Firstly, what is PCOS?

PCOS is characterised by higher-than-normal levels of androgens or male sex hormones, which leads to metabolic and reproductive system dysfunction. It is the leading cause of infertility in females and, unfortunately, 70% of cases go undiagnosed(2). There are however nutritional and supplemental strategies that have shown to be of great benefit to women with PCOS, with some studies showing improvements comparable to common pharmaceutical treatments.

What causes PCOS?

Insulin resistance is present in as many as 70% of PCOS cases(3, 11). Elevated insulin levels can cause disruption to metabolic signalling pathways leading to an excess secretion of luteinizing hormone (LH) by the pituitary gland, which results in an overproduction of androgens by the theca cells of the ovaries(1). Excess small follicles accumulate on the ovaries however regular ovulation is not triggered. Diagnosis of PCOS is made by a medical professional using the Rotterdam Criteria based on 2 of 3 positive criteria including menstrual irregularity, hyperandrogenism, and polycystic ovaries on ultrasound(2).

Signs and symptoms of PCOS:

• Infrequent periods (less than six to eight per year) or amenorrhoea (an absence of menstrual periods).
• Hirsutism (male pattern hair growth to face, chin, or body), or male pattern alopecia.
• Hormonal acne.
• Weight gain, or difficulty losing weight.
• Metabolic syndrome (insulin resistance, pre-diabetes, obesity, or high cholesterol).
• Polycystic ovaries on ultrasound: more than 10 small antral follicles on both ovaries or one ovary.
• Mood changes (anxiety or depression).
• Difficulty falling pregnant.

Nutritional treatment of PCOS

There are many natural approaches that can be utilised to support women with PCOS to improve symptoms and wellbeing.

1. Seek guidance from a natural health professional who can appropriately assess, test, and treat your symptoms.
2. A low glycaemic index (GI) diet includes eating a variety of low glycaemic index fruits, vegetables, and wholegrains, alongside protein and healthy fats, whilst minimising processed and high GI foods. A low GI diet has shown to improve serum insulin levels, LH, follicle stimulating hormone, and total testosterone levels, reduce total cholesterol levels, reduce hirsutism, and improve emotional health in women with PCOS(9).
3. Support a healthy weight. 60% of women with PCOS struggle with excess weight, and weight gain can be accelerated by unbalanced hormones and insulin resistance(2). Dietary and exercise strategies are an important part of the management of PCOS.
4. Myo-inositol. Supplementation with myo-inositol can be of significant benefit to women with PCOS by improving ovulation rate, frequency of menstrual cycles, and metabolic and hormonal profiles(8). Another study found that Myo-inositol improved insulin responses and insulin sensitivity, comparable to that of the medication metformin for women with PCOS(10).
5. N-Acetyl Cysteine (NAC). One study found that NAC supplementation can improve lipid profiles, fasting blood sugar, and fasting insulin better than metformin in women with PCOS(6). Similar findings were found by Gayatri et al (5), whereby NAC improved weight loss, acne, hirsutism, insulin resistance and fasting insulin levels in women with PCOS greater than metformin.
6. Magnesium. Lower serum magnesium can worsen insulin resistance and increase testosterone levels in women with PCOS(7). Magnesium supplementation can be used to improve insulin resistance, improve androgen levels (testosterone and DHEA-s), and reduce the inflammatory marker C-reactive protein in women with PCOS(4).

You can learn more about PCOS in these blogs:

Holistic Management of Polycystic Ovarian Syndrome (PCOS)

Do you have the signs and symptoms of Polycystic Ovarian Syndrome (PCOS)?

References

1. Baptiste, C. G., Battista, A. T., Trottier, A., & Baillargeon, J. P. (2009). Insulin and hyperandrogenism in women with polycystic ovary syndrome. The journal of steroid biochemistry and molecular biology, 122 (1-3). doi. 10.1016/jsbmb.2009.12.010
2. Boyle, J., & Teede, H. J. (2012). Polycystic ovary syndrome: An update. Australian Family Physician, 41 (10). https://www.racgp.org.au/afp/2012/october/polycystic-ovary-syndrome
3. Briden, L. (2017). Period repair manual (2nd ed.).
4. Cutler, D.A., Pride, S.M., & Cheung, A.P. (2019). Low intakes of dietary fiber and magnesium are associated with insulin resistance and hyperandrogenism in polycystic ovary syndrome: A cohort study. Food Sci Nutr, Feb 27;7(4):1426-1437. doi: 10.1002/fsn3.977.
5. Gayatri, K., Jena, K. S., & Kumar, B. B. (2010). Metformin and N-acetyl Cysteine in Polycystic Ovarian Syndrome–-A Comparative Study. Indian Academy of Clinical Medicine (1):1-7. DOI: 10.1177/117739361000100002
6. Javanmanesh, F., Kashanian, M., Rahimi, M., & Sheikhansari, N. (2016). A comparison between the effects of metformin and N-acetyl cysteine (NAC) on some metabolic and endocrine characteristics of women with polycystic ovary syndrome. Gynecol Endocrinol ;32(4):285-9. doi: 10.3109/09513590.2015.1115974.
7. Luo, X., Cai, W.Y., Ma, H.L., Cong, J., Chang, H., Gao, J.S., Shen, W.J., Wang, Y., Yang, X.M., & Wu, X.K. (2021). Associations of Serum Magnesium With Insulin Resistance and Testosterone in Women With Polycystic Ovary Syndrome. Front Endocrinol, Jun 23;12:683040. doi: 10.3389/fendo.2021.683040.
8. Pundir, J., Psaroudakis, D., Savnur, P., Bhide, P., Sabatini, L., Teede, H., Coomarasamy, A., & Thangaratinam, S. (2017). Inositol treatment of anovulation in women with polycystic ovary syndrome: A meta-analysis of randomised trials. BJOG: an international journal of obstetrics and gynaecology. 125. doi: 10.1111/1471-0528.14754.
9. Saadati, N., Haidari, F., Barati, M., Nikbakht, R., Mirmomeni, G., & Rahim, F. (2021) The effect of low glycemic index diet on the reproductive and clinical profile in women with polycystic ovarian syndrome: A systematic review and meta-analysis. Heliyon. 2021 Nov 9;7(11):e08338. doi:10.1016/j.heliyon.2021.e08338.
10. Tagliaferri ,V., Romualdi, D., Immediata, V., De Cicco. S., Di Florio, C., Lanzone, A., & Guido, M. (2017). Metformin vs myoinositol: which is better in obese polycystic ovary

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