PCOS Deep Dive

Polycystic ovarian syndrome (PCOS) is a hormonal condition that affects 10% of menstruating people in their reproductive years and is the leading cause of infertility. However, PCOS is more than a fertility issue; it is a whole-body chronic condition.

Although there is no cure for PCOS, symptoms can largely be managed through lifestyle changes and understanding the root cause of your condition. Every case of PCOS is unique and there is no “one size fits all” solution. Thus, each treatment plan should be personalized and aligned with your lifestyle, values, and goals.

This journey will look different depending on the individual, which is why Pollie focuses on creating personalized recommendations for each of our members. In today’s article, we want to share several general lifestyle tips to help you start thinking about ways to customize your own PCOS management. 

PCOS and nutrition

Research has shown eating foods that help to stabilize blood sugar and lower inflammation has been proven to improve PCOS symptoms, but there is no “perfect diet” that fits all of our bodies and circumstances. However, you may have noticed that certain dietary modifications (low-carb, keto, gluten-free, and plant-based, just to name a few) are frequently recommended to people with PCOS. The evidence on these diets is mixed, but eliminating entire food groups is not an approach that works for everyone.

Rather than focusing on restrictive diets, maintain a sustainable way of eating by following an intuitive eating approach to nourish your body. Making a lot of changes can be overwhelming, so let's keep it simple. Below are some general guidelines to follow.

Break out of diet culture mentality: PCOS is a chronic condition that requires long-term and sustainable habits. Restrictive approaches can end up being more harmful in the long run.

Focus on the quality of your meals over quantity: Focus on the nutrients that each meal is providing you. You can do this by visualizing your plate filled half with veggies, a quarter with whole grains, and a quarter with quality protein. Don’t forget to also include some healthy fats in there like seeds or nuts!

Stop restricting carbs: When it comes to carbs, choose whole grains instead of simple, refined carbs and limit liquid carbs. You can still have these items, but just be mindful of how much you are consuming.

Focus on whole foods: Consuming whole foods will ensure you are getting optimal nutrients with every choice you make. This helps to steady hormones related to appetite regulation, sugar balance, and stress.

These guidelines are simple to follow if you make your meals at home, but can also be a great template for when you are ordering out as well!

PCOS and movement

When it comes to exercise, the most important thing is to find a form of movement that is as good for your mind as it is for your body. And that is going to look different for everyone! Exercise has been shown to improve PCOS symptoms by improving insulin regulation, mental health, sleep, and metabolic function (1, 2, 3). 

Are high intensity workouts safe for people with PCOS?

People with PCOS tend to have a higher rate of insulin resistance than the general population and high intensity exercises can be especially helpful to improve insulin regulation and body composition. That said, the key takeaway here is still to avoid putting excess stress on the body, which can often happen if you overdo high intensity workouts. Allowing your body time to recover and incorporating low-impact movement like yoga, pilates, or hikes, can also be helpful! 

If you have PCOS and are not insulin resistant, being sure to emphasize gentle movement and recovery will be even more important. That is because stress and inflammation is a likely culprit of your symptoms. 

Read more on how you can balance high intensity workouts with PCOS here.

How can I balance movement with PCOS?

If you are still trying to figure out how to incorporate more movement into your routine, check out the tips below.

Find movement you love: Movement does not equal going to the gym or signing up for expensive classes. It can also include things like going on walks, hiking with friends, jamming out to your favorite songs, or playing sports with your community.

Try new things: Switch up your routine to find fun ways to incorporate movement into your schedule! Whether it’s trying yoga for the first time or going to laser tag, exploring different activities can help you move your body when you are feeling bored.

Find your “why”: Getting into a new routine is not easy, and most people push through several weeks or even months of discomfort before getting into the groove of a new workout regimen. But understanding how consistent movement can improve your PCOS symptoms and overall health can serve as motivation.

Don’t be too hard on yourself: Try to avoid criticizing yourself and feeling guilty for skipping a workout on a busy week. Remember that it’s the small changes overtime that will lead to long-term improvements for your mind and body!

PCOS and stress management

Another major lifestyle component that plays a role in PCOS management is stress management.

Stress can worsen and even catalyze PCOS symptoms due to the consistent elevated cortisol levels that results from specifically, chronic stress. Daily elevated cortisol levels can disrupt the hypothalamus-pituitary-adrenal axis (HPA axis), which plays an important role in how the body reacts to stress (4). When there is dysfunction in the HPA axis, hormones are not at optimal levels and can lead to fatigue, weight gain, and lack of sleep. Additionally, cortisol can impact androgens, or our male hormones like testosterone and DHEA-S. Unmanaged, constant stressors in life can inadvertently increase androgens even more and worsen symptoms.

PCOS itself is a stressful and complicated condition. From its physical manifestations to the way it increases risk for other chronic conditions, there is a vicious cycle when it comes to stress and PCOS. That’s why it’s important to incorporate stress management tools that fit your lifestyle to improve your health both physically and mentally. 

How can I keep my stress under control?

Getting stress under control is no easy feat, but being aware that you are ready to make a change is the first step. Below are several ideas for stress management:

• 1-1 therapy: If therapy is financially possible, we recommend exploring this as an option. Especially when it comes to stress, learning how to rewire the thought patterns in your brain through cognitive behavioral therapy (CBT) or another therapeutic technique can be life changing.
• Group therapy: If 1-1 therapy is not realistic for you but you still are craving more structured counseling, we recommend considering group sessions. This can be a wonderful way to learn from others and learn therapeutic frameworks, all while paying a lower price point.
• Support groups: For many, peer support is a powerful tool. Chronic stress can be isolating, and connecting with others with similar goals can be a great support mechanism and accountability tool.
• Meditation: Meditation has been shown to have positive effects on stress and has even shown to be helpful for conditions worsened by stress, such as PCOS (5). There are various resources centered around meditation and you can find many options for self-guided meditations.
• Mindfulness techniques: Using a blend of principles from both meditation and psychotherapy, mindfulness frameworks can be an easy thing to learn and start incorporating into your everyday life. 
• Routines that center you: Keep a list of activities on your phone or near your desk so that you can easily pick something from the list when you are feeling overwhelmed. We recommend having ideas with a variety of times involved (e.g., full-day hike vs. a 5 minute stretching session) so that you can pick and choose according to your schedule.
• Medication: While many people are able to manage their anxiety sans-pharmaceuticals, there is no shame in turning to medication for the short, medium, or long-term if your mental health is taking a toll on your quality of life. 

Rest and PCOS

Sleep is critical for helping your mind and body recover and recharge and has been linked to memory consolidation (6). Without quality rest you may experience brain fog and an inability to focus, but lack of sleep goes even deeper than that - especially if you have PCOS.  Sleep is also significant for managing stress levels and vice versa. And, keeping your stress under control is a key part of keeping PCOS symptoms and inflammation at bay. However, people with PCOS often experience hormone imbalances relating to cortisol and melatonin. 

Since both of these hormones are responsible for the sleep-wake cycle, these imbalances can cause sleep disorders such as insomnia and sleep apnea and subsequently contribute to additional stress, thus catalyzing a vicious feedback loop (7). 

How can I establish a sleeping routine?

Establishing a sleep routine can also improve its quality and the amount of sleep you get. Perhaps the most important thing to maximize the quality of your shut-eye is your sleep routine.

Below are some general tips that you can try:

• Limit screen time: If possible, try to avoid screens for at least 30 - 60 minutes before bed. The more time you put away your cell phone, laptop, and TV, the better! 
• Consider blue light glasses: Blue light glasses can help filter out blue light from electronic screens, which has been shown to be particularly aggravating from a vision as well as sleep perspective. These can be particularly helpful in the morning and before bed, but many people see a difference from wearing them through the course of the day. 
• Aim for morning sunlight: Getting morning sun exposure within a few minutes of waking can help regulate your circadian rhythm. Bonus points if you can get outside at several points throughout the day! 
• Give yourself time to digest after dinner: Many people are aware it is not good to eat right before bed. While having a large meal and going to sleep right afterward probably won’t make you feel too good, some people with blood sugar regulation issues do find that a small snack with protein before bed can help balance their blood sugar levels. 
• Be mindful of caffeine intake: Even if you do not feel like your afternoon cup of coffee gives you jitters, it may be taking a toll on your sleep. Try to stick to caffeinated beverages just in the morning.
• Optimize your sleep environment: The “best” sleep environment is said to be quiet, cool, and dark. If this does not reflect your room, consider investing in a white noise machine or blackout shades. 
• Be consistent: Establishing a regular-wake sleep schedule, such as waking up and going to bed at the same time every day, can be helpful for helping your body get into a better sleep schedule. 
• Practice breathing exercises: If your mind races at night, try guided breathing techniques or meditation to shift your focus on something else.

Supplements and PCOS

Finally, supplements can be especially helpful for people with PCOS. Many studies have recommended some dietary supplements to be a part of managing PCOS because each has at least one functional property in PCOS-induced pathways (8). Talk to your healthcare profession about how dietary supplements may be able to assist in the management of your PCOS. Common PCOS supplements include (8): 

• Magnesium: The research on magnesium supplementation is not concrete at present. Some studies suggest that magnesium may play a role in improving insulin resistance due to its links to glucose metabolism..
• Inositol: Inositol is often combined with metformin and can help to enhance insulin function. It has also been shown to move glucose into our cells faster, helping to keep our blood sugar levels more stable.
• Berberine: Berberine is known for having several functions including helping to reduce inflammation, increasing insulin sensitivity, and encouraging ovulation each cycle (in turn improving fertility).
• N-Acetyl Cysteine (NAC): NAC is an antioxidant compound which reduces the number of free radicals that can damage cells in our body. NAC is associated with improved chances of conceiving and more regular ovulation.
• Calcium and vitamin D: Vitamin D and calcium work best together since vitamin D is needed to absorb calcium. Research shows that vitamin D and calcium may improve menstruation cycles, follicle, maturation, and insulin resistance.

How can I find a quality supplement?

There are dozens of different supplements to choose from and due to limited regulations, finding a high quality supplement can be confusing and overwhelming. Below are some things to look out for when searching for supplements.

Look for third-party testing: Although third-party testing is not required, some manufacturers will voluntarily choose to go through this process to show consumers they are producing high quality products.

Review the supplement facts: When choosing a supplement, be sure you know exactly how much of an ingredient it contains. Be weary of proprietary blends that do not break down what is included in the blend.

Know the difference between water vs. fat soluble vitamins: Not all vitamins are absorbed by your body in the same way! Vitamins A, D, E, and K are fat soluble vitamins and are best absorbed by your body with a form of fat. Water soluble vitamins (vitamin C and B vitamins) dissolve in water and be absorbed by the body without fat. 

Take note of common allergens: If you have dietary restrictions or allergies, be sure to read the label to ensure that it fits with your lifestyle. 

If you don’t know where to start, The Daily Hormone Balance is formulated for anyone coming off birth control, struggling with PCOS symptoms, perimenopausal, or just feeling “hormonal.” It contains berberine, passion flower, grapeseed extract, vitamin B1, vitamin B6, vitamin B9, vitamin B12, magnesium, and zinc which have been shown to reduce severity of PCOS symptoms (8). The Daily’s effectiveness has also been clinically tested through a third-party and you can check out the results, here.

If you have questions about supplements, be sure to talk to your healthcare provider to determine what supplements suit you. 

These lifestyle modifications may seem daunting at first, but know that you do not have to implement all the changes at once. Start small and build daily habits in a way that fits your lifestyle, needs, and goals. Not sure if you have PCOS? Check out this article here!

Pollie’s PCOS mobile app can also help you learn how to manage your hormones in a way that works for you with the support of empathetic care teams, advanced labs, a personalized PCOS Plan, symptom tracking, education, and more. You can learn more about Pollie’s membership options here.

References:

1. Woodward, A., Klonizakis, M., & Broom, D. (2020). Exercise and Polycystic Ovary Syndrome. Advances in experimental medicine and biology, 1228, 123–136. https://doi.org/10.1007/978-981-15-1792-1_8
2. Kite, C., Lahart, I. M., Afzal, I., Broom, D. R., Randeva, H., Kyrou, I., & Brown, J. E. (2019). Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Systematic reviews, 8(1), 51. https://doi.org/10.1186/s13643-019-0962-3
3. Harrison, C. L., Lombard, C. B., Moran, L. J., & Teede, H. J. (2011). Exercise therapy in polycystic ovary syndrome: a systematic review. Human reproduction update, 17(2), 171–183. https://doi.org/10.1093/humupd/dmq045
4. Stephens, M. A., & Wand, G. (2012). Stress and the HPA axis: role of glucocorticoids in alcohol dependence. Alcohol research : current reviews, 34(4), 468–483.
5. Mayo Clinic. (2020, April 22). Meditation: A simple, fast way to reduce stress. Mayo Clinic. Retrieved March 25, 2022, from https://www.mayoclinic.org/tests-procedures/meditation/in-depth/meditation/art-20045858#:~:text=Meditation%20can%20produce%20a%20deep,physical%20and%20emotional%2
6. Division of Sleep Medicine at Harvard Medical School. (2007, December 18). Sleep, learning, and memory. Sleep, Learning, and Memory . Retrieved April 28, 2022, from https://healthysleep.med.harvard.edu/healthy/matters/benefits-of-sleep/learning-memory#:~:text=Research%20suggests%20that%20sleep%20helps,essential%20for%20learn
7. Mesarwi, O., Polak, J., Jun, J., & Polotsky, V. Y. (2013). Sleep disorders and the development of insulin resistance and obesity. Endocrinology and metabolism clinics of North America, 42(3), 617–634. https://doi.org/10.1016/j.ecl.2013.05.001
8. Günalan, E., Yaba, A., & Yılmaz, B. (2018). The effect of nutrient supplementation in the management of polycystic ovary syndrome-associated metabolic dysfunctions: A critical review. Journal of the Turkish German Gynecological Association, 19(4), 220–232. https://doi.org/10.4274/jtgga.2018.0077