What is PCOS?

Polycystic ovary syndrome (PCOS) is defined as a group of symptoms that affect women of all races and ethnicities in their reproductive age. PCOS is the result of a sex-hormone imbalance that consists in an over-production of male hormones and a scarcity of female ones. This shortage allows masculine hormones to prevail and leads to anomalous periods and over-hairy bodies. PCOS is highly heritabledaughters born to mothers with PCOS have a 5-fold increased risk of developing PCOS themselves. However, environmental factors, such as obesity, play a part too.

PCOS Symptoms

PCOS is difficult to diagnose due to a non-distinctive clinical picture. According to the NIH, to be diagnosed with PCOS, every woman must show 2 out of the 3 following symptoms: 

  • Excess of male hormones (androgens) which leads to a  hairy face, chest, belly, or upper thighs 
  • Irregular or absent menstrual cycles
  • Multiple fluid-filled sacs, known as cysts, in your ovaries

Additional signs of PCOS include:

  • Very heavy periods and/or pelvic pain
  • Oily skin and/or acne
  • The whole range of weight issues, from difficulty to lose weight, to weight gain and obesity 
PCOS is the result of a sex-hormone imbalance that consists in an over-production of male hormones and a scarcity of female ones.

PCOS myths

There are many myths surrounding PCOS. Here are some of the most common:

Polycystic ovaries equals PCOS 

Cysts in your ovaries don’t necessarily mean you have PCOS; about 7% of women have an ovarian cyst at some point in their lives, worldwide. Having a polycystic ovary (or ovaries) in itself is not a condition, nor is it linked to a dangerous or malignant clinical picture. Plus, there are some differences between polycystic ovaries and PCOS: the former is asymptomatic, doesn’t interfere with conception, and is not always linked to a hormonal disorder; the latter is quite the opposite. 

Women with PCOS are condemned to being overweight or obese 

Women with PCOS have more difficulty losing weight due to an imbalance in insulin levels that alters glucose metabolism and influences the excess of androgens. However, lifestyle and diet are the frontline therapy in women with PCOS. Getting to a healthy weight leads to clinical benefits in PCOS regardless of what diet you choose to follow. These benefits include amelioration of circulating male hormone levels and increased ovulation. A significant weight reduction can be achieved with an energy deficit of 30% (circa 500 – 750 kcal/day), according to the latest PCOS guidelines

Women diagnosed with PCOS are always sterile

It’s common to associate PCOS with infertility and percentages are not reassuring, as ±75% of PCOS affected women are infertile. Conception problems are due to a hormonal imbalance which interferes with egg maturation and ovulation. The equation is easy: if there is no ovulation, or ovulations are irregular, pregnancy isn’t possible. Plus, due to tricky hormone levels, pregnant women affected by PCOS are more prone to miscarriages. However, these reasons should not discourage you if you are a woman with PCOS wanting to start a family.  Applying lifestyle changes that lead to weight loss can restore ovulation and lead to pregnancy. Losing 5-10% of your body weight is enough to make conception easier in 55-100% of women with PCOS within 6 months of losing the weight. Moreover, science today helps women with PCOS conceive thanks to clinical and pharmacological approaches.

Soy and its derivatives are dangerous for PCOS affected women

Soy contains fitoestrogens, which are natural substances that have a similar structure to the female hormone estrogen but with a stimulating power 100-1000 times weaker than human estrogen. The fitoestrogen contained in soy is called isoflavone and is often thought to be responsible for additional imbalance in PCOS patients. This myth was debunked in 2 studies. The first showed that soy isoflavone significantly decreased insulin resistance, triglycerides, and oxidative stress in those with PCOS. The second showed that dietary soy helps women with PCOS reduce weight, improve sugar control and reduce blood levels of the male hormone testosterone. However, as the Latins used to say, in medio stat virtus (virtue is in the middle). This means that, as every food in our diet, soy should not be abused. Go for fermented soy, such as tempeh, tofu, natto, and limit it to 2-3 servings per week.

Intermittent fasting is a great tool for weight loss that could help correct the hormonal and metabolism imbalances that occur with PCOS . Illustration by Elfy Chiang

How can intermittent fasting help?

Intermittent fasting, or taking a break from eating for periods of time, has been shown to help with symptoms of PCOS. This pattern of eating  reduces inflammation, ameliorates glucose and insulin levels and leads to a broad improvement of androgen levels and ovarian function (with possible beneficial effects on infertility). It has also been speculated that fasting could ameliorate the impact of male hormone excess on the human body by limiting the excess of insulin, which is partially responsible for the abnormal release of androgens. Changes in glucose and insulin blood levels are a few benefits of intermittent fasting that lead to a balanced metabolism.  With normal insulin and glucose levels, you can expect to see weight loss or, at least, no weight gain. And with a decrease in male hormones, you should see reductions in facial hair and skin improvements. To get started, we recommend 12-hour overnight fasts, adding 1-hour increments every 5 days or so. 16-hour fasts have been shown to reduce markers of inflammation and cellular damage in women with PCOS, but the number of hours you fast depends on how much weight you want to lose and your goals. Intermittent fasting is flexible and can be adopted regardless of your lifesytle. To see what type of intermittent fasting is right for you, check out this blog post.

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