Polycystic Ovarian Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with insulin resistance and hyperandrogenism. PCOS affects 12-20% of Australian women of reproductive age, and is a leading cause of infertility. The condition also leads to an increased lifetime risk of gestational diabetes, type 2 diabetes and endometrial cancer.

How is PCOS diagnosed?

The first evidence-based international guideline on PCOS was published in June 2018, with more than 3000 international health professionals and patients involved in determining the topics needing to be addressed. This initiative represents the first time a full set of guidelines has been developed and published encompassing all aspects of the condition, including mental health aspects.

In short, a diagnosis of PCOS should meet any two of the following three criteria: visible ovarian cysts on ultrasound, unusually short or long menstrual cycles, and hyperandrogenism. Further, a PCOS specific tool, called the PCOSQ, has been developed and validated across ethnic groups with the condition, which includes 26 items that relate to a number of specific PCOS symptoms, such as emotions, hirsutism, weight, infertility and menstrual dysfunction.

How is PCOS treated?

According to the 2018 International Evidence-Based guideline for the Assessment and Management of PCOS, lifestyle management is the first-line therapy for ALL women diagnosed with PCOS, irrespective of insulin resistance, weight status or fertility concerns. 

“Lifestyle management” is essentially about weight loss and exercise, but it is important to follow research-based advice in both diet and physical activity. Avoiding restrictive or fad diets if you have PCOS is crucial. This includes the keto diet and diets that cut out dairy, soy, or gluten without medical reason. Dieticians recommend that women with PCOS learn how to optimise their glycaemic load across the day, that is, learn what and when to eat in order to manage blood glucose variation. Research also shows that increasing dietary fibre, particularly from eating legumes, may reduce free testosterone and manage cholesterol levels. More recently, it has been suggested that a “Mediterranean style” dietary approach, which increases omega-3 consumption, may improve insulin responses and your lipid profile. A doctor may also recommend certain supplements and a personalised strategy to target hormonal differences.

Regarding exercise, for modest weight loss and prevention of weight regain, a minimum of 250 minutes of moderate intensity or 150 minutes of vigorous intensity physical activity per week, or an equivalent combination of both, is recommended. Physical activity may include leisure time activity, transportation such as walking or cycling, occupational work, household chores, games, sports or planned exercise in the context of daily, family and community activities.

If you suspect that you have PCOS, ask your GP for a referral to a gynaecologist and a dietitian.

Sources:

“A GP Guide to Polycystic Ovary Syndrome,” October 2019, found at http://www.ausdoc.com.au