In a woman’s ideal world, hormones are balanced, menstrual cycles are regular and fertility is not an issue. Unfortunately, that is not the case for the 1 out of 10 reproductive-age women in the United States who live with polycystic ovary syndrome (PCOS).
“PCOS is characterized by high levels of male sex hormones [androgens] and problems with ovulation,” explains Angela Grassi, MS, RDN, founder of the PCOS Nutrition Center. Due to this hormonal imbalance, an egg might not mature or get released each month, causing absent or irregular periods. It’s the most common cause of ovulatory infertility, Grassi says.
As women age with this disorder, there are long-term metabolic complications. “Emerging research now shows that if PCOS is not well managed, it can lead to long-term health risks such as an increased risk for type 2 diabetes and cardiovascular disease as women get older,” explains Grassi, who spoke about nutritional interventions for women with PCOS at The Academy of Nutrition and Dietetics’ Food and Nutrition Conference & Expo in Chicago.
Defined primarily as an endocrine disorder, PCOS is associated with metabolic abnormalities such as insulin resistance (when cells don’t respond to normal levels of insulin, leading to abdominal weight gain), fatty deposits in the liver and high triglycerides, a type of blood fat that can lead to cardiovascular disease.
“PCOS is a syndrome of symptoms,” says Christina Boots, MD, an obstetrician-gynecologist with Northwestern Fertility and Reproductive Medicine. A patient’s explanation of symptoms coupled with lab work are used to make a diagnosis.
If two of the following three criteria are met, a physician will suspect PCOS:
— Irregular menstrual cycles of greater than 35 days, which implies that the patient is not ovulating every month.
— Facial or body hair, also called hirsutism, and/or acne or thinning hair or balding, all of which can indicate high levels of androgens.
— Ovarian cysts, or tiny follicles around the ovaries, seen via ultrasound.
Treatments for PCOS
Treatment options include oral contraceptives or the steroid spironolactone, which can decrease androgens and reduce excessive body hair and acne. Progesterone therapies like intrauterine devices (IUDs) or the Depo-Provera birth control shot can “help balance hormones and keep the endometrial lining of the uterus from building up, which decreases the risk for endometrial cancer,” Boots says.
If fertility is a concern — and it typically is with PCOS — then restoring ovulation is important. “If women are not cycling then they are not ovulating. Most women respond nicely to ovulation-induction medications,” Boots says. Such drugs include letrozole and clomiphene citrate.
Metformin, which decreases insulin resistance, can also be used for PCOS, as it helps with weight loss, improving pregnancy rates and preventing type 2 diabetes. It is typically used as an adjunct therapy in conjunction with lifestyle changes.
Lifestyle modifications include replacing added sugar and simple carbohydrates in the diet with complex carbohydrates — such as whole grains, beans and lentils — to decrease the amount of insulin circulating in the bloodstream. Losing excess weight and getting regular exercise can also improve insulin sensitivity and hormone imbalances.
Diet and lifestyle changes play an important role in managing PCOS. “A diet rich in anti-inflammatory foods, such as fruits, vegetables, fish, olive oil and nuts, has been shown to reduce inflammation and help with fertility in PCOS women,” Grassi says.
Depression, anxiety and poor body image often accompany PCOS, so the psychological aspect of the illness is an important component of care as well. “PCOS is associated with increased risk for mood and eating disorders,” says Julie Friedman, PhD, executive director of binge eating treatment and recovery at the Eating Recovery Center, part of Insight Behavioral Health Centers.
PCOS often brings with it high rates of body dissatisfaction and overconcern with weight and shape. Friedman works alongside registered dietitian nutritionists to get patients eating balanced meals on a regular schedule.
“We also work on managing stress and improving sleep in patients to increase overall well-being and decrease inflammation compounded by stress hormones,” Friedman says. “The theory is that androgens impact eating disorder behavior risk, so if you can lower excess androgens, you lower the risk for eating disorder behaviors.”
Boots works to treat all aspects of the disorder by having PCOS patients consult with registered dietitian nutritionists and psychologists, as well as encouraging them to try complementary therapies like acupuncture and herbal therapy to improve their quality of life.
Even as women age and their reproductive concerns about PCOS are put to the side, lifestyle management is important. Eating well, regular exercise, good-quality sleep and stress management are all long-term, continuous treatments for PCOS patients.
Sustained changes are necessary to successfully combat the possible complications of the illness, such as heart disease and type 2 diabetes. “The metabolic symptoms of PCOS never go away,” Boots says, making long-term management essential.
Victoria Shanta Retelny, RDN, is a lifestyle nutrition expert and author of Total Body Diet for Dummies. Follow her @vsrnutrition.