Healthy Living with PCOS
What is Polycystic Ovary Syndrome (PCOS)?
PCOS is a common hormonal endocrine condition affecting approximately 7 million women and teenage girls.1 Symptoms may vary from woman to woman. Many, but not all, women with PCOS experience weight gain or have a hard time losing weight. Others have higher levels of the male hormone testosterone, which can cause facial hair growth and acne. High testosterone levels can also keep women from ovulating and interfere with fertility.
Insulin resistance is one of the main factors associated with PCOS. Insulin is a hormone that allows our cells to use glucose (sugar) to produce energy. When insulin resistance occurs, cells lose their ability to respond normally to insulin. When this happens, more and more insulin is produced. Insulin resistance can lead to type 2 diabetes. Early diagnosis and management of PCOS is important because PCOS has been linked to an increased risk of diabetes, heart disease, high blood pressure, and endometrial cancer. PCOS is also a common cause of infertility.2 Making lifestyle changes like eating a healthful diet and exercising regularly may help reduce the chance of developing these conditions.
Diet, Lifestyle, and PCOS
Following a low-glycemic diet, achieving a healthy weight, and being physically active helps manage PCOS symptoms.
The glycemic index (GI) is a measure of how much a carbohydrate-containing food increases blood sugar and insulin levels. Choosing foods that have a low GI can cause a slower rise in blood sugar levels and result in lower levels of insulin secretion. Studies have shown improved insulin sensitivity and more regular menstrual cycles in women with PCOS who follow a low-GI diet compared with those who do not.3 Dried beans, berries, 100% whole-grain breads, oatmeal, quinoa, and non-starchy vegetables are examples of low-GI foods.
Being a healthy weight is important because obesity is associated with increased insulin resistance. Moderate weight loss (at least 5% of total body weight) has been shown to improve insulin and testosterone levels and normalize menstrual cycles in women with PCOS.4
Regular exercise is very important and can help manage PCOS symptoms. Recent research has found that a type of cardio workout called high intensity interval training (HIIT) decreases insulin resistance, increases HDL (“good” cholesterol) levels, and decreases body fat in women with PCOS.5 HIIT alternates between bouts of challenging, intense exercise and easy, low- intensity exercise.
Another study showed that vigorous activity improved insulin resistance and decreased the risk of metabolic syndrome among women with PCOS. For every hour of vigorous activity per week, metabolic syndrome risk decreased by 22%.6 Remember to consult your healthcare provider before beginning an exercise regimen. If you are just starting to exercise, any increase in movement each day is good, so start small and slowly increase to more intense exercise.
Supplements and PCOS
In addition to eating a healthful diet and daily exercise, there is research to suggest that certain nutritional supplements may also be helpful.
Inositol is a nutrient that is found in fruits, beans, grains, and nuts and also produced by the body. Research has shown that inositol decreases insulin resistance, reduces testosterone levels, regulates menstrual cycles, and promotes ovulation in women with PCOS.7-9 Inositol supplementation also supports normal lipid (blood fat) levels10, promotes egg quality in women trying to become pregnant , and has been shown to reduce the risk of gestational diabetes (diabetes that starts during pregnancy) among pregnant women. 11-13
Two forms of inositol have shown benefit for women with PCOS: myo-inositol (MI) and D-chiro-inositol (DCI). Studies have shown that taking a combination of these two forms, in the body’s naturally occurring ratio of 40 to 1, is more helpful than taking either form alone.14-15
The recommended dosage for most women is a combination of 2,000 mg of MI plus 50 mg of DCI, taken twice a day. Studies have shown that inositol is safe and well-tolerated.16 It generally takes at least three months of daily inositol supplementation to see improvement in test results and/or the return of regular menstrual cycles.
Omega-3 Fish Oil
Research has shown that omega-3 fish oil offers many benefits to women with PCOS, including reduced depression, lower testosterone levels and more regular menstrual cycles.17-18
Women with PCOS may benefit from taking an omega-3 fish oil supplement, especially if they do not eat fatty fish (salmon, herring, sardines, tuna, trout, and mackerel) at least twice a week. Studies indicate that taking 1,200 mg of omega-3 fish oil daily may be beneficial.19
Many women with PCOS take the medication metformin. Research has shown that long-term use of metformin decreases levels of vitamin B12 in the body. If you are taking metformin, ask your healthcare provider to check your vitamin B12 level to determine if supplementation would be right for you.
Vitamin D is a fat-soluble vitamin that has several important roles in our bodies. Vitamin D3 is produced in our skin when exposed to sunlight, and it is also found in some foods (fatty fish, egg yolks, and fortified milk and orange juice).
Approximately three out of four women with PCOS are vitamin D deficient. Vitamin D deficiency is associated with insulin resistance, metabolic issues, and menstrual irregularities.20
There is not complete agreement on the optimal daily dose of vitamin D. The current Recommended Dietary Allowance (RDA) is 600–800 IU per day, depending on age. The upper limit is set at 4,000 IU per day. Most vitamin D experts consider these doses conservative and recommend higher intakes for most adults, particularly those who have low vitamin D levels.
The daily dosage of vitamin D you need will depend on several factors, including your current vitamin D blood level. Speak to your doctor to determine how much vitamin D you need.
Coenzyme Q10 (CoQ10)
CoQ10 is is a naturally occurring antioxidant that is essential for cellular energy production. It is produced in the body and found in virtually all cells.
Recent research in women with PCOS found that taking supplemental CoQ10 along with the medication clomiphene citrate increased ovulation and pregnancy rates more than clomiphene alone.21
Another study found that CoQ10 improved fasting blood sugar and insulin levels, and decreased total cholesterol and LDL (“bad cholesterol”) levels.22
N-Acetyl Cysteine (NAC)
NAC is an amino acid used in the body to produce glutathione, an antioxidant. Research suggests that NAC can improve the body’s use of insulin, decrease fasting blood sugar levels, decrease body and facial hair, and help regulate menstrual cycles in women with PCOS.23-25
1. PCOS Foundation brochure. What is PCOS? Available at: http://www.pcosfoundation.org/PCOS-Education-trifold.pdf. Accessed: June 6, 2017.
2. Costello et al. Aust N Z J Obstet Gynaecol. 2012; 52(4):400-3.
3. Marsh et al. Am J Clin Nutr. 2010; 92:83-92.
4. Faghfoori et al. Diabetes Metab Syn. 2017; Apr 5 [Epub ahead of print].
5. Almenning et al. PLoS ONE. 2015; 10(9), e0138793.
6. Greenwood et al. Fertil Steril. 2016; 105(2):486-93.
7. Artini et al. Gynecol Endocrinol. 2013; 29(4):275-9.
8. Benelli et al. Int J Endocrinol. 2016:3204083.
9. Constantino et al. Eur Rev Med Phamacol Sci. 2009; 13:105-10.
10. Minozzi et al. Eur Rev Med Phamacol Sci. 2013; 17:537-40.
11. Ciotta et al. Eur Rev Med Pharmacol Sci. 2011; 15(5):509-14.
12. Papaleo et al. Fertil Steril. 2009; 91(5):1750-4.
13. Crawford et al. Cochrane Database Syst Rev. 2015; 17(12)CD011507.
14. Nordio and Proietti. Eur Rev Med Phamacol Sci. 2012; 16:575-81.
15. Colazingari et al. Arch Gynecol Obstet. 2013; 288:1405-11.
16. Carlomagno and Unfer. Eur Rev Med Pharmacol Sci. 2011; 15:931-6.
17. Dokras et al. Obstet Gynecol. 2011;117(1):145-52.
18. Nadjarzadeh et al. Iran J Reprod Med. 2013;11(8):665-72.
19. Rondanelli et al. Arch Gynecol Obstet. 2014;290(6):1079-92.
20. Wehr E et al. Eur J Endocrinol. 2009;161(4):575-82.
21. El Refaeey et al. Reprod Biomed Online. 2014 Jul;29(1):119-24.
22. Samimi et al. Clin Endocrinol (Oxf). 2017;86(4):560-566.
23. Fulghesu et al. Fertil Steril. 2002;77(6):1128-35.
24. Javanmanesh et al. Gynecol Endocrinol. 2016;32(4):285-9.
25. Thakker et al. Obstet Gynecol Int. 2015;2015:817-849.