According to the World Health Organization, up to 70% of women affected by PCOS remain undiagnosed. We spoke to nutritional therapist Lucia Stansbie about the challenges regarding diagnosis as well as lifestyle and clinical-related treatment options
Polycystic Ovary Syndrome, also known as PCOS, is a hormonal disorder that affects women of reproductive age and is characterised by different symptoms such as missing or very irregular periods, adult acne, hirsutism (meaning hair growth in areas such as chin and jaw, and chest), adult acne and struggling to maintain a healthy weight. Other manifestations include acanthosis nigricans (dry, dark patches of skin that usually appear in the armpits, neck, or groin), male bolding pattern (at the temples), and struggling to conceive.
A nutritionist can help manage PCOS, addressing not only the individual’s state but also lifestyle factors, exercise, stress, and mental health.
How common is PCOS, and what are the risk factors?
PCOS is a relatively common condition, affecting between 5-15% of women of childbearing age, or one in ten. Because of the variety of symptoms and the fact that it is not always present with adult acne, missing or irregular periods, and evident ovarian cysts, it can be undiagnosed for many years, assessed only when a complete hormonal test is done for different reasons (one of the main being struggling to conceive).
The main risk factors that play a role in the development of PCOS are:
- Genetics – there is evidence of a predisposition to developing this condition, as often different female members of the same family present with it.
- Insulin resistance – women presenting with insulin resistance and elevated blood glucose levels are more susceptible to developing the condition.
- Clinical obesity – excessive body weight is linked to a higher possibility of developing PCOS, even though this condition can also be seen in women of all body types. This is because of the likely insulin resistance associated with clinical obesity.
- High levels of stress – can potentially lead to the development or exacerbate PCOS because of the connection between steroid hormones such as cortisol and testosterone (which is usually elevated in PCOS).
- Hormonal imbalances – in PCOS, androgen (testosterone) levels are elevated. This can be due to many factors, including nutrition, medications, and lifestyle.
What are the key challenges currently facing the diagnosis, treatment, and management of PCOS?
The main challenge is the wide variety of symptoms, which vary from woman to woman, as some can display adult acne and lack of periods while others don’t display any but find out only when trying to conceive. Another challenge is also the fact that many women spend years on contraception, which can mask symptoms that will otherwise emerge. There are multiple tests to diagnose PCOS, mainly blood tests assessing hormonal (both male and female) and blood glucose levels. In a clinical setting, scans can also be a useful diagnostic tool, as they will show any ovarian cysts even if the sole presence of cysts is not enough to diagnose PCOS. They can also be present in other conditions not related to PCOS.
A holistic clinical evaluation, considering the individual reproductive health history, symptoms, and questions around lifestyle and diet, can give a great indication. Still, a diagnosis can be issued only with blood test data.
In terms of treatment, there are different routes:
- Lifestyle and dietary changes improve insulin sensitivity and hormonal balance and stabilise weight (if needed).
- Hormonal therapies: the contractive pill can be prescribed to stabilise hormonal levels and ease symptoms, but it is not applicable for women trying to conceive.
- Insuline-sensitizing medications, such as metformin, can help improve insulin resistance and weight.
How can PCOS impact someone’s mental health?
PCOS can have an impact on mental health, as symptoms such as adult acne, weight gain, and hirsutism can increase self-consciousness and anxiety, as well as contribute to low self-esteem and body dissatisfaction.
Research also shows that women with PCOS can be at higher risk of developing eating disorders as a way to control weight, but also because of the instability of blood glucose levels, which can increase cravings.
Hormonal fluctuations and blood sugar imbalances associated with PCOS can also affect mood, causing mood swings and emotional instability.
Fertility challenges in women with PCOS can also affect mental health and mood in women trying to conceive.
