Health & Wellness

Polycystic ovary syndrome (PCOS)

Can’t lose weight despite doing everything right? Polycystic Ovary Syndrome affects hormone levels in one in five women.
Published 13 October 2016

Fiona Tewierik was 18 when she was diagnosed with Polycystic Ovary Syndrome (PCOS). Her irregular periods stopped completely at 18 so she saw a GP who referred her to a gynaecologist. After an ultrasound and blood tests, he bluntly told Fiona she had PCOS, was infertile and – as a result – would probably never have children.

“I wasn’t given any information, not even a brochure, and it was very confronting,” admits Fiona, who is now a nurse in Melbourne. “Later I saw a GP who clarified exactly what the condition is and what to expect. She explained that I needed to keep an eye on my weight and lifestyle and talked me through the symptoms of PCOS, such as acne and hair growth. She also put me on the pill to try and regulate my cycles.” In time, Fiona realised that PCOS didn’t have to take over her life – and that she also had a key role to play in helping manage the condition.

What is Polycystic Ovary Syndrome?

Roughly 20 per cent of women of reproductive age are affected by PCOS – a condition triggered by a hormonal imbalance that leads to health issues including irregular or heavy periods and infertility. While its exact cause is still unknown, women with PCOS have higher levels of male hormones or androgens, which can lead to acne and excess hair. Polycystic ovaries are also present in some cases. Women with PCOS are also more likely to gain weight, find it harder to lose weight and are more resistant to insulin – putting them at greater risk of diabetes. However, these risks can all be managed, delayed or prevented, according to Professor Helena Teede, an expert in women’s and metabolic health.

How is it diagnosed?

“There’s no single test currently available to help diagnose PCOS,” explains Professor Teede. “PCOS is a collection of features and, if you have two out of three key symptoms, then you have PCOS. These three main features include having polycystic ovaries, high levels of androgens and not ovulating, so you usually have irregular periods.”

If you notice any of these symptoms, Professor Teede’s advice is to see a health practitioner, who will take a history of your cycle and do an ultrasound and blood tests to measure androgen levels. “These tests will help confirm the diagnosis and give your practitioner an idea of the severity of the PCOS,” she adds. “It will also allow them to rule out other conditions such as a range of thyroid problems.”

The physical and emotional effects of PCOS

When Fiona reached her mid-20s, managing her weight and dealing with excess body hair became part of the reality and frustration of living with PCOS. “I’m self-conscious about the hair and my weight,” she admits. “I exercise regularly and eat healthy foods, but I’m overweight and it’s a struggle. My weight can fluctuate by anywhere between 10kg and 20kg.” 

Having a helpful mindset plays a part too “Not only does exercise help with the weight loss, it makes me feel better and makes me feel that I do have some control over PCOS,” she says.

The importance of managing weight

In addition to the emotional and physical toll of putting on weight, there’s further health implications as well. Having overweight or obesity can lead to insulin resistance which, in turn, can bring about the development of diabetes and heart disease. While a healthy diet and physical activity can make a difference, medication may sometimes be needed to reduce insulin resistance and the risk of diabetes. These medications, such as a low-dose contraceptive pill, progesterone or metformin, also help reduce excess hair growth and regulate periods. Women with PCOS find extra weight tends to accumulate around their stomach, and they can often feel powerless to lose it. “Women with PCOS may need to manage kilojoules and exercise more than other women,” says Professor Teede. The good news? Losing just five per cent of your body weight can improve fertility and reduce the risk of diabetes and heart disease – along with providing a significant boost to self-esteem levels.

Healthy eating suggestions

Along with regular exercise, a healthy GI diet is important in managing the weight gain associated with PCOS, says accredited practising dietitian Julie Gilbert. Gilbert recommends focusing on a diet of low-fat, high-fibre foods, such as breads, cereal, pasta, rice and fruit, eating low-fat dairy in small quantities and managing portion sizes. “Look at how you make up your plate. A quarter of your plate should be carbs, a quarter lean protein like fish, chicken, pork or beef, and half vegetables or salad,” she says. For breakfast, Gilbert suggests high-fibre cereals like rolled oats or untoasted muesli with low-fat milk or yoghurt, along with snacks fewer than 400 kilojoules. “Weight management for women with PCOS is so important for their emotional outlook. When the number on the scales comes down, measurements come down and they feel in control,” she explains.

Create a helpful mindset

Psychologist Dr Mandy Deeks believes the emotional impact of PCOS and its symptoms are often vastly underestimated. “The diagnosis can be very frustrating and we find women are highly likely to be experiencing anxiety and depression as a result of having excess weight and body hair,” she says. 

According to Dr Deeks, however, receiving a proper diagnosis and the right treatment – such as appropriate medication, support and advice on diet and physical activity – can make PCOS easier to live with and to manage.

In some cases therapy is useful to help tackle negative body image. “It’s about empowering women to take control, work on their self-esteem and do everything they can to accept and manage the condition,” Dr Deeks adds.

Fiona agrees it’s vital to work through the frustrations that come with PCOS and instead focus on managing its impacts and symptoms. “The most difficult part for me is struggling with the idea that my husband and I may never have our own children,” she says. “But while I get tired of the symptoms, I live with them and remind myself it could be a lot worse. I have PCOS – not a life-threatening illness.”

What about endometriosis?

While PCOS can affect fertility, endometriosis is another leading cause of female fertility issues.

What is it?

Endometriosis affects about 10 per cent of women, of which about 30 per cent experience infertility. Symptoms vary but pain is the most common – such as period pain, pain during or after sex, and abdominal, back or pelvic pain. Heavy or irregular bleeding and spotting can also occur. The cause? There are various theories, explains gynaecologist Dr Michael Cooper. “Endometriosis is where the lining of the uterus grows outside the uterus on ligaments, ovaries and sometimes the bowel,” Dr Cooper tells. He says some women are predisposed genetically, and it seems to occur more often in women who haven’t had children, or deferred pregnancy. Research from the Queensland Institute of Medical Research (QIMR) has found a link between strong period pain in adolescence and an increased risk. Girls who started their period after the age of 14 were at less risk of the condition. QIMR research also found being overweight at the age of 10 doubles the future risk of endometriosis.

The options?

Treatment differs depending on severity and symptoms. Hormone therapies may reduce the growth of endometrial cells, and specialists sometimes recommend the pill. Surgery is another option which can help remove visible endometriosis. If you think you might have endometriosis, it’s best to talk to your health practitioner first.