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Polycystic ovary syndrome affects millions of women in the UK and around the world – so what exactly is it?
September marks PCOS Awareness Month – an entire month dedicated to raising awareness of the often unrecognized (and untreated) female health condition polycystic ovary syndrome, also known as PCOS.
The hormonal imbalance affects millions of women worldwide and one in ten women in the UK – but despite being so common, there are still many misunderstandings about what it is and how to effectively treat it.
For example, many people assume that PCOS means you can’t have children – when in fact it does NHS reports that most women with PCOS can conceive with treatment.
While things are changing – the government has appointed Maria Caulfield as the first ever female health minister and announced a women’s health strategy after a UK survey revealed damning statistics about the gender health gap and how conditions like PCOS are undertreated – more needs to be done.
Although there is no cure, there are a number of ways to manage the condition so that it does not affect your life – just like with endometriosis symptoms, PMDD symptoms and PMS symptoms. Below, experts break down the main symptoms and treatment options, as well as dispel some more common myths about PCOS.
What is PCOS?
PCOS is a female health condition characterized by small, fluid-filled sacs called follicles (not cysts, as the name suggests) in your ovaries.
PCOS can cause irregular periods (or even no periods) as well as a number of other possible side effects.
“It’s the most common female hormonal disorder, with some studies suggesting that up to one in five of us are affected,” says gynecologist Dr. Anita Mitra, aka. Gynae Geek.
How do you know if you have PCOS?
Good question – because it’s not always easy to spot. Mitra explains that diagnosis requires two of the following three to be present:
- Irregular or absent periods
- Signs of excess male hormones, including excess body, facial hair, or acne
- High levels on a blood test
- Polycystic ovaries (as seen on an ultrasound).
“About 70% of women with PCOS also have some degree of insulin resistance, the hormone that regulates our blood sugar. This results in overproduction, which drives the ovaries to produce a lot of testosterone, the root of many of the symptoms.’
Currently, the exact cause of PCOS is unknown, and although it is believed that there may be a genetic link at play, this has yet to be proven through scientific research.
So, what are the symptoms of PCOS?
There are a number of different symptoms that are often seen in PCOS cases. “The most common symptoms are acne and/or problems with menstruation – either irregular (oligomenorrhoea) or total absence (amenorrhea), says Dr. Anita.
The NHS lists other common symptoms such as:
- Excessive hair growth on the face and body
- Weight gain
- Thinning hair
- Hair loss from the head
- Difficulty getting pregnant.
All of these symptoms are worth a trip to see your doctor and discuss, especially if you are concerned that you may have PCOS.
To diagnose the condition, your doctor will likely order some form of hormonal testing, but also to rule out other possible hormonal disorders. They may also arrange an ultrasound to examine your ovaries and a blood test to measure your hormone levels.
Please note, however: according to the NHS website, more than half of women with PCOS never experience symptoms.
What is the treatment for PCOS?
Know this: PCOS is treatable. Your doctor will be able to advise which ones are best for you, but below we’ve broken down some of the most common ones.
1. Birth control pills
Birth control pills can relieve PCOS symptoms—but you should know that the combined birth control pill doesn’t balance your hormones the way many people think, or so Anita shares.
“It will get you back to a regular cycle, but it’s likely that your periods will go back to being irregular when you stop, as this doesn’t correct the underlying hormonal problem. Taking this also tends to help with acne.’
A treatment option for women who want to get pregnant is medication that encourages ovulation; the first option is usually a drug called Clomefine and if this does not work Metformin may be recommended.
“This is an anti-diabetic drug that can be used to improve insulin sensitivity, which can be at the root of PCOS in many women,” Anita tells us. “It has been shown to improve menstrual cycle regularity and increase the chance of ovulation, which is important if you are trying to conceive.”
“But the most common side effects are diarrhea and stomach cramps.”
“An over-the-counter supplement, this has become very popular,” explains Anita. “It also seems to act as an insulin sensitizer, but doesn’t seem to have the same side effects as Metformin. There are a couple of different types of inositol and it’s myo-inositiol form that seems to be most effective.’
“But there haven’t been any really big studies or trials yet, so we’re not really sure of the optimal dose. As such, you probably won’t find many doctors recommending it yet – but I think it will come in the future .’
Want to read more about PCOS supplements? Read one woman’s journey here.
“Spironolactone is a prescription drug with anti-androgen activity,” explains the Harley Street dermatologist Dr. Justine Kluk. “Higher levels and more potent activity of androgens, such as testosterone, can be seen in women with PCOS and contribute to the typical features of thinning scalp hair, excess body hair and acne, known as hyperandrogenism.”
While the drug can be very effective in reducing these symptoms, it is not currently licensed for the treatment of acne in the absence of PCOS. But: “Interestingly, it’s now believed that 19 to 39% of women with adult acne actually have underlying PCOS,” adds Justine.
Can a PCOS diet help?
Next question: can PCOS be managed through diet and lifestyle? Short answer: absolutely.
“This is one of my favorite topics to talk about,” enthuses Anita. ‘I did a whole podcast on the subject with Dr Rupy Aujla.’
As this PCOS treatment article points out, one of the best ways to stop insulin resistance is to lead a healthy, balanced lifestyle. Not sure what that means? Try the following:
1. Get more sleep
The benefits of getting enough sleep are very well documented and if nothing else, we’ll all agree that we feel better after getting our full eight hours.
But it’s also important when it comes to PCOS: “This helps reduce stress hormone levels, which can also increase insulin resistance,” confirms Anita. If you’re struggling with your sleep at the moment, try one of these great sleep apps.
2. Eat a balanced diet
Reduce excess sugar intake, ignore the ketogenic diet and instead think of carbohydrates as quality over quantity, advises Anita.
“Go for whole grains, oats, etc that are high in fiber, which helps your body get rid of old estrogen that can otherwise be recirculated and exacerbate the hormonal imbalance.”
On each plate, aim for a balance of:
- Whole grain carbohydrates
- Fiber (fruit and vegetables)
3. Aim for colorful vegetables
It is also important to make sure you are getting enough vitamins and minerals. ‘Try to eat a really colorful diet to get a lot of fibre, but also for everyone phytonutrients (plant-based) that contain all the chemicals essential to the chemical processes involved in healthy hormone production and ovulation, she explains.
Healthy fats are also required for healthy hormone production. What is essentially a Mediterranean diet has been shown to be the healthiest for PCOS.
4. Move consciously
Did you know? Extreme exercise can worsen hormonal imbalances, says Anita. “Exercise is important for women to help build muscle mass, which can increase insulin sensitivity, so some form of strength training like weights or bodyweight-centered training,” she shares.
‘I don’t think there is a ‘best’ exercise for PCOS – it’s whatever you like and will stick with.’
Yoga (read our summary of MCs favorite yoga classes, here) have been shown to be helpful in some studies. “I think it can also be very useful as a way to build strength but also to relax the mind,” stresses Anita. Don’t miss our guides to different types of yoga and yoga postures, while you’re here.
PCOS and weight loss
“Many patients tell me they’ve been told to lose weight,” Anita tells us. “Weight loss will also help with PCOS, as excess adipose tissue can contribute to insulin resistance. But I never make this the focus of my advice because I think it can be quite negative.”
Actually, a 2013 study conducted at Georgia Regents University found that the association between PCOS and obesity may be exaggerated because the women who seek treatment for it become heavier.
“If you can adapt your lifestyle and focus on the positive things you can bring to your body through diet and exercise, I think you can get to the same point but with a healthier mindset.”
PCOS and pregnancy
It is true that the condition is one of the leading causes of infertility – but it is very treatable. ‘PCOS can affect fertility as it can stop ovulation; if you don’t ovulate, you don’t release an egg and therefore can’t get pregnant, Anita explains.
As described above, medications are available to encourage ovulation, and the NHS writes: “With treatment, most women with PCOS can become pregnant.”
However, Anita reminds us that lack of ovulation does not apply to everyone with PCOS and even if you have PCOS and are not ovulating currently, it does not mean that you will not in the future.
“If you have PCOS and don’t want to get pregnant, use birth control; I’ve seen lots of ‘surprise’ pregnancies in women with PCOS because they thought they couldn’t get pregnant.’
For more information and resources on living with PCOS, visit the NHS website or pcosaa.org.
If you have PCOS or think you might have it, know this – you’re not alone, and as this article highlights, there are whole groups of doctors, experts and women who have it themselves out there ready to help.
Please note that the purpose of this feature is to inform, not replace one-to-one medical consultations. Always discuss your health with a doctor to get advice tailored specifically to you.