Polycystic Ovary Syndrome

If you have been diagnosed with Polycystic Ovary Syndrome (PCOS) and been told that you have Insulin Resistance, you are very welcome to make an appointment with ACE Diets Specialist Dietitians. We will help you to design your individual diet and lifestyle plan aimed to avoid blood glucose swings and reduce your Insulin Resistance. If you are overweight or obese, we will work together to help you to lose weight and keep it off.

POLYCYSTIC OVARY SYNDROME OVERVIEW

Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders. It is estimated that PCOS affects approximately 5%-10% of women of reproductive age (12–45 years old) and is thought to be one of the leading causes of female sub-fertility.

The key symptoms are obesity, irregular or absence of menstruation, acne, excess hair growth on the face and body and excessive amounts of male hormones. The type and severity of symptoms vary greatly among women. The exact cause is not totally clear, but most experts agree that the major factor is insulin resistance.

INSULIN RESISTANCE

Insulin is a hormone made in pancreas (a gland behind your stomach).

The role of insulin:

To control blood sugar levels. When blood sugar levels rise, which is usually due to the carbohydrate intake, insulin is released to take up the blood sugar and move it into the muscle, fat and liver cells to be used for energy.
To act on the ovaries to cause them to produce testosterone (male hormone).

Many women with PCOS have insulin resistance. This means that pancreas has to produce more insulin then it would normally be necessary to keep the blood sugars at the normal range. It is because cells in the body have become more resistant to insulin.

High levels of insulin or hyperinsulinaemia can cause following problems in the body:

Increased testosterone level (male hormone), which interferes with the normal development of follicles in the ovaries. As a result, many follicles tend to develop but often do not develop fully. This causes period problems and reduced fertility.
Excess hair growth on the body and thinning of the scalp hair due to increased testosterone level.
Weight gain and difficulty losing weight.
Increased risk of heart disease due to increasing blood cholesterol level and blood clotting factors.
Increase risk of diabetes by up to 40% by age 40.

NUTRITIONAL ADVICE

Due to discovery of insulin resistance in PCOS, the treatment is no longer just aimed at treating the individual symptoms such as erratic periods, hirsutism, acne. Instead it is now aimed at treating the cause – insulin resistance. If insulin resistance is present (it is not always the case), the best treatment is diet, exercise and weight loss if needed. Most doctors prefer to start with diet and exercise and turn to medications if appropriate.

If you are trying to become pregnant, decline in insulin levels will result in decline in testosterone, which will result in reduction in ovarian cysts. Helping to re-establish the delicate balance of your hormones, enhances the likelihood of ovulation, without which, the chance of becoming pregnant are small.

WEIGHT LOSS

Approximately 50 – 60% of women with PCOS are obese. If you are overweight or obese, excess fat can make insulin resistance worse. This may then cause the level of insulin to rise even further. High levels of insulin can contribute to further weight gain producing a ‘vicious cycle’. Losing weight, although difficult, can help break this cycle.

It has been shown that losing even 5% of body weight can lead to an improvement in skin, regularity of menstrual cycles and decreased insulin levels. However many women with PCOS experience difficulty losing weight, possibly due to high insulin levels promoting fat storage. These continuously high insulin levels keep blood sugar levels low, which in turn often prompts cravings for sugary carbs.

LOW GLYCAEMIC LOAD DIET

The standard low fat high carbohydrate weight loss diet may not be the best approach for women with PCOS. The aim of the diet is to achieve more stable blood glucose and reduce the post-meal blood sugar spikes. High intakes of refined carbohydrates (i.e. sweets, white bread, white rice, etc.) will quickly turn to sugar and cause elevated levels of insulin. Therefore, the best advice is a low Glycaemic Load (GL) diet. It will help to keep your blood sugar levels stable and will also make you feel fuller for longer. You should limit sugary, highly refined carbohydrates and replace them with low Glycaemic Index (GI) carbohydrates such as wholegrains and vegetables. In addition, it is not just about the type of carbohydrates but also the portion size. There is also evidence that eating protein-rich foods such as fish, lean meat and tofu, together with low GI carbs, helps to minimise the blood sugar spikes and therefore limit the rises in insulin.

STRESS

Stress can cause the cascade of the hormonal changes that contribute towards development and progression of Insulin Resistance. Therefore relaxation exercises, spending time with your loved ones, prioritising, having a good night’s sleep and watching funny movies and laughing are very important components in the treatment of PCOS.

EXERCISE

Exercise is also one of the key factors in the treatment of Insulin Resistance. According to many studies, women with PCOS can reduce their Insulin Resistance just with moderate activity even without losing weight.

MEDICATIONS

You doctor can prescribe you a number of medicines that can help you deal with the different symptoms of PCOS.

Over-the-counter treatments containing benzoyl peroxide (eg Oxy 10 lotion) can help reduce acne. Your GP may prescribe antibiotic tablets or creams to treat your acne.
Oral contraceptive (eg Dianette) can help to reduce the testosterone production by your ovaries, which will improve both acne and excess hair.
Metformin reduces insulin resistance. This means your body needs less insulin to control your blood sugar levels. Less insulin means less testosterone, which will help with excess hair and irregular periods and your ovaries will start to release eggs (improve fertility).
Fertility medicines including clomifene citrate and tamoxifen can stimulate your ovaries to release eggs. You can take these for up to a year. If clomifene makes you ovulate but you don’t become pregnant after six months, your doctor might suggest intra-uterine insemination (this is when sperm is placed directly into your womb). If fertility medicines don’t help improve your fertility, your doctor may offer hormone therapy or surgical treatment. You can also consider assisted conception, such as IVF (in vitro fertilisation), egg donation or surrogacy.

HOW CAN A DIETITIAN HELP?

If you been diagnosed with Polycystic Ovary Syndrome (PCOS) and been told that you have Insulin Resistance, you are very welcome to make an appointment with ACE Diets Specialist Dietitians. We will help you to design your individual diet and lifestyle plan aimed to avoid blood glucose swings and reduce your Insulin Resistance. If you are overweight or obese, we will work together to help you to lose weight and keep it off.

If you are living in Dorset or Hampshire around Poole, Bournemouth, Christchurch, Verwood, Ferndown, Dorchester, Ringwood, New Forest or Southampton, I would recommend to book face-to-face consultation. People who live further a field or just prefer to have consultation at the comfort of their home, can book a Skype, FaceTime or phone consultation.