There is no cure yet for PCOS. There are many medications and natural PCOS supplements available to assist with managing the syndrome. A healthy lifestyle with the correct diet and exercise regime as well as stress managing techniques and rest are imperative for a healthy life with PCOS.
What does insulin resistance mean?
Insulin is a hormone and like all hormones binds to its unique receptor. In the case of insulin, it binds to the insulin receptor. As a consequence of correct alignment and binding, signal transduction occurs (like placing your car key into your car starter motor and as long as it fits correctly, then the electronics come on and the car is ready to drive).
Signal transduction is the activating of a series of intra-cellular ‘relay stations’ (intra-cellular signaling molecules), which conduct the hormonal message. One of its many actions is to activate GLUT4 (Glucose transporter 4), which when activated migrates to the cell surface and literally open the ‘gate’ for glucose to enter the cell lowering blood glucose levels. Hence GLUT4 is the cellular ‘gatekeeper’ for glucose disposal out of blood into the cell.
If any point along the signal transduction pathway is interrupted, the removal of sugar from the blood into the cell will not occur effectively, homeostatic mechanisms will results in more insulin release to ‘try to lower sugar levels and the vicious cycle continuous. This is Insulin Resistance.
In PCOS there are insulin receptor (IR) gene polymorphisms and insulin receptor substrate (IRS) polymorphisms suggesting that the encoded gene product being the insulin receptor or insulin receptor substrate will malfunction in its ability to relay the signal to GLUT4 to get over to the cell surface and let sugar in.
The ‘toxic brew’ of high insulin and high blood sugar levels are part of the range of pathological consequences in PCOS like ovarian dysfunction with hyper production of androgens and oestrogens disturbing pituitary hormone secretion inducing low FSH/LH ratio which further disturbs ovarian function preventing maturation of follicles and a ‘polycystic’ state.
Metabolically, insulin resistance also induces weight gain, fat deposition, fatty liver, higher chance of Type 2 Diabetes, and cardiovascular disease and high blood pressure.
But I am thin, can I still get PCOS?
But just as some young women with a lot of ovarian cysts do not have PCOS, some women with Metabolic Syndrome and insulin resistance are thin. At least 30% of women with PCOS are not overweight or obese
I have been told I have cysts on my ovaries, does that mean I have PCOS?
It is not uncommon for women to have an occasional ovarian cyst/cysts. However chronic ovarian multiple enlarged immature follicles ‘cysts’ with hyper androgenism, and weight gain with irregular periods is more likely to be PCOS.
Can I fall pregnant with PCOS?
Indeed, but it may be more difficult. Firstly, you need to ovulate at the time of sexual activity, then conception needs to occur and healthy implantation and growth is a prerequisite for a healthy pregnancy. .
All these processes are more problematic in PCOS patients with poor ovulation, less chance of fertility, higher risk of miscarriage and higher risk of gestational diabetes which also places the baby at risk.
The better treated the PCOS is, the more likely the pregnancy has a chance for healthy delivery.
Are there foods I should avoid or include more of?
All foods provoking an insulin response should be avoided. All sugar, sugar in all and every form including avoiding honey, all syrups (rice syrup, maple syrup, agave syrup etc.), all high glycemic index fruit (essentially all fruit except a very small serving of berries (what you can fit in the palm of your hand, i.e. a few blueberries, raspberries and strawberries). Avoid all dried fruit, all sauces which have sugar added, all packaged or canned food which has sugar added and do not forget alcohol especially fermented alcohol like wine, beer, sparkling wine, sherry, port. Minimal amounts of spirits if you want an alcoholic drink would likely be a better choice.
Avoid all storage vegetables like pumpkin, carrot, potato butternut squash, as well as all grains (wheat, rice, oats, corn, barley, rice, millet quinoa etc which are in pasta, bread breakfast cereals crackers
Can I have surgery to remove my cysts? Will that help?
Very rarely is surgery done. Medical treatment is always the first option. The original discovers of this illness, Doctors Stein and Leventhal in the 1930’s found that wedge resection of ovaries of their PCOS patients ‘cured’ their condition. Discuss with your gynecologist once you have tried a conservative approach with diet, exercise, supplements and medications.
People have told me that PCOS is only a problem to worry about when I want to get pregnant. Is this true?
No, PCOS affects multiple systems of your body. At a cosmetic level, treatment of acne and hair growth topically will be temporary and not change the drivers of the hyperandrogens. The persistent hyperinsulinemia and ensuing hormonal and metabolic dysfunction, need careful investigation and treatment. Some women have a milder form of the illness and may not even be aware that there is an obvious problem, feeling they are not eating well and not exercising enough and have unusual cycle which is their ‘normal’. All this may be underlying PCOS.
Remember PCOS occurs about one in every 10 women (approximately 10% 10 women in a hundred), so it is surprisingly common.
My doctor told me I have to take contraceptive pills to have a period. Why do I have to have a period?
Without a period as a starting point of a cycle, the normal maturation of follicles and selection of a dominant follicle for ovulation cannot occur.
Taking the oral contraceptive pill may regulate your cycle, lower androgens and correct some of the hormonal imbalances. However, the Pill contains potent synthetic oestrogens, which some women react to as PCOS is a condition of hyperoestrogenemia. The MiniPill which is a progestin (synthetic form of progesterone) maybe an alternative.
I have noticed a discoloration around my neck. Is this anything to be concerned about?
Discolouration around the neck under the arms and in the groin in PCOS patients is called Acanthosis Nigricans. It occurs in about 30% people with PCOS and likely caused by high insulin. By lowering insulin the condition should improve.