Polycystic ovary syndrome (PCOS) is a condition characterized by painful, irregular periods, poorly controlled weight, and fertility issues. The common criteria used to diagnose PCOS are the presence of ovarian cysts, increased androgen levels (male hormones), and irregular periods (Adamska et al., 2020). Not only are the symptoms of PCOS frustrating and discouraging, but this health condition can also be difficult to manage.
While PCOS directly impacts the reproductive system, many people don’t realize that it can be caused by problems with metabolic hormones. Gaining an understanding of the metabolic system as it relates to PCOS allows you to take charge of this health condition and live a happier life.
Why is it important to know about metabolic hormones to understand PCOS?
When you think of metabolism, you may think of someone with a tiny waist who boasts a “fast metabolism” and gets to eat whatever she wants. It is true that metabolism plays a significant role in weight regulation, but it is much more complex. The endocrine system produces metabolic hormones like insulin, ghrelin, and leptin to regulate the body’s response to eating and utilization of energy.
Insulin is a hormone secreted by the pancreas that ensures a stable blood sugar level. This prevents high amounts of glucose circulating in the body, which can lead to health problems like inflammation or diabetes. Other metabolic hormones that participate in weight control are ghrelin, which controls appetite and hunger, and leptin, which helps tell the brain that you’re full after a meal (Adamska et al., 2020).
For your weight to be under control, these hormones must be in balance. A study by Al Saggaf et al. (2018) found that levels of ghrelin and leptin are not always irregular in women with PCOS, but they are linked to elevated insulin levels and insulin resistance, which are known contributing factors of PCOS.
Insulin resistance versus sensitivity
As it relates to PCOS, insulin sensitivity is a good thing, because it means your body is sensitive to the insulin being produced. The body will respond appropriately to the insulin secreted by the pancreas and use it to stabilize blood sugar levels. Insulin resistance means your body has difficulty responding to the insulin being produced, and will make more. As a result, the body has too much insulin in circulation, which is also known as hyperinsulinemia. People with uncontrolled hyperinsulinemia are more likely to go into an inflammatory state, which can cause a number of issues, such as further hormonal imbalances and mood disorders to name a few.
Insulin Resistance and PCOS
If you’ve been diagnosed with PCOS and have been told you have insulin resistance, you may be thinking, “I’m not a diabetic. What does insulin have to do with my ovaries?”
Here’s the thing: one of the underlying causes of PCOS is insulin resistance. Due to hyperinsulinemia (as a result of insulin resistance), the ovaries produce extra androgens, which are male hormones (like testosterone). This harms the ovaries’ ability to release mature eggs, which causes irregular periods and difficulty conceiving a baby. High androgen levels also cause symptoms like acne, unwanted facial hair (hirsutism), and male pattern baldness (CDC, n.d.).
Sometimes women with PCOS are diagnosed with metabolic syndrome because both conditions share common symptoms and treatment modalities. Metabolic syndrome is a condition characterized by a disruption to the body’s ability to use energy, which leads to inflammation and cardiovascular risk factors. Common characteristics of metabolic syndrome are high blood pressure, high lipid levels in the blood, abdominal obesity, and insulin resistance (Cazzola et al., 2021). Because of these shared characteristics, treatment for both PCOS and metabolic syndrome place emphasis on getting metabolic hormones under control.
How does diet impact metabolic hormones?
Many people consume an inflammatory diet and don’t even realize it. The standard American diet contains highly processed, grab-and-go foods that accommodate a busy lifestyle. Processed foods often contain refined sugar, which causes insulin spikes, and leads to inflammation.
Studies have found that chronic inflammation has been linked to a diet containing higher intake of sugar and trans fat for patients diagnosed with metabolic syndrome and obesity. Additionally, magnesium deficiency is commonly found in patients with metabolic syndrome (Cazzola et al., 2021).
As a result of an inflammatory diet, the insulin resistance-hyperinsulinemia-inflammation cycle perpetuates. This leads to further hormonal imbalance, and in turn, fluctuating weight that can be difficult to manage.
What’s the typical treatment for PCOS?
Treating PCOS is a multifactorial approach that includes lifestyle modifications such as altering diet and exercise routines. Your healthcare provider will work with you to get to the root of metabolic hormone imbalances, insulin resistance, and chronic inflammation. From there, you’ll be able to work together to correct the unfavorable symptoms of PCOS.
Here are some common medical treatments used to manage PCOS:
- Metformin. While this oral medication is most commonly prescribed as a treatment for metabolic syndrome, it’s also used to treat PCOS. Metformin helps with insulin resistance by telling your body to utilize the insulin being produced, rather than ignoring the insulin already there and making more. By getting insulin resistance under control, Metformin helps limit the production of androgens, the male hormones that contribute to PCOS symptoms.
- Berberine is an herb commonly used in Traditional Chinese Medicine to treat and prevent cardiovascular problems like heart attacks, stroke, and hypertension. Its ability to cause vasodilation helps relax the vascular beds to reduce blood pressure, minimizing the risk of embolism and damage to the vascular wall. Berberine is also known to reduce inflammation. Similar to Metformin, this herbal supplement assists with insulin resistance so that your body can use the insulin it’s making (Annunziata et al., 2019).
- Magnesium. Adding magnesium supplementation is often recommended by healthcare providers in treatment of metabolic syndrome and PCOS. In addition to managing blood sugar levels, magnesium helps with cardiovascular effects like lowering blood pressure. An added bonus: magnesium also helps improve mood!
- Birth control. For women who are not trying to conceive, taking birth control may be incorporated in the treatment plan for PCOS because of its ability to tightly control hormone levels. Having balanced hormones will reduce the chance of androgen production and help manage PCOS symptoms like hirsutism, acne, and thinning hair.
What will you notice as you improve insulin resistance?
When you get to the root of insulin resistance, you’ll be able to combat that overproduction of insulin in the body. By making your body more sensitive to insulin, other hormones follow suit and begin to balance. Having balanced hormones will help you glow from the inside out. Look forward to having:
- Happier skin. Corrected insulin resistance means less androgen production and therefore fewer breakouts.
- More regular periods. Woo hoo! Regular insulin levels allow for hormonal balance and results in getting your period on a more predictable schedule.
- Improved mood. A study by Alharbi et al. (2020) demonstrated that using Metformin in conjunction with diet and lifestyle changes significantly reduced depression in women with PCOS. According to this study, Metformin was specifically used for its antidepressant effects because it blocks the expression of a gene in the brain that can cause depression. Additionally, the study noted that when insulin resistance was under control, women with PCOS reported being happier because they were finally able to manage symptoms like acne and hirsutism.
Here’s what you can do.
When creating a treatment plan for PCOS with your provider, remember that getting to the root of the problem is just as important as symptom management. While your provider can prescribe the right medications for your specific needs, you can get started by making changes to your lifestyle.
The least invasive way to start managing PCOS is by changing lifestyle habits surrounding diet, exercise, and smoking.
When it comes to diet, we know that metabolic hormones are impacted by calories, fat, and carbohydrate intake. A low-calorie or reduced carbohydrate diet may be recommended by your healthcare provider if it’s identified that you need to lose weight. Rather than crash-dieting to get immediate results, think about making changes to your diet that you’ll incorporate long term.
Start by swapping out starchy foods with whole grains and incorporating more whole fruits and vegetables into your diet. Not only are these better sources of energy than refined sugar, fruits and vegetables are good sources of fiber, which helps with digestion. When the digestive system is slowed down and has to work too hard to help you use food for energy, you’re more likely to have inflammation. Another way to combat inflammation is by adding foods with anti-inflammatory properties to your diet like beets, blackberries, and nuts.
Choosing the right types of fat in your diet is important in managing PCOS. Go for the fats that contain protein and fill you up, like nuts and legumes. A study by Adamska et al. (2020) found that dietary fat directly impacts ghrelin and leptin levels. When these hormones are balanced, your body will do a better job of telling you when you’re full and you’ll have better control of your appetite.
Since we know that many people with metabolic syndrome and PCOS tend to be magnesium deficient, you can find ways to start incorporating this trace element into your diet. Foods like whole grains, avocados, and kale are great sources of magnesium. Thinking about making a magnesium-rich grain bowl? Add chia seeds on top! These little super seeds are a great addition to your diet because they help maintain regular blood sugar levels while keeping you fuller longer.
When you nourish your body with foods that support healthy metabolic and endocrine systems, you’ll be on your way to becoming more responsive to insulin, while facilitating stable metabolic hormonal levels.
Exercise! Remember to incorporate activity that gets your heart rate up at least 3 times a week, for 30 minutes each. A sedentary lifestyle is directly linked to abdominal obesity, another risk factor for inflammation and insulin resistance.
Looking for a reason to quit smoking? Cigarettes and vaping cause damage to blood vessels, putting you at risk for cardiovascular disease, and you guessed it, inflammation.
Create a medical treatment plan with your provider
Don’t lose sleep trying to manage PCOS alone. Getting PCOS symptoms under control takes time and participation on behalf of you and your healthcare provider. You can start with diet and exercise changes, but when considering how to navigate PCOS medically, have a conversation with your provider about what the best fit will be for you. Discuss supplements like Berberine and magnesium before you start taking them. If you decide to go with a prescription medication like Metformin or birth control, make sure to let your provider know about any other medications you’re taking.
When you combine lifestyle changes with a treatment plan that addresses the underlying cause of PCOS (metabolic hormone imbalances, particularly insulin resistance) you’ll be able to improve your condition in order to become a happier, healthier version of yourself. Cheers!
Written by Alexa Davidson, MSN, RN
Alexa is a registered nurse and freelance health writer with over a decade of experience in neonatal and pediatric cardiac intensive care. When she’s not busy putting pen to paper, she can be found recreating dishes from her favorite restaurants at her home in Charleston, SC.
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Centers for Disease Control and Prevention. (n.d.). PCOS (Polycystic Ovary Syndrome) and Diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/pcos.html