What is PCOS?
Polycystic ovary syndrome, or also PCOS, is one of the most common disorders of the female reproductive system. Actual numbers are very difficult to ascertain, but in the UK it is reported that 1 in 10 women suffer from polycystic ovary syndrome
and the worldwide estimate of the prevalence of this disorder is between 5% and 20% with up to half of these women not necessarily having any symptoms. The exact cause of this disorder is not yet known, but it is thought to be hereditary. It begins to manifest itself in adolescence but can also develop in later years, usually as a result of weight gain.
The name of the disease is based on one factor of the disease, which is the multiplication of follicles (sacs containing immature eggs) on the ovaries, which may or may not subsequently form cysts. During PCOS, the follicles are then unable to release a mature egg, meaning that ovulation does not occur, making conception impossible. It is therefore best to consult the possible reasons for infertility with your gynaecologist.
To be diagnosed with PCOS, you must exhibit at least 2 of the 3 factors of the disease, which are:
- Cystic ovaries
- Prolonged, irregular or non-existent menstruation
- Hyperandrogenism (elevated levels of male hormones, especially testosterone and androstenedione)
Symptoms of PCOS
Each of the three factors of polycystic ovary syndrome is responsible for different symptoms. These symptoms are more pronounced when you are overweight or obese and often exercise and weight loss will help to improve them. It is important to note that the affected woman often does not suffer from all the symptoms listed and also that they may occur to varying degrees. On the other hand, not all women with cystic ovaries have PCOS.
- Cystic ovaries
As described above, it is a condition in which an excessive number of follicles (up to 24 are reported) form on one or both ovaries but do not mature. This condition prevents ovulation and thus complicates conception. The only way to find out if you have cystic ovaries is then a pelvic ultrasound (ultrasound). This symptom occurs in 15% of women diagnosed with PCOS.
- Irregular menstruation
A symptom that a woman may notice on her own are various menstrual cycle anomalies. The most noticeable is a cycle length that lasts longer than 35 days, meaning only 9 menstrual periods per year. Sometimes there may be a complete omission of periods, but in some women it may be manifested only by heavier periods. It is common to use hormonal contraceptives to relieve these symptoms. However, the International Health Organization (WHO) states that if you don’t plan to get pregnant, it is essential to menstruate at least once every three months to avoid further health complications, including uterine lining cancer.
Excessive male hormones, or hyperandrogenism, is a symptom that can be detected by a blood test in a laboratory. It is mainly an elevated level of testosterone and androstenedione. On its own, this symptom occurs in 5% of women of reproductive age, 70% of which are caused by polycystic ovary syndrome. The most common manifestations are acne, inflamed skin, hair loss and the appearance of thicker hair, for example on the face (hirsutism).
Other manifestations of the disease:
This manifestation is related to insulin resistance. It mainly involves the accumulation of fat in the abdominal plane, more visceral fat, increased blood pressure, elevated blood sugar and high cholesterol. MS increases the risk of type 2 diabetes and cardiovascular disease.
Although the true origin of the disease is still unknown, one possible reason is hormonal imbalance. In women affected by this disease, 4 hormones are mainly in imbalance:
- Testosterone – women normally produce small amounts of this hormone in the adrenal glands and ovaries, excess causes: acne, hair loss, more pronounced pubic hair growth, low voice, muscle growth, or enlarged clitoris. High levels of testosterone affect the ovaries, specifically inhibiting egg maturation.
- Luteinizing Hormone (LH) – LH normally stimulates ovulation and testosterone production in the ovaries its role is to release the mature egg from the follicle, since this does not occur in PCOS, its concentration increases. High levels of this hormone have an abnormal effect on the ovaries, or the formation of more follicles.
- Insulin – in PCOS there is an increased resistance of cells to insulin, they do not absorb this hormone from the bloodstream, which leads to an increase in the level of insulin in the blood. In addition, the increased concentration of insulin leads to higher secretion of male hormones.
- Sex hormone-binding globulin (SHBG) – levels of this hormone are lowered precisely by the high concentration of insulin in the blood. Normally, SHBG is involved in suppressing androgens by lowering testosterone levels.
- Prolactin – Elevated levels of this protein have been found in only a few women suffering from PCOS. In a healthy woman, it is responsible for the overgrowth of the mammary glands and milk production. Elevated concentrations of this hormone are associated with just hyperandrogenism, anovulation, long or irregular menstrual cycles, unexpected lactation and loss of libido.
The most common myths about PCOS
- You cannot get pregnant with PCOS – The manifestation of PCOS is not necessarily cystic ovaries (see above), nor does this manifestation necessarily mean reduced fertility. There are many other reasons for infertility and it is important to consult your doctor.
- You have PCOS because you are overweight – Being overweight only worsens the symptoms of the disease. Therefore, it is not the cause of it. The exact origin of PCOS is unknown, but it shows a link to genetics. Recent studies show that polycystic ovaries themselves are only a manifestation of the disease, and not its cause, which is probably a hormonal imbalance.
- If you suffer from PCOS, it is impossible to lose weight – Weight loss with PCOS is more difficult as there is increased insulin resistance, which also causes increased cravings. Many women suffering from the condition also struggle with overweight and obesity, but this doesn’t mean it’s impossible to lose weight, just that it’s harder for most women.
- Losing weight will get rid of PCOS – Although the American Association of Clinical Endocrinology recommends a weight loss of 5-15% to reduce the severity of PCOS symptoms, losing weight is not a cure for the disease. There is no cure for PCOS and treatment focuses on managing symptoms, which is achieved by regulating hormone levels (e.g. insulin), and this is what a healthy lifestyle and weight loss contribute to.
How do cystic ovaries affect weight loss?
To better understand how PCOS specifically affects weight loss, it’s a good idea to explain the total daily energy expenditure (TDEE) equation. This equation consists of the following units:
- BMR = basal metabolic rate, accounts for about 70% of total energy expenditure. This is the energy we burn just by living and breathing without any movement.
- NEAT= thermogenesis based on non-exercise activity, i.e. all other movement not constituting training. This is roughly 15% of total energy expenditure.
- TEF= thermic effect of food. represents how much energy is burned by the actual digestion of the food ingested. It accounts for about 10% of total energy expenditure.
- EAT= exercise-induced thermogenesis. It accounts for about 5% of total energy expenditure and represents calories burned by exercise.
The equation looks like this: TDEE=BMR (70%)+NEAT (15%)+TEF (10%)+EAT (5%)
However, PCOS has an unfortunate effect on the amount of energy burned through basal metabolic rate (BMR). For a healthy woman, BMR represents 70% of all energy expended. For a woman suffering from PCOS, this proportion is 14-40% less. BMR then accounts for 42-60% of total energy expenditure.
This reduction in resting energy expenditure probably stems from the insulin resistance that affects women with PCOS and thus takes a toll on their bodies. This condition leads to an impaired ability of cells to process glucose from the bloodstream and thus contributes to increased body weight. Other risk factors include a sedentary lifestyle and being overweight or obese. Insulin levels can be balanced with a healthy lifestyle, a healthy diet and physical activity.
Specifically, it is recommended to avoid foods with high carbohydrate content and high glycemic index (GI).
3 tips to deal with obesity in PCOS
- Low glycemic index diet
This is a diet focused on eating foods with a low glycemic index. It means limiting or completely eliminating sugar-rich and high-calorie foods from your diet. The glycaemic index is actually a unit that indicates the ability of foods to raise blood sugar levels, the higher it is, the greater the rise in levels. Conversely, foods with a low glycemic index can lower blood sugar, thus having a positive effect on weight loss and type 2 diabetes
. Furthermore, a low-glycemic diet is associated with weight and cholesterol reduction.
Low glycemic index foods include most healthy, whole grain foods, fruits and vegetables, meats, eggs, dairy products and their vegan variants. Foods to avoid are: white bread, some varieties of potatoes, pasta and noodles, white long grain rice, sweetened plant milks, chips, breakfast cereals and various sweets (cakes, sweets, etc.)
In addition, a low glycaemic diet reduces inflammation in the body, thus counteracting some of the side effects of PCOS such as acne
. Chronic inflammation, often affecting women with PCOS, associated with obesity. It is foods rich in refined sugars and processed foods that are thought to be the source of inflammation in the body.
- Regular physical activity and sufficient sleep
Although it is harder for women suffering from this symptom to perform well physically, the effect of regular exercise is not negligible. Regular physical activity in women with PCOS leads to a reduction in insulin levels in the blood and thus contributes to weight loss, especially in the trunk area
. In addition, decreasing testosterone levels have been found with strength training. In order to be effective exercise needs to be primarily consistent, i.e. exercise for at least 45 minutes at least 3 times a week.
One of the side symptoms of PCOS can be interrupted sleep, sleep apnea or insomnia. Lack of sleep increases the activity of hunger-inducing hormones such as ghrelin and cortisol, which can lead to overeating. Poor sleep is associated with obesity, increased BMI and a higher risk of fat storage in the abdomen. Conversely, weight loss is associated with improved sleep quality.
- Beware of malnutrition
Prolonged calorie restriction can lead to a slower metabolism, and eating too few calories negatively affects levels of hormones that control appetite. This reaction of the body then leads to further weight gain. Rather than focusing on drastic calorie restriction, it is therefore a good idea to cut out unhealthy foods full of refined sugar and unhealthy fats from your diet.