Lifestyle Tips for Managing PCOS

By Terry Linde | March 15, 2023

Brent Bauer, M.D., Mayo Clinic

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders among women, affecting up to 20 percent by some estimates.1 It’s also one of the most complex, with various potential causes and complications that make treating it a challenge. However, lifestyle changes can help alleviate symptoms and reduce the risk of long-term issues.

Be on the Lookout for These Signs of PCOS

PCOS is a condition associated with hormonal imbalances and metabolic problems that impact a woman’s health and appearance. Although PCOS typically affects a woman early in puberty or around the time of her first menstrual period, the condition can develop later; for example, in response to substantial weight gain.2

To be diagnosed with PCOS, a woman needs to have at least two of the following three signs. In women with obesity, these signs might be more severe:2,3

  • Infrequent, irregular, or prolonged menstrual cycles. This can mean fewer than nine periods a year, more than 35 days between periods, or abnormally heavy periods.
  • Excess facial and body hair (hirsutism), occasionally severe acne, and male-pattern baldness. These signs result from high levels of androgens, particularly testosterone, in the body.
  • Ovaries that don’t form eggs properly or don’t release eggs during ovulation. This can lead to tiny fluid-filled sacs (cysts) in the ovaries and problems with fertility.

In addition, a woman with PCOS might experience weight gain or a problem losing weight, darkening of the skin (especially in neck creases, the groin, and under the breasts), and skin tags in areas like the armpits and neck.3

PCOS is associated with many complications, including mental health issues such as anxiety and depression, cardiovascular disease, type 2 diabetes, high cholesterol, high blood pressure, and sleep apnea. Some findings estimate that a woman with PCOS has four times the risk of developing endometrial cancer. Also, a pregnant woman with PCOS faces a greater risk of miscarriage, gestational diabetes, and preeclampsia – a serious blood pressure condition that develops during pregnancy.3,4

Possible Causes of PCOS

Although the exact cause of PCOS is unknown, there are multiple potential culprits. Researchers know that many women with PCOS have insulin resistance – when the body doesn’t process insulin properly and it compensates by making more insulin. This leads to an increased insulin level in the bloodstream, which can increase androgen production and cause problems with ovulation. Obesity can also increase insulin levels and aggravate PCOS symptoms. Although between 50-80 percent of women with PCOS are obese, it’s unknown whether PCOS causes symptoms like insulin resistance and obesity or whether these factors lead to PCOS.4,5

Genetics likely play a role in developing PCOS. Daughters born to mothers with PCOS have five times the likelihood of developing the condition.4 Environmental factors also influence risk. Some research indicates that women with PCOS have significantly higher blood levels of endocrine-disrupting substances such as bisphenol A (BPA), a chemical compound used in plastic manufacturing.6  

Chronic inflammation is also a factor in PCOS. Research shows that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens. Inflammatory markers such as C-reactive protein (CRP), interleukin-18 (IL-18), tumor necrosis factor-alpha (TNF-α), and white blood cell counts are higher in women who have PCOS than women of similar age and body mass index (BMI) who don’t have PCOS.7

Lifestyle Changes Help Manage PCOS

Treatment for PCOS is tailored to address individual symptoms – for example, utilizing treatments to restore fertility if a woman is struggling to become pregnant. However, most PCOS treatment plans begin with lifestyle changes, which are some of the most effective ways to manage the condition. Experts recommend starting with the basics: maintaining a healthy weight, eating nutritious foods, and staying active to balance hormones, reduce insulin resistance, and prevent complications such as diabetes.8

  • A little weight loss goes a long way. Losing as little as 5-10 percent of body weight can significantly improve symptoms and, in some women, restore ovulation. The American College of Obstetricians and Gynecologists stresses that reducing overall calorie intake is one of the most critical factors for weight loss.2,9,10 If you’re struggling to lose weight, then consider working with a nutritionist, endocrinologist, or another expert to address your specific health issues and create a customized weight-loss plan.2
  • Choose a healthy diet. A diet that’s high in nutritious foods and low in processed foods that contain added sugars, sodium, and trans fats will help manage PCOS and reduce the risk of developing other health complications. Experts recommend consuming complex carbohydrates that are high in fiber, such as fruits, vegetables, whole grains, cooked dry beans, and peas. These foods raise blood sugar more slowly than refined carbohydrates (sugar, white bread), helping maintain normal levels.11 In accordance with these recommendations, studies have found women who adhere to a Mediterranean diet (a diet of colorful fruits and vegetables, legumes, fish, red wine in moderation, and plenty of olive oil) are at lower risk for developing PCOS.1 Read more about Dr. Bauer’s dietary recommendations to support fertility.
  • Exercise regularly. Exercise helps lower blood sugar levels. If you have PCOS, then increasing daily activity and participating in a regular exercise program might treat or prevent insulin resistance, keep your weight under control, and help you avoid complications such as diabetes. Physical activity can also positively impact your mood. PCOS research recommends at least 120 minutes of vigorous exercise per week.2,13              
  • Manage stress. Regularly practicing mind-body techniques, such as meditation, yoga, and breathing exercises, as well as getting adequate sleep, can relieve stress, anxiety, and depression in women with PCOS. Research shows that women with PCOS who utilized stress management techniques improved their quality-of-life scores. Some women find cognitive-behavioral therapy (CBT) helpful, a form of talk therapy that teaches you to recognize inaccurate or negative thoughts and change how you respond to challenging situations. Studies report women with obesity who undergo CBT in conjunction with diet and exercise programs to see improvements in depression and self-esteem.4,14,15
  • Ask your healthcare professional about an inositol supplement. Some studies suggest that inositol – an essential structural component of cell membranes that is necessary for proper insulin signaling – might support insulin sensitivity, reduce the time it takes to ovulate, and promote normal androgens levels, including testosterone.* It might also support other metabolic factors, such as normal waist-to-hip ratio and healthy cholesterol and triglyceride levels.16-19 
  • Check your vitamin D status. In a study of women with PCOS, increased daily vitamin D intake resulted in a significant decrease in testosterone.* The study also found vitamin D helped maintain healthy inflammatory markers (measured as C-reactive protein) and decreased oxidative stress in women with PCOS.20*

To supplement lifestyle changes, a medical professional might recommend medication or other treatments based on your individual symptoms and needs.1,3,4,10 PCOS is a lifetime disorder that requires long-term management. Combining several treatment options might be the most effective way to manage the condition. By making some lifestyle changes and working with a healthcare professional, many women who have PCOS live normal lives without significant complications.21

A Word from Thorne

As mentioned above, inositol might provide nutritional support for women with PCOS.* Ask your healthcare professional about Ovarian Care, which contains the ratio of myo-inositol to D-chiro-inositol found to be most effective for supporting women with PCOS.*

If you are interested in exploring your vitamin D level, then take Thorne’s easy, at-home Vitamin D Test.

References

  1. Gershenson DM, Lentz GM, Valea FA, Lobo RA. Chapter 39: Polycystic Ovary Syndrome. In: Comprehensive Gynecology 8th ed. Elsevier; 2022. 
  2. Polycystic ovary syndrome (PCOS). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439. [Accessed July 1, 2022]
  3. Polycystic ovary syndrome. U.S. Department of Health & Human Services, Office of Women’s Health. https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome. [Accessed July 2, 2022]
  4. Hoeger KM, Dokras A, Piltonen T. Update on PCOS: consequences, challenges, and guiding treatment. J Clin Endocrinol Metab 2021;106(3):e1071-e1083.
  5. Polycystic ovary syndrome. Endocrine Society. https://www.endocrine.org/patient-engagement/endocrine-library/pcos. [Accessed July 2, 2022]
  6. Hu Y, Wen S, Yuan D, et al. The association between the environmental endocrine disruptor bisphenol A and polycystic ovary syndrome: a systematic review and meta-analysis. Gynecol Endocrinol 2018;34(5):370-377. 
  7. Rudnicka E, Suchta K, Grymowicz M, et al. Chronic low-grade inflammation in pathogenesis of PCOS. Int J Mol Sci 2021;22(7):3789. 
  8. Gu Y, Zhou G, Zhou F, et al. Life modifications and PCOS: old story but new tales. Front Endocrinol 2022;13.
  9. Barbieri RL, Ehrmann DA. Treatment of polycystic ovary syndrome in adults. https://www.uptodate.com/contents/treatment-of-polycystic-ovary-syndrome-in-adults. [Accessed July 2, 2022]
  10. American College of Obstetricians and Gynecologists. Practice Bulletin No. 225: Polycystic ovary syndrome. Obstetrics & Gynecology. 2018.
  11. Carbohydrates: How carbs fit into a healthy diet. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/carbohydrates/art-20045705. [Accessed July 2, 2022]
  12. Barrea L, Arnone A, Annunziata G, et al. Adherence to the Mediterranean diet, dietary patterns and body composition in women with polycystic ovary syndrome (PCOS). Nutrients 2019;11(10):2278. doi: 10.3390/nu11102278. 
  13. Patten RK, Boyle RA, Moholdt T, et al. Exercise interventions in polycystic ovary syndrome: a systematic review and meta-analysis. Front Physiol 2020;11:606.
  14. Yin MXC, Du LB, Zou XN, et al.  Can psychosocial intervention suppress testosterone and triglycerides among women with polycystic ovary syndrome? A feasibility trial. Front Psychol 2021;12:690539.
  15. Cognitive behavioral therapy. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610. [Accessed July 2, 2022]
  16. Pkhaladze L, Russo M, Unfer V, et al. Treatment of lean PCOS teenagers: a follow-up comparison between myo-inositol and oral contraceptives. Eur Rev Med Pharmacol Sci 2021;25(23):7476-7485.
  17. Soldat-Stanković V, Popović-Pejičić S, Stanković S, et al. The effect of metformin and myoinositol on metabolic outcomes in women with polycystic ovary syndrome: role of body mass and adiponectin in a randomized controlled trial. J Endocrinol Invest 2022;45(3):583-595. 
  18. Akbari Sene A, Tabatabaie A, Nikniaz H, et al. The myo-inositol effect on the oocyte quality and fertilization rate among women with polycystic ovary syndrome undergoing assisted reproductive technology cycles: a randomized clinical trial. Arch Gynecol Obstet 2019;299(6):1701-1707.
  19. Shokrpour M, Foroozanfard F, Afshar Ebrahimi F, et al. Comparison of myo-inositol and metformin on glycemic control, lipid profiles, and gene expression related to insulin and lipid metabolism in women with polycystic ovary syndrome: a randomized controlled clinical trial. Gynecol Endocrinol 2019;35(5):406-411.
  20. Jamilian M, Foroozanfard F, Rahmani E, et al. Effect of two different doses of vitamin D supplementation on metabolic profiles of insulin-resistant patients with polycystic ovary syndrome. Nutrients. 2017;9(12):1280. doi: 10.3390/nu9121280.
  21. Barbieri RL, Ehrmann DA. Beyond the basics: polycystic ovary syndrome. https://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics. [Accessed July 2, 2022].

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