Polycystic ovary syndrome (PCOS) and fertility

PCOS is the most common cause of menstrual irregularities and infertility which is often under-diagnosed. As the name implies, PCOS is a condition in which the ovaries are covered with cysts — small, fluid-filled sacks — leading to an array of symptoms such as acne, hirsutism (male-pattern hair growth on the upper lip, chin, chest, and abdomen), hair loss, irregular periods and depression. Since it is a ‘syndrome’, it is important to note that not all the symptoms need to be present for a diagnosis to be made. Symptoms vary but the most frustrating ones are often weight gain and infertility.

Below are pictures of polycystic ovaries:

What causes PCOS and its symptoms?

The major culprit appears to be insulin resistance. But what exactly causes the insulin resistance is unclear.

Insulin is a hormone that transports glucose (end product of the digestion of carbohydrates and our body’s main energy source) from our bloodstream and into our cells where it is used as energy. To keep it simple, visualise insulin as a ‘key’ that ‘opens’ the ‘locked doors’ on our cell walls to allow glucose molecules to enter.

So insulin resistance means that the ‘key’ (insulin) does not fit well in the ‘locks’ of many of your cells. When this happens, your pancreas start producing more insulin (because ALL your cells need glucose) and you develop hyperinsulinaemia — high levels of insulin in the blood, and hyperglycaemia — high glucose levels in the blood.

How PCOS causes weight gain

Excess insulin in the blood causes weight gain by promoting accumulation of fat (especially above your belly button). The bad news is that the higher your body fat percentage, the more insulin resistant you become which, in turn, forces your body to produce even more insulin and you put on even more weight...

How PCOS leads to infertility

Hyperinsulinaemia stimulates the insulin receptors on your ovaries which react by producing excessive amounts of testosterone, the male sex hormones naturally produced by both men and women. These greater-than-normal amounts of testosterone hinder ovulation by disrupting the balance of the female sex hormones. Without the right hormonal balance, conception cannot take place because the maturation of eggs (that are supposed to be released and fertilised) does not occur. This also causes irregular menses.

How to cope with PCOS

Although PCOS is not completely reversible, there are a variety of treatments that can reduce or minimise bothersome symptoms.

Medications

The approach to treat PCOS depends on the extent of the condition. You may want to consult an OBGYN for proper guidance: do not attempt to buy over-the-counter medications which can actually worsen your condition.

Exercise: The most effective treatment for PCOS

Exercise can help boost your metabolism (the amount of energy your body uses to maintain its vital functions) which will facilitate weight loss and thus, improve your insulin resistance. When you become less insulin resistant, your other symptoms may improve.

Exercise for most days of the week for at least 30 minutes. You can split these 30 minutes in two 15-minute sessions or take a 10-minute walk in the morning, at lunch and in the evening. The key is to break a sweat and have your heart-rate go up (but not so much that you cannot hold a conversation).

Diet: The aim is to reduce insulin resistance and prevent weight gain

A registered dietitian can offer nutrition guidance for your specific needs and assess your dietary habits. To find a dietitian in your area, visit the British Dietetic Association website. Below are a few dietary tips that can help you cope in the mean time.

Foods that cause surges in insulin levels:

• Meals that are loaded with carbohydrates;
• Refined products (like white bread/pasta) that are rapidly broken down to glucose;
• Sugar-laden foods and beverages (including diet soft drinks);
• Consuming fruits on an empty stomach;
• Fruit juices (the natural sugar present in fruit juice is rapidly absorbed in the blood since juices lack fibre).

Eat 3 main meals and 1 or 2 snacks: Try to eat on schedule and avoid skipping meals in order to keep your blood sugar levels constant. This will also prevent overeating and sugar cravings.

Follow the Eatwell Guide for portion sizes

Control your carbohydrate intake: Avoid consuming more than 45 grams of carbohydrates at one meal.
45 grams of carbs equal 3 slices of bread OR 1 ½ cup of rice/pasta/oats/whole grains and cereals OR one large pita bread OR 3 small potatoes OR 6 to 9 crackers.

Snacks: limit your carbs to 15 grams. Snack smartly!

Slow carbs rule: Choose more whole grains, wild or brown rice, whole grain pasta and so on.

Vegetables: Try to eat at least 3 non-starchy vegetables daily, especially green vegetables which are rich in fibre that has been shown to prevent rapid rises in blood glucose levels. Green veggies like broccoli are good sources of chromium, a mineral that appears to improve insulin resistance (Broccoli mac and cheese? Not a good idea...).
You may want to limit consumption of starchy vegetables like corn, peas, yam, tapioca and potatoes as they contribute to your carbohydrate intake as well.

Fruits: Limit intake to one per meal and avoid fruit juices (even the 100% natural ones) as they lack fibre.

Protein: In women with PCOS, protein helps prevent binges by preventing dips in blood glucose levels. Your best choices are lean meats, skinless chicken, soya, and eggs. Try to have fish at least twice a week (that does not mean fish and chips!).

Be careful of high protein diets: studies have linked these types of diets with increased incidence of infertility.

Fats: Limit trans-fats found in commercial products — nutrition labels should state ‘trans fat free’. Have an omega-3 rich diet (sources: canola oil, nuts, seeds, fatty fish — tuna, salmon, trout).

Water: Keep yourself well hydrated (consume at least 1.5 to 2L of water daily) since dehydration can lower your metabolism which could lead to weight gain.

Listen to your body: Take your time to eat and recognise the signals your body sends you when it is full (it usually takes about 20 minutes) so slow down and savour each bite.

The PCOS road may be bumpy but remember: 1 in 10 women suffer from PCOS. You are not alone. Be assured that most women with PCOS are able to lead a normal life without significant complications.

• References

  U.S. Department of Health and Human Services, Office on Women’s Health (2010) Polycystic Ovary Syndrome (PCOS) (Accessed August 2013).

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