PCOS affects up to 13 per cent of women, and those assigned as female at birth, of reproductive age, including up to 16 per cent of people who identify as Aboriginal and Torres Strait Islander.¹

The dysfunctions associated with this syndrome can result in infertility, hirsutism (excessive hair growth), acne, obesity, diabetes, and osteoporosis.

Symptoms & first signs of PCOS

Irregular Periods

One of the most common symptoms is the irregularity of the menstrual cycle.

A typical menstrual cycle ranges between 21 to 35 days in length, with an average period lasting between three and seven days. Due to the hormonal imbalance caused by PCOS, some may never form a consistent cycle, having months or years between each period.

Insulin Resistance

Because of the impact on the endocrine symptom, around 85 per cent of those with PCOS experience insulin resistance. Noticeable symptoms include:

• Cravings for salty or sweet foods
• Fatigue
• Increase in need to urinate
• Darkening of skin in the armpits, groin or behind the neck
• Increased thirst or hunger

Weight Gain and Obesity

People with PCOS have a higher rate of being overweight or obese, a direct result of the reproductive and metabolic symptoms as confirmed in a recent 2019 study in Australia². In fact, 50 per cent of those living with it fall into the obese weight range.

Hirsutism (Excessive hair growth), Acne & Hair Thinning

Due to the increased androgens (male hormones) and higher testosterone levels, people with PCOS often develop acne and excessive hair growth, or what is known as hirsutism. Coarse hair growth often occurs on the face - particularly the chin, upper lip, and sideburn areas. However, it can also affect the chest, stomach, legs, and arms.

Contrastingly, others may suffer from hair thinning, hair loss, and baldness (alopecia), also a result of excessive male hormones.

Infertility

Approximately 70 per cent of cases experience fertility issues or difficulties. There are several causes, including irregular periods, as, without ovulation, pregnancy is not possible. 

Those with PCOS typically have larger ovaries, and many small cysts containing immature eggs. These immature eggs that do not develop normally, can interfere with ovulation, preventing an egg from being released. This issue can be compounded by hormone imbalances and instances of obesity. 

Causes

While there’s no exact known cause, researchers have found that genetics and family history play a strong role.

Diagnosis & treatment of PCOS

Due to the wide variety of symptoms associated with PCOS, there is no one-size-fits-all shared experience, and not all symptoms need to be present to be diagnosed.

The methods of diagnosis include ultrasound scans, to check for ovarian cysts, and blood tests to gauge androgen, glucose, and cholesterol levels.

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Why is early diagnosis important? 

It’s important for young people to be diagnosed early so that they can feel educated on their condition, and how to best manage symptoms. 

When diagnosis and appropriate referral to team members occurs, as a flow-on effect, mental health is going to be better. Having hair where you don’t want it, acne and problems with weight management can weigh heavily on a person of any age. 

When this is addressed early, understandably a person is more likely to have better self-esteem, and hopefully, be less likely to experience anxiety and depression. 

Early intervention can reduce the risk of future chronic illnesses such as gestational diabetes, type 2 diabetes, high cholesterol, and cardiovascular disease³.

Learning about one’s own diagnosis of PCOS, the impact it might have on future fertility and how to manage symptoms can make people feel more empowered when it comes to deciding on what to do if they want to have children, and what their options could be. 

Lastly, early diagnosis and intervention can reduce the risk of endometrial hyperplasia. Endometrial hyperplasia refers to the irregular thickening of the uterine lining⁴.

In a cycle of those with ‘normal’ periods, progesterone will drop when pregnancy doesn’t occur which is what gives way to a menstrual bleed. Without the usual fluctuation of progesterone during the luteal phase of the period cycle, the uterine lining builds up and thickens. 

This will also contribute to bleeding that is heavier and irregular. Endometrial hyperplasia is more likely to occur in those who have less than 4 menstrual bleeds a year and this increases the risk of endometrial cancers⁵.

As there are multiple problems faced by people with PCOS, the various treatments depending on the most troublesome issue. Although there is no cure, there are some ways to treat it.

Management – Lifestyle perspective

For those who are overweight or obese, a 5 per cent to 10 per cent decrease in body weight can improve menstrual regularity, ovarian volume and hirsutism symptoms⁶.

Because of the endocrine system involvement, many physicians recommend a diabetic approach to a PCOS diet. This includes low glycaemic index (GI) and whole foods, as opposed to highly processed ones.

One of the most important things to do is to be well supported by a team of health professionals. An example of people to have in the team includes a general practitioner (GP), dermatologist, gynaecologist or fertility specialist, endocrinologist, exercise physiologist, counsellor or psychologist, and dietitian. Those who receive care from a team of health professionals rather than just one health professional in isolation have better treatment and health outcomes. 

With all the complexities and intricacies of this syndrome, it can be easy to forget about some of the more first-line strategies for management. This is where nutrition and exercise can really help. There is an abundance of evidence on how to best manage it from a lifestyle perspective. 

Often one of the first places a GP, or primary healthcare professional might focus on is weight loss. This is where some anxieties may arise for those with this. 

Often, they will have come to their doctor or GP with concerns about how to manage symptoms and the first piece of advice is to lose weight. Research does show that losing 5-10 per cent of body weight can have a significant impact on symptoms in people who are carrying excess weight⁷.

However, it is also important to focus on other strategies rather than just using weight loss as a primary management strategy. More important than the actual change in weight are the types of behaviours or eating habits that can be changed.

Healthy lifestyle or dietary strategies include: 

• A focus on carbohydrates, specifically types, timing and the total amount of carbohydrates
• Have a varied and mixed diet that meets 5 servings of vegetables and two serves of fruit. 
• Include omega-3 fatty acids in the diet for anti-inflammatory and heart health purposes, as well as reduce saturated fat intake
• Have regular blood tests taken (annually)
• Undertake regular enjoyable physical activity
• Check in with a counsellor or psychologist if needed.

As insulin resistance affects a high proportion of people with PCOS, it is important to know that it can occur in people of all weight ranges. It occurs in 75 per cent of those who present as being of a lean body type. 

Diet and PCOS

A key feature of eating for PCOS is by following a low GI diet. The glycaemic index is a measure of how quickly a food raises blood sugars after eating. 

Low GI carbohydrates are often (not always) higher in fibre, and likely to be of the wholegrain variety. Ideally, including or swapping over to brown rice, wholemeal pasta, wholegrain bread, quinoa, and rolled oats. 

This is to combat symptoms of insulin resistance, which also assists with improving other follow-on symptoms. 

Consuming a low GI diet over an extended period has been shown to increase menstrual regularity, insulin sensitivity and reduce body fat. It also showed improved bloods in areas of fasting insulin, triglycerides, and total cholesterol⁸.

Another way to manage insulin resistance is to consume smaller, more frequent meals that are balanced with a source of protein, and healthy fats. This ensures that there is a slow, consistent release of glucose into the bloodstream. It also protects against the development of gestational diabetes in pregnancy and type 2 diabetes in later life.

When trying to reduce the risk of cardiovascular disease long term, it is important to include omega-3 fatty acids in the diet. 

Omega 3 fatty acid intake has been associated with improved mental and physical health benefits, as well as being linked with an improved boost in mood, cardiovascular health, and anti-inflammatory markers⁹.

Omega-3 intake has also been linked with improved pathology, around lowered cholesterol and triglyceride levels¹⁰. Omega 3 fatty acids are found in abundance in oily fish such as mackerel, sardines, trout, and salmon. Also, plant-based foods such as walnuts, flaxseeds, chia seeds, hemp seeds, edamame, and seaweed. 

If a diet is high in unsaturated fat sources like omega 3’s, then saturated fat sources such as butter, lard, coconut, cured or processed meats, sausages, biscuits, and cakes are likely to be reduced. 

The tailoring of different food groups is not the only thing that can help nutrition-wise. It turns out, specific nutrients can also be helpful for symptom management. Research shows that those with PCOS are more likely to have nutrient deficiencies of Vitamin D, Magnesium and Zinc¹¹.

Vitamin levels and PCOS

The question is: Why is it concerning that these nutrients are low? Vitamin D is important for immune health, and bone health. However, in the context of PCOS, adequate vitamin D status is shown as being protective for mood and mental health. 

Research has also shown that low levels of vitamin D are associated with higher androgen levels and having adequate levels can contribute to improved menstrual cycle length and pregnancy outcomes^12,13.

Some research has shown that magnesium has been shown to impact insulin resistance and to be protective against oxidative stress and inflammation¹⁴.

Across the research, supplementation of zinc across various studies has shown improvements or a reduction in body hair, insulin resistance, lipid balance, scalp hair loss and inflammatory markers^15,16,17.

Just a note of caution, that it is important for anyone (not just those with PCOS) to seek out assistance from a qualified health professional. Supplementation of any nutrient can very easily reach levels of toxicity, especially when people may be taking a few supplements, they may be ‘double dipping’. 

Exercise

We can’t talk about PCOS without emphasising the importance of regular enjoyable movement. 

From a clinical point of view, regular movement improves insulin sensitivity, blood sugar levels, and lowers cholesterol. As those with this syndrome may be more prone to depression, anxiety, low moods and self-esteem, enjoyable exercise or movement can improve mental health and well-being^18,19.  

Cosmetic Treatments

Negative body image has been found to impact those suffering from PCOS, who have a higher instance of anxiety and depression. 

The excessive hair growth that is often present can be a cause of distress for many, but there are cosmetic treatments that can assist. These include waxing, laser hair removal, depilatories, electrolysis, and shaving.

Hormonal Therapy

A variety of hormone treatments are available, depending on the issue that is being experienced. One of these is oral contraceptives, which assist in regulating the menstrual cycle and decreasing androgen production.

Insulin-sensitising drugs

Insulin-sensitising drugs, such as metformin, are commonly used to treat insulin resistance. It is often used in conjunction with ovulation-inducing medication, such as Clomiphene citrate, to increase its effectiveness in improving fertility²⁰. 

PCOS Resources

• Australian Family Physician Fact Sheet
• Jean Hailes for Women’s Health Fact Sheet
• Jean Hailes for Women’s Health webpage
• Health Direct
• Very Well Health
• Queensland Fertility Group
• Barriers and facilitators to weight management in overweight and obese women living in Australia with PCOS: a qualitative study
• Diagnosis experiences of adolescents with polycystic ovary syndrome: Cross-sectional study
• Diet and exercise as a management strategy for symptoms of polycystic ovary syndrome: the views of women in the community.
• Polycystic ovary syndrome: is a Western diet sabotaging our best efforts at management?