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  • Polycystic Ovary Syndrome (PCOS)

    Polycystic Ovary Syndrome (PCOS) is a collection of hormonally induced symptoms that affects women of all ages. It gets this name since a primary feature is the abundance of cysts in the ovaries. The cause of PCOS is currently unknown, but it is related to hormone imbalance and has shown to run in families. PCOS affects around 1 in 10 people with ovaries in the UK, but research suggests this number could be as high as 1 in 5 as more than half do not have symptoms. However, the number is likely to be higher as people often go undiagnosed. While there is no cure for PCOS, we can do our best to manage symptoms and make things easier.

    What are the symptoms of PCOS?

    • Irregular or no periods
    • Irregular or no ovulation
    • A difficulty getting pregnant or other fertility concerns
    • Oily skin and acne
    • Thinning or loss of hair from the scalp
    • Thick hair growth on the face, chest, arms and back also known as hirsutism
    • Weight gain or difficulty losing weight
    • Depression
    • Anxiety
    • Insulin resistance or a higher risk of it – 60-80% of PCOS sufferers can develop this

    What is required for a diagnosis of PCOS?
    Two of these three indicators are usually required to be present for a diagnosis of PCOS:
    • Irregular or infrequent periods, indicating that the ovaries may not regularly release eggs
    • Unusually high levels of testosterone often detected through a hormonal blood test
    • The presence of polycystic ovaries (enlarged, with fluid-filled sacs surrounding egg cells) in an ultrasound scan

    What medications can I take to manage symptoms?

    After speaking to your GP, the doctor will do what they can to help you manage PCOS. GPs may not always have the time or expertise to delve into PCOS. Still, there is a chance they may refer you to an endocrinologist for further help. Most likely, they may offer you medication for your individual symptoms. Remember that whilst lifestyle measures can improve PCOS experiences, medication can work and change things on a level that food cannot.

    You may be prescribed the oral contraceptive pill to assist with irregular periods, acne and other excess androgen-related symptoms. The combined contraceptive pill can help maintain the balance hormone levels at different parts of the cycle and help to regulate periods. Anti-androgenic contraceptive pills might be more suitable in PCOS if those are the symptoms you are struggling with.

    Metformin can be prescribed to improve insulin sensitivity and blood glucose management in particular. It can help avoid diabetes, so it may be offered to prediabetics and those with PCOS due to the increased risk of developing type 2 diabetes.

    What supplements can I take to manage symptoms?

    Vitamin D
    Some people take a Vitamin D supplement to combat the higher risk of deficiency in PCOS. A daily supplement of 10-25mg a day or 1000iu is recommended. You can read more about Vitamin D here.

    Omega-3
    Omega-3 supplements may be helpful for inflammation and insulin resistance. This can be in the form of fish or algal oil, and a supplement of 500mg combined DHA and EPA is combined. If you are pregnant, you can still take omega-3 supplements but avoid any with Vitamin A or sourced from liver e.g. cod liver oil – it can potentially cause harm to your baby. You can read more about Omega-3 in this article.

    Inositol
    Research is emerging around the use of inositol in managing PCOS symptoms, particularly for those struggling with irregular periods or fertility. Inositol is a sugar present in our brains and other organs. Two key types, myo-inositol (MI) and d-chiro-inositol (DCI), both play a role in insulin control and fertility and can be taken as a combined supplement. Some research shows that taking a supplement with a high ratio of MI to DCI (40:1) has been most effective. However, these supplements can be expensive, so it is recommended to try them for a few weeks before deciding whether they are effective for longer-term use.

    Please remember that supplements may not be necessary or suitable for everyone, and it is best to consult with your GP or a nutrition professional if you have any concerns or queries.

    What else can I do to manage symptoms?

    Stress management
    There are several different tools or ‘crutches’ that we can incorporate into our lives, not only when stress occurs, but in our daily routine, to offer continuous management. These may include things like:
    • Mindfulness
    • Yoga
    • Movement
    • Podcasts
    • Speaking to someone
    • Journaling
    • Food and cooking
    • Drawing/art
    • Face masks/nail painting/massages and other self-care you enjoy
    • Saying no to things you don’t have time or energy for
    • Creating boundaries
    • Asking for help

    Movement

    Whilst weight loss and eating a more balanced diet can improve symptoms, engaging in regular movement has been shown to improve PCOS symptoms, including reducing insulin resistance, independent of dieting and weight loss. Think about what movement looks like for you and what is enjoyable and compliant with your lifestyle. If it feels like a big task for you, it may not be the right kind of movement, so it’s worth exploring your options. It can be easy to think that not managing a 5K walk isn’t good enough, but remember, even a short trip to the post box, stretching, and even vacuuming all count.

    Sleep

    Inadequate or poor-quality sleep can disrupt our appetite hormones. It can also affect the regulation of blood sugar levels and increase cortisol (stress) levels.
    Commit to maintaining good sleep hygiene and stress management tools, which may help calm the anxiety you may be feeling before bed. You can try:
    • Putting your phone and other screens away an hour or two before bedtime
    • Going out during the day, especially experiencing daylight in the early morning
    • Making sure your bedroom is a comfortable temperature to avoid sleep disruption
    • Incorporating mindfulness, journaling or body scans to calm the mind if it is racing at night

    Nutrition

    It is essential to ensure that with PCOS, you are eating enough and regularly throughout the day. Food restriction may lead to overeating and more instability in blood levels which can affect insulin resistance. A regular eating pattern of similar quantities and time of day will stabilise blood sugar levels and improve insulin sensitivity.

    There is a big misconception that those with PCOS should cut out or reduce their carbohydrate intake. The reality is that all carbs, especially high fibre carbohydrates coupled with protein, can undoubtedly help PCOS symptom management.

    To help become more aware of your appetite levels, it may help to use a ‘hunger wheel’ or scale rating. Using a hunger wheel as a visual guide can encourage you to be mindful of your hunger and notice how this presents itself in your body.

    Body image

    We all experience insecurities about our bodies. It can be useful to explore these further with a lens of giving more kindness and appreciation to our bodies. Writing a thank you letter to your body, or noticing the functions and experiences it allows us to have can be quite freeing. You can explore accepting compliments you receive from others and even offering them to those around you too. Through these exercises, you may learn to have more self-compassion and acceptance in your skin, too.

    References:

    nhs.uk. 2019. Polycystic Ovary Syndrome. Available at:
    <https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/>

    Papalou, O. and Diamanti-Kandarakis, E. , 2016. The role of stress in PCOS. Expert
    Review of Endocrinology & Metabolism, 12(1), pp.87-95.

    Monash.edu. 2011. International Evidence-Based Guideline For The Assessment And
    Management Of Polycystic Ovary Syndrome 2018. Available at:
    https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-
    Guidelines_20181009.pdf.

    Jakubowicz, D. , Barnea, M. , Wainstein, J. and Froy, O. , 2013. Effects of caloric intake timing on insulin resistance and hyperandrogenism in lean women with polycystic ovary syndrome. Clinical Science, 125(9), pp.423-432.

    Haqq, L. , McFarlane, J. , Dieberg, G. and Smart, N. , 2014. Effect of lifestyle intervention
    on the reproductive endocrine profile in women with polycystic ovarian syndrome: a systematic review and meta-analysis. Endocrine connections, 3(1), pp.36-46.

    Ross, R. , Janssen, I. , Dawson, J. , Kungl, A.M. , Kuk, J.L. , Wong, S.L. , Nguyen‐Duy, T.B. , Lee,
    S. , Kilpatrick, K. and Hudson, R. , 2004. Exercise‐induced reduction in obesity and insulin resistance in women: a randomized controlled trial. Obesity research, 12(5),
    pp.789-798.