Polycystic ovarian syndrome (PCOS) is a complex hormonal condition that is characterised by having many cysts on the ovaries. Specifically, someone with PCOS will have many partially formed follicles on their ovaries, which each contain an egg. Ultimately, these partially formed follicles rarely grow to maturity or produce eggs that can be fertilised.
High levels of insulin, as well as insulin resistance, are common in women with PCOS. Insulin resistance means insulin is not doing its job effectively, therefore more and more insulin is required to get the same result; with the result being stable blood glucose levels. And unfortunately high levels of insulin can lead to weight gain, as well as increase the production of male hormones known as androgens. In turn, high levels of Androgens in women impact ovulation.
Prevalence & Cause
PCOS affects around 1 in 10 women, with almost 70% of cases undiagnosed.
Surprisingly, the cause of PCOS is not fully understood, although family history, genetics, hormones and lifestyle factors play a role in its development.
To be diagnosed with PCOS, women need to have 2 out of the following:
Irregular or absent periods
Excess facial or body hair growth, acne, scalp hair loss or high levels of androgens (e.g. testosterone).
Polycystic ovaries visible on an ultrasound
Symptoms of PCOS can include:
Irregular menstrual cycles
Amenorrhoea (no periods)
Excessive facial or body hair growth
Scalp hair loss
Reduced fertility – related to less frequent or absent ovulation
Treatment of PCOS
A. Lifestyle modifications B. Weight loss if overweight C. Medical treatment – with hormones or medications
Research shows that losing just 5-10% of weight, if you’re BMI is greater than 25 (overweight or obese), can deliver significant benefits, including:
Reduced symptoms such as facial/body hair growth, scalp hair loss and acne
Restoration of normal hormone production – This can help to regulate periods and may improve fertility.
Dietary & lifestyle interventions to improve PCOS symptoms
Calorie deficit - for those who are overweight, a hypocaloric (plus nutrient-dense) dietary pattern with an energy deficit of about 30% (~500-750 calorie deficit per day) is recommended. On average, this means aiming for about 1200 to 1500 calories per day. This will likely improve menstrual cycle regularity, response to ovulation, insulin levels, blood glucose levels and reduce excess androgens.
Total carbohydrates - it has been found that a low carbohydrate dietary pattern, meaning a diet that contains less than 45% of energy/calories coming from carbohydrates, can be beneficial in managing PCOS. Carbohydrates are found in breads, cereals, fruit, starchy vegetables, legumes, dairy and processed foods.
Types of carbohydrates - low glycemic index (G.I) carbohydrates are your best carbohydrate choices if you have PCOS. These digest and absorb more slowly into your blood stream, resulting in a slower and lower insulin response. They are also more favourable for your gut health. Some low G.I carbs include rolled oats, sweet potato, wholegrain pasta and legumes.
Types of fats - A high monounsaturated fat diet (~18% of total fat) is also beneficial. These types of fats offer anti-inflammatory benefits and are found in nuts, seeds, avocado and olive oil. Respectively, it is also recommended that saturated fats are limited to less than 8% of total calories per day. You can find more info on saturated fats here.
Protein - A high intake of protein is recommended for those with PCOS. Considering calorie requirements, it is suggested to consume about 27% of your calories from protein. Some protein rich foods include legumes, tofu and oily fish.
The DASH diet - The DASH (Dietary Approaches to Stop Hypertension) diet is one such diet promoted for those with PCOS. It is characterised by a high intake of vegetables, wholegrains, fruits, nuts, seeds, vegetable oils, and some lean meats.
Exercise - A minimum of 30 to 60 minutes of moderate to intense physical activity is recommended per day. This is a general recommendation, however it will significantly benefit women with PCOS. Ideally this would involve a combination of aerobic (e.g. jogging, cycling, swimming, walking), resistance (e.g. weight training, pilates, circuit) and flexibility (e.g. yoga, stretching) exercises.
Vitamin D - There is some limited evidence that Vitamin D supplementation may be beneficial for follicular development in women with PCOS, and when combined with metformin (a medication) it may help to improve regular menstrual cycles. Further to this, researchers have found that a high dose of vitamin D combined with a daily probiotic (high dose) may reduce total testosterone and excess hair growth, plus improve mental health in women with PCOS.
Omega-3 Fatty acids - There is some limited evidence that suggests beneficial effects of omega-3 fatty acids on menstrual cycle regularity and some cardiovascular risk factors in women with PCOS.
Soy isoflavones - Some research has found that soy isoflavone supplementation at a dose of 36-53mg per day for two to three months may reduce total testosterone. Despite this finding, evidence is lacking in this area and therefore further studies are required to determine recommendations. You can find more information on soy here.
Prebiotics - Research has shown that prebiotics may decrease CRP (an inflammatory marker) and excess hair growth (hirsutism score) among women with PCOS.
More on prebiotics here.
Probiotics - Certain probiotics may improve hormonal (free androgen index and sex hormone binding globulin) and inflammatory (total antioxidant capacity, total glutathione) indices in women with PCOS. More on probiotics here.
Inositol - Supplementation of inositol appears to be effective in improving fertility in women with PCOS. High doses of inositol appear effective in improving testosterone levels and insulin sensitivity. Further to this, Inositol has been shown to significantly improve acne in women with PCOS. Bam! More info here.
Personalised nutrition - An individualised healthy lifestyle plan, including personalised nutrition, exercise, sleep and stress management recommendations is ideal in the management of PCOS. This means tailoring a plan to an individual’s social and cultural constructs. If a plan is tailored to your individual needs, you are more likely to adhere and follow it. And a plan that can be followed is very likely the most important criteria when developing a healthy lifestyle plan. If you're interested in more tailored advise, book in with an Accredited Practicing Dietitian that works in this area.
Note: Before taking any supplements, it is recommended that you consult with your Dietitian or Doctor.
The Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41-7. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/14711538
Dewailly D, Lujan ME, Carmina E, Cedars MI, Laven J, Norman RJ, et al. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2014 May-Jun Feb;20(3):334-52. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/24345633
Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet. 2007;370 (9588):685-97. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/17720020
Zawadski JK, Dunaif A. Diagnostic Criteria for Polycystic Ovary Syndrome. In: Givens JHF, Merriman G, editors. The polycystic ovary syndrome. Cambridge (MA): Blackwell Scientific; 1992 p 377-84.
Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009 Feb;91(2):456-88. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/18950759
Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016 Dec;31(12):2841-55. doi: 10.1093/humrep/dew218. Epub 2016 Sep 22. PMID: 27664216. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/27664216/
Naz MSG, Tehrani FR, Majd HA, Ahmadi F, Ozgoli G, Fakari FR, Ghasemi V. The prevalence of polycystic ovary syndrome in adolescents: a systematic review and meta-analysis. Int J Reprod Biomed. 2019 Sep 3;17(8):533-42. doi: 10.18502/ijrm.v17i8.4818. PMID: 31583370; PMCID: PMC6745085. Abstract available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745085/
Livadas S, Kollias A, Panidis D, Diamanti-Kandarakis E. Diverse impacts of aging on insulin resistance in lean and obese women with polycystic ovary syndrome: evidence from 1345 women with the syndrome. Eur J Endocrinol. 2014 Sep;171(3):301-9. doi: 10.1530/EJE-13-1007. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/25053727
Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al.; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment