What is PCOS?
Polycystic Ovary Syndrome (PCOS) is the most common endocrine (hormonal) condition worldwide affecting at least one in 10 women, trans men and non-binary folk. However, three quarters of those living with PCOS are never diagnosed. There is no “cure” for PCOS, but the good news is that simple lifestyle changes can often be really effective at helping you manage PCOS symptoms in both the short term and longer term, whether or not you require medical treatment. As a nutritionist and person living with PCOS, I would love to see more conversations taking place this September, which is officially PCOS Awareness Month.
What are the common symptoms of PCOS?
Common symptoms of PCOS may include irregular or absent periods, acne, excess facial and body hair, scalp hair loss, anxiety, depression, infertility, sleep disturbances, disordered eating, gaining weight easily and insulin resistance, all of which can have a negative impact on quality of life.
There is a set criteria for diagnosis called the Rotterdam Criteria and it’s important to see your GP if you think you may have the condition:
In adults, two out of the three features of PCOS are required for a diagnosis in the revised criteria (Rotterdam Criteria, 2003):
Oligomenorrhea (irregular menstrual periods) or amenorrhea (absence of menstrual periods)
Hyperandrogenism (based on clinical (signs on the body) and/or biochemical signs (hormone levels in the blood))
Polycystic ovaries (on the ultrasound ≥ 12 follicles measuring 2‐9 mm in diameter and/or an ovarian volume > 10 mL in at least one ovary)
Myth 1: You did something to cause it
There is a tendency for women to be blamed or to blame themselves when it comes to health conditions including Polycystic Ovary Syndrome (PCOS). This is a documented result of societal stigma, unreliable advice and pervasive and often inaccurate myths. You are not to blame for your PCOS. This is a complex genetic trait which we are still learning more about. Polycystic ovary syndrome is still a poorly understood condition and the exact cause is unknown. While national and international guidelines recommend lifestyle changes to be the first line of treatment for PCOS, even before medication, women with PCOS often receive very little advice around their diet and lifestyle.
It is also impossible to recognise the social determinants of health which negatively affect people living with PCOS. Health is a privilege in our current world, one that is not available to everyone. This could be due to a lack of access to healthcare, housing, healthy food or one of the many other inequalities present in society.
Myth 2: PCOS only affects you if you’re “overweight”
PCOS can affect people of all sizes. Most studies included in a 2019 review could not conclusively determine whether PCOS contributed to excess weight gain or if excess weight caused PCOS. While it is true that excess body weight is a risk factor, PCOS also affects two out of 10 people in the so-called “healthy” body weight range with a BMI less than 24.9 (or 23 for Asians). This is often referred to as having ‘lean PCOS’. Many people with lean PCOS also show evidence of insulin resistance and acne/ excess hair growth. A significant proportion of those with lean PCOS are found in studies using MRI scans to have increased amounts of visceral fat, which is found around the abdominal cavity. I always encourage my clients with PCOS to focus on what they can add into their diet rather than what they remove. We know that cycles of yo-yo dieting, also known as ‘weight cycling’, can actually lead to increased weight gain in the longer term. Low-calorie dieting also increases levels of the stress hormone cortisol, which is already dysregulated in women with PCOS. People with PCOS are at increased risk of eating disorders, especially binge-eating disorder. In addition, higher levels of anxiety, depression, and obsessive-compulsive disorder (OCD) are noted in PCOS. Weight stigma makes it particularly difficult for people with PCOS living in larger bodies to access medical care and treatment.
Myth 3: Testosterone is a “male” hormone”
This is factually incorrect. Testosterone is a hormone produced by all genders. It is often referred to wrongly as the ‘male’ hormone, which reinforces the gender binary and adds to the stigma associated with PCOS, as most cis women with PCOS have some symptoms of androgen (testosterone) excess, such as acne or excess hair growth. The truth is that all humans produce all three sex hormones – testosterone, oestrogen and progesterone – in different amounts, depending on their gender, age and stage of life.
We live in a society where any amount of facial and body hair on cis women is considered unacceptable due to patriarchal and racist beauty standards. Excessive facial and/or body hair growth is the most recognisable sign in PCOS and a huge psychological and financial burden for many. The medical term for excessive facial and body hair growth is ‘hirsutism’. Androgen excess or local androgen sensitivity can cause hairs to be thicker and darker.
In some people, making lifestyle changes can help slow hair growth. For those wishing to remove hair, consider both short-term and longer-term treatments as laser hair removal can be expensive and may not deliver the desired results. There is also the option of androgen suppression with the Pill and/or androgen blockers. This is just one more example where one size doesn’t fit all in PCOS as everyone responds differently to treatments
Myth 4: The cysts on my polycystic ovaries are causing me pain.
Pain is not a feature of PCOS. Tiny ‘cysts’ may be seen in one or both ovaries on a pelvic ultrasound scan in those with PCOS. These are not true cysts but immature egg follicles which do not grow to any significant size and do not cause pain. There may be other coincidental causes of pain in PCOS, such as painful periods, pelvic infections, endometriosis or a symptomatic ovarian cyst, and treatment for these will depend on the underlying cause. If you are having persistent pain it is really important that you seek medical advice and do not assume it is because of PCOS.
Myth 5: There is no way to treat PCOS.
Can you control PCOS and live healthily? Absolutely. While there may be no cure for this hormonal disorder, there is plenty of hope and help available to make it possible to live a full and joyful life with PCOS, whether or not you require medication such as metformin or the Pill.
Sustainable lifestyle changes for managing PCOS include:
- Enjoy a dietary pattern that is rich in plant foods as only plants contain fibre including fruit, vegetables, whole grains, legumes (beans, peas, lentils, soya), nuts and seeds, herbs and spices with water as your drink of choice. This helps promote healthy gut bacteria, reduces inflammation and oxidative stress, normalises blood sugars, and lowers insulin resistance.
- Move your body regularly, ideally in a form you enjoy. This is especially helpful after a meal – a short walk for 15 minutes can help curb blood sugar peaks. Resistance training is particularly helpful for improving body composition and reducing androgen excess in PCOS.
- Prioritise a regular sleep routine and aim to get seven to nine hours restorative sleep every day.
- Avoid smoking, minimise alcohol and avoid excess caffeine.
- Manage stress through mindfulness, meditation, psychotherapy, yoga or any other relaxing activity to manage stress levels.
- Spend time with your support network and nurture relationships with friends and/or family.
Disclaimer: Always seek the advice of your GP or other qualified health provider regarding a medical condition. The above is not a substitute for a professional diagnosis or individual medical or nutrition advice.
Check out my book Living PCOS Free
Living PCOS Free is a practical guide to managing Polycystic Ovary Syndrome (PCOS), the most common hormonal disorder worldwide, affecting at least 1 in 10 women and people assigned female at birth. With over 35 years’ of clinical experience, Dr Nitu Bajekal breaks through misinformation, providing clarity and support to help you tackle your symptoms – from irregular periods to acne and anxiety. The book features over 30 plant-based recipes and a 21-day plan by Nutritionist Rohini Bajekal, real-life patient case studies, myth-busters, affirmations, illustrations and top tips for anyone looking to optimise their hormonal health and improve their well-being.
