By Julie Redfern, R.D., L.D.N.
Brigham and Women's Hospital
Are you having trouble losing weight? Have you been plagued by menstrual irregularities, acne or excess facial hair? If you answer yes to one or some of these questions, you may have a condition called polycystic ovary syndrome. PCOS affects 6% to 10% of women of childbearing age.
Possible Causes of Polycystic Ovary Syndrome
Polycystic ovary syndrome is a complex female endocrine (hormone) disorder. Male hormone levels in a woman's body tend to go up and female hormones don't cycle normally. But the key issue for many women with PCOS may be insulin resistance. Insulin is a hormone secreted by the pancreas. Its job is to move the sugar from our blood to our cells, where it is used for energy or stored for future use. Insulin resistance occurs when the normal amount of circulating insulin becomes less effective in moving blood sugar into cells. The pancreas responds by making more insulin, but over time the cells resist these high levels. Both sugar and insulin continue to build up in the blood.
The underlying cause of insulin resistance is probably genetic, but lifestyle has a big influence on what actually happens. Obesity and physical inactivity can promote its occurrence in many women. But even thin women who exercise regularly can have PCOS.
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Relationship Between PCOS and Diet
Eighty percent of women with PCOS are obese, tending toward an apple-shaped body type. The mainstay of treatment for PCOS is weight loss. A weight loss of only 5% can improve insulin resistance, leading to lower levels of male hormones (and less facial hair), improved menstrual function, and a reduction cholesterol abnormalities. The best approach is a healthy weight-loss diet and exercise routine.
Unfortunately, many women with PCOS have a difficult time losing weight. There may be a connection between high male-hormone levels and increased appetite; glucose intolerance also may play a role in weight gain.
Even if your weight gain is caused by some physiological consequence of PCOS, lifestyle changes offer you the best chance of successful weight loss. These may include restructuring your eating habits, managing depression and anxiety, learning stress-reduction techniques, and starting an individual exercise program.
Research tells us that a healthy diet includes lean proteins, heart-healthy fats and a moderate amount of carbohydrates. Lean proteins include fish, skinless poultry, egg whites, beans (especially soy and their products), nuts and nut butters. Heart-healthy fats include liquid oils from olives, canola, soybeans, corn, flaxseed, sunflower and peanuts. In addition, fats from nuts, seeds and fish are also a healthy choice.
Choose carbohydrates that have a low glycemic index. The glycemic index is a measure of how quickly and how strongly a food increases blood sugar and insulin levels. Choosing foods with a lower glycemic index may help to reduce carbohydrate cravings, especially whole, intact grains that are high in fiber. Eat 100% whole-grain breads, brown rice and steel-cut oats, or try something new such as barley or the grain quinoa. Dried beans, and fruits, such as berries, are also excellent examples of low glycemic foods.
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Medications for Polycystic Ovary Syndrome
Many doctors are using insulin sensitizers, such as metformin (Glucophage) for PCOS. Metformin decreases insulin resistance and may improve the physical appearance of women with the disorder. Combination birth-control pills help to restore the balance of estrogen (female hormone) to androgen (male hormone). Oral contraceptives can decrease facial hair and acne and regulate the menstrual cycle. Fertility issues may require clomiphene or other medication to stimulate ovulation.
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Another Consequence of Insulin Resistance
There is public health concern about long-range complications from insulin resistance. Insulin resistance is related not only to PCOS but also to metabolic syndrome (also called syndrome X). People with metabolic syndrome often have high blood pressure, a low HDL (good) cholesterol level, elevated triglyceride levels and high fasting blood sugars, in addition to insulin resistance. They are almost always overweight, if not obese. Metabolic syndrome carries a high risk of developing type 2 diabetes and coronary heart disease. Like PCOS, the most important treatment of metabolic syndrome is diet, exercise and weight reduction.
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Julie Redfern, R.D., L.D.N., is a registered dietitian in the nutrition consultation service at the Brigham and Women's Hospital. She specializes in nutrition counseling for the Obstetrics and Gynecology Department. She is a graduate of the University of Vermont, and completed her internship at the University of Cincinnati Medical Center.