By Eva Boland – Exercise Physiologist
Polycystic Ovary Syndrome (PCOS) is the most common endocrinopathy in women, affecting approximately 12% of Australian women of reproductive age. Unfortunately, up to 70% of these women are undiagnosed.
PCOS, like any syndrome, can see women suffer from a myriad of symptoms that have a significant effect on reproductive health, mental health, and quality of life. It’s important to note that each woman will be affected differently.
The main signs and symptoms of PCOS
- Oligomenorrhea – less than 8 periods a year, ‘skipping’ periods or very long cycles (>42 days). This means women with PCOS ovulate less often, and consequently can experience reduced fertility. However, women with PCOS have the same live birth rate as non-PCOS women; it’s just that they may need a little extra help with ovulation induction to achieve this.
- Changes in reproductive hormones and other markers that result in the oligomenorrhea mentioned above.
- Clinical and/or biochemical hyperandrogenism. This means a woman might have higher levels of testosterone in her blood, or may have the clinical signs of high testosterone, including hirsutism (increased body hair), acne, and alopecia (hair thinning on the scalp).
- Difficulty maintaining a healthy body weight. This is one of the most frustrating aspects of PCOS for many women.
- Insulin resistance. Irrespective of body weight, 70-90% of women with PCOS are insulin resistant. At high levels, insulin acts at the ovary to impair the hormones of the menstrual cycle, driving testosterone levels up and impairing ovulation. Insulin resistance worsens as body fat increases and left untreated can lead to type 2 diabetes.
- Increased depression and anxiety. In fact, studies have shown that 36% of women with PCOS have depression, and 42% have anxiety.
- Negative body image and body image distress, particularly in those with a higher BMI (>30).
A diagnosis of PCOS can be overwhelming. Education and support are often severely lacking, leading to increased anxiety and paralysis to act. Where to start and what to focus on? Many women I see in the clinic feel like they need multiple different treatments to target each aspect of their condition. However, if we take the approach that this is a multi-system condition, with one of the primary ‘drivers’ being insulin resistance, then we can relax a little. Improving your body’s ability to respond to insulin via lifestyle then becomes the focus. What does this mean? Diet, exercise, and mental health support! But before we get to that, let’s review what’s not helpful and doesn’t work.
Beware the pseudoscience 💊
The internet is awash with PCOS ‘treatments’ that are not based on science, and very much based on selling product. Here are a few things you might come across on the internet that you should steer clear of:
- Treatment based on PCOS ‘types’. Types may include a ‘thyroid type’, an ‘inflammation type’ or an ‘insulin resistant type’. None of these are recognised by medical science. Most women with PCOS are insulin resistant, and have higher inflammation levels, but that doesn’t mean they are a ‘type’. These websites are designed to sell you expensive supplements and programmes.
- PCOS vitamins and minerals. See you GP first to discuss getting your blood levels checked. In most cases, buying these products just results in expensive pee.
- Avoiding gluten and diary. There is absolutely no credible evidence to show these foods are detrimental to women with PCOS. Of course, if you are eating heavily processed versions of these foods often, that might not be ideal.
- To date, there is not enough research to show if probiotics have positive health outcomes in women with PCOS. You should focus on a diet full of probiotic friendly prebiotics, such as whole grains, fibrous vegetables, fruits, and legumes.
- Fasted exercise. No, do not do this. This is part of diet culture and does not result in any meaningful change to body composition over time.
- Fasting diets (5:2, 16:8 etc). Again, part of diet culture. Beware; this is often a slippery slope to disordered eating and an unhealthy relationship with food. There are times when this way of eating might be useful, but I strongly suggest seeing a dietitian to see if this method is safe for you before starting.
What works? 🍎💧🏃♀️🤝
First line treatment for PCOS is lifestyle intervention. We know that losing just 10% of body weight makes a huge difference to your insulin resistance and reproductive health. Most women notice their menstrual cycle becomes more regular and their symptoms improve over a 6-12 month period. You’ll need support with your diet, learning how to reduce the energy density of your diet whilst concurrently boosting nutrient quality (think high fibre, healthy fats, lean protein).
In terms of exercise, we know you’ll need a mix of cardio and resistance training for best results. Exercise can significantly improve your insulin resistance independently of weight loss (win!).
If you are new to exercise, then starting small and building up to 30 minutes most days is what you’ll aim for. I encourage you to pick things you enjoy, as consistency is important. Walking is an easy way to start, building up to hilly walks across an 8 week period.
If you are a long time exerciser, then transitioning to a mix of whole body resistance training and high intensity cardio sessions can help improve your insulin resistance. Don’t forget recovery sessions – not every session should be go-go-go. As a rule, you should have two easier sessions for every hard session over a 7-day training cycle. Eventually, every woman with PCOS should aim for at least 150 minutes of moderate intensity cardio, and two resistance training sessions, each week. For weight loss, exercise duration may need to be up to 300 minute a week (5 hr / week), but again, take your time to build up to this over months, not days!
Your support team 👩⚕️👋
For any syndrome-based condition you need a team around you. Getting help from university trained healthcare professionals that are registered with accreditation bodies is crucial. Along with your GP and gynaecologist, these professionals could include the following:
For exercise support: Accredited Exercise Physiologist
For diet and nutrition support: Accredited Practicing Dietitian
For mental health and body image support: Registered Clinical Psychologist
Your GP will be able to arrange a Team Care Arrangement (TCA), which entitles you to 5 sessions from the above healthcare professionals over a 12-month period with a partial rebate from Medicare. You many also qualify for a mental health care plan – speak to your GP about this.
If any of this resonates with you, and you need help with your PCOS and lifestyle, call us and book with Eva Boland, Accredited Exercise Physiologist, today.
Jean Hailes: https://www.jeanhailes.org.au/health-a-z/pcos
International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018: (https://www.clinicalguidelines.gov.au/portal/2598/international-evidence-based-guideline-assessment-and-management-polycystic-ovary)
NHMRC Centre for Research Excellence in Women’s Health in Reproductive Life (CRE WHiRL): https://whirlcre.edu.au/