Nutrition for PCOS
By Natalie Vallone, RD, & Grace Goodwin Dwyer, MS, MA, RD, IBCLC
Polycystic Ovarian Syndrome, commonly referred to as PCOS, is one of the most common hormonal diagnoses, and yet there are so many misconceptions surrounding it.
Read on to understand what's going on with a "PCOS" diagnosis and how you can take care of yourself, including supporting your fertility.
What is PCOS?
Polycystic Ovarian Syndrome is the result of hormonal imbalance that affects about 5-10% of women during their reproductive years. A healthcare provider may diagnose you with PCOS if you experience at least two out of the three common signs:
Irregular or missed periods —> This is one of the most common signs of PCOS. Your periods may also be heavy or unpredictable.
High androgen levels —> Androgens are a category of hormone and testosterone is the most well-known of the group. It’s normal for women to have some testosterone, but in PCOS, testosterone levels may be higher than typical.
Polycystic ovaries —> With PCOS, your ovaries may become enlarged and develop tiny cysts, which can impair their function.
What are the signs and symptoms of PCOS?
In addition to the three major criteria listed above, signs and symptoms of PCOS can include:
Acne and/or oily skin
Excess hair growth on the face and body (hirsutism)
Thinning of the hair on the head
Weight gain
High blood pressure
Insulin resistance
Elevated triglycerides
So what exactly causes PCOS?
It’s not 100% clear exactly what causes PCOS, but genetics likely play a big role.
A number of hormonal changes occur during PCOS to both the reproductive and metabolic systems. Some research suggests that PCOS is caused by increased levels of Luteinizing Hormone (LH) at the start of the menstrual cycle, which prevents an LH surge towards the middle of the cycle. Without this surge, ovulation doesn’t take place and women may experience irregular periods. Women with PCOS tend to experience higher androgen levels, which can lead to irregular menstrual cycles as well.
In addition to these reproductive hormone differences, there are a couple of metabolic hormones that change with PCOS: cholecystokinin (CCK), insulin, and leptin. With PCOS, these hormones can shift in a way that impacts hunger and fullness.
How Does PCOS Affect Fertility?
Some people might not actually realize they have PCOS until they’re trying to get pregnant and become more aware of their cycle. While PCOS is one of the most common fertility challenges, it is also one with multiple strategies that can help.
The primary obstacle of getting pregnant with PCOS is that ovulation can be irregular or not happen at all. According to the women’s health experts at Jean Hailes, many women with PCOS “experience reduced fertility or “‘sub fertility’, where it might take longer to conceive, or they might need further medical assistance to achieve a pregnancy.”
Some research shows that lifestyle changes (more on those below!) can significantly boost your chances of becoming pregnant sooner. Medications like clomiphene may be prescribed to help make ovulation occur, and some portion of women end up seeking further fertility treatments like IUI or IVF.
Like anyone who is trying for a baby, it’s helpful to track your cycles with PCOS. Even if they’re irregular, this can help you get a sense of your baseline and be useful data to share with your healthcare team.
What can I do to help with PCOS?
One of the best ways to manage PCOS symptoms - whether it’s insulin resistance or infertility - is through lifestyle intervention. Small adjustments to how you eat and move can improve your metabolic health and your chances of conception.
Nutrition Strategies
CARBOHYDRATES —> focus on fiber
Fiber is the non-digestible portion of a carbohydrate. Fiber is helpful for PCOS because it helps with blood sugar as well as satiety (feeling full or satisfied after eating), since it slows down how quickly food moves through our digestive tract and how quickly blood sugar levels rise. Including fiber rich foods such as whole grains, fruits, vegetables, and legumes is a great way to keep you satisfied.
PROTEIN —> helps with hunger
Protein is key in helping you balance hunger hormones like CCK, leptin, and insulin. Consistently pairing your carbohydrates with a protein or fat source helps improve satiety and blood sugar. For example, an apple is a delicious snack, but on its own it may cause a sharp spike and then drop in insulin. Try pairing it with some Greek yogurt or nut butter. Not only will this stabilize insulin levels, but it will also make your meal or snack more filling!
FAT —> omega-3s to the rescue
Omega-3 Fatty Acids are super beneficial to everyone, but especially for women with PCOS. They have been shown to help reduce high triglyceride levels, decrease inflammation in the body, and lower testosterone in women with PCOS. Omega-3's are “essential”, meaning we must get them from our diet or supplements (our body cannot make them on its own). Some great sources of omega-3 fatty acids include walnuts, salmon, mackerel, tuna, chia and flax seeds, and fish oil or algae oil supplements.
Other Lifestyle Strategies
Movement
Getting regular movement that feels good in your body is another core strategy for maximizing your health with PCOS. Rather than focus on extreme exercise that feels punishing or draining, it’s more beneficial to find something that you actually enjoy, even if it’s as seemingly simple as a short walk while listening to a podcast.
Stress Management
Finding some calm in your life when you have PCOS is especially important for multiple reasons. First, the symptoms of PCOS in and of themselves can be stressful! Second, stress can worsen insulin resistance. And third, depression and anxiety are more common among women with PCOS (correlation versus causation is unclear, but we can conclude that you need to be extra gentle with your mental health!).
Getting rid of stress entirely is not an option for any of us - but managing your stress means finding ways to decompress and stay calm. This looks different for different people, but being outdoors, using creativity, yoga, and other mindful activities are all popular options.
Should I go dairy or gluten free to manage my PCOS?
If you Google nutrition tips for PCOS, you’ll likely find sources telling you to cut out food categories like gluten and dairy. However, most women can eat dairy and gluten and still see metabolic and reproductive hormone improvements, especially when focusing on high-fiber carbohydrates and protein.
Some people find a correlation between increased dairy intake and worsened acne, which can already be a stressful side effect of PCOS. Recent research shows that fat-free and low-fat milk tend to have a greater impact on acne compared to full-fat milk.
Supplements for PCOS
Just like with nutrition, you might encounter a wide variety of recommended supplements when it comes to PCOS. It can be overwhelming to know where to start. Research has currently been exploring some supplements that may offer benefits to women with PCOS.
Keep in mind that it’s important to get individualized guidance with supplements since they are not a one-size-fits-all approach. Yearly blood work will help you determine if you are lacking in any vitamins or minerals that may be affecting your PCOS symptoms. Here is a rundown of some of the most popular options:
Inositol → Myo-inositol has been pretty well studied for PCOS and shows promising results! It has been shown to improve sensitivity to insulin, as well as boost egg quality and ovulation.
Vitamin D → Research has found that vitamin D deficiency is correlated with worsened PCOS symptoms, Some studies found that vitamin D supplementation helped regulate menstrual cycles. However, we still need more research since not all the results were statistically significant.
N-Acetylcysteine (NAC) → NAC is an antioxidant and amino acid that helps reduce stress and inflammation. In one literature review, women who took NAC tended to have better birth outcomes than those who took a placebo. NAC may help reduce insulin resistance and cholesterol levels in women with PCOS.
PCOS Medications
Lifestyle modifications are generally the first step for regulating hormone imbalances from PCOS. However, you can also speak to your healthcare team about medication options.
Some key medications your healthcare provider may prescribe are:
Metformin → Metformin is an insulin sensitizing agent, which helps your body reactive more effectively to insulin in response to glucose. This helps to stabilize blood sugar, insulin, and androgen levels in the body.
Clomiphene → Clomiphene (Clomid) may help you ovulate if you're trying to conceive.
Oral Contraceptives → Birth control pills or rings containing estrogen and progestin may help regulate your menstrual cycle and reduce hirsutism and acne.
Bottom Line
A PCOS diagnosis can feel overwhelming, especially if symptoms make day-to-day life hard or you’re worried about your chances of having a baby. Fortunately, strategies like managing stress, pairing carbohydrates and protein, and following a smart supplementation regimen can significantly help.
Since food and lifestyle intervention are some of the primary “treatments” for PCOS, working one-on-one with a dietitian can be extremely helpful in alleviating the stress or burden you may feel in managing your symptoms while trying to conceive!