Polycystic Ovary Syndrome (PCOS) is a relatively new condition which was only defined in 1988. Since its recognition, more and more women, and even teenage girls as young as 11 years of age, are being diagnosed with this syndrome. Many of the symptoms that characterise PCOS are diet-related and require dietary interventions as part of the overall treatment.
Symptoms of PCOS
According to René Smalberger (2010), the President of the Association of Dietetics in South Africa (ADSA) and the US Department of Health and Human Services (2010), polycystic ovary syndrome is diagnosed when a woman has the following cluster of symptoms:
- Hyperandrogenism (excessive production of androgens or male hormones) which can cause hirsutism (male-pattern growth of hair on the face, chest, stomach, back, thumbs, toes)
- Irregular or absence of menstrual periods
- Development of many small cysts in the ovaries
- Infertility due to hormonal imbalances and the ovarian cysts that prevent ovulation
- Acne, oily skin or dandruff and other skin manifestations such as thick, dark brown or black patches of skin on the neck, arms, breast or thighs, and excessive skin tags (small skin flaps in the armpits or on the neck)
- Weight gain, obesity especially so-called android obesity around the waist and in the abdomen, which tends to resist attempts at weight loss
- Hair loss particularly male-pattern loss of hair and baldness
- Sleep apnoea - patients stop breathing for short periods during sleep
- Anxiety or depression
- Insulin resistance with raised insulin and blood glucose levels. Insulin resistance increases the risk of developing type 2 diabetes mellitus, hypertension and heart disease (metabolic syndrome)
(Smalberger, 2010; USHHS, 2010)
Incidence of PCOS
Researchers believe that up to 10% of women in their reproductive years suffer from PCOS. What is particularly troubling is the fact that girls are being diagnosed with PCOS at younger and younger ages (USHHS, 2010).
Causes of PCOS?
At present we are not sure what causes PCOS, but there seems to be a strong genetic tendency for women in some families to develop PCOS. Another theory proposes that the overproduction of insulin may be linked to all the other hormonal derangements and symptoms, particularly the production of androgens (USHHS, 2010).
Unipolar or bipolar psychiatric patients were found to have a higher incidence of obesity (57-68%) and are more likely to suffer from metabolic syndrome (25-49%) (Smalberger, 2010). At this stage it is not possible to say if psychiatric conditions like bipolar disorder (manic-depressive disorder) or the use of antidepressants cause PCOS and insulin resistance, or if developing PCOS and insulin resistance with all its attendant problems, causes depression.
PCOS usually requires a team approach. Medical specialists such as gynaecologists and dermatologists will treat the hormonal and skin/hair manifestations of this condition, while endocrinologists or physicians may assist with prescribing medications to help control raised insulin and blood fat levels, as well as hypertension. Patients with bipolar disorder require treatment by a psychiatrist and/or clinical psychologist.
However, most of the symptoms and problems related to PCOS, insulin resistance and metabolic syndrome also require dietary treatment, for example:
- Control of blood glucose and insulin levels by means of a low-glycaemic index (GI) and glycaemic load (GL) diet
- Weight loss by using a reduced-energy, low-fat, low-GI diet. Weight loss can in many cases reduce the symptoms of PCOS and insulin resistance dramatically
- Control of raised blood fat levels by means of a diet that is low in total fat, cholesterol, saturated fatty acids and trans-fats
Self-help for Patients
Your PCOS, insulin resistance or metabolic syndrome may be diagnosed by your GP during a routine checkup, or your gynaecologist when you go for fertility treatment, your dermatologist when you develop acne, male-pattern baldness and/or hirsutism, a physician if you develop resistant obesity, raised blood fat levels, hypertension or type 2 diabetes, or by a psychiatrist if you suffer from bipolar disorder or depression.
However, if your doctor does not refer you to a dietician for an appropriate diet to help you lose weight, control diabetes or hypertension, or lower your blood fat levels, you as the patient need to ask the doctor to refer you to a clinical dietician.
You can also find a dietician on your own by visiting the Association for Dietetics in SA website and clicking on "Find a Dietician" to find a dietician in your area so that you can make your own appointment to obtain dietary assistance.
The correct diet is an integral part of the treatment of PCOS and all its manifestations, so make quite sure that you don’t miss out on this vital part of your treatment.
- (Dr IV van Heerden, DietDoc, May 2010)
(Smalberger R (2010). Food for insulin resistance and polycystic ovary syndrome. The Specialist Forum, Feb 2010, pp: 40-41; USHHS (2010). Polycystic Ovary Syndrome (PCOS). Frequently asked questions. US Department of Health & Human Services. (http://www.womenshealth.gov/faq/polycystic-ovary-syndrome.cfm)