What is PCOS + A Non-Diet Approach to Managing Your New Diagnosis
So, you recently got a diagnosis of PCOS. And chances are you were told by your doctor to go on a diet, maybe even lose weight and exercise more. You're overwhelmed, still not even 100% sure what PCOS is and also feeling like you did something wrong to get this diagnosis.First off, know that you did nothing wrong to be diagnosed with PCOS. And second, there are ways to manage PCOS without going on a restrictive diet. We'll talk through all of those here so that you both understand what's happening in your body as well as feel empowered to know how to care for yourself and manage your symptoms.The likelihood is that you went to your health care provider (HCP) with a couple of things going on. Maybe you have had an irregular period, either longer or sporatic, or even an absent period. Maybe you have noticed hair growth on your face or back and acne. These are common reasons PCOS is explored and considered.
WHAT IS PCOS?
So what is PCOS? PCOS stands for Polycystic Ovarian Syndrome, a hormonal condition that occurs in approximately 5-10% of women. Even though it's a relatively common condition, there's still a lot that we don't know about it and there is a lot of conflicting information as far as the cause and how to best treat and manage symptoms. It's believed that both genetics and environmental factors play a role. Even though there's a lot to still learn about this condition, we do know that a number of hormones play a role including insulin, progesterone, and testosterone.Because of the effect that PCOS has on women's menstrual cycles, one of the complications with PCOS can be having a harder time getting pregnant. Another factor with PCOS is the effect that it has on insulin resistance which makes it more likely to lead to developing type 2 diabetes and metabolic syndrome. I share this not to cause fear, just to educate and empower you. But I also know that this can be hard to hear. Know that because you have PCOS does not mean you won't be able to get pregnant and does not mean that you'll get diabetes. It just means your body is more likely than someone without PCOS to develop those complications. Towards the end of this post we'll talk about what you can do to love on and care for your body with this diagnosis and even thrive.
DIAGNOSING PCOS
PCOS is a syndrome which means it's a group of symptoms and findings that together lead to a diagnosis. The diagnosis criteria that your health care practitioner may have used to come to the conclusion that you have PCOS is called the Rotterdam criteria which states you have to have two of either hyperandrogenism (which is excess hair growth and elevated testosterone levels), irregular or absent ovulation, or polycystic ovaries. This is actually a relatively new recommendation for diagnosis. In the past, as you may have guessed by the name "polycystic ovarian syndrome", women were only diagnosed if they had cysts on their ovaries. But now what we know is that someone can have PCOS without cysts and just have hyperandrogenism with abnormal ovulation. But something else to note is that just because your HCP finds cysts on your ovaries does not mean that you have PCOS. Again, you need more than just one symptom.What happens next is blood work to check hormone levels. Some key labs that your HCP will look at are first a pregnancy test, TSH, prolactin, and 17-hydroxyprogesterone to rule out other potential causes of your symptoms such as a thyroid condition, pregnancy, or hypothalamic amenorrhea. If all is normal they'll check FSH, LH, estradiol, testosterone, DHEAS, insulin, and perform an ultrasound on your ovaries to check for cysts.
COMMON TREATMENTS
If you've been diagnosed with PCOS, the likelihood is you have been given a lot of information, some confusing, some scary, some frustrating. You are probably feeling a lot of emotions right now. But know that you are not alone and there are many ways to manage your PCOS and still live a full and healthy life.Let's first talk about common treatment approaches health care providers will take.The first treatment route that most HCPs take will be prescribing birth control which can help with hair growth and acne. Some resources will share that birth control can treat irregular periods, but we know that birth control works like a bandaid and doesn't actually lead to your body creating it's own hormones for a healthy cycle. I'm all for birth control for it's intended use...as pregnancy protection. But with PCOS it doesn't actually treat the root of what is going on as far as your cycle goes and doesn't increase the likelihood of pregnancy when you come off.Another common medication used in treatment is called Metformin which can address insulin resistance which can occur for some people with PCOS. Metformin is commonly used with diabetes type 2 treatment. It works by helping to control the amount of glucose in your blood and increase your body's response to insulin. For some people with PCOS (not all), they can experience insulin resistance so Metformin can help prevent the development of diabetes type 2.If you are in a larger body, you'll likely hear your doctor recommend weight loss and diet/lifestyle modifications. We'll talk more about why I, personally, don't agree with this recommendation. I have seen far too often HCPs recommending weight loss and diet change without truly knowing what the research says and also giving out this advice without compassion and without real education.We've talked about this a little bit already, but the problem with these common treatments and recommendations is that they treat the symptoms from a surface level. But the problem here is they don't address the root of what's going on.My goal here is to inform and educate you to be an advocate for your own health, not to necessarily steer you in one way or another. But I also want to provide you with options to help you manage your PCOS that your HCP may not have shared with you so that you have a full understanding. You may decide that for you, a conventional approach is what you want and that is 100% ok. But if you're looking for alternatives to solely relying on medication, I wanted to be sure to address lifestyle recommendations as well!
LIFESTYLE MODIFICATIONS FOR PCOS
Let's, now, talk about another approach to consider for the treatment of PCOS. We talked above about common treatments you've probably heard, read about, or even been told by your HCP and that these treatments tend to treat the surface issues as opposed to getting to the root of what's going on.I believe the best treatment route for PCOS, as for most diagnoses, is a combination of lifestyle, natural, and medical intervention. But one study I read stated that "lifestyle modification is the cornerstone of treatment for PCOS". And yet, it also stated that 45% of women reported not being told about what they could do from a lifestyle perspective to manage and treat symptoms.One thing I teach and you'll read here is approaching health from a whole-person perspective. This means that diet and exercise aren't the only things that make a person healthy. Our whole health is made up of our physical health, nutritional health, environmental health, mental health, and spiritual health. We can take on the same approach when talking about PCOS. Let's address each of these a little more closely.
PHYSICAL
Physical activity, so any movement, has been shown to be beneficial for women with PCOS, independent of weight loss. Exercise can improve insulin sensitivity that's associated with PCOS. We also know the benefits of activity and movement for mood and body appreciation, both which may suffer with a diagnosis of PCOS.
NUTRITIONAL
The goal of nutrition with PCOS is not to create stress. Stress has a slew of negative effects on our health and can work against you as you are working to manage your PCOS. I believe that nutrition is a tool you can use, but shouldn't be something that causes more anxiety on you. My approach is to say, how can you work with your body and care for your body right now?A couple of things to think about with eating are going to be eating enough and eating consistently (every 3-4 hrs), eating all macronutrients (no you don't have to eliminate carbs and fat), combining fat or protein with carbohydrate snacks which helps regulate blood sugar, eating enough fiber and choosing fiber-rich foods like whole grains. These can all help with blood sugar regulation but aren't meant to be set-in-stone rules you follow 100% of the time. But again, this is an amazing way to care for your body and even think about cultivating a stronger relationship with your body through healing.You're going to see information when you google "diet for PCOS" that highlights decreasing calories, fat, and carbs and losing weight. I felt like I needed to address this a little more closely. First off, we know that focusing on weight loss for anyone takes them away from a healthy relationship with themselves and is the leading cause of eating disorders. Not to mention, any diet that is extreme and unsustainable and solely focuses on weight loss has a high chance of causing weight cycling which is the leading cause of weight gain and overall decrease in health. This is why I strongly disagree with HCPs who recommend weight loss and a low-calorie diet for anyone, but specifically here, for women with PCOS. Instead, I suggest focusing on health-promoting behaviors and not focusing on weight loss.
ENVIRONMENTAL
It's believed that a possible cause of PCOS could be toxins in our environment. Endocrine-disrupting chemicals are used in many products on the market today, from personal care products, to makeup, to household cleaners and candles. We can't control all of the chemicals we come in contact with on a day-to-day basis and we shouldn't fear and get anxious about them, but there are some simple things you can do and can control when it comes to the ingredients you're exposed to. A great solution is to switch to non-toxic and safer personal care products, makeup, and household cleaners. I love recommending essential oils in place of candles as well. This doesn't have to be an overwhelming overhaul. But it's something to think about and consider for yourself.
MENTAL
Our mental health is one of the most under-considered aspects of our health in my opinion. And yet it plays such a huge role in our overall well-being. Some ways to care for your mental health include getting enough and good quality sleep, taking deep breaths throughout the day, pausing to connect with yourself and ask yourself, "what do I need?", taking social media and screen breaks, committing to a morning routine. This is not an exhaustive list by any means. But the goal here is to draw your attention to all the things you can do to care for your mental health. I, personally, believe that without good mental health every other part of our well-being suffers.
SPIRITUAL
We are spiritual creatures, made for a bigger purpose than just ourselves. And no matter what your spiritual background, it's important to draw a connection to that purpose within yourself. For me, that means a personal relationship with God and regularly spending time with Him in prayer and reading my Bible. For you with a diagnosis of PCOS, a greater connection with your spiritual being can help you see the good that can come from any and every situation...even this major change. You have a purpose. You are called to something great. I hope this helps clarify some of what you've just learned and gives you hope. Your new diagnosis, like any change we encounter, will continue to shape you into the person you are made to be. What other questions do you have? I'm here supporting and loving on you. RESOURCES:
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Redman, Leanne M., Karen Elkind-Hirsch, and Eric Ravussin. "Aerobic exercise in women with polycystic ovary syndrome improves ovarian morphology independent of changes in body composition." Fertility and sterility 95.8 (2011): 2696-2699.
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Palioura, Eleni, and Evanthia Diamanti-Kandarakis. "Polycystic ovary syndrome (PCOS) and endocrine disrupting chemicals (EDCs)." Reviews in Endocrine and Metabolic Disorders 16.4 (2015): 365-371.
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Blackshaw, Lucinda CD, et al. "Barriers and Facilitators to the Implementation of Evidence-Based Lifestyle Management in Polycystic Ovary Syndrome: A Narrative Review." Medical Sciences 7.7 (2019): 76.