Polycystic ovary syndrome (PCOS) – What you need to know

Polycystic ovary syndrome (PCOS) – What you need to know

Polycystic ovary syndrome (PCOS) affects up to 15-20% of reproductive-aged women worldwide and is a leading cause of infertility. It is a complex condition that involves multiple factors, including genetic predisposition, hormonal imbalances, insulin resistance, and inflammation. It is associated with abnormal ovaries, dysfunctional ovulation and an excess of male hormones. Although it was first identified in 1935, we still do not know exactly what causes it, and there is still no guaranteed cure.


What are the symptoms associated with PCOS?

Common symptoms include:

  • Irregular periods: Women with PCOS may experience infrequent periods or have periods that are irregular in length or duration.
  • Excessive hair growth: Excessive hair growth, also known as hirsutism, is a common symptom of PCOS. It typically occurs on the face, chest, and back.
  • Acne: Women with PCOS may experience acne that is resistant to traditional treatments.
  • Weight gain: Many women with PCOS struggle with weight gain, especially around the abdomen.
  • Hair loss: Thinning hair or hair loss on the scalp is another common symptom of PCOS.
  • Darkening of the skin: Women with PCOS may experience darkening of the skin in areas such as the neck, groin, and underarms.
  • Polycystic ovaries: PCOS is named after the presence of multiple small cysts on the ovaries. These cysts can cause pain or discomfort.
  • Infertility: Hormonal imbalances associated with PCOS can make it difficult for women to conceive.


How is PCOS diagnosed?

Diagnosing polycystic ovary syndrome (PCOS) can be challenging because there is no single test to definitively diagnose the condition. Instead, we use a combination of medical history, physical examination, and laboratory tests to make a diagnosis.


To be diagnosed with PCOS, you must have at least two of the following three criteria:

  • Irregular periods or no periods.
  • Elevated levels of androgens (male hormones) as evidenced by blood tests or clinical symptoms such as hirsutism or acne.
  • Multiple cysts on the ovaries as seen on ultrasound


Why is it important to treat PCOS?

PCOS is as much a metabolic condition, as it is a hormonal one. Many women with PCOS have insulin resistance with high insulin levels. This is a key driver of conditions like obesity, diabetes and heart disease. If left unchecked, women with PCOS are at much higher risk of developing these debilitating chronic illnesses. This makes PCOS a serious condition not to be taken lightly!


A mainstream approach

Mainstream medicine tends to look downstream from the point of diagnosis, with little attention to the sequence of preceding events that may have contributed to the establishment of your PCOS. The focus is on symptomatic relief and risk reduction. In this context you may be offered hormonal treatment, e.g. the contraceptive pill to help regulate your periods and help with your acne. You may also be offered metformin to help reduce the risks associated with any underlying insulin resistance. As long as your condition is active, these interventions play an important role.


What is happening upstream?

There are a number of underlying drivers of your PCOS that make a significant contribution to your risk of developing PCOS. Addressing these drivers with lifestyle and nutritional interventions will go a long way towards addressing hormonal balance and may also significantly reduce your symptoms. So what are these drivers and how can you address them?


  • Inflammation. We know that chronic low-grade systemic inflammation is at the root of all lifestyle-related conditions, and PCOS is no exception. Inflammation contributes to insulin resistance by dialling down the insulin sensitivity of your liver, fat and muscle cells. Chronic low-grade inflammation also play a role in the excessive production of androgens, the sex hormones responsible for male characteristics. By addressing the causes of low-grade inflammation, we can significantly reduce the impact of one of the main PCOS contributors.

The following inflammatory contributors can be addressed through lifestyle and nutrition:

    • Chronic stress
    • Not enough exercise / too much sitting
    • Not sleeping enough
    • Inflammatory foods
    • A nutrient-poor diet
    • Gut health
    • Obesity 
    • High insulin levels (caused by inflammation and causes inflammation)


  • Insulin resistance (IR).  65% to 95% of women diagnosed with PCOS also present with insulin resistance. One of the drivers of insulin resistance is persistently high insulin levels, which can be detected up to 10 years before the onset of IR. Once your cells become insulin resistant, your insulin levels will increase even more as your body tries to keep your glucose levels within a normal range. High insulin levels cause all kinds of mischief. It exacerbates chronic inflammation, it blocks fat-burning and drives obesity, it increases the production of male hormones, and it is one of the key drivers of PCOS. In the ovaries, high insulin levels contribute to abnormal ovarian follicle development, resulting in multiple immature follicles presenting as ‘cysts’ on ultrasound. These dysfunctional follicles is the reason for decreased ovulation and irregular or no periods.

The following drivers of insulin resistance can be addressed through lifestyle and nutritional interventions:

    • Inflammation as already discussed
    • Chronic stress triggering abnormally high blood glucose levels, even if you’re not eating much
    • A diet high in processed carbs
    • Not enough exercise and therefor not enough lean muscle mass
    • Oxidative stress caused by exposure to environmental toxins


  • Hormonal imbalance. Most women with PCOS will also have problems with acne and abnormal and excessive hair growth. This is caused by an excess of testosterone, a hormone responsible for male characteristics. Insulin plays an important role in testosterone metabolism, with high insulin levels triggering increased testosterone production in fat cells, as well as disrupting the testosterone : oestrogen balance in the ovaries. High testosterone levels interfere with normal ovarian follicle development, resulting in suppressed ovulation and the formation of multiple immature follicles. This in turn results in low progesterone levels compared to oestrogen levels. By addressing inflammation and insulin sensitivity, as well as mitochondrial health (oxidative stress), your hormone levels may be stabilised and your symptoms reduced.


How can you take back control of your own hormonal and metabolic health?

A healthy lifestyle is the most important tool in your personal toolbox! It doesn’t have to be complicated or difficult. Remember, it is what you do most of the time that matters the most. So, it’s ok to veer off the ‘healthy living’ path now and then. Where do you start? Choose one aspect of your lifestyle you would like to improve and start there. It can be as simple as adding a leafy green salad to your meal, or going for a 30 minute walk. Every small step in the right direction will make a difference and will make it easier and easier to add more steps.




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