Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects women of reproductive age worldwide in all ethnic groups. Women with PCOS produce an excess amount of the male hormone (androgen). High levels of androgen prevents the ovaries from releasing eggs which causes irregular menstrual cycles.
There is no exact cause of PCOS but factors such as excess insulin, low-grade inflammation, heredity and excess androgen may play a role. Excess insulin may increase androgen production, causing difficulty with ovulation. Research has shown that PCOS has a strong genetic association.
This condition is most often diagnosed by the presence of two of the three following criteria: hyperandrogenism (high levels of male hormones), ovulatory dysfunction (irregular periods) and polycystic ovaries. Each of these findings may have multiple causes other than PCOS, therefore a targeted history and physical examination are required to ensure accurate diagnosis and treatment.
Symptoms experienced due to nutrient deficiencies include insulin resistance, eating disorders, weight gain, cardiovascular disease, mood disorders, sleep apnoea, weakness and fatigue, anovulation, gestational diabetes, non-alcoholic fatty liver disease, preeclampsia (high blood pressure in pregnancy), thinning hair and hair loss, unwanted hair growth and acne.
It has been found that overweight women who lose just 5% of their body weight can lead to a significant improvement of PCOS symptoms. Losing weight is achieved by exercising regularly and eating a healthy diet including fruit and vegetables (5 portions daily), whole foods (wholewheat and whole grain bread/cereals and brown rice) and lean sources of protein such as fish and chicken. Studies have found that avoiding sugar, following a low carbohydrate and higher monounsaturated fat diet may assist with reducing insulin levels and promote weight loss, which helps to reduce symptoms of PCOS. Other healthy lifestyle changes include reducing alcohol intake and improving sleep patterns to ensure enough sleep.
Regular exercise is essential for PCOS patients. Guidelines for PCOS suggest at least 150 minutes of moderate physical activity per week. This includes exercises such as brisk walking, jogging, cycling and swimming which can help with increasing your body’s sensitivity to insulin. Strength training (at least two days a week), including body weight exercises such as push-ups, squats and tricep dips can also help to improve the function of insulin in the body.
Women with PCOS often have elevated insulin levels due to insulin resistance. Metformin makes the body more sensitive to insulin and decreases the amount of glucose the liver releases, therefore improving the symptom of insulin resistance associated with PCOS. Metformin treatment differs in the case of type 2 diabetes where it treats two conditions, namely when the body doesn't produce insulin or it resists insulin.
Most women who have PCOS can conceive but it may take a longer period of time to get pregnant. This happens as these women have irregular periods which means they do not ovulate every month. Also being overweight can contribute to infertility, especially for women suffering from PCOS. Therefore, adopting a healthy lifestyle can improve the chance of a pregnancy.
Inositol is a carbohydrate that influences the body’s insulin response. Studies have shown that supplementation may be effective in lowering both fasting blood glucose and HbA1c levels. The two forms of inositol, myo-inositol (MI) and D-chiro-inositol (DCI) were found to have insulin-like properties and are involved in increasing insulin sensitivity of different tissues to improve metabolic functions.They help as second messengers for insulin and their deficiency contributes to the various features of PCOS. Correction of MI and DCI deficiency together, by using Myo and D-chiro-inositol (MDI) therapy, may help alleviate symptoms experienced from PCOS.
Calcium is a mineral that is associated with healthy bones and teeth. Food sources of calcium include dairy products (milk,cheese and yogurt), fortified plant based milks (almond, soy and rice), canned sardines with bones, almonds, winter squash, edamame beans and leafy greens (spinach, kale, bok choy and turnip). It is difficult for the body to break down calcium in the gut and absorption is often low from food sources, therefore supplementation ensures optimal absorption of calcium to meet daily requirements. Oxalates and phytates found in some plant foods (green leafy vegetables, soy products, tea, beans, nuts) bind to calcium and also reduce the absorption of this mineral. Therefore, it is important to avoid eating high oxalate and phytate rich foods with calcium. Studies have shown that calcium supplementation with the use of metformin among women with PCOS improved menstrual regularity, follicular maturation and decreased serum insulin levels.
Chromium is an essential mineral that plays an important role in the regulation of insulin action and its effects on carbohydrate, protein and lipid metabolism. It assists with blood glucose balance and weight loss which helps to control symptoms experienced with PCOS.
Co-enzyme Q10 is an antioxidant produced by the body which cells use for growth and maintenance. Studies have found that supplementation with this nutrient reduces serum fasting plasma glucose and improves glucose metabolism.
Folic acid is a B vitamin used by the body to make new cells and is the synthetic form of folate used in supplements. It is important for brain function, mental and emotional health and also aids in the production of the body’s genetic material. Folic acid plays a significant role in tissue and cell growth during pregnancy, infancy and adolescence. Studies have shown that serum folate levels decrease during metformin therapy. Supplementation with folic acid resulted in improved glucose metabolism and improved fertility among women with PCOS. The methylated form of folic acid is called methyltetrahydrofolate and is the preferred form of this nutrient.
Magnesium is an essential mineral found in the body. It is present in many foods (wholegrains, dark, leafy vegetables, legumes and nuts) and also as a dietary supplement. Magnesium serves as a cofactor in more than 300 enzymatic reactions, which include those responsible for blood pressure, glycemic control and the degradation of lipids. A low intake of magnesium containing foods predisposes a higher prevalence of magnesium deficiency. Supplementation with magnesium glycinate (easily absorbable form) is beneficial for PCOS as it assists with reducing inflammation, insulin resistance and improves mood.
Vitamin B12 (cobalamin) plays an important role in cell metabolism, red blood cell formation, nerve function and the production of DNA. Food sources of vitamin B12 include meat, poultry, fish and dairy products. Plant foods do not contain this nutrient, therefore people following a vegan or vegetarian diet should consider taking a B12 supplement. Deficiency of B12 amongst women with PCOS can lead to insulin resistance and obesity. Studies have shown that serum vitamin B12 levels decrease during metformin therapy. Supplementation with this mineral can help to fight insulin resistance. The methylated form of vitamin B12 is called methylcobalamin and is the preferred form of this nutrient.
Vitamin D is a fat soluble vitamin and is found in animal food sources such as salmon, herring, sardines, cod liver oil, canned tuna and egg yolks. Plant based sources of vitamin D include mushrooms which can synthesize vitamin D when exposed to UV light. Research suggests that Vitamin D also plays an important role in bone health as it regulates calcium in the blood by absorption of calcium from the gut. Studies have found that supplementation with vitamin D among women suffering from PCOS significantly decreased fasting plasma glucose, improved insulin resistance and serum fasting insulin.
Vitamin K is also a fat soluble vitamin and plays a function in assisting with blood clotting in the body. There is evidence that this vitamin helps to keep bones healthy. Good sources of vitamin K include green leafy vegetables (broccoli and spinach), vegetable oils and cereal grains. Small amounts can also be found in meat and dairy products. Vitamin K supplementation in women with PCOS has been shown to reduce androgen levels within the body and improve insulin sensitivity.
Zinc is an essential mineral found throughout your body. It is involved in many aspects of cellular metabolism and plays a role in enhancing immune function, protein and DNA synthesis, wound healing and cell signaling and division. Food sources of zinc include oysters, chicken, red meat, legumes and nuts. Studies have shown that women with PCOS suffer from zinc deficiency possibly related to poor diet intake, poor absorption or increased excretion of this mineral. Supplementation with zinc has been found to have a positive effect on insulin resistance in women with PCOS.
The contraceptive pill or using an intermittent course of progesterone tablets may be prescribed to regulate periods.
Medicines such as particular combined oral contraceptive tablets, cyproterone acetate, spironolactone, flutamide and finasteride work by blocking the effects and suppressing the production of the male hormones.
Metformin is also effective in achieving weight loss in women with PCOS. The weight loss effect of metformin appears to be caused by the reduction in insulin resistance as well as by appetite suppression.
Clomiphene is usually the first treatment recommended for women with PCOS who want to get pregnant. If clomiphene is unsuccessful, another medicine called metformin can be recommended. Metformin is used to treat type 2 diabetes but also lowers insulin and blood sugar levels in women with PCOS. It also stimulates ovulation, encourages regular monthly periods and lowers the risk of miscarriage. As many women with PCOS have insulin resistance, metformin can be used in certain circumstances to encourage fertility and control symptoms of PCOS. The positive effects of metformin on menstrual function and infertility may be caused by decreased insulin resistance and lowered testosterone levels. In vitro fertilization (IVF) injections or treatment may be offered.