What Lifestyle Habits Help You Manage PCOS? Here’s what We Know.
A PCOS diagnosis often comes when you least expect it. Hunting the web for useful information is confusing. Guidance to “lose weight” for managing PCOS without any strategies is not helpful. We’re here to help.
PCOS is a complex condition that requires a multi-pronged treatment strategy. With the right knowledge and support team, managing your symptoms gets easier.
If your goal is to get pregnant, PCOS-supportive ways of eating and exercising are similar for prenatal care.
A diagnosis of Polycystic Ovary Syndrome, commonly known as PCOS, comes when many women least expect it. Related to hormonal imbalances, PCOS is an endocrine disorder in which a woman’s ovaries become enlarged and develop cysts.
While many may have heard of PCOS in passing, most do not know that PCOS affects between 5-13% of women of reproductive age and is a leading cause of infertility.
The cause of PCOS is unknown but genetic and environmental factors are involved. There is no cure for PCOS. Rather, a combination of medical intervention and lifestyle strategies is recommended.
Symptoms, Clinical Features & Complications
Because women experience a range of symptoms, including those like acne that many do not associate with a serious health condition, PCOS is often undiagnosed until a woman experiences changes in her menstrual cycle or is having trouble getting pregnant.
Symptoms of PCOS include:
Obesity, weight gain, trouble losing weight especially around the abdomen
Hirsutism (excessive body hair, typically on the face, chest, abdomen, or upper thigh region)
Dyslipidemia (abnormal blood lipid levels)
Acanthosis nigricans (patches of thick, dark skin)
To diagnose PCOS, a clinician will evaluate three main clinical features: absence of ovulation, high levels of androgens (hormones produced in the ovaries), and the presence of ovarian cysts.
Due to the presence of hormonal imbalances, PCOS is associated with an increased risk of other conditions and diseases including low-grade chronic inflammation, hypertension (high blood pressure), dyslipidemia (abnormal blood lipid levels), overweight and obesity, type 2 diabetes, depression, anxiety, eating disorders, and pregnancy and infant complications. A management plan will take into account these potential long-term complications.
Once PCOS is diagnosed, a woman will work with her practitioner to develop an individualized management plan.
The treatment goals for PCOS are to improve hormonal imbalances, lose and/or maintain body weight, prevent complications, and improve quality of life. Finally, if a woman with PCOS has had trouble getting pregnant, a management plan will address infertility.
To achieve these goals, areas of focus include medications, eating patterns, exercise, and stress management.
PCOS-Healthy Eating Pattern
An eating pattern that is supportive of managing PCOS is similar to other anti-inflammatory eating patterns such as the Mediterranean Diet.
Eat whole foods such as vegetables, fruit, legumes like beans and lentils, whole grains, nuts, and seeds. Choose moderate portions of high-quality carbohydrates (starchy vegetables, fruit, legumes, whole grains) paired with lean proteins. Select moderate portions of heart-healthy foods like avocado, olive oil, nuts, and seeds. Incorporate sources of omega-3 fatty acids including salmon, sardines, and seeds like flax, hemp, and chia. Drink water and other unsweetened beverages.
Limit or avoid foods that do not support an anti-inflammatory eating pattern such as foods with refined carbohydrates and added sugars. These include snack foods, white bread, white rice, baked goods, candy, soda, energy drinks, and sweetened cereals and yogurts. Choose fatty cuts of meats, processed meats, and whole dairy products sparingly. Limit alcoholic drinks to one per day.
Insulin Resistance and Blood Sugar Management
Insulin resistance is a common feature of PCOS that is exacerbated by being overweight and obese as well as physical inactivity. To better understand insulin resistance, let’s first describe how your body turns food into energy by producing insulin.
When you eat, your body breaks down food into glucose, also known as sugar, and your blood sugar level rises. Your pancreas makes the hormone insulin to help glucose enter muscle, fat, and liver cells, where it is used to generate energy. As insulin helps glucose enter your cells, your blood sugar level begins to fall into a normal range. Insulin resistance occurs when your cells do not respond as well to insulin. As a result, your pancreas makes more insulin, and your blood sugar level may remain higher than normal. Consistently having high blood sugar levels damages the body.
To reduce insulin resistance and manage blood sugar levels, focus on dietary strategies that relate to the macronutrients in the foods we eat – carbohydrates, protein, and fat. Compared to protein and fat, carbohydrates most affect blood sugar levels. Do not avoid carbohydrates, though. Rather, choose high-quality, whole food carbohydrates most often and eat meals and snacks that contain a balance of carbohydrates, protein, and fat.
A healthy way of eating is only one part of managing PCOS. It’s also important to get regular physical activity. Being active can help reduce insulin resistance and increase ovulation rates and menstrual cycle regularity. Not to mention, engaging in regular exercise is beneficial for overall physical and mental health.
Engage in at least 150 minutes per week of moderately vigorous activity, including at least two full-body strength training sessions with dumbbells, kettlebells, weight machines, and/or bodyweight only. Aim to be less sedentary and more active overall.
Some studies report that between 50-90% of women diagnosed with PCOS also have overweight or obesity. There is no one cause of overweight or obesity, but hormonal disturbances are involved.
Studies report that even 5% weight loss can make a difference in PCOS symptoms by decreasing abdominal fat, androgen index, and insulin resistance. Weight loss also improves blood lipid levels, menstrual cycle regularity, and fertility.
Weight loss is complicated. It’s not as simple as estimating calories consumed and burned. The primary strategies to lose or maintain weight align with recommendations to manage PCOS – choose sensible portions of whole foods most often, craft balanced meals and snacks, and exercise regularly including strength training.
General tips to support weight management include:
Avoid restrictive diets, cleanses, or extreme exercise plans.
Eat plentiful non-starchy vegetables. Choose lean proteins.
Choose moderate portions of higher-fat foods.
Set goals for daily lifestyle habits.
Enjoy fun foods like desserts sometimes.
Avoid eating when bored or stressed.
Choose unsweetened beverages most often.
Improve sleep quantity and quality.
Mental Health and Eating Disorders
It will come as no surprise that the symptoms of PCOS impact quality of life for many affected women. In turn, PCOS affects both the risk of mental health disorders and eating disorders.
Between 28-64% of women with PCOS may have depression and anxiety (Nunes et al., 2019). One contributing factor to the prevalence of mental health disorders in women with PCOS is weight and body image issues. In one study, women with PCOS had four times the risk of having an eating disorder compared to women without PCOS (Lee et al., 2017).
While addressing lifestyle habits may be part of a treatment plan for mental health and eating disorders, seek professional support from qualified healthcare practitioners to discuss individualized care.
Like many medical conditions, PCOS is linked to increased stress. Part of PCOS treatment should include coping with stress using tools such as self-care, reading, meditation, journaling, experiences in nature, and more.
Final Thoughts on Managing PCOS
The first step to managing PCOS is speaking with your doctor. A combination of medication, eating and exercise strategies, and stress management can improve symptoms. Seeing a fertility specialist is also a priority if your goal is to get pregnant. Following a PCOS treatment plan developed by you and your healthcare team and consistently practicing healthy lifestyle habits can enhance well-being and help you live a happy life with PCOS.
Barrea L et al. Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS). Nutrients 2019;11:2278.
Blay SL, Aguiar JVA and Passos IC. Polycystic ovary syndrome and mental disorders: a systematic review and exploratory meta-analysis. Neuropsychiatric Disease and Treatment 2016;12:2895-2903.
Günalan E, Yaba A and Yilmaz B. The effect of nutrient supplementation in the management of polycystic ovary syndrome-associated metabolic dysfunctions: A critical review. J Turk Ger Gynecol Assoc 2018;19:220-32.
Jiskoot G et al. A three-component cognitive behavioural lifestyle program for preconceptional weight-loss in women with polycystic ovary syndrome (PCOS): a protocol for a randomized controlled trial. Reproductive Health 2017;14:34.
Kataoka J et al. Weight Management Interventions in Women with and without PCOS: A Systematic Review. Nutrients 2017;9:996.
Kite C et al. Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Systematic Reviews 2019;8:51.
Lee I et al. Increased risk of disordered eating in polycystic ovary syndrome. Fertil Steril. 2017;107(3):0015-0282
Lim SS et al. Lifestyle changes in women with polycystic ovary syndrome (Review). Cochrane Database of Systematic Reviews 2019;3:CD007506.
Lin AW et al. Dietary and Physical Activity Behaviors in Women with Polycystic Ovary Syndrome per the New International Evidence-Based Guideline. Nutrients 2019;11:2711.
Nunes Rd et al. Lifestyle interventions and quality of life for women with polycystic ovary syndrome: a systematic review and meta-analysis protocol. Medicine 2019;98:50(e18323).
Polycystic Ovary Syndrome. NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development. January 2017. Available from: https://www.nichd.nih.gov/health/topics/pcos
Teede HJ et al. Recommendation from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018;110(3):364-379.
Zhang X, Zheng Y, Guo Y and Lai Z. The Effect of Low Carbohydrate Diet on Polycystic Ovary Syndrome: A Meta-Analysis of Randomized Controlled Trials. Int J of Endocrinol 2019;2019:4386401.