My Guide To PCOS: Polycystic Ovary Syndrome

PCOS

Illustration by Marta Pucci

Article by: Sila Kurtoglu

What is PCOS?

I was diagnosed with PCOS in my early teens. In my world of sports and fitness, this was not good news! So what is it and why would I think like that?

PCOS is a condition that is related to reproductive disorders of females. The persistent hormonal disbalance leads to multiple small follicles (often referred to as cysts) on the ovaries. These cysts are thought to be caused by higher levels of testosterone (and my Dad was surprised that I’m gay?), which prevents the mature follicle (the egg) from busting out the ovary each month.

Diagnosing PCOS

Referring to the Rotterdam Criteria, to be diagnosed with PCOS you must have at least two of the three following symptoms. Other conditions that might cause these symptoms must be excluded.

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Irregular Periods

This could be the absence of periods (amenorrhoea) or irregular periods (oligomenorrhoea, where your period is less than 6-8 periods a year).

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Hyperandrogenism

This means having higher levels of androgens, a class of sex hormone. Physical signs include facial and body hair growth, or severe acne.

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Polycystic Ovaries

These are the cysts we discussed previously. This is usually assessed using pelvic ultrasound in people who are not going through puberty.

What are the symptoms of PCOS?

PCOS increase serious complications among females. Women with PCOS may not have all these symptoms but I personally have strong symptoms with the first first. If you’d like further resources into each of these symptoms, please DM me.

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Infertility. Women have difficulty getting pregnant because of not ovulating
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Irregular Cycle. Infrequent absent, and/or irregular menstrual cycles

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Obesity. Weight gain, usually with extra weight around the waist

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Hirsutism. Increased hair growth on the face, chest, stomach, back, hands and feet

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Skin Issues. Acne, oily skin, and/or dandruff

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Stress, Anxiety & Depression. Weight with PCOS are more susceptible to stress due to the hormonal impact

Does PCOS have risk for other health issues?

Unfortunately yes, which is why it is even more important we – women with PCOS – must look after our bodies through fitness and nutrition. Please don’t read each health issue concerned that you will develop all of them, statistically that will just not happen.

Insulin resistance. Insulin lowers the blood sugar by storing the glucose in cells. The cells become resistant to the constant insulin and need more to be signalled to lower the blood sugar. When this resistance goes on for a while, you have high insulin and high blood sugar.

Diabetes. Insulin resistance can progress to type 2 diabetes. More than 50% of woman with PCOS have diabetes or pre-diabetes by the age of 40.

Heart attack. Having PCOS can put you at risk of elevated cholesterol and triglyceride levels and low levels of HDL (“good” cholesterol”). Risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.

Anxiety & Depression. The hormone imbalance can lead to mental health issues including mood swings, anxiety, depression, and eating disorders.

Does PCOS have risk for other health issues?

In order to understand the implications of these hormones in PCOS, it’ll be helpful to remind ourselves what a typical menstrual cycle looks like in someone without PCOS: 

Because PCOS varies so much from person to person it is hard to define what a typical menstrual cycle looks like for women with PCOS. The above may be close or very different to what you are experiencing, either are fine. The purpose here is to understand your body and some of the factors that play into your symptoms. Discussing hormones will take more than an blog post, but please understand that people with PCOS are more sensitive to the impact of stress, as it exacerbates the hormonal pathways of PCOS, leading to elevated testosterone and cortisol (the stress hormone) levels, which can contribute to the development of cysts on the ovaries.

MANAGING STRESS IS CRUCIAL TO THE MANAGEMENT OF PCOS SYMPTOMS.

Managing PCOS

The circles are some of the supportive strategies I have learnt and advise my clients with PCOS. Diets teach us to “go hard or go home”. This approach can often exacerbate symptoms, for instance, if you experience a lot of fatigue around your condition, but wake up super eager to hit the gym, that might overall be counterproductive. This diagram shows how I manage PCOS, arranged in order of my priorities based on practicality, accessibility and impact.

As we know from the previous slide, PCOS is caused by hormones being out of balance, and stress only exacerbates this. One of the major benefits of meditation is to help reduce stress, so I can’t recommend it enough; it can play a vital role in your symptoms & hormone balance.

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Managing PCOS

Gentle nutrition focuses on what we can add into our diets to help support our health, rather than what we ‘should’ cut out. As a nutrition coach I always advise my clients to approach nutrition this way, rather than diving into a diet.

Carbs – what’s the big deal. You may have been told to ditch the carbs to help manage insulin resistance, but this simply isn’t sustainable. Instead focus on eating a variety of carb foods and opting for those with high fiber as this helps slow the breakdown and absorption of glucose into the bloodstream (thus reducing your body’s demand for insulin), but also provides lots of food for our gut bugs. Double win!

Vitamin F – fats are important. Including adequate amount of fats & protein alongside your carbs not only reduces the overall glycemic load of the meal (e.g. the overall effect on our blood sugar levels), but certain types of fat, especially unsaturated omega 3 fatty acids, also addresses the chronic inflammation that underlies PCOS, as these fats act as antioxidants.

Getting enough protein. An adequate protein intake has been proven to reduce levels of androgen hormones & insulin, and increase levels of SHBG (which helps to bind free testosterone in the blood). Also, most high protein foods include Zinc, a nutrient that’s great as low levels have been suggested to reduce insulin sensitivity.

Movement

Engaging in some form of regular activity will improve your levels of key hormones involved in PCOS (including increasing levels of FSH, SHBG and reducing levels of testosterone and other key androgen hormones). Movement also has a profound effect on reducing insulin resistance and helping to manage blood sugar levels.

Weight training. Interestingly, many women with PCOS are actually quantitatively quite good at a lot of sports and performance-based activities, particularly those that are power based (e.g. weight training).

Joyful movement. Finding an activity that you enjoy and have fun with is super important for sustainable habits, rather than making movement a chore. Whether that’s a brisk walk around the park, dancing in your lounge, or doing a HIIT workout.

Listen to your body. Finally, when we’re talking about movement, more is not always better; if you’re feeling fatigued then it’s a sign that perhaps it’s time to reflect and rest. As we know from my circles of supportive strategies circles and managing PCOS, rest is super important too!

Mental health & body image

People with PCOS are more likely to have anxiety & depression when compared to people without PCOS, so it is even more important to look after our mental health. This might include talking to a therapist, chatting to friends or family, or practicing mindfulness. Research also shows people with PCOS have an increased prevalence of negative body image, impacting feelings on health, appearance, mood and physical fitness. Let me make this clear, I know and understand this can have an impact on your desire to participate in self care and positive movement that works to improve our mental health, so I have outlined a few beginner strategies to boost your mental health.

Self care. Give yourself time to rest, eat a variety of foods, move and stretch, and spend time with those you love. Often when we feel rubbish about ourselves it’s because we are forgetting to dedicate time to ourselves.

Changing your self talk. Thinking about how we talk about our body and other people’s bodies is important, hat words do we use, are they positive/negative/neutral. Take a piece of paper and brainstorm 100 things you like about you!

Consider your media use. Consider the messaging you’re consuming on social media and follow positive messaging not obsessive body imagining. Perhaps have a social detox of positive vibes only.

Personal Trainers need to understand PCOS

PCOS needs to be understood and talked about by Personal Trainers more. I have created this Guide on PCOS to help support PTs and people with PCOS alike, to change this.

PCOS reduces your BMR (Basal Metabolic Rate) from 14-40%. 40% is significantly high, that’s the equivalent of 4 gym sessions a day (find out more on TDEE). Meaning it is impossible for a Personal Trainer to try give you a fitness programme without taking PCOS into consideration.

To conclude, adopting a healthy lifestyle is the most important method of controlling PCOS; control a healthy weight, eat right, look after your mental health and take your recommended medications. Also, please ask me questions, I have created this guide on PCOS from a collective of paid-for studies and my own personal experience on PCOS. I am a Personal Trainer and Nutrition Coach, I plea for PCOS to be better understood in the fitness industry.

Any questions?

Please contact me, I am very happy to help on this topic!
IG: @sk_personaltraining

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