So, you’ve been diagnosed with Polycystic Ovarian Syndrome (PCOS), now what?

Your doctor might have told you to go lose some weight and a quick internet search will tell you to cut out gluten, dairy, soy, white bread, pasta and so forth. Your cousin swears by cutting out carbs.

What is PCOS?

PCOS is the most common endocrine (hormonal) disorder in women of reproductive age. This disorder affects about 1 in 10 women from period onset to menopause (1). PCOS is diagnosed using the Rotterdam criteria as well as your medical history, blood tests and ultrasound. To be diagnosed with PCOS, you need to meet 2 of 3 criteria:

  1. Oligo-anovulation (irregular or no periods)
  2. Clinical or biochemical hyperandrogenism (clinical signs include excess hair growth or acne)
  3. Polycystic ovaries on ultrasound

What causes PCOS?

Current evidence suggests the cause is unclear (2), however it’s likely to be a combination of genetics, lifestyle, and environment. If you have an immediate family member with the condition, you are more likely to have it. Your risk of PCOS also increases if you are of Asian, Aboriginal and Torres Strait Islander and African background.

What are the signs and symptoms of PCOS?

The signs and symptoms of PCOS are due to an imbalance of hormones: insulin and testosterone.

The symptoms include:

  • Acne
  • Darkening skin
  • Weight gain
  • Irregular or no periods
  • Male pattern hair loss
  • Hair growth on face, chin
  • Fertility problems
  • Depression and anxiety

Are there different types of PCOS?

There are four different presentations of PCOS (3), with the most common presentation being hyperandrogenism + ovulatory dysfunction + polycystic ovaries.

This may present as weight gain (or difficulty losing weight), high testosterone (acne, hair growth on face or chin, hair thinning) and menstrual issues.

Each presentation has its own long term and metabolic implications, and therefore dietary intervention.

Why would diet be important?

Current evidence suggests insulin resistance is a driver of PCOS, regardless of body size. Insulin resistance alters ovarian function, increasing testosterone which drives symptoms and causes central weight gain. Tailored dietary advice can help you understand how to manage insulin resistance through managing your carbohydrate intake (what types, how much and how often) within the context of a balanced diet.

Additionally, women with PCOS are at higher risk of developing metabolic conditions such as diabetes, high cholesterol, and high blood pressure. So, any changes we can make to your diet can not only help reduce symptoms but also help reduce the risk of developing these associated conditions.

What diet is best for PCOS?

There is no one recommended diet for PCOS. It is recommended to follow general population guidelines, and deal with any individual nutritional concerns as they arise. Improving your diet quality by increasing your intake of wholefoods through plenty of vegetables, fruit, wholegrains, legumes, and omega 3s can help manage the inflammatory aspect of this condition.

The goal is to find an eating pattern that is nutritionally balanced, not unduly restrictive, and sustainable in the long run.

What about gluten, soy and dairy?

There is insufficient evidence to support cutting out any of these foods for women with PCOS, unless you have coeliac disease, are lactose intolerant, have a dairy allergy or have other intolerances.

Gluten is a protein found in foods containing wheat, rye and barley. Often by cutting out foods containing gluten you are lowering your carbohydrate intake, which may be why some find symptom improvement. The downside however is you could be missing out on key nutrients such as fibre.

Soy is often touted as a food to avoid in PCOS because of the fear of the impact on hormones. Whilst it does contain phytoestrogens, which VERY weakly mimic the hormone oestrogen, research shows that it can lower testosterone and improve insulin resistance (5).

Dairy is often suggested to be avoided due to claims it increases inflammation, which is what you want to avoid in condition with chronic inflammation. The evidence, however, suggests dairy may have anti-inflammatory effects in people with metabolic disease (6). So if you enjoy dairy, carry on.

If you have PCOS and are looking for evidence-based, realistic and sustainable dietary advice to help you eat well and feel good long term – then we are the team for you.

References:

  • Jean Hailes [internet]. Melbourne, Victoria: Jean Hailes, 2019. Polycystic ovary syndrome (PCOS); 2019. [cited 2022 March 11. Available from: https://www.jeanhailes.org.au/resources/pcos-fact-sheet
  • Barthelmess EK, Naz RK. Polycystic ovary syndrome: current status and future perspective. Front Biosci (Elite Ed). 2015 February 26; 6: 104-119.
  • Azziz R. Polycystic Ovary Syndrome. Obstetrics & Gynecology. August 2018: Volume 132 (issue 2): p 321-336.
  • International PCOS Network. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Available at: https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline
  • Zilaee, M et al. The effects of soy isoflavones on total testosterone and follicle-stimulating hormone levels in women with polycystic ovary syndrome: a systematic review and meta-analysis. Eur J Contracept Reprod Health Care. 2020 Aug;25(4):305-310.
  • Bordoni, A et al. Dairy products and inflammation: A review of the clinical evidence. Crit Rev Food Sci Nutr. 2017 Aug 13;57(12):2497-2525.