September is PCOS awareness month, so let's explore one of the most prevalent endocrine and metabolic disorders that impact women of reproductive age.
Polycystic ovarian syndrome (PCOS) in the UK alone, affects approximately 1 in 10 women (albeit numbers could likely be much higher due to those who do not seek medical advice).
PCOS is characterised by having at least two of the following:
Elevated androgens (a group of hormones which include testosterone) seen on either bloodwork or via physical symptoms (e.g. acne or excess facial hair)
Absent or irregular ovulation (presented as menstrual irregularities)
Cysts on the ovaries
Common symptoms include missing or irregular periods, acne, weight gain, infertility, female pattern hair loss and excessive facial or body hair.
Less talked about symptoms include anxiety, depression, sleep disturbances, skin tags and acanthosis nigricans.
PCOS is more than a gynaecological disorder, it is systemic; and can affect the entire body including metabolism, the immune system, the cardiovascular system, the skin, the gut and even the mental health. Whilst we don’t know the exact cause, we do know is that it is complex and multifactorial, with both genetic and environmental factors playing a large role.
Blood sugar dysregulation
Insulin resistance is prevalent in around 65-80% of women with PCOS. Consistently high blood sugar and increased levels of insulin over time, eventually results in insulin no longer responding appropriately. The glucose it needed to put into cells, ends up being stored as physical fat or fat within the blood, leading to weight gain and/or high triglycerides.
It is important to note that insulin resistance and dysregulated blood sugar is independent of obesity and can be a feature of those who have a healthy body weight.
Signs that your blood sugar is not being managed include:
Energy dips
Brain fog
Cravings for sweet foods
Frequent hunger
Acne
Low mood
Irritability
Disrupted Circadian Rhythm
Women with PCOS have higher rates of sleep disorders (e.g. sleep apnoea) than those without PCOS, regardless of body weight. The high levels of androgens, insulin resistance, changes to both cortisol and melatonin secretion along with anxiety and depression, can play a role in sleep disturbances.
This can have a negative effect on the circadian rhythm aka our body clock. Both inability to fall asleep (tired yet wired feeling) and/or sleep disturbances may leave those with PCOS feeling like they have permanent jet lag and cannot wake up properly in the mornings.
Long-term this can lead to an increased risk of type 2 diabetes, a deterioration in cardiovascular health and chronic fatigue.
On a day-to-day basis this can exacerbate blood sugar highs and lows and result in both low energy and altered hunger and satiety hormones – resulting in overeating, not feeling full and ultimately, weight gain.
Endocrine Disruptors
Research has shown that those with PCOS tend to have higher levels of endocrine disrupting compounds like BPA, suggesting that this could be an environmental factor in the development of the condition.
Endocrine disruptors are specific toxic compounds that can disrupt hormones.
Bisphenol A (BPA), phthalates and dioxins are commonly found in receipts, plastics, cans, beauty products, and farmed fish.
These toxic compounds can disrupt oestrogen pathways and block the natural hormonal function.
Practically, what can you do?
Whilst you cannot ‘cure’ PCOS, you most certainly can manage symptoms and reduce your risk of chronic metabolic conditions.
Avoid “naked” Carbs:
Pair your carbohydrate sources with plenty of protein, fibre and healthy fats.
This can help to keep blood sugar stable and prevent too much insulin being released from the pancreas.
Fancy a bagel? Add a source of protein and some veggies to make it balanced.
Add more colour to your plate:
Those with PCOS can have low-grade inflammation in the body. Eating a diverse array of colourful fruits and vegetables can support provide lots of antioxidant support to reduce inflammation.
Plus, diverse and colourful fruits and vegetables will provide plenty of polyphenols and fibre to support your microbiome and help keep you fuller for longer. Soups are a great way to pack in lots of nutrients in one meal.
Support your body clock:
Exposure to natural daytime light first thing and avoiding screens at night will support your circadian rhythm and therefore all the key hormones involved in sleep.
Get outdoors for your morning cuppa and avoid scrolling for 1-2 hours before bed.
Find your happy place:
Stress will increase cortisol in the body. This increased cortisol raises blood sugar as a survival mechanism to run from a tiger. The problem is you’re not necessarily running from a tiger…you may just be stressed that you’re late to work.
That high blood sugar then feeds the cascade of PCOS symptoms associated with poor blood sugar control.
Identify your triggers and find what works for you in terms of stress management.
Maybe it is getting outdoors in nature, maybe its breathwork, or maybe it’s a dance around your living room. Find your happy place.
Ditch the plastic (and receipts):
Opting for online receipts, as well as ditching the plastic, can help to minimise the harmful effects of endocrine disruptors.
Repurpose glass jars as Tupperware to save having to buy new containers.
Move your body:
The fastest way to regulate high blood sugar via movement. Going for a walk after a meal can be a great way to support blood sugar.
Even gentle types like walking can work wonders and can not only support you physically, can be a great way to support mental health.
But if you want most bang for your buck, incorporate some form of resistance training. Whether you wear a weighted vest, use your own body weight, resistance bands or physical weights, this can support physical bodily strength as well as metabolic health.
References
Briden, L. (2021). Hormone Repair Manual Every Woman’s Guide to Healthy Hormones After 40. Australia: Macmillan. pp.52-167.
Fernandez, R.C. Moore, V.M. Van Ryswyk, E.M. et al. (2018). ‘Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies’, Nat Sci Sleep, 10, pp. 45–64.
Gersh, F. (2018). PCOS SOS. USA: Integrative Medical Press. Pp. 27-199.
NICE. (2024). Polycystic Ovary Syndrome. [Online]. Available at: https://cks.nice.org.uk/topics/polycystic-ovary-syndrome/
Patient. info. (2024). Polycystic Ovary Syndrome. [Online]. Available at: https://patient.info/womens-health/polycystic-ovary-syndrome-leaflet
Urbanetz, L.A.M.L. Soares Junior, J.M. Maciel, G.A.R. et al. (2023). ‘Does bisphenol A (BPA) participates in the pathogenesis of Polycystic Ovary Syndrome (PCOS)?’, Clinics, 78
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