What is PCOS?
Polycystic ovary syndrome (PCOS) is an endocrine (hormone-related) disorder that affects a large number of pre-menopausal women, with prevalence rates ranging from 3–10% depending on the population and diagnostic criteria used.[1] PCOS is characterized by androgen excess (e.g., high testosterone, male-pattern body hair growth) and/or ovarian dysfunction (e.g., ovarian cyst-like growths, infertility, irregular menstruation).
What are the main signs and symptoms of PCOS?
Some of the most common signs and symptoms of PCOS are irregular menstruation cycles, obesity, hirsutism (male-pattern body hair growth), loss or thinning of hair on the scalp, and acne. Common findings include high circulating androgen (e.g., testosterone) levels and cyst-like growths on the ovaries. Other signs and symptoms include insulin resistance, including the risk of type 2 diabetes. PCOS is also often associated with comorbid conditions such as: obesity, dyslipidemia, type 2 diabetes, and infertility.[2]
How is PCOS diagnosed?
A diagnosis of PCOS is typically based on meeting at least 2 of the following 3 criteria: (1) anovulation or oligo-ovulation (indicated by a lack of or infrequent menses), (2) androgen excess, and (3) small cyst-like growths on at least one of the ovaries, with other potential causes of these factors (e.g., Cushing’s syndrome, thyroid dysfunction, hyperprolactinemia) being ruled out.[3][4]
What are some of the main medical treatments for PCOS?
Medical interventions used to treat PCOS target specific patient symptoms and presentation of the condition. For example, insulin resistance is usually treated with metformin, irregular periods are often treated with oral contraceptives, spironolactone might be tried for symptoms of androgen excess, and infertility can be treated with clomiphene.[5]
Have any supplements been studied for PCOS?
One of the most well studied supplements for PCOS is inositol. Some studies have found inositol can improve insulin resistance and fertility in PCOS, though the quality of the evidence is not especially high.[6][7] Other supplements investigated for PCOS include L-carnitine, omega-3 fatty acids (e.g., fish oil), alpha-lipoic acid, berberine, and N-Acetylcysteine.[8][9]
How could diet affect PCOS?
A variety of diets (e.g., DASH, low glycemic index, low carbohydrate) have been shown to be beneficial for females with PCOS. These diets can be conducive to a reduction in calorie intake, which is beneficial for conditions secondary to PCOS such as metabolic syndrome, obesity and impaired glucose tolerance.[10][11]
Are there any other treatments for PCOS?
Since PCOS is tightly linked with metabolic abnormalities, exercise is often recommended. In addition to reductions in insulin and insulin resistance, increased physical activity has also been linked to lower androgen levels and improved reproductive function in PCOS.[12][13] More research is needed to determine which types of exercise are most beneficial.
A number of studies have investigated the effect of acupuncture on PCOS, with effects seemingly no different than placebo.[14][15]
What causes PCOS?
A combination of environmental and genetic factors have been proposed to increase a person’s predisposition towards developing PCOS.[16]
High androgen levels seem to be the main cause of the clinical features of PCOS, including infertility, hirsutism, hair loss, and acne.[16] Also, about half of the women with PCOS have abnormal insulin resistance and subsequent hyperinsulinemia (high insulin levels) which contribute to the metabolic manifestations of PCOS.[17]
Examine Database: Polycystic Ovary Syndrome (PCOS)
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Frequently asked questions
Polycystic ovary syndrome (PCOS) is an endocrine (hormone-related) disorder that affects a large number of pre-menopausal women, with prevalence rates ranging from 3–10% depending on the population and diagnostic criteria used.[1] PCOS is characterized by androgen excess (e.g., high testosterone, male-pattern body hair growth) and/or ovarian dysfunction (e.g., ovarian cyst-like growths, infertility, irregular menstruation).
Some of the most common signs and symptoms of PCOS are irregular menstruation cycles, obesity, hirsutism (male-pattern body hair growth), loss or thinning of hair on the scalp, and acne. Common findings include high circulating androgen (e.g., testosterone) levels and cyst-like growths on the ovaries. Other signs and symptoms include insulin resistance, including the risk of type 2 diabetes. PCOS is also often associated with comorbid conditions such as: obesity, dyslipidemia, type 2 diabetes, and infertility.[2]
Women with PCOS and obesity were reported[18] to exhibit a significant increase in hunger one hour after an ad libitum meal in comparison to a control group that took two hours to reach significance. Interestingly, these differences did not coincide with changes in ghrelin (a hunger hormone). Even more perplexing is the fact that PCOS is associated with higher levels of leptin[19], a satiety hormone. This suggests that people with PCOS may have some form of leptin resistance. Recent research[20] is beginning to determine the mechanism for leptin resistance in PCOS.
Women with PCOS commonly have problems with fertility, but this doesn’t mean that it is impossible to get pregnant if you have PCOS. Many women with PCOS may still ovulate intermittently. However, PCOS is associated with an increased risk of adverse pregnancy outcomes including gestational diabetes, preeclampsia, preterm delivery, and miscarriage.[27] Multiple therapies have been shown to improve ovulation and increase the chances of pregnancy in women with PCOS, including clomiphene citrate, gonadotropins, and laparoscopic ovarian drilling. For women who are not ovulating, assisted reproductive techniques can be an effective means to obtain pregnancy.[28]
Hirsutism — abnormal hair growth with a male pattern of distribution — is one of the main manifestations of PCOS, with about 70-80% of women with PCOS experiencing this condition.[29] The primary cause of hirsutism in PCOS is an excess of androgens and an increased sensitivity of hair follicles to androgens, leading to abnormal patterns of hair growth. Reducing androgen secretion is the main treatment for hirsutism, which can be accomplished by using a combined oral contraceptive and antiandrogen treatment regimen or a combination of antiandrogens and another method of contraception (the latter due to the risk of birth defects from antiandrogens). Metformin and lifestyle changes may also be effective.[29]
A diagnosis of PCOS is typically based on meeting at least 2 of the following 3 criteria: (1) anovulation or oligo-ovulation (indicated by a lack of or infrequent menses), (2) androgen excess, and (3) small cyst-like growths on at least one of the ovaries, with other potential causes of these factors (e.g., Cushing’s syndrome, thyroid dysfunction, hyperprolactinemia) being ruled out.[3][4]
Medical interventions used to treat PCOS target specific patient symptoms and presentation of the condition. For example, insulin resistance is usually treated with metformin, irregular periods are often treated with oral contraceptives, spironolactone might be tried for symptoms of androgen excess, and infertility can be treated with clomiphene.[5]
One of the most well studied supplements for PCOS is inositol. Some studies have found inositol can improve insulin resistance and fertility in PCOS, though the quality of the evidence is not especially high.[6][7] Other supplements investigated for PCOS include L-carnitine, omega-3 fatty acids (e.g., fish oil), alpha-lipoic acid, berberine, and N-Acetylcysteine.[8][9]
A variety of diets (e.g., DASH, low glycemic index, low carbohydrate) have been shown to be beneficial for females with PCOS. These diets can be conducive to a reduction in calorie intake, which is beneficial for conditions secondary to PCOS such as metabolic syndrome, obesity and impaired glucose tolerance.[10][11]
Abdominal obesity and insulin resistance are two metabolic characteristics of PCOS that may improve in response to a carbohydrate-restricted or low-carbohydrate diet. Low-carbohydrate diets containing <45% carbohydrates are effective for reducing body mass index, improving insulin sensitivity and certain blood lipids, and increasing sex hormone binding globulin levels in women with PCOS, along with reducing testosterone in studies lasting more than 4 weeks.[21] There may also be psychological benefits to low-carbohydrate diets, and one study found a significant reduction in depression and increase in self-esteem in women with PCOS who were following a high-protein, low-carbohydrate diet, despite the absence of weight loss.[22] It should be noted that this was just one pilot study, and there is a lack of evidence on how dietary composition affects psychological outcomes in PCOS.
Since PCOS is tightly linked with metabolic abnormalities, exercise is often recommended. In addition to reductions in insulin and insulin resistance, increased physical activity has also been linked to lower androgen levels and improved reproductive function in PCOS.[12][13] More research is needed to determine which types of exercise are most beneficial.
A number of studies have investigated the effect of acupuncture on PCOS, with effects seemingly no different than placebo.[14][15]
While weight loss is not necessary for women with PCOS to improve their condition, losing weight can benefit the hormonal imbalances and insulin resistance that are characteristic of PCOS. As little as a 5% reduction in weight has been shown to improve insulin resistance and menstrual function in women with PCOS.[23] Weight loss can be achieved through lifestyle modifications such as diet and exercise, both of which can also improve insulin resistance and hormone levels independent of weight loss.[24][25][26]
Exercise is recommended as a lifestyle strategy to improve reproductive and metabolic health in women with PCOS. Improved insulin sensitivity is one of the primary ways that exercise benefits PCOS, however, reduced weight and adiposity and an improvement in cardiovascular disease risk factors are also among the benefits for PCOS that have been attributed to exercise.[30]
Beneficial effects of aerobic exercise in PCOS have been found for insulin sensitivity, cholesterol, aerobic capacity, and body composition [31] as well as for psychological well-being [32]. While the evidence is limited, there is some suggestion that exercise interventions improve menstrual regularity and pregnancy and ovulation rates in women with PCOS.[13] As for how much exercise is enough, it is recommended that women with PCOS obtain at least 150 minutes of physical activity per week.
A combination of environmental and genetic factors have been proposed to increase a person’s predisposition towards developing PCOS.[16]
High androgen levels seem to be the main cause of the clinical features of PCOS, including infertility, hirsutism, hair loss, and acne.[16] Also, about half of the women with PCOS have abnormal insulin resistance and subsequent hyperinsulinemia (high insulin levels) which contribute to the metabolic manifestations of PCOS.[17]
References
Examine Database References
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- Blood glucose - M Nordio, E ProiettiThe combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation aloneEur Rev Med Pharmacol Sci.(2012 May)
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- Blood glucose - Alessandro D Genazzani, Alessia Prati, Susanna Santagni, Federica Ricchieri, Elisa Chierchia, Erica Rattighieri, Annalisa Campedelli, Tommaso Simoncini, Paolo G ArtiniDifferential insulin response to myo-inositol administration in obese polycystic ovary syndrome patientsGynecol Endocrinol.(2012 Dec)
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- PCOS Symptoms - Papaleo E, Unfer V, Baillargeon JP, Fusi F, Occhi F, De Santis LMyo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trialFertil Steril.(2009 May)
- PCOS Symptoms - Raffone E, Rizzo P, Benedetto VInsulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS womenGynecol Endocrinol.(2010 Apr)
- PCOS Symptoms - Unfer V, Carlomagno G, Rizzo P, Raffone E, Roseff SMyo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trialEur Rev Med Pharmacol Sci.(2011 Apr)
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