Understanding PCOS

What is Polycystic
Ovary Syndrome (PCOS)?

PCOS is a hormonal condition. Hormones are chemical messengers that control the way the body works. For example, during puberty hormone changes send out signals in the body to start periods in girls.

PCOS is a common condition with up to 1 in 5 women of child bearing age affected.

In PCOS two hormones, insulin and male type hormones are produced in higher levels, which results in problems such as;

  • periods less regular (more or less often)
  • emotional problems (anxiety or depression)
  • hair growth on face, stomach, back
  • acne, or pimples
  • easy weight gain
  • delays getting pregnant
  • diabetes
  • more risk factors for heart disease 
.

Not all women with PCOS will have all of these symptoms as PCOS can vary between women and changes with age.

It is the increased levels of male type hormones that cause the ovaries to work differently causing many of the problems listed above.

Two out of three of the following are needed for the Diagnosis.

  1. Periods less regular (more or less often)
  2. Signs of male type hormones –increased body hair, acne or increased male type hormones on blood test.
  3. Presence of ovarian follicles on an ultrasound

Normally, it takes couple of years after periods start for them to settle into a regular pattern. Therefore, a diagnosis of PCOS cannot be made during that time. Also, girls on the contraceptive pill may need to wait until they are off the pill for three months to get a clear diagnosis (there will be a need to take another form of contraception during that time).

 

What causes PCOS?

PCOS occurs in all groups but also appears to follow family and ethnic lines, which means it is more common in certain groups such as Indigenous, Asian and North African women. Also lifestyle patterns such as the way we eat and exercise can make the condition better or worse. Increased weight also increases the likelihood of developing PCOS.

  • Genetics
  • Hormonal changes.
  • Lifestyle

Factors contributing to the development of PCOS

Male type hormones

Male type hormones also known as testosterone and androgens are found in all women in small amounts. Women with PCOS produce slightly higher levels (but not as high as men).

Insulin

Insulin’s most important job is to help control the sugar (glucose) levels in the body by helping to get it into the cells to be used for energy, or to send into storage
if not needed. This way the level of glucose in the blood is always kept the same.

  • Insulin works like a key to let glucose (energy) into the body cells.
  • In PCOS many women have insulin resistance, where the cell won’t let insulin 
work properly, resulting in higher levels of insulin in the blood.
  • Higher insulin levels can make people gain weight easier and may increase appetite.
  • Insulin is able to do its job better if women with PCOS exercise regularly.
  • Higher insulin levels can eventually lead to pre-diabetes and to diabetes type 2.

The transition from insulin resistance to diabetes

 

Insulin Resistance————–Pre-diabetes——————–Type 2 diabetes

Good news.. 
Being active on most days, eating well and losing only a few kilos if needed, is the best way to keep insulin and male type hormones levels lower and working normally.

 

 

Emotional Problems

It is important for women with PCOS look after their emotional health because it is common to have problems like anxiety, depression, due to the features of the PCOS and how women feel about themselves.

It is important to ask questions like

  • Am I feeling ok?
  • Am I really enjoying the things that I usually like to do?
  • Do I feel tired or worried a lot of time?

If you are concerned about the answers for any of these questions, it is important to talk to your health practitioner and together find ways to improve the mood. Other things that might improve your mood are staying active, and getting more support from friends or other women with Pcos. Some useful links to support groups are listed at the back of this book.

What do the ovaries do?

The main job of the ovaries, which are small oval shaped organs in the pelvic area, is to assist women to get pregnant by producing an egg each month. Often, in women with PCOS the eggs don’t fully develop. This is the main cause of the difficulties getting pregnant

Most women with PCOS do not have problems getting pregnant but some will. Also once pregnant some women may have more difficulties such as miscarriages and problems during birth.

The best way to increase your chances of getting pregnant is to plan your family earlier in life if possible as our fertility is higher under the age of 35 years, and also to be really healthy by eating well and being as active as possible, and to lose a few kilos if overweight. This can help your periods become more regular and help to produce an egg which is ready to become fertilised.

The healthier you are before getting pregnant the better your chances of getting pregnant and having a healthy pregnancy and a healthy baby. It is ideal to lose some weight if overweight and to make sure you are eating a balanced diet with a rich variety of foods such as fruits and vegetables and being as active as possible. You should also take folate supplements.

If after trying these things you are still unable to get pregnant your doctor can discuss medical therapies.

Regular periods

It is common for women with PCOS to have periods that do not come for many months or which come too often.

The best ways to help your periods to become more regular is by;

  • Lifestyle changes (getting active and loosing few kilos if overweight might really help)

Having regular periods helps keep the uterus healthy, so if you have less than 4 periods a year, discuss this with your health practitioner.

Healthy weight

If overweight, weight loss as little as 5 – 10% of body weight or just a few kilos can help improve your symptoms such as irregular periods and prevent long term problems such as diabetes and heart disease.

The diet that will be of most benefit is a balanced, healthy diet that everyone should be eating. It is important to weigh yourself weekly but make sure you know what to do if your weight does go up a little. If you need support to help you to lose weight then ask your naturopath for more details. You may need a dietary assessment.

 

Holistic approach in PCOS

 

There are four key steps to the approach: Assessment, Diet, Exercise and Supplements.

 

Assessment

It is important to identify what type of PCOS you have and what role it plays in your overall health picture. First, a health history will include many questions such as: Are you thin or overweight? Do you have acne, hirsutism or irregular cycles? Are you trying to conceive? Do you have a family history of diabetes? Second, an ultrasound can give visual confirmation about the existence and the extent of cysts on the ovaries. Third, blood tests can rule out other diseases, focus treatment strategies, and provide baselines for evaluating the effects of treatment. The blood tests that are often recommended are Testosterone (free and total), DHEA-S, FSH, Estradiol, Thyroid panel (TSH, free T4, free T3), Prolactin, Lipid panel (cholesterol), fasting glucose and insulin.

 

Diet

The cliché is so true… You are what you eat! PCOS is a condition that is dramatically affected by the food choices you make every day. The important rules to live by here are that you choose real foods that are low glycemic, and that you eat small frequent meals. It’s interesting to think about how many of the items on the grocery store shelves these days our great grandparents would even recognize as something to eat. So first, shop the perimeter of the store and focus on real food, like fruits, vegetables, meats, dairy, and whole grains. You want to choose foods that look like they came from a farm, not a factory. Second, the low glycemic diet described in The Natural Diet Solution for PCOS and Infertility is a highly effective way to manage the insulin resistance that is so often at the root of PCOS. And third, it’s not just about what you eat, it’s also about when you eat, so try for small frequent meals. Keeping a regular schedule of meals and snacks that maintains a steady blood sugar will help to prevent cravings and help you succeed in your diet changes. Your food is your medicine, three times a day, or in this case, perhaps five or six times per day!

To help you better, I have included the allowable food list, which makes your shopping easier.

Exercise and PCOS
How much exercise should I do?

Evidence shows that 150 minutes per week, ideally 30 minutes per day is recommended for women with PCOS. This significantly helps to reduce PCOS symptoms, and the risk of developing other health problems such as diabetes. The addition of some more vigorous activity such as walking and swimming etc., at moderate to high intensity (to the point of feeling a bit flushed, breathing faster, and can’t sing or hold a conversation) coupled with intense activity like weight lifting, will be of greatest benefit.

  1. Plan ahead.

Schedule physical activity into daily routine and try to stick to it. A commitment to being active needs to be long term and should become a normal part of everyday lifestyle. Recognise the barriers to activity and plan to overcome them, for example if time is limited try getting up earlier or walking during a lunch break.

 

 

  1. Equipment.

It is not necessary to spend a lot of money to begin exercising. Start with a good pair of training shoes and comfortable clothes. Take a water bottle and don’t forget to wear sunscreen and a hat when exercising outside.

  1. Get support.

The support and encouragement of family or friends will increase the chances of success in making lifestyle changes. Surveys show that women enjoy exercise more when accompanied by friends.

4.Choose an activity

Before deciding on activities consider factors such as convenience of location, budget, pre-existing medical conditions and level of enjoyment.

  1. Be creative.

Try something different; vary the type, location and time of activity to ensure boredom does not set in.

  1. Keep at it.

Persistence is the key to maintaining an active lifestyle. Try to continue being active even when motivation is low. Make sure all equipment is ready and don’t pre-think exercise-just do it.

  1. Set goals.

Set both short and long term goals to have something to work towards. Be realistic and start with small achievable goals and build up to a higher level of fitness.

  1. Build in rewards.

Having an incentive can help to get motivated. A reward could be anything from buying a favourite magazine, getting a manicure or taking time for reflection.

  1. Be aware of body signals.

Exercising is not about ‘no pain, no gain’. If an activity causes pain either slow down or stop altogether. Pain is a sign that something might be wrong, if it continues see a health practitioner.

  1. Have fun.

Enjoyment is essential to maintain a long term commitment to being more physically active. Be selective in choosing activities, get involved in group activities and when possible exercise with friends.

 

One of the most significant ways to decrease your PCOS symptom is by increasing your exercise. You need to start where you are and gradually increase, as you are able. My top 3 picks to a balanced exercise plan are resistance, aerobics, and stretching. First, resistance exercise, or weight training, helps to build lean muscle tissue. This lean tissue makes you stronger and raises your metabolic rate so you’ll burn fat faster. Second, aerobic exercise increases your heart rate, burns fat, and gives you that exercise high that can help to elevate your mood for the rest of the day. Third, stretching exercises help to prevent injury and help to calm the mind.

 

Sustainable weight-loss takes time and commitment.

 

 

The most important thing to remember before embarking on a weight-loss journey is that the best gift you can give yourself is time. Programs that claim to solve your weight-loss woes in a few weeks, after it has taken you 10 or 20 years to gain the weight, are misleading and irresponsible. Sustainable weight loss that does not compromise metabolic rate takes time. Those wanting to shift 10 kilograms need to dedicate three months, those wanting to lose 20 kilograms need six months and those wanting to shed over 30 kilograms need almost a year.

Others prefer weight-loss groups or consulting a dietitian. Whichever method you choose, make sure that one suits your lifestyle and its not a quick fix program.

Finally, once you have established a realistic timeframe and style of eating, the most important part of the weight-loss journey is learning to trust yourself. You know your body well enough to know whether your issues are overeating or not moving enough. You may need a professional to guide you in the right direction, but you are more than capable of monitoring your own food intake and committing to moving your body more.

Some of the best weight-loss outcomes come from making small, sustainable changes over a period of weeks. Simply reducing portion sizes, moving more and being mindful of extras that can slip in throughout the day can easily see a shift of three to five kilograms without much work at all.

Supplements

This is a big category that can include vitamins, minerals, micronutrients, and herbal medicines. It’s hard to narrow it down because each case is so unique in terms of priorities. So a tailor made program is recommended for you. Your naturopath will assess your current health status and make needed recommendations.

Sleep problems

Women with PCOS often experience sleep problems. The problems include snoring, uneven breathing patterns during sleep, and sometimes stopping breathing for short periods. This may be caused by increased weight. Women report they often wake up feeling tired, with a sore throat, and generally feeling low in energy throughout the day. If this happens to you discuss with your health practitioner for more natural sleep support.

Lifestyle

The most successful way to treat PCOS is by living a healthy life. The way you eat, exercise and generally stay healthy is the best way to reduce your symptoms. When making change to your lifestyle, avoid short term fad diets or changes you can’t keep up for long, make sure you are ready to change and that you have support around you. Importantly, set small achievable goals that you can manage such as always taking the stairs not the lift, try a pedometer and work out ways to increase your steps each day or changing to low fat milk or swapping juice for water and build these up slowly over time. Keep an eye on your weight and aim for prevention of weight gain or slow steady small weight losses.

Conclusion

PCOS is a very common condition caused by changes in two main hormones; insulin and male type hormones. It affects women differently with symptoms such as emotional challenges, increased body hair, acne, weight gain, problems getting pregnant and irregular periods. PCOS does not go away and in the longer term increases the risk of diabetes and heart disease risk factors. The best way to manage PCOS is by developing a good relationship with health professionals such as GPs, by living a healthy lifestyle, with a good diet and regular exercise.

 

In- Clinic testing

  • Iridology
  • Nutritional status
  • Gut flora status tests

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