For those who menstruate, periods might be something we don’t take much notice of. Some may find their 28-day cycle runs like clockwork, yet others struggle with irregular periods which can differ in the flow and length, or have cycles that vary from the average time. And while irregular periods may be normal for you and can happen for all sorts of reasons, one possible cause is polycystic ovary syndrome (PCOS).
PCOS is a common endocrine disorder that affects the way the ovaries work. It’s thought to affect one in 10 women, yet many may not even know they have it, with the condition often only coming to light when they’re investigated for irregular periods, or sometimes if they’re trying to start a family. So although it’s reasonably common, there’s still a lot we don’t yet know about PCOS. Here, we’ll set the record straight with some key facts.
The 2021 Fertility Journey Survey showed that 49% of those taking part didn’t actually realise they had PCOS until they started trying to conceive.
Since PCOS often diagnosed during fertility investigations, many worry it will impact their ability to conceive. Himanshu Borase, fertility specialist and consultant gynaecologist at Herts Fertility, says: “One third of those I see at fertility clinics have PCOS. One of the reasons that PCOS patients struggle is that they may not be releasing an egg regularly.”
Releasing eggs to ovulate is what is needed to conceive. However, studies show that the majority of those with PCOS who wish to have children do go on to do so, many without needing fertility treatment.
Despite the name, your ovaries aren’t covered with cysts like you might imagine. Instead, the cysts often refer to harmless follicles. People with PCOS have more follicles than those who don’t, and these follicles are often unable to release an egg. While they may look ‘cyst-like’, they aren’t true cysts – they don’t behave like cysts in that they won’t burst or grow bigger, and aren’t in any way linked to more serious conditions, such as ovarian cancer.
We often talk about PCOS in relation to periods, but the condition can affect your hair and skin as well. This is because women with PCOS have excess androgen – in other words higher levels of male hormones in your body, which can manifest in ways such as an increase in facial hair. Studies have shown PCOS can result in hair and skin problems, such as hair loss, acne, and seborrhea (a red itchy skin rash with white scales).
PCOS is thought to run in families, so you’re more likely to develop it if a close relative has PCOS, too. However, that doesn’t mean it’s simply genetic. Other factors are linked to PCOS as well, including high levels of insulin in the body.
“People with PCOS are often insulin resistant, which means your body does not effectively utilise the insulin you produce,” explains nutritional therapist Michele Scarr. “The body may try to increase the levels of insulin it produces to keep your blood sugar levels normal. Higher levels of insulin can lead to an increase of testosterone, which may disrupt the hormonal balance and exacerbate PCOS symptoms.”
Insulin resistance is why PCOS is also linked to diabetes. A recent study published in Human Reproduction Open that followed women with PCOS showed that around 19% of participants went on to develop type 2 diabetes, compared to just 1% of the control group. While this means it’s certainly not inevitable, if you experience any symptoms of diabetes it’s really important to make an appointment to speak with your GP.
Like many long-term health conditions, PCOS can impact both your mental and physical health. A study by the University of Cardiff found women with PCOS were more likely to be diagnosed with mental health conditions such as depression, bipolar disorder, and anxiety. While another study in the Journal of Pharmacy & BioAllied Sciences showed that 40% of those with PCOS can experience depression.
There are a few reasons why that may be. PCOS is driven by hormones, so the altered hormonal levels may impact mental health. It may also be due to the stress and worry of living with PCOS – the unpredictable nature of periods, or undergoing fertility treatment to conceive.
While having an irregular cycle could make trying for a baby more tricky, those with PCOS can still fall pregnant – so if that’s not on your agenda, contraception is important. The contraceptive pill is often used as this can also help regulate cycles in those with PCOS, but it may take some experimenting to find one that works best for you.
“There is evidence that combined pills are beneficial for women with PCOS due to the oestrogen, which counteracts high testosterone levels and improves symptoms such as acne,” explains GP and medical director of The Lowdown, Dr Frances Yarlett. “However the progestogen part of the combined pill can also help to improve symptoms.”
Given what we know about the role of insulin in PCOS there are studies that show following a low-carbohydrate diet may help with this. But why?
“Reducing refined carbs can help manage blood sugar, and also help with weight loss. Replacing refined carbohydrates with lower GI, high fibre options can slow down digestion and the release of glucose into the bloodstream,” says nutritionist Michele Scarr.
When insulin resistance occurs, the body produces higher levels than normal. This causes ovaries to produce too much testosterone, which can impact or prevent ovulation. This cycle happens to women with PCOS, and the extra insulin in the body can lead to weight gain, with studies showing that between 40–80% of women with PCOS are ‘overweight’. But, it’s important not to feel at blame for this.
“Women with PCOS don’t burn off as much weight, even when they’re eating exactly the same amount of food compared to weight match controls,” explains Professor Colin Duncan of the University of Edinburgh.
Remember though, your value is not determined by a number on a scale.
PCOS is usually diagnosed in premenopausal women, but just because you stop having periods doesn’t necessarily mean your PCOS will stop. For those embarking on the menopause, it also brings additional challenges as symptoms can be similar.
Whether you’re looking to regulate periods, or are trying to start a family, be sure to speak to your GP for support and advice on managing PCOS.
To connect with a nutritionist like Michele, or to find out more about PCOS, visit nutritionist-resource.org.uk
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