Polycystic ovarian syndrome (PCOS) is a condition which arises due to hormonal imbalance. As a result, women with PCOS often have irregular menstrual cycles as well as unpredictable or missed ovulation. Small fluid-filled cysts may also develop in one’s ovaries but this is not always the case.
PCOS is one of the most common causes of female infertility as up to 15 per cent of women of reproductive age tend to have it. Women may get PCOS any time after puberty but most of them are diagnosed in their early 20s or 30s when they are trying to get pregnant.
The exact cause of PCOS is unknown, however, there is evidence that genetics may play a role in the development of this condition. Several other factors may also play a role in developing PCOS, including the presence of higher levels of male hormones known as androgens, insulin resistance and low-grade inflammation processes.
The most common symptoms of PCOS may include irregular periods; abnormal hair growth; acne, especially on the face, back and chest; obesity; skin darkening; abdominal pain; thinning of hair; skin tags; mood changes; chronic fatigue; and infertility.
At times, the symptoms may be milder and, as result, go unnoticed. In most cases, PCOS may be diagnosed after a pelvic physical examination, along with blood and pelvic ultrasound testing.
The medical treatment for PCOS is tailored to one’s symptoms and medical history and also considers whether one wishes to get pregnant in the near future.
Treatments for women who are not currently planning a pregnancy may include medications such as hormonal birth control, insulin-sensitising medicine, androgen blockers as well as lifestyle changes such as healthy eating, regular exercise, stress management and weight loss.
In those wishing to become pregnant, ovulation-inducing drugs as well as IVF therapy may also be offered upon consultation with a gynaecologist.
One of the best ways to cope with PCOS through balancing insulin sensitivity, body composition and weight management is to focus on improving one’s eating patterns as well as engaging in healthy eating and exercise routines that will also promote weight loss.
Even a small amount of weight loss can affect hormone levels and help to regulate one’s menstrual cycle. Several studies have linked obesity, body fat distribution and nutritional habits with the hormonal and metabolic profiles of PCOS. With insulin resistance now established as a key influence in the development of PCOS, lessening insulin levels and improving insulin sensitivity play an important role in its management.
Diet plays a significant role in the regulation of blood sugar and insulin levels. Hence, the adoption of a diet which is low in saturated fat and high in fibre, from predominantly low-glycaemic-index-carbohydrate foods, is suggested for women suffering from PCOS. The glycaemic index (GI) is a value used to measure how much specific foods increase blood sugar levels over time, when such food is eaten alone.
Foods may be classified as low, medium and high GI foods and correspondingly have a numeracy scale from 0 to 100. Low GI foods are those that are slowly absorbed. Thus, the blood sugar is released healthily in a slower pace, resulting in a GI rating of 55 or lower.
Low GI foods include unsweetened milk, nuts, pulses, wholegrain cereals, bread as well as most fruit and vegetables – with the exception of pineapple and watermelon, which are known to be high GI foods, due to having a GI of 66 and 72, respectively.
The medical treatment for PCOS is tailored to one’s symptoms and medical history
High glycaemic foods include sugary foods, white bread, potatoes, white rice as well as sugary soft drinks. For instance, white bread has a GI of 100 while wholemeal bread has a GI of 71. Such foods tend to be fast absorbed and, hence, blood sugar rises quicker in the body.
Carbohydrates make up to 45 to 60 per cent of one’s daily energy intake. In PCOS-friendly diets, it is important to choose low GI foods as the main sources of carbohydrates. Protein is also essential in flattening any blood-sugar curve rises. Recent evidence also suggests that a higher intake of protein improves both the blood sugar and insulin responses to a glucose load, hence, it is important to consume low GI foods with protein sources.
Good options for breakfast for PCOS sufferers may include a slice of wholemeal bread with home-made hummus, tomatoes and cucumber. Low-fat fruits, low-sugar yoghurts, nuts as well as chia seed puddings are also considered as suitable snacks.
A choice of healthy carbohydrates and protein that are adequate for lunch or dinner include salmon, chicken or omelette with spinach, with a choice of low GI carbohydrates such as quinoa, bulgar wheat, wholegrain rice as well as grilled or steamed vegetables. The dietary fibre found in fresh fruits and vegetables helps with improved satiety and is therefore associated with significant reductions in the glucose response after carbohydrate-rich meals.
Furthermore, as the human body has a virtually infinite capacity to store fat, it is recommended that individuals with PCOS consume less than 30 per cent of their daily total calories from fat. Ideally, the consumption of saturated fats should be very low and replaced with an increased consumption of unsaturated fatty acids, which are found in oily fish such as salmon, avocados, nuts and olive oil, which have been reported to improve insulin sensitivity.
If excess hair growth or acne are an issue, cosmetic treatments might also be helpful. Beauty salon treatments for acne may include the use of acne masks containing beneficial ingredients like sulphur and charcoal, which help dry out the surface of the skin by absorbing excess sebum. Specific serums and products are also used that usually contain other ingredients like vitamin C or salicylic acid. Vitamin C contains anti-inflammatory properties and helps reduce the redness and swelling that comes with acne whereas salicylic acid exfoliates and clears the pores.
During acne facial treatments, a high- frequency machine may also be used on the face, chest and back, which enriches the oxygen supply to the skin and leaves an antibacterial chemical reaction on the surface of the skin. During facials, a lymphatic drainage massage may also be performed, which encourages brighter skin, reduction in puffiness and helps with acne healing.
To complement all of this, relaxing body massages are always recommended to increase blood flow and improve circulation. Such salon treatments often go hand in hand with a home-care range of products, which include ingredients like tea tree oil that kills bacteria.
High testosterone levels in PCOS might also result in hair loss or hair thinning due to a hormonal imbalance in the hair follicles. Both of these hair conditions can be managed by regularly washing the hair with a specific shampoo and conditioner, intake of healthy hair vitamins as well as via home or salon treatments, such as hair masks and leave-in treatments which help in strengthening the hair follicle and prolong its longevity.
If a person is considering dyeing the hair, it’s important to avoid products that contain bleach or perm as well as straightening and keratin treatments. Moreover, when exposed to bright sunlight, the use of hair sunblock along with adequate coverage hats which offer maximal hair protection from UV rays is also advised.
Georgiana Farrugia Bonnici is a medical doctor, Thea Mifsud is a registered nutritionist, Claudia Borg is a beauty therapist and Clayton Balzan is a hair stylist.