How to Treat PCOS: Lifestyle Tips Beyond the Scale

Lifestyle advice is more than just weight loss – it’s a holistic approach to health. As polycystic ovary syndrome (PCOS) is a complex condition with multiple health risks, it’s important to consider all aspects of well-being. To treat PCOS, lifestyle tips are often more practical and helpful. The common prescription to lose weight doesn’t account for the whole picture of health.

Learn more about the different types of PCOS and why PCOS needs to be diagnosed & treated even if you are not concerned with fertility in our other blog posts.

Lifestyle Change is Hard for All Women

Not only do women with PCOS struggle to overcome barriers, but all women face numerous barriers to healthy lifestyle change.

The available research shows all premenopausal women with or without PCOS are at a higher risk of dropout from nutrition and lifestyle changes when compared to women of older age¹. Not to get on another soapbox of feminism and the unequal division of labour at home, but women of reproductive age having higher dropout rates could be due to family responsibilities, poor partner support, low mood, lack of childcare for self-care or exercise, fatigue and lack of time.

Despite knowing what may be healthy, many women still struggle to adopt the changes needed due to the roles and demands women face every day. Keep reading to understand the barriers women with PCOS may face and some strategies to overcome them.

Diets for PCOS and Weight Loss

I know, we were going to look at topics beyond the scale, but we can’t ignore PCOS lifestyle tip #1. While weight loss might not benefit all women with PCOS (we see you type D!), it can be a reasonable goal for others.

A healthy diet (paired with regular physical activity) is beneficial for women with PCOS by helping them achieve and/or maintain a healthy weight, regulate hormones, improve metabolic factors (such as insulin resistance) and lead to better body image. Even a 5-10% weight loss has been shown to improve health and PCOS symptoms.

Sticking to a diet is tough for anyone, but especially for women with PCOS. PCOS puts women at a metabolic disadvantage, requiring careful planning of macronutrients and foods to maximize satiety and prevent overeating.

Impact of PCOS on Hunger, Cravings and Appetite

Women with PCOS face unique challenges with hunger and satiety, with some research showing changes in hunger and satiety hormones, and reports of hunger sooner after eating compared to women without PCOS¹.

Meaning some women with PCOS have difficulty feeling satisfied and full after meals. However, the research studies that have initially shown these differences in women with PCOS have not been repeated since which means that this research may not be 100% applicable to women with PCOS.

Check out our blog on how to stop cravings sweets after supper!

PCOS Hormone Levels

The majority of women with PCOS have insulin resistance and subsequently, high levels of insulin (hyperinsulinemia) which may predispose women with PCOS to gain weight¹. High levels of androgens may also predispose women with PCOS to store fat in their abdomens which can exacerbate insulin resistance¹.

PCOS and Metabolism

There is conflicting research showing women with PCOS may have altered metabolisms including lower metabolisms and metabolic inflexibility, meaning that the metabolism has a reduced ability to switch between burning fat for energy in fasting conditions from carbohydrates¹. The metabolic inflexibility in women with PCOS may be related to insulin resistance and hyperandrogenism in women with PCOS¹.

No one diet has proved superior to another for the purpose of weight loss, so it’s important to choose a diet that is both healthy and sustainable.

A sustainable diet is any diet that you can follow and enjoy for the rest of your life.

PCOS and Disordered Eating

Disordered eating among women with PCOS is estimated to be between 1.33 to 3 times higher than women without PCOS². An unhealthy relationship with food can make it difficult for women with PCOS to stay consistent with nutrition and lifestyle changes. Plus when you factor in that many women with PCOS struggle with hunger and fullness cues, fatigue, cravings, and feel disconnected from their bodies – staying consistent with diets for PCOS or exercise can seem near impossible.

While weight loss can help treat 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! Read more about improving PCOS without weight loss here or how to boost confidence without weight loss here.

PCOS Nutrition: Antioxidants

Now, moving away from the scale! For women with PCOS, lifestyle tips are more than just the amount of food, but the quality of the food.

Antioxidants are powerful compounds in food that act to prevent oxidation leading to cell damage and potentially the development of diseases. A study compared antioxidants in the diets of Iranian women with PCOS and metabolic syndrome to women with only PCOS³. Women with both PCOS and metabolic syndrome consume fewer antioxidants in their diets including selenium, zinc, chromium, carotenoids, and vitamin E.

This is problematic as antioxidants prevent cell damage and disease development, and some may help improve features of metabolic syndrome such as insulin resistance, metabolism of sugars and fats and inflammation.

The study was well-designed, matching the two groups for their BMI, physical activity, income, and education level. This brings up the question – why are women with both PCOS and metabolic syndrome consuming a diet lower in antioxidants than women with only PCOS?

Metabolic syndrome brings a slew of health concerns to women, on top of their PCOS symptoms. Juggling so many health concerns like high fasting blood sugar, high blood pressure, high cholesterol, high triglycerides, excess weight and/or hormonal imbalances can make it confusing where to start on your health journey. Dietitians can help you prioritize and focus your strategy to improve your health, taking away the guesswork.

Zinc and PCOS

Zinc influences many systems in the body. Several studies have shown that women with PCOS have low serum levels of zinc. Zinc deficiency could be involved in the development of depression, fatigue, insulin resistance, poor immune system functioning, and poor growth of skin, hair, and nails – many of which are related to PCOS⁴.

Zinc plays a critical role in regulating a woman’s hormones while keeping inflammation, fats, and sugars in check. In deficiency, these become unbalanced, causing prerequisites to PCOS and other health conditions. It could be that a dietary deficiency of some of these important nutrients eventually leads to PCOS and metabolic syndrome since deficiency disrupts normal metabolic and endocrine functions.

If you want to read more about zinc and PCOS, check out our previous blog article here!

Best Foods for PCOS: Antioxidants

While these nutrients show promise for women with PCOS, hold off on running to the supplement store. A food-first approach is always more beneficial than mega-dosing with supplements!

Nutrients don’t work in isolation so there is value in getting them through food that has multiple other nutrients and compounds interrelated and interacting with each other.

Here are the best food sources for each antioxidant:

• Selenium: Brazil nuts, seafood, and organ meats.
• Zinc: meat, fish, seafood, and fortified cereals.
• Chromium: present in small to medium amounts in many foods including meats, grain products, fruits, vegetables, nuts, spices, brewer’s yeast, beer, and wine – but amounts vary due to processing techniques.
• Carotenoids: found in plant foods and converts to vitamin A in the body and are found in foods like sweet potato, carrots, pumpkin, spinach, peppers, mangoes, cantaloupe, etc.
• Vitamin E: nuts, seeds, whole grains, fortified cereals, leafy greens, and vegetable oils.

As these are just the highest sources, know that you will get smaller amounts of these nutrients from other foods too.

PCOS and Exercise

Women with PCOS have unique health profiles and challenges, thus exercise is an important PCOS lifestyle tip.

The minimum amount of exercise for adults is 150 minutes per week at moderate intensity or 75 minutes of vigorous-intensity per week. For weight loss and weight maintenance efforts, this increases to 250 minutes per week of moderate-intensity or 150 minutes per week of vigorous-intensity.

While this may seem like a lot, consider the daily breakdown:

• ~20-36 minutes of moderate intensity daily or 4 hours of moderate intensity activity per week
• ~11-20 minutes of vigorous intensity daily or 38 minutes of vigorous intensity activity twice per week

If you refer to count steps (yay for goal tracking!), aim for at least 10,000 steps per day combined with normal-life activities and exercise. For example, exercise from work, doing household chores, and structured physical activity. Try to get 30 minutes of structured physical activity per day, or about 3000 steps.

As with diet, it’s important to choose a physical activity routine that is enjoyable as it will be more likely to be sustained and lead to lasting results. If you really hate running then please, don’t run – there are many other forms of exercise to choose from.

Sleep

Hitting the hay, counting sheep, hitting snooze… sleep is often a forgotten and underrated aspect of health. If you’re looking for PCOS lifestyle tips beyond diet, sleep should be one of the first areas to check.

Obstructive sleep apnea (OSA) is more common in women with PCOS, leading to fatigue during the day if left undiagnosed and untreated. In fact, upwards of 35% of women with PCOS have OSA compared to 9-38% of the general population¹.

Let’s see why sleep is so important.

Let’s say a woman with PCOS wants to lose weight but is struggling with OSA. She may find weight loss difficult since less sleep is a risk factor for gaining extra weight⁵. In addition, lack of sleep can cause chronically elevated cortisol levels (our stress hormone) potentially preventing weight loss. Despite this association, the research in this area has not been clear.

Regardless, feeling fatigued during the day will make it difficult for any lifestyle change. Sleep hygiene must be addressed as it forms one of the core pillars of health. Without good sleep, other efforts to improve health could be in vain.

Body Image, Sexual Health and Mental Health

You may be surprised that this is one of our PCOS lifestyle tips. Given that the most common signs of hyperandrogenism PCOS are facial hair, acne, and hair loss, it’s actually another important pillar, it’s not hard to see why this is a significant challenge women with PCOS face.

Reports of depression in women with PCOS are 44% compared to 17% of healthy women. Also, this finding was true despite BMI, meaning the depressive symptoms may not be weight-related⁶.

Psychosexual dysfunction (low sex drive) is also common among women with PCOS. It has been reported in 13.3-62.5% of women with PCOS. While this may seem minor to some, a healthy sex drive is an important indicator of health. When struggling with poor body image, depression, anxiety, or psychosexual dysfunction, it becomes challenging to engage in health promotion activities like physical exercise or forming social and/or romantic relationships.

Clearly, this is another core pillar of health and should be considered with diet, exercise and weight loss efforts.

Change Your Habits: Behavioural Strategies

Knowing all of these great PCOS lifestyle tips, how does one implement them? Various behavioural strategies could help⁷. These include:

• Goal setting
• Self-monitoring
• Stimulus control
• Problem-solving
• Assertiveness training
• Slower eating
• Reinforcing changes
• Relapse prevention

Making small goals to propel you towards your larger goals is an important behavioural strategy. The Goal Setting Theory states that specific, difficult, yet achievable goals lead to better results than less descriptive goals⁷.

Goal setting is something that may be done with the help of an app. Although, a study found that Canadians (in Alberta and Ontario) set poor goals on their own and rarely tracked their progress using an app⁸.

While behavioural strategies are possible for anyone to do independently, consider the success rate of those who work with a health professional such as a Registered Dietitian. Greater weight loss success has been seen in female patients working with Dietitians to reduce calories, increase physical activity and employ self-management strategies compared to those trying to lose weight without a Dietitian_⁷.

Dietitians work with you to develop a strategy that suits your individual situation, choosing the strategies to best suit your needs. PCOS isn’t simple and neither are you. You deserve practical, tailored advice to reach your health goals.

Have you ever been frustrated with planning snacks for PCOS?

We know it can be difficult to figure out what is best for your unique needs. That’s why we created Powerful PCOS Snacks, a resource by dietitians that has the latest research and years of experience built into it. Here’s where you’ll find practical solutions to snack problems so that you can start thriving with PCOS today.

You’ll learn how to craft delicious snacks and meals around your lifestyle without feeling overwhelmed or having to guess at portion sizes, striving for perfection, and sacrificing pleasure in the process. With this guide, there won’t be any more guesswork – just delicious and empowering nutrition knowledge tailored specifically to tackle those challenges of PCOS!

Download our free resource now and start feeling confident about what snacks are right for YOU!

References

1. Ee, C., Pirotta, S., Mousa, A. et al. Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success. BMC Endocr Disord 21, 234 (2021). https://doi.org/10.1186/s12902-021-00890-8
2. 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.
3. Zaeemzadeh, N., Jahanian Sadatmahalleh, S., Ziaei, S. et al. Comparison of dietary micronutrient intake in PCOS patients with and without metabolic syndrome. J Ovarian Res 14, 10 (2021). https://doi.org/10.1186/s13048-020-00746-0
4. Nasiadek M, Stragierowicz J, Klimczak M, Kilanowicz A. The Role of Zinc in Selected Female Reproductive System Disorders. Nutrients. 2020; 12(8):2464. https://doi.org/10.3390/nu12082464
5. Hirotsu C, Tufik S, Andersen ML. Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep Sci. 2015 Nov;8(3):143-52. doi: 10.1016/j.slsci.2015.09.002. Epub 2015 Sep 28. PMID: 26779321; PMCID: PMC4688585.
6. Dokras, A., et al., Increased risk for abnormal depression scores in women with polycystic ovary syndrome: a systematic review and meta-analysis. Obstet Gynecol, 2011. 117(1): p. 145-52.
7. Jacobs M, Harris J, Craven K, Sastre L, Sharing the ‘weight’ of obesity management in primary care: integration of registered dietitian nutritionists to provide intensive behavioural therapy for obesity for Medicare patients, Family Practice, Volume 38, Issue 1, February 2021, Pages 18–24, https://doi.org/10.1093/fampra/cmaa006
8. Lieffers JR, Haresign H, Mehling C, Hanning RM. A retrospective analysis of real-world use of the eaTracker® My Goals website by adults from Ontario and Alberta, Canada. BMC Public Health. 2016 Sep 15;16:978. doi: 10.1186/s12889-016-3640-6. PMID: 27628048; PMCID: PMC5024431.
9. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Copyright Monash University, Melbourne Australia 2018.
10. https://www.nccih.nih.gov/health/antioxidants-in-depth