The treatment of PCOS (polycystic ovary syndrome) aims to improve PCOS symptoms, manage any health risks that come with PCOS, and improve overall quality of life. The treatment or approach may vary depending on the person's specific symptoms, goals, and plans for fertility - and the doctors they're working with. At Fertifa, we have an in-house clinical team who have specialised in women's health issues like PCOS for many years.

What is PCOS?

Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects the reproductive system in women. It is characterised by a combination of signs and symptoms. The most common symptoms of PCOS include:

The most common symptoms of PCOS

• Irregular menstrual cycles: One of the hallmark symptoms of PCOS is irregular or absent menstrual periods. Women with PCOS may experience infrequent periods or have cycles that are longer or shorter than average.
• Ovarian cysts: PCOS is named after the presence of small cysts on the ovaries. These cysts are actually follicles that have not developed properly and contain eggs. However, not all people with PCOS have ovarian cysts, and their presence is not necessary for diagnosis.
• Hyperandrogenism: PCOS often causes an excess production of androgens (male hormones). This can lead to symptoms such as hirsutism (excess hair growth on the face, chest, back, or other areas), severe acne, and hair thinning or loss on the scalp.
• Weight gain and difficulty losing weight: Many people with PCOS struggle with weight management. PCOS can make it harder to lose weight due to insulin resistance, which can lead to excess weight gain, particularly in the abdominal area. It is completely normal to worry about maintaining a normal weight, but remember that PCOS looks different in each individual and consulting with your healthcare provider is a great step to discuss weight concerns. No matter how your body mass and composition changes, remember that it is completely normal and sometimes even healthy to gain extra weight
• Insulin resistance and type 2 diabetes: Insulin resistance is a common feature of PCOS, where the body's cells do not respond adequately to insulin, resulting in high blood sugar levels. Over time, this can increase the risk of developing type 2 diabetes.
• Skin issues: PCOS can be associated with skin issues, including oily skin, severe acne, and acanthosis nigricans (darkening and thickening of the skin, often in body folds such as the neck, armpits, or groin).
• Mood changes: Some people with PCOS may experience mood swings, anxiety, or depression. The hormonal imbalances and the impact on body image can contribute to these emotional changes.
• Cholesterol levels: People diagnosed with PCOS may be at a higher risk for experiencing elevated cholesterol which can increase the risk of heart attack or stroke. These hormone imbalances can be confirmed with tests and by seeing your healthcare provider.

It's important to note that PCOS symptoms can vary greatly between individuals, and not all people with PCOS will experience all of these symptoms. The diagnosis of PCOS is typically made based on a combination of symptoms, a physical examination, and laboratory tests. If you suspect you have PCOS, it's important to consult with a healthcare professional for proper evaluation and diagnosis.

What are the risks of PCOS?

PCOS increases the risk of developing endometrial cancer due to the prolonged exposure of the endometrium to unopposed estrogen (or oestrogen). This can lead to endometrial hyperplasia and may lead to endometrial cancer if not treated and regulated. Following some of the steps and treatments discussed below can help you manage and treat PCOS to avoid the risk of endometrial cancer.

There is also a risk of developing fertility issues in people with PCOS. People of childbearing age who are trying to conceive may need additional hormone therapies or alternative treatments.

How to treat PCOS

Diet

Following a balanced diet that is low in processed foods, added sugars, and refined carbohydrates while including things like whole grains, lean proteins, fruits, and vegetables can help regulate blood sugar levels and improve overall health.

Benefits of a Healthy Diet

Following a healthy diet can play an important role in helping to regulate and manage PCOS symptoms. The health benefits of certain dietary choices will vary and are not always the same from person to person. Here are some recommendations that may help:

1. Balanced and nutrient-dense diet: Focus on consuming a balanced diet that includes a variety of whole foods, such as fruits, vegetables, lean proteins, whole grains, and healthy fats. This can help regulate blood sugar levels, manage weight, and provide essential nutrients.

2. Low Glycemic Index (GI) foods: Choose foods with a low glycemic index, as they have a slower and steadier impact on blood sugar levels. This includes foods like whole grains, legumes, non-starchy vegetables, and low-sugar fruits.

3. Complex carbohydrates: Opt for complex carbohydrates over refined carbohydrates. Whole grains, such as quinoa, brown rice, and oats, provide more fibre and nutrients, and they help regulate blood sugar levels.

4. Healthy fats: Include healthy fats in your diet, such as avocados, nuts, seeds, and olive oil. These fats can help improve insulin sensitivity and promote hormone balance.

5. Lean proteins: Choose lean sources of protein, such as chicken, fish, tofu, beans, and lentils. Protein can help stabilise blood sugar levels, promote satiety, and support muscle health.

6. Reduce added sugars and processed foods: Limit or avoid foods and beverages that are high in added sugars, as they can lead to insulin spikes and worsen insulin resistance. Additionally, minimise processed foods, which are often high in unhealthy fats, added sugars, and refined carbohydrates.

7. Portion control: Pay attention to portion sizes and practice mindful eating. Be aware of your hunger and fullness cues, and aim for balanced meals that include a combination of protein, carbohydrates, and healthy fats.

8. Regular meal patterns: Establish regular meal patterns by eating at consistent times throughout the day. This can help stabilise blood sugar and insulin levels and support hormonal balance.

9. Hydration: Drink plenty of water and avoid sugary beverages. Staying hydrated is important for overall health and can help with digestion and metabolism.

10. Individualised approach: Work with a registered dietitian or healthcare professional experienced in PCOS to develop an individualised diet plan tailored to your specific needs, preferences, and health goals.

Remember, lifestyle modifications such as diet changes take time to show significant effects. Consistency, patience, and a long-term approach are essential for successful management of PCOS through diet.

Foods to avoid with PCOS

When managing PCOS through diet, it can be helpful to be mindful of certain foods that may exacerbate symptoms or contribute to insulin resistance. While individual responses to foods can vary, here are some general recommendations on foods to limit or avoid:

1. Refined carbohydrates: Foods high in refined carbohydrates, such as white bread, white rice, sugary cereals, pastries, and sweets, can cause rapid spikes in blood sugar levels and worsen insulin resistance. Opt for whole grains and complex carbohydrates instead.

2. Added sugars: Foods and beverages with added sugars, such as soft drinks, fruit juices, candies, and sweetened snacks, can lead to increased blood sugar levels and weight gain. Check food labels for hidden sources of added sugars and choose naturally sweetened alternatives when possible.

3. High-Glycemic Index (GI) foods: High-GI foods, like white potatoes, instant rice, and some breakfast cereals, can cause blood sugar levels to rise quickly. Choose lower-GI options such as sweet potatoes, quinoa, and steel-cut oats.

4. Saturated and trans fats: Limit the intake of saturated fats found in fatty meats, full-fat dairy products, and processed foods. Avoid trans fats commonly found in fried and commercially baked goods, as they can increase inflammation and cardiovascular risks.

5. Processed and packaged foods: Processed and packaged foods often contain unhealthy fats, added sugars, and high sodium levels. Opt for whole, unprocessed foods whenever possible.

6. Caffeine and alcohol: While moderate consumption may be acceptable for some individuals, excessive caffeine and alcohol intake can disrupt hormone balance and impact insulin sensitivity. It's best to consume these in moderation or avoid them if you notice they worsen your symptoms.

7. Dairy products: Some women with PCOS may be sensitive to dairy products. If you suspect dairy intolerance or notice worsened symptoms after consuming dairy, consider reducing or eliminating dairy from your diet. Opt for non-dairy alternatives like almond milk or soy milk if needed.

8. High-sodium foods: Foods high in sodium, such as processed meats, canned soups, and fast food, can contribute to water retention and bloating. Be mindful of your sodium intake and choose low-sodium options when available.

Remember, these recommendations are general guidelines, and it's important to listen to your body and work with a registered dietitian, Fertifa doctor or healthcare professional experienced in PCOS to develop a personalised diet plan that suits your needs.

Exercise

Engaging in moderate-intensity aerobic exercise for at least ~150 minutes per week can help improve insulin sensitivity, manage weight and weight loss, and regulate menstrual cycles.

• Improved insulin sensitivity: Regular exercise helps improve insulin sensitivity, which is often impaired in PCOS. By making your body's cells more responsive to insulin, exercise can help regulate blood sugar levels, reduce insulin resistance, and improve metabolic function.
• Weight management: PCOS is often associated with weight gain or difficulty losing weight. Exercise can aid in weight management by burning calories, increasing muscle mass, and boosting metabolism. Maintaining a healthy weight can help regulate menstrual cycles, reduce androgen levels, and improve fertility.
• Hormone regulation: Exercise can help balance hormone levels in the body. It may help lower excessive androgens (male hormones) that are often elevated in PCOS, which can contribute to symptoms such as acne, hirsutism (excess hair growth including facial hair), and irregular menstrual cycles.
• Stress reduction: Regular physical activity can help reduce stress and improve mood. PCOS can be associated with increased stress levels, and exercise can provide natural stress relief, promoting overall wellbeing.
• Cardiovascular health: PCOS increases the risk of cardiovascular diseases. Exercise, particularly aerobic activities like brisk walking, jogging, cycling, or swimming, can improve cardiovascular health, lower blood pressure, and reduce the risk of heart disease.

Some tips for incorporating exercise into your PCOS management

• Aim for a mix of aerobic exercise and strength training. Aerobic exercises help improve cardiovascular health, while strength training builds lean muscle mass, which can increase metabolism and aid in weight management.
• Start slowly and gradually increase the intensity and duration of your workouts. Consistency is key. Begin with 15-20 minutes of exercise and gradually work your way up to at least 150 minutes of moderate-intensity aerobic activity per week.
• Find activities you enjoy to make exercise more sustainable. Whether it's dancing, swimming, cycling, or any other form of physical activity, choosing something you enjoy will help you stay motivated and engaged.
• Include resistance training 2-3 times per week to build strength and muscle mass. This can be done using free weights, resistance bands, or bodyweight exercises.
• Incorporate both structured workouts and daily movement. Look for opportunities to be active throughout the day, such as taking the stairs instead of the elevator or going for a walk during your lunch break.
• Listen to your body and adjust your exercise routine as needed. If you experience any pain or discomfort, consult with a healthcare professional or a certified fitness trainer for guidance.

Remember, it's important to consult with your healthcare provider before starting any new exercise regimen, especially if you have any underlying health conditions, medical history or concerns. They can provide personalized recommendations and ensure that exercise is safe and appropriate for you.

Medications and Supplements

In some cases, medication may be prescribed to manage specific symptoms or underlying hormonal imbalances. Always consult your healthcare provider about which mediation might work best for you and your symptoms.

Prescription Medications Used to Treat PCOS

• Oral contraceptive pills: Birth control pills containing estrogen and progestin can help regulate irregular periods and reduce androgen levels. Hormonal birth control can also be used as an acne treatment.
• Anti-androgen medications: Medications such as spironolactone may be prescribed to reduce excessive hair growth (hirsutism) and improve acne by blocking the effects of androgens.
• Metformin: This medication is commonly used to manage insulin resistance and can help regulate menstrual cycles, improve fertility, and reduce the risk of developing type 2 diabetes.
• Fertility medications: Women trying to conceive may be prescribed medications to induce ovulation, such as clomiphene citrate or letrozole.

Over-the-Counter Herbal Supplements for Treatment of PCOS

While there are several over-the-counter (OTC) herbal supplements available that claim to help manage PCOS symptoms, it's important to approach them with caution. While some herbal supplements may have anecdotal or traditional evidence supporting their use, their effectiveness and safety have not been extensively studied in well-controlled clinical trials. Herbal supplements are not regulated as strictly as prescription medications, so the quality and potency of these products can vary.

Before considering any herbal supplement for PCOS treatment, it's crucial to consult with a healthcare professional who is knowledgeable about herbal medicine and PCOS. They can provide guidance based on your specific situation and help ensure that any potential risks and interactions with other medications are considered.

Here are a few herbal supplements that have been suggested for PCOS symptom management that you can discuss with your healthcare provider to see which might complement your other treatments best.

• Cinnamon: Some studies suggest that cinnamon may help improve insulin sensitivity and regulate menstrual periods in women with PCOS. However, more research is needed to establish its efficacy and safety.
• Inositol: Inositol, specifically myo-inositol and D-chiro-inositol, has shown promise in improving insulin sensitivity, ovarian function, and fertility outcomes in women with PCOS. It is available as a supplement and is generally considered safe, but it is still recommended to consult with a healthcare professional before starting it.
• Spearmint tea: Spearmint tea has been traditionally used to manage unwanted hair growth in women with PCOS. Some studies suggest that it may have anti-androgenic effects, but more research is needed to confirm its effectiveness.
• Vitex agnus-castus (chasteberry): This herb is commonly used for hormonal imbalances and menstrual irregularities. It may help regulate menstrual cycles, but evidence specifically for PCOS is limited, and it may not be suitable for everyone.

Remember, herbal supplements should not replace conventional medical treatments for PCOS. They should be used as complementary options, and it's important to inform your healthcare provider about any supplements you are taking to ensure safe and effective management of your condition.

Other treatments for PCOS

Depending on the specific symptoms and needs of the individual, additional treatments may be recommended. For example, laser hair removal or electrolysis can be options for managing excessive hair growth. In cases where fertility is a concern, assisted reproductive technology (ART) and fertility treatments may be used, such as in vitro fertilisation (IVF) or intrauterine insemination (IUI).

Working with a healthcare provider or your Fertifa doctor to come up with a personalised treatment plan is a great way to get started with your PCOS treatment. Understanding how best to treat PCOS can help prevent long-term health problems. Remember, it's always recommended that you discuss several different treatment options for PCOS as everyone is unique and will respond in different ways to treatments.