Basis of the Polycystic Ovary Syndrome: A Literature Review Including Discussion of PPAR-gamma. PPAR research, 2007, 49109. https://doi.org/10.1155/2007/49109
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