Polycystic ovary syndrome (PCOS) is the most common female endocrinopathy, affecting as many as 15% - 18% of women of reproductive age and is characterized by anovulation, androgen excess (primarily ovarian, but also adrenal in origin) and the appearance of polycystic ovaries on ultrasound.
Symptoms that are most troublesome to patients include hirsutism, obesity, infertility and menstrual disorders.
PCOS patients are not always markedly overweight but PCOS is strongly associated with abdominal obesity and insulin resistance.
There are various clinical phenotypes and they can change over the life span with weight gain, and can coexist in the same patient. Individualized treatment remains the main approach, but grouping the phenotypes and following therapeutic recommendations may also prove to be clinically suitable.
The four main causes of the physiological basis of PCOS include:
Disorders of gonadotropin hormonal synthesis
The appearance of insulin resistance
The influence of the present excessive body fat
The metabolic pathways involved in PCOS (the secretion and activity of insulin, encoding for steroidogenesis, and other metabolic and hormonal pathways)
Treatment:
Use of drugs to either improve insulin sensitivity or to promote weight loss are justified as a short-term measure, and are most likely to be beneficial when used early in combination with diet and exercise.
Lifestyle change is the first line of treatment for the management of women with PCOS but is not an alternative to its pharmacological treatment
According to literature Effective approaches to nutrition and exercise improve endocrine features, reproductive function and cardiometabolic risk profile--even without marked weight loss.
Regular physical activity, maintaining appropriate body weight, following healthy dietary patterns and avoiding tobacco use is vital in prevention and treatment of metabolic disorders, and is included in clinical guidelines for various conditions (including PCOS)
Focusing on overall wellbeing and mental health is a personal choice, and while it is not an immediate fix, it is an important step towards a more fulfilling life.
DIET
Low Glycemic Index (GI) diet
Diet rich in n-3 fatty acids
Elimination of saturated fat
Dietary α-linolenic acid (e.g. flaxseeds)
in PCOS patients with advanced obesity and/or obesity accompanied by full-blown metabolic syndrome, the introduction of a ketogenic diet may provide even better results than a diet with a LGI (low glycemic index).
A general conclusion is that by following the main principles of a healthy diet, the physiological homeostasis can be managed, as well as faster recovery from disease achievedPHYSICAL ACTIVITY
Physical training potentiates the effects caused by insulin sensitivity through the optimization of glucose transport and metabolism
Vigorous intensity exercise may have the greatest impact on cardiorespiratory fitness, insulin resistance, and body composition
Vigorous aerobic exercise and resistance training to improve insulin sensitivity and androgen measurements are warranted for women with PCOS. The minimum aerobic activity per week should be 120 min
SLEEP
Mental health disorders are highly prevalent in PCOS cases, which are associated with significantly more frequently experienced states of anxiety and depression, as well as sleep disorders
Sleep deprivation has been connected with increased risk of IR (insulin resistance), obesity, and type 2 diabetes (T2D).
Sleep disorders can be considered as one of the first symptoms leading to the weakening of the body’s protective properties and intensification of the pathways associated with insulin resistance in the course of PCOS.HERBS SUPPORTING TREATMENT
A balanced diet to support insulin management is the most important treatment for PCOS; drinking infusions of some herbs would therefore be a very good complement to the therapy, such as
Aloe vera, cinnamon (Cinnamomum verum)
Green tea (Camellia sinensi)
Chamomile (Matricaria chamomilla)
White mulberry (Morus alba)
These herbs have properties of regulating lipid and carbohydrate metabolism they can be used by all phenotypes of PCOS women.
Another group of herbs is indicated especially for women with PCOS with biochemical evidence of increased levels of androgens: green mint (Mentha spicata L.), which has an antiandrogenic effect and restores follicular development in ovarian tissue.
Licorice smooth (Glycyrrhiza glabra) has been used in the treatment of PCOS because of its antiandrogen and estrogen-like activity. However, licorice is not a flawless solution, having the potential to induce hypertension, hypokalemia, and metabolic alkalosis.
Curcumin seems to be an efficient reducer of oxidative-stress related complications in patients with PCOS
Summary:
Regarding PCOS It has been shown that significant improvement depends on modifiable factors related to the improvement of lifestyle, the introduction of a diet, especially a low-calorie diet with reduced GI, normalization of sleep and the introduction of daily physical activity. In addition, supplementing the diet with antioxidants and herbs seems to be highly effective in combating the chronic inflammation (Curcuma longa), improving liver steatosis (Silybum marianum, Nigella sativa) and the frequently occurring intestinal dysbiosis (probiotic therapy).
References:
Szczuko, M., Kikut, J., Szczuko, U., Szydłowska, I., Nawrocka-Rutkowska, J., Ziętek, M., Verbanac, D., & Saso, L. (2021). Nutrition Strategy and Life Style in Polycystic Ovary Syndrome-Narrative Review. Nutrients, 13(7), 2452. https://doi.org/10.3390/nu13072452
Farshchi, H., Rane, A., Love, A., & Kennedy, R. L. (2007). Diet and nutrition in polycystic ovary syndrome (PCOS): pointers for nutritional management. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 27(8), 762–773. https://doi.org/10.1080/01443610701667338
Legro, R. S. (2017). Evaluation and Treatment of Polycystic Ovary Syndrome. In K. R. Feingold (Eds.) et. al., Endotext. MDText.com, Inc.