Diagnosis & Treatment of PCOS is Important Even If You Don’t Want to Get Pregnant
PCOS has been called “one of the leading causes of female infertility.” The symptoms of PCOS can be both disrupting and uncomfortable; many women feel they don't belong to their bodies.
It's estimated that at least 10% of women have PCOS with up to 70% remaining undiagnosed. PCOS is a complex hormonal syndrome that can lead to a wide range of symptoms, including irregular periods, excess hair growth, acne, weight gain, and difficulty losing weight.
PCOS can affect your entire body, not just the ovaries! The condition is often associated with fertility issues but it also leads to other chronic health problems such as high blood pressure, insulin resistance, heart disease, and sleep disorders. That is why early detection and diagnosis of PCOS with a physical exam and blood tests is so important, even if you are not planning on getting pregnant!
Is PCOS linked to other health problems?
Researchers don't know if PCOS causes the most common problems or whether these problems are caused by PCOS or other conditions.
PCOS affects more than just fertility and is an important piece of women's health.
While there is no cure for PCOS, early detection and treatment can help to prevent or manage many of the associated conditions. If you think you may have PCOS, it is important to talk to your doctor so that you can get the care and support you need.
This won't be a ‘fun' read but it is important to understand the risk of developing comorbidities associated with PCOS. Here are some of the statistics:
While I am not a big fan of using the O-word, it was one of the few ways I could write about the relationship between body weight and Polycystic Ovary Syndrome (PCOS).
Between 38-88% of women with PCOS struggle with weight. Women with obesity have a 2.77 times higher chance of developing PCOS compared to those without obesity (1). Note that this does not mean that being in a larger body causes PCOS; it only means that women in larger bodies tend to have PCOS.
Insulin Resistance (IR)
IR and the subsequent higher insulin levels (hyperinsulinemia) are found in 44-70% of women with PCOS (2).
Type II Diabetes
About 25-30% of women with PCOS will have higher blood sugar levels (aka impaired glucose tolerance) by 30 years old (3).
15% of women with PCOS also have diabetes compared to 2% of women without PCOS (3).
Women with PCOS have an increased risk of developing metabolic syndrome, gestational diabetes, and type II diabetes regardless of their BMI but it is amplified by obesity (4).
Obstructive Sleep Apnea (OSA)
Women with PCOS have a 2 times higher risk of developing OSA compared to women without PCOS, regardless of their BMI (1).
It is not entirely known why women with PCOS are at a higher risk of OSA, even if they have a lower body weight but some theories include:
OSA is also linked to insulin resistance, regardless of BMI, which may be related to changes in stress hormones such as cortisol.
Higher levels of male hormones called androgens including testosterone may increase breathing instability during sleep.
Hormonal imbalance including lower progesterone levels may increase the risk of upper airway dilator resistance which means it is harder to breathe.
Increased weight contributes to a higher risk of OSA in both women with or without PCOS.
Depression & Anxiety
A meta-analysis of the available studies showed that women with PCOS have a greater than 3 times the chance of depressive symptoms and 5 times the chance of anxiety symptoms compared to women without PCOS (5).
The risk was higher for depressive symptoms in women with PCOS regardless of BMI but in the studies that adjusted for BMI, it was found that higher BMIs had a significantly elevated chance of depressive symptoms in women with PCOS (5).
Most of the studies have been conducted with adults but it is likely that adolescents with PCOS have an increased prevalence of anxiety & depressive symptoms as well (4).
If a woman does not ovulate for a longer period of time, it can increase the risk of developing endometrial cancer. There is newer research showing PCOS is associated with ovarian and breast cancer but it has not been clearly defined yet (3) and the absolute risk of developing endometrial cancer in women with PCOS is relatively low (4).
There is an increased risk of eating disorders and disordered eating in women with PCOS (4). The estimated prevalence of disordered eating among women with PCOS varies between 1.33 to 3 times higher than those without PCOS (6). It is recommended that all health care providers screen all women with PCOS for any disordered eating patterns, especially those with higher BMIs (6).
It is not clear exactly why women with PCOS have higher levels of disordered eating but the research suggests it may be related to higher BMI, weight concerns, great body dissatisfaction, depression & anxiety symptoms, and lower quality of life.
Based on my experiences working with women with PCOS, it's a very tough condition where women feel less in control around food or disconnected from their bodies and struggle with symptoms of high androgen levels such as irregular menstrual cycle and unwanted hair growth including body hair.
Irritable Bowel Syndrome
Studies have found that 12-29% of women with PCOS also have IBS (7).
1 study found that the subtype of IBS, predominately constipation IBS, was higher in women with PCOS compared to other subtypes of IBS (7).
The only differences in weight or bloodwork between women with PCOS & IBS vs. women with PCOS were of women with PCOS & IBS were a little older, had lower levels of TSH (thyroid-stimulating hormone), and higher frequency of metabolic syndrome (8). More research needs to be done in this area of research and women’s health.
My Nutrition Treatment Plan for Women With Polycystic Ovary Syndrome (PCOS)
In any assessment with women, I am screening for signs of high androgen levels and high insulin levels. If I ever have concerns, I make recommendations for women to discuss their symptoms with their primary care provider since I cannot make any diagnoses as a Registered Dietitian. My goal is to treat PCOS in a holistic manner, help my clients navigate the healthcare system, and receive treatment for the “whole” of the condition vs. only 1 side such as fertility. I also try to help women understand their condition in a more thorough way, dispel any diet myths, and develop some compassion for themselves. It is a tough condition that is difficult to manage, beating yourself up or working with a health care provider who shames you in addition to these struggles is the last thing you need.
As discussed above, I do check for signs of conditions that women with PCOS also tend to have such as:
Many of the foods I would recommend to women with PCOS to help balance their blood sugar include whole grains, beans, lentils, soy, vegetables, and fruit. However, these foods can also worsen gut health symptoms for those IBS & PCOS.
If you were unaware of your trigger foods and you added a bunch of the foods I mentioned above, this can be a barrier to sticking with a healthy diet! Helping my clients determine which foods they can eat without pain or discomfort is very important!
I also may refer clients to a physiotherapist for pelvic floor treatment as pelvic floor health impacts IBS symptoms as well!
Receiving treatment for OSA is extremely important for both physical and mental health but it is also important to address OSA if my client wants to lose weight.
Weight loss can resolve OSA for some people but not for everyone. I have had clients who were unable to lose weight until they had their sleep apnea treated and it could be due to many factors such as inflammation, worsening insulin resistance, impact on cravings/appetite, fatigue, mental health, and even lowering your metabolism itself.
Eating disorders and disordered eating:
While weight loss can improve PCOS symptoms, we also need to make sure that we are not worsening any potential negative relationship between food and mental health. Yes, weight loss can help improve the severity of PCOS symptoms but weight loss does not cure PCOS nor does it mean you are healthier.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age. While the most common PCOS symptoms are irregular menstrual periods, excess hair growth, body hair growth, and difficulty losing weight, many women don't realize they have it until they experience other concerns like infertility, ovarian cysts, higher blood glucose levels, or high blood pressure. If you think you may have PCOS, it's important to get diagnosed as early as possible so you can start treatment. A holistic approach to treating PCOS is often most successful, and I would be happy to chat with you about which treatment option might be best for you. Don’t suffer in silence – reach out today for a clarity call!
(1) Barber TM, McCarthy MI, Wass JA, et al. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf) 2006;65:137–45. https://doi.org/10.1111/cen.14421
(2) Cioana M, Deng J, Nadarajah A, et al. Prevalence of Polycystic Ovary Syndrome in Patients With Pediatric Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(2):e2147454. doi:10.1001/jamanetworkopen.2021.47454
(3) Daniilidis, A., & Dinas, K. (2009). Long term health consequences of polycystic ovarian syndrome: a review analysis. Hippokratia, 13(2), 90–92.
(4) Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., & International PCOS Network (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human reproduction (Oxford, England), 33(9), 1602–1618. https://doi.org/10.1093/humrep/dey256
(5) Laura G. Cooney, Iris Lee, Mary D. Sammel, Anuja Dokras, High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis, Human Reproduction, Volume 32, Issue 5, May 2017, Pages 1075–1091, https://doi.org/10.1093/humrep/dex044
(6) Pirotta, S., Barillaro, M., Brennan, L., Grassi, A., Jeanes, Y. M., Joham, A. E., ... & Moran, L. J. (2019). Disordered eating behaviours and eating disorders in women in Australia with and without Polycystic Ovary Syndrome: a cross-sectional study. Journal of clinical medicine, 8(10), 1682.
(7) Dursun, H., Uyanıkoglu, H., Uyanıkoglu, A., & Sabuncu, T. (2018). Incidences of irritable bowel syndrome and its subtypes in patients with polycystic ovary syndrome. JOURNAL OF CLINICAL AND ANALYTICAL MEDICINE, 9(4), 329-332.
(8) Kałużna, M., Kompf, P., Wachowiak-Ochmańska, K., Moczko, J., Królczyk, A., Janicki, A., Szapel, K., Grzymisławski, M., Ruchała, M., & Ziemnicka, K. (2022). Are patients with polycystic ovary syndrome more prone to irritable bowel syndrome?, Endocrine Connections, 11(4), e210309. Retrieved May 16, 2022, from https://ec.bioscientifica.com/view/journals/ec/11/4/EC-21-0309.xml