Understanding PCOS and How Nutrition Can Help

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal condition that affects 12-18% of females of reproductive age, with rates rising to 21% in high-risk groups like Indigenous Australian women (Jean Hailles, 2020). Despite its prevalence, up to 70% of those affected remain undiagnosed (Teede et al., 2018).

PCOS presents differently in each individual, but common symptoms include:

• Irregular or infrequent periods (cycles longer than 35 days)
• Lack of ovulation
• Skin issues such as acne and darkened patches
• Hair changes (excessive growth or thinning/loss)
• Weight gain
• Increased anxiety and depression
• Multiple ovarian follicles seen on ultrasound (though not always present)
• Difficulty conceiving
• Sleep disturbances, including sleep apnea
  
  

Diagnosing PCOS

A PCOS diagnosis requires meeting at least two of the following three criteria:

1. Irregular or absent ovulation (infrequent or missing periods)
2. High androgen levels (detected via blood tests or symptoms like acne, excess hair growth on face/body, or scalp hair thinning)
3. High numbers of ovarian follicles seen on ultrasound

These hormonal imbalances can interfere with ovulation, making conception more challenging. Excess androgens also contribute to insulin resistance, disrupting menstrual cycles and contributing to acne, hair growth and mood disturbances with increases in long-term health risks.

What is Lean PCOS?

Lean PCOS occurs in individuals who are within a healthy weight range but still experience PCOS symptoms. While weight loss is often recommended for managing PCOS, it is not an appropriate strategy for those with lean PCOS. Instead, dietary and lifestyle modifications can play a crucial role in improving PCOS symptoms and overall health (Rasquin Leon et al., 2022).

The Role of Nutrition in PCOS Management

Diet plays a powerful role in managing PCOS, particularly in addressing insulin resistance and reducing symptom severity. While there is no single "best" diet for PCOS, individualised nutrition strategies can support hormonal balance, energy levels, and regular menstrual cycles (Moran et al., 2013). The key point being, nutrition needs to be indiviualised, as everyone with PCOS is different!

How Effective is Diet for PCOS Symptoms?

Research and clinical experience show that the right dietary and lifestyle changes can significantly improve PCOS symptoms. A 2010 study compared the effectiveness of medical treatments (Metformin or Clomid or both) versus lifestyle interventions (diet and exercise). The lifestyle intervention group showed greater improvements in pregnancy rates, hormonal balance, and metabolic markers, highlighting the powerful impact of nutrition and exercise in PCOS management (Legro et al., 2010).

Understanding Insulin Resistance in PCOS

Insulin resistance (IR) affects nearly 85% of those with PCOS, making it a key driver of the condition. Insulin is responsible for regulating blood sugar levels, but in insulin resistance, the body's cells become less responsive to insulin, leading to elevated blood sugar and insulin levels. 

Symptoms of insulin resistance include:

• Fatigue
• Sugar cravings (especially after meals)
• Weight gain, particularly around the midsection
• Brain fog
• Increased hunger

Left unmanaged, insulin resistance can increase the risk of type 2 diabetes, high cholesterol and disrupt ovulation and menstrual cycles (Silvestris et al., 2018).

Managing PCOS with Carbohydrates: Low or Low-GI?

Carbohydrates are often misunderstood in PCOS management. The goal is not to eliminate them but to choose and distribute them wisely throughout the day to maintain stable blood sugar levels.

Low-GI (glycemic index) carbohydrates are particularly beneficial, as they release glucose slowly into the bloodstream, preventing insulin spikes. Some simple low-GI swaps include:

• White rice → Brown basmati or Doongara rice
• White bread → Whole grain, rye, or sourdough bread
• White potato → Sweet potato
• Crackers → Nuts & seeds
• Chocolate bar → Hot chocolate made with full fat milk

Spreading carbohydrate intake throughout the day can also improve energy levels and metabolic balance. For example, opt for a balanced breakfast (e.g., nuts, seeds, fruit and Greek yoghurt), a whole grain sandwich for lunch, and a dinner with fibre-rich carbs like quinoa or brown rice (Barrea et al., 2021).

The Mediterranean Diet for PCOS

The Mediterranean diet is one of the most effective dietary patterns for PCOS. It is anti-inflammatory, heart-healthy, and supports hormonal balance. This diet emphasizes:

• Healthy fats: Extra virgin olive oil (EVOO), all nuts & seeds
• Colorful vegetables: A variety of fibre-rich, nutrient-dense options
• Seasonal fruits (in moderation)
• Legumes and whole grains (lentils, beans, quinoa, whole wheat)
• Lean proteins such as poultry, eggs, and seafood (especially omega-3-rich fish like salmon)
• Moderate dairy intake (fermented options like yogurt and Grana Padano cheese) (Papakonstantinou et al., 2020) - full fat is better than skim due to less IGF-1.
  
  

Final Thoughts

PCOS is a complex condition, but nutrition and lifestyle changes can make a significant difference in managing symptoms, improving fertility, and supporting long-term health. Working with a registered dietitian who specialises in PCOS can help you create a sustainable, personalised approach to nutrition that works for your body and lifestyle.

Get in touch at [email protected] or Book a Consultation here

References

• Barrea, L., Verde, L., Severino, R., et al. (2021). "Glycemic Index and Glycemic Load in the Management of PCOS: Nutritional Implications and Health Outcomes." Nutrients, 13(3), 846.
• Diamanti-Kandarakis, E., & Dunaif, A. (2012). "Insulin Resistance and the Polycystic Ovary Syndrome Revisited: An Update on Mechanisms and Implications." Endocrine Reviews, 33(6), 981-1030.
• Jean Hailes (2020). "PCOS: Polycystic Ovary Syndrome." Retrieved from www.jeanhailes.org.au
• Legro, R. S., Barnhart, H. X., Schlaff, W. D., et al. (2010). "Clomiphene, Metformin, or Both for Infertility in the Polycystic Ovary Syndrome." New England Journal of Medicine, 363(11), 1054-1065.
• Moran, L. J., Hutchison, S. K., Norman, R. J., & Teede, H. J. (2013). "Lifestyle changes in women with polycystic ovary syndrome." Cochrane Database of Systematic Reviews, 2011(2), CD007506.
• Papakonstantinou, E., Papadaki, A., & Vasilaki, M. (2020). "The Mediterranean Diet and PCOS: A Nutritional Approach." Nutrients, 12(11), 3345.
• Rasquin Leon, L. I., Salazar-Carbonell, C. J., & Vázquez-Borrego, M. C. (2022). "Lean PCOS: Understanding a Unique Phenotype." Current Opinion in Endocrinology, Diabetes, and Obesity, 29(2), 151-157.
• Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2003). "Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)." Human Reproduction, 19(1), 41-47.
• Silvestris, E., de Pergola, G., & Rosania, R. (2018). "Obesity and Infertility: Metabolic and Endocrine Mechanisms." Obesity Reviews, 19(1), 34-50.
• Teede, H. J., Misso, M. L., Costello, M. F., et al. (2018). "Recommendations for PCOS Diagnosis and Management." Fertility and Sterility, 110(3), 364-379.