Polycystic ovary syndrome (PCOS) is a common hormonal-metabolic condition that affects roughly 1 in 10 women of childbearing age. Yet despite its ubiquitous nature, there is so much about PCOS that is still unknown, and much which is misunderstood. In honour of PCOS Awareness Month, we’re setting the record straight on the top 10 myths about PCOS.
Despite the name, having Polycystic Ovary Syndrome does not mean you will have cysts on your ovaries. For one, they are not actually really cysts. The are tiny follicles that may look like small cysts, but they are very different. In a typical menstrual cycle, there is a surge of luteinizing hormone (LH) which signals the ovaries to release an egg. But women with PCOS already have high LH levels or multiple LH peaks in a cycle, so when there is no LH surge to signal ovulation. The egg is never released, only to have “cysts” form there instead. However, it’s important to know that not all women with PCOS have these follicle cysts on their ovaries. Instead, they may experience any combination of symptoms of PCOS other than cystic follicles which include:
Many women with PCOS have a tendency to weight-gain because of a lowered sensitivity to insulin - a hormone that regulates blood sugar. When blood sugar rises (after we eat), the pancreas releases insulin into our blood to take nutrients like glucose (sugar) into our cells, which is then used for energy and cell function. But in some cases, like with certain types of PCOS, our bodies become desensitized to the insulin - meaning you have to produce more insulin to get the job done. This is known as “insulin resistance” and it can make it difficult to lose weight because the body stores excess blood sugar as fat. However, it does not apply to everyone with PCOS. Insulin resistance PCOS is one of the four types of PCOS (more on this below). Therefore, it affects many women with PCOS (about 70%), but not all! There are women who are of average (or lower) weight with PCOS. In fact, it is not uncommon for women of average weight with PCOS to get undiagnosed, as they do not appear to have one of the more “obvious” markers.
Hirsutism (abnormal hair growth) is another symptom of PCOS due to an excess of hormones called androgens (male sex hormones). The ovaries produce excessive amounts of these androgens (i.e. testosterone), causing excessive growth of “male” pattern hair. This can manifest as hair on a woman’s face, back, chest, abdomen, or thighs. While hirsutism is an underlying sign of PCOS, (or another endocrine condition), not every woman will have this symptom. According to the American College of Obstetricians and Gynecologists (ACOG), about 70% of women with PCOS experience hirsutism. But that also means 30% do not!
It is true that predicting ovulation can be more challenging with PCOS. That’s because one of the common problems with PCOS is high Luteinizing Hormone (LH) all month long. This occurs because the ovaries are overstimulated and are constantly trying to ovulate, without actually releasing an egg. But that does NOT mean it is not possible! In this case, the method you choose to track ovulation is key. One thing that does NOT work well for women with PCOS is Ovulation Predictor Kits (OPKs). OPKs work by examining the rise in LH that occurs up to 44 hours before ovulation. A rise in LH signals the ovary to release an egg, so when your levels reach a certain threshold, it's reasonable to predict that ovulation will happen within the next 12 to 36 hours. However, with PCOS, the high, irregular LH surges can cause you to see positive OPK results every day even though you are not actually ovulating. A much more accurate way to predict ovulation for women with PCOS is the Fertility Awareness Method. This natural family planning strategy involves tracking your basal body temperature, cervical mucus (quantity and quality) and cervical positioning.
While PCOS is one cause of infertility, a PCOS diagnosis is not an infertility diagnosis. You can still get pregnant naturally! The reason infertility and PCOS are so strongly connected is that two of the most common symptoms of PCOS are irregular ovulation and anovulatory cycles. And no ovulation means no baby. In fact, that’s why PCOS is also medically know as Ovarian Disorder, Type 2. BUUUUTTTT… while there is no “cure” for PCOS, it is treatable, and you CAN get and stay pregnant. Multiple studies show that lifestyle changes such as the right diet, fitness routine, stress management, proper sleep, supplements (and in some cases medication) are extremely effective at helping women with PCOS ovulate and have healthy pregnancies. If you are trying to conceive with PCOS, do not lose hope!
There are actually four types of PCOS! Knowing which one you are dealing with is key to helping you manage symptoms and conceive when you are ready to start a family. Insulin-Resistant PCOS is the most common (about 70% of cases), and involves high levels of insulin that can prevent ovulation and trigger the ovaries to create excess testosterone. The second most common type is Pill-Induced PCOS, which develops as a result of birth control pills use, which artificially suppresses ovulation. This is the only type that is usually temporary and reversable. The third kind, Inflammatory PCOS, can cause the ovaries to make excess testosterone, resulting in physical symptoms and lack of ovulation. The fourth kind is Adrenal PCOS, which can develop following periods of chronic stress. In this case, DHEA-S (another type of androgen from the adrenal glands) will be elevated instead of testosterone and androstenedione. Finally, while this is not officially a classification of PCOS, there is also something called “atypical PCOS” which means you experience some PCOS symptoms but don't fit into any of the normal categories.
It is true that many women with PCOS experience irregular cycles. However, an irregular cycle does not automatically mean a PCOS diagnosis. PCOS is just ONE of many causes of an irregular menstrual cycles including thyroid disorders or other endocrine conditions, stress, fibroids, even extreme dieting.
Dairy and gluten sensitivities have become more widespread in our society. I won’t go into a long explanation right now as to why that is, but it has a lot to do with modern agricultural practices. For example, the wheat grain has been altered so much that it is not today what it was a few decades ago. Equally, cows are not given the same feed today as they had been just a few decades ago. There is a lot more to it, but the point is, for a variety of reasons, more and more people are reacting to these foods. Such reactions can cause inflammation in the body. That’s why some women find that cutting out gluten and/or dairy helps them to decrease inflammation in the body and therefore manage their PCOS symptoms. But notice I say SOME women and not ALL women. Again, a big part of this goes back to understanding what type of PCOS you have. If you have inflammatory PCOS, and gluten/dairy are triggers for you, then yes, cutting these out could be a good thing. But what if you have one of the the other 3 types of PCOS? If your PCOS is insulin-resistant PCOS, for example, then cutting out dairy is not going to affect it much. There is also the possibility that you have inflammatory PCOS but gluten and/or dairy are not your triggers foods at all. You may be having an inflammatory response to different foods, or maybe environmental factors. Or stress! The point is, this is very individual. If your have inflammatory PCOS then cutting out these foods MAY help, but I encourage you to investigate first by using an elimination diet and/or working with a nutritionist. Finally, a quick tip regarding dairy. If you do find you react to it, try A2 casein dairy before giving up on dairy altogether. Most dairy products contain the A1 casein which causes inflammation. However, not all cows produce this casein - only Holstein cows do. Jersey cows, goats and sheep produce the A2 casein which is fine for most people.
Another common diet myth. A lot of my clients with PCOS try keto because they have seen it work for someone else. But not everyone is the same!!! First off, remember that there are different types of PCOS. Keto may work well for women with insulin-resistant PCOS because keto is focused on eating low-sugar, whole non-processed foods. The problem is keto is difficult to sustain for a lifetime, and PCOS is a life-long syndrome. There are other ways to eat low-carb that are not as extreme as keto and more sustainable. Also, if you have a different type of PCOS, this may not make as big of an impact for you anyway. For example, if you have inflammatory PCOS then following an anti-inflammatory diet would be more important than a low-carb one. Finally, remember that you’re not just a person with PCOS, you are a unique individual with a number of other bio-chemical functions, personal preferences and needs and your nutrition plan needs to meet ALL of these. Let’s imagine for a second that a new all-mushroom diet was discovered to be the best diet for PCOS (is are not by the way), but the problem is that you cannot stand the taste or mushrooms. Or maybe you have a mushroom allergy. Or perhaps you can’t eat mushrooms for religious reasons. What then? You would need to find an alternative that worked for YOU. That’s why I believe everyone should eat according to their needs and bioindividuality. To summarize, when choosing a diet for PCOS, consider 1. What kind of PCOS you have; 2. What your bioindividual needs are; and 3. What kind of dietary lifestyle is going to be sustainable for you.
I have often heard the term “lifestyle disease” when describing PCOS and it drives me nuts, because it makes it sound like PCOS is something you did to yourself. So let me set the record straight. PCOS is not your fault!!! Yes, it is true that PCOS responds brilliantly to diet and lifestyle changes (which is very very good news) but PCOS is not a lifestyle disease, it is a common endocrine disorder that affects 12–18% of women. While the definitive cause(s) of PCOS are still unknown, there are several factors that are believed to play a role. Some of these are lifestyle related such as poor diet, environmental toxins, and stress. However, another factor may be genetics. If you have relatives, such as your mother, sister or aunt with PCOS, your risk of developing it may be increased. If you have been given a PCOS diagnosis, my recommendation is not to dwell on what you may have done wrong to end up here. Don’t waist energy on self-blame! Rather, focus on what you can do moving forward and take back control of your fertility future.
I'm glad you could join me today in setting the record straight. Stay tuned for future posts this month as we dive into specific diet and lifestyle strategies for each of the 4 types of PCOS.
Finally, if you have questions about PCOS, fertility, or how to get support with your fertility journey, please contact me for a free info session.
Learn more about how to track ovulation with PCOS using the Fertility Awareness Method.
Read about Ovulation Predictor Kits (OPKs) and why they do not work for women with PCOS.
Ewa Reid is a Registered Holistic Nutritionist, certifying Fertility Support Practitioner, nutrition & fertility educator, wife, and mother. You can learn more about Ewa on our About page.
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