Lifestyle changes benefit women with PCOS at all ages and stages of life
Polycystic ovary syndrome, PCOS, is one of the most common hormonal diseases of women worldwide. In PCOS there is a combination of dysfunction of follicles and ovulation, imbalance of sex hormones, and high levels of insulin. Not all patients may have all of these features.
If you or someone you know is one of five women of child-bearing age in the U.S. who suffers from infertility, you may have heard of PCOS. It is the single most common cause of female infertility, affecting one out of every ten women. PCOS makes conceiving difficult due to irregular ovulation. But infertility is only one symptom of this condition which effects a woman’s health well past conception.
Pregnancy in PCOS patients has a higher risk of complications including miscarriage, premature delivery, infants requiring NICU care after delivery, gestational diabetes (diabetes during pregnancy), pre-eclampsia, pregnancy induced hypertension, and Cesarean section.
Other symptoms of PCOS include irregular menstrual cycles, excessive or abnormal male-pattern hair grown on the face or body (hirsutism), male-pattern hair loss from the scalp, severe acne, and difficulty losing weight. A disproportionate percentage of women with PCOS are overweight or obese compared to the general population, but there are some PCOS patients who are of normal weight or underweight. Regardless of body weight, up to 70% of PCOS patients have insulin resistance.
The health risks of PCOS are not limited to a woman’s child-bearing years and pregnancies. Women with PCOS are at significantly higher risk than the general female population of developing type 2 diabetes before age 40, heart disease, stroke, high blood pressure, cholesterol problems, and endometrial cancer.
But there is hope for safe treatment of this common condition. Despite the uncertain causal relationships in PCOS, studies show modest weight loss (5-10%) in PCOS can improve ovulatory function, pregnancy rates, and metabolic risks. Lifestyle changes aiming to reduce excess weight and improve insulin resistance are the first-line treatment for infertility and other symptoms associated with PCOS.
Among the difficulties of treating PCOS is that many medications are contraindicated during pregnancy which makes safely conceiving even more stressful. The latest weight-loss medication class, which includes blockbusters Ozempic, Wegovy, and Mounjaro, caused fetal harm in animal studies and there are no human pregnancy studies. Due to the long “wash out” period for these medications, drug manufacturers recommend waiting two months after the last dose before even trying to conceive.
I have a deep personal connection to women with PCOS. I was diagnosed with PCOS over thirty years ago as a teenager, and have suffered from infertility, gestational diabetes, and pregnancy induced hypertension. In my early 40s I was almost diagnosed with type 2 diabetes when my hemoglobin A1c reached 6.4 (6.5 and above is diabetic). That was over six years ago and was the final push I needed to prioritize my own health and change my lifestyle.
There are many benefits of making sustainable long-term lifestyle changes in PCOS including: improved ovulation and chances of conceiving with or without fertility medications; weight loss without medications that may cause fetal harm in cases of unplanned pregnancy; improved maternal and fetal health during and after the pregnancy; and improved health in the decades after childbearing by reducing risks of type 2 diabetes, high blood pressure, and heart disease. Women with PCOS, at any stage of their life, can expect to receive compassionate, holistic care as a patient at Mind Over Metabolism.