WHAT IS POLYCYSTIC OVARIAN SYNDROME?
Polycystic Ovarian Syndrome (PCOS) is a non-estrogen dominant hormone disorder common among woman of reproductive ages. It is not a disease, but more of a clustering of symptoms driven by a particular trigger or root cause. This root cause will lead the brain to produce certain hormones in abnormal amounts.
Woman with PCOS will typically present with an excess of androgen-based hormones (testosterone) which results in menstrual cycle changes, skin discolouration patches, increased facial and body hair, acne, cysts in the ovaries and risk of type two diabetes as well as infertility. If you’ve got PCOS, when you ovulate the eggs will leave the sacs long before they have matured, they will then merge with one another and distribute themselves on the outer walls of the ovary in the form of tiny cysts. This means the eggs released from the ovaries are not able to perform their reproductive functions, hence why fertility issues are commonly seen. Often, women with PCOS have problems with their metabolism which can lead to body weight issues.
PCOS can look different from person to person and not all PCOS diagnoses are the same as there are 5 different causes for PCOS to present.
INSULIN RESISTANT PCOS: By far the number one cause of PCOS in woman is insulin resistance, between 50-80% of woman will have this form. Too much insulin can impair ovulation and tells the ovaries to produce more testosterone instead of estrogen. It also stimulates your pituitary gland to make more luteinizing hormone.
POST PILL PCOS: Ethinylestradiol in birth control pills can potentially cause insulin resistance thus leading to PCOS onset. The pill should never be used to treat PCOS. If your periods were normal before taking hormonal birth control and now you meet the diagnostic criteria for PCOS you may have the post-pill type of PCOS.
INFLAMMATORY / IMMUNE DRIVEN: Chronic low grad inflammation has emerged as a key contributor to the pathogenesis of PCOS. Chronic stress, anxiety, abuse, toxin exposure or allergies can all contribute to this immune driven hormonal response,
ADRENAL DRIVEN: 10% of PCOS cases will fall into this category. The body no longer functions via the HPO (brain the ovary) axis to manufacture sex hormones and is going through the HPA (brain to adrenals) axis instead due high stress exposure.
GENETICALLY DRIVEN: Some people will genetically have a gene that predisposes them to PCOS.
From a medical perspective PCOS has been difficult to manage for many and there is no blanket “cure”. From an Exercise and Health professional standpoint there are many things one can do through exercise and nutrition lifestyle changes to help calm down the root cause driving the PCOS symptoms. Finding out what the root cause of your PCOS is of high importance.
As a rule of thumb, calorie deficits and more exercise aren’t how to navigate managing your PCOS and PCOS associated weight gain. If you are currently working with a trainer or a GP who has placed you on a very restricted calorie intake and long training sessions daily to try and lose the weight, it is safe to say, this person doesn’t understand the nature of PCOS and its relationship with exercise and dieting stress. You don’t want to drive an already inflamed body into more inflammation by increase cortisol. Our bodies will release cortisol in response to stress. It is important to remember that exercise is a form of “stress” as too very restrictive dieting.
Exercise is extremely beneficial for PCOS but only when it is prescribed in the right type, amount, frequency, and intensity. The best exercise modality/regime is one that improves your insulin resistance, burns calories, whilst simultaneously reducing androgen and cortisol levels
Therefore, the best modalities are:
Strength training: Strength training improves insulin sensitivity as a result of increasing lean muscle mass. Strength training does a much better job of fighting abdominal fat, a University of Pennsylvania study found that overweight or obese women, ages 24–44, who were assigned to an hour of weight training twice a week reduced their proportion of body fat by nearly 4%. Muscle is more metabolically active which means every bit of muscle you gain will increase how many calories you burn through the day both at rest and during activity. Three full body strength sessions a week including compound movement patterns is a good starting point.
Sprinting or short High Intensity Interval Training (HIIT) workouts: Studies have shown that HIIT improves insulin sensitivity during and (up to 1-3 days) after this exercise modality. What exactly is HIIT? Its full body movements with or without weights or sprinting, but for a very short period, with rest in between, for a maximum of 20 minutes.
Low intensity movement: (daily walking, yoga, leisurely bike ride or swim) these activities have been shown to reduce not only cortisol levels but also and ACTH, which stimulates our body to produce more androgens (‘male’ hormones). These male hormones are responsible for some symptoms of PCOS, such as acne and unwanted hair growt
What to avoid?
Long duration high intensity sessions (over an hour with high heart rates and insufficient rest)
Long Endurance training
Both these modalities will lead to increases in cortisol which will add to further inflammation and increasing insulin resistance in those with PCOS.
Listed below are some tips and strategies through dietary changes and supplementation that can also help manage symptoms and address the root cause of your PCOS.
Consult with a dietitian who understands PCOS well!
Ensure you are consuming adequate protein daily!
Avoid being on harsh calorie deficits, you will do better in a fed state!
Reduce high fructose corn syrup intake.
If post pill PCOS reduce dairy intake.
Magnesium Theonate for those with Adrenal Driven PCOS.
Metformin and Inositol have been shown to have good success in those with Insulin Resistance driven PCOS.
DIM, Zinc and Peony Liquorice Root are all known supplements to assist in management of PCOS associated symptoms.
Saw Palmetto can help to reduce excess DHT in woman who suffer with PCOS acne on face back and chest.