A healthier lifestyle is considered the first step to managing PCOS. This starts with a healthy diet, regular physical activity, and maintaining a healthy weight.
These will all help to:
- reduce insulin resistance
- improve other hormonal problems in PCOS
- improve menstrual cycles
- improve fertility
- prevent more long term complications like type 2 diabetes
Regular physical activity and a healthy eating plan is one of the most important areas for managing PCOS.
Watch the video below where dietitian Terrill Bruere gives a fresh approach to lifestyle and diet advice for the management of PCOS. Terrill explains that your weight isn’t a simple equation of energy in = energy out. She talks through trigger points for emotional eating, and explores the issues of dieting, while giving practical tips throughout.
Consider the whole picture
Health is also about sleep, stress and time management, having a healthy relationship with yourself and your body and many other things for you as an individual. It may be that working on some of these issues will also help you to achieve other changes that you wish to make. For instance, if you don’t exercise because of your feelings about your body then it is good to discuss this. If eating well is difficult because of lack of time or stress in your life then it can be difficult to improve this situation.
It is also not as simple as knowledge and willpower. Problem solving and planning goes with good intentions to help with achieving goals and maintaining motivation over time. Making changes to keep healthy in busy and changing life circumstances is an ongoing process.
Weight & PCOS
PCOS can occur in both slender and overweight women, however, women with PCOS are more likely to struggle with their weight and particularly with extra weight around their abdomen. It is not entirely clear why this is the case but insulin resistance and changes to appetite hormones that increase hunger are likely to be involved.
The most important factor is to prevent the slow creep of weight that nearly all women in western society are struggling with at present and to maintain a healthy weight throughout life. Preventing weigh gain is much easier than trying to lose weight once it is on.
Research shows that for all weight loss diets people usually regain weight within about two years. The risk of fad dieting and strict food rules and behaviours for women with PCOS is that they may regain weight very quickly as genetically/hormonally their body is good at surviving periods of feast and famine.
The benefit of changes made slowly
Weight increase is the outcome over time of many factors such as sleep, hormones, stress and eating behaviour – as well as food and activity. The best aim for your weight if you need to lose some is to aim to reduce slowly. For anything more than this consult a health professional experienced in PCOS treatment.
Research studies have shown it only takes a weight loss of five to ten per cent of your initial body weight to:
- reduce insulin resistance
- regulate menstrual cycles
- restore ovulation and improve fertility
- reduce testosterone and improve hair and acne
- improve health during pregnancy
- improve emotional health (self-esteem, anxiety, depression)
- reduce risk factors for diabetes and heart disease
Changes aimed at slow weight loss from sensible lifestyle adjustment are more likely to be successful in the long run. Sometimes not gaining weight is a major achievement in itself that can easily be overlooked. An approach combining healthy eating, physical activity and healthy behaviour strategies will increase the likelihood of weight loss, rather than just using a single tactic.
Weight loss itself is more difficult however than diet programs make it seem. Success depends on having realistic goals and regularly making lifestyle changes that are achievable and can be kept up.
Food, eating & PCOS
The eating guidelines that assist with PCOS management are the same as recommended for the general population and for people with other metabolic conditions such as diabetes or high cholesterol. You don’t need a complicated diet plan but it does help to understand what you are trying to achieve with sensible food choices and eating patterns.
Good food choices and eating in an even pattern throughout the day will lead to a more even pattern of blood glucose levels. This can help to reduce insulin levels and may also affect other hormone levels, so that energy and mood are better and there are less appetite problems.
When you eat
Start with breakfast and then aim to eat every few hours over the day. For some people this will be three main meals and the occasional snack while for others it will be five to six smaller meals and snacks spread over the day. If meals and snacks are skipped because you are busy during the day the risk is becoming too hungry and overeating later in the day.
It is a good idea to plan time to regularly stop and eat, have a glass of water and catch up with yourself during the day.
Adjust the times that you eat each day to suit your lifestyle and appetite and prevent overeating at any one time
What to eat
Healthy eating means eating a variety of foods that provide the nutrients to maintain health, feel good and enjoy life. Some foods can be eaten any time and help maintain health, whilst other foods should only be eaten occasionally. Even when not actively trying to lose weight, a healthy diet will ensure you are getting a healthy and adequate intake of nutrients, vitamins and minerals.
What is the best dietary approach for women with PCOS?
There is not any one dietary approach that is ‘best’ for all women with PCOS. There are many dietary approaches you can try, including modifying the amount and type of carbohydrate, protein or fat in your diet. Generally, the research shows no differences in weight, reproductive, metabolic (risk for diabetes or heart disease) or psychological (quality of life) outcomes for different diets.
Carbohydrate & Glycaemic Index (GI)
Carbohydrate foods, particularly the carbohydrates from wholegrain wheat, oats, rye, rice, fruit and vegetables provide important nutrients and fibre. These are essential to good health and energy and should not be eliminated from your diet.
The GI in carbohydrates is important because carbohydrates with a low GI produce lower glucose levels and insulin levels in the blood after they are eaten compared with carbohydrates with a high GI. For instance rolled oats have a lower GI (51) than corn flakes (80).
You can reduce the intake of refined carbohydrates in your diet, such as those found in foods like biscuits, cakes, soft drinks and confectionery without harm.
In general women are recommended to have a moderate protein intake but there is usually enough protein in the average Australian diet already. There is some evidence that weight loss can be improved with more protein because the protein reduces hunger levels and this may be particularly helpful for women with PCOS. You don’t need extra protein in the form of bars and powders however, just include protein containing foods in meals and snacks over the day.
For more information on the best foods for your health see our guidelines for good nutrition.
Physical activity & PCOS
Regular exercise seems to be most effective in improving insulin resistance, even without any noticeable change in weight or body fat measurement. Improving insulin resistance is very important as this is the cause of many of the complications in PCOS.
Regular physical activity will help to:
- reduce androgens
- improve insulin resistance
- regulate cycles
- induce ovulation
- improve fertility
- increase energy levels
- improve self esteem
- reduce anxiety and depression
These improvements are achieved even when weight loss doesn’t occur.
Physical activity improves insulin resistance and helps prevent weight gain, rather than simply being about burning calories for weight loss.
What type of exercise should you do?
Research has shown any type of regular exercise is effective in improving PCOS symptoms. Whether it is moderate or vigorous aerobic exercise or resistance (using weights) exercise, women’s PCOS symptoms will improve.
While a variety of exercise is good to maintain interest and motivation, it isn’t essential to achieve the benefits. As long as you are moving and enjoying it, the type of exercise is not so important.
The best thing to do is to aim to include some type of physical activity every day for at least 20 min and build this up over time. This can also be broken up into smaller 10-15 min sessions spread out over the day, and can include both structured exercise and incidental exercise
Usually a mixture of exercise activities that build both cardiac fitness and muscle strength is recommended.
How much exercise should I do?
Current guidelines for all Australians recommend engaging in moderately intensive physical activity for a minimum of 150 min per week (approximately 20 min per day). If you are trying to lose weight, this may need to be increased to 225-300 min per week (about 40 minutes per day).
For the management of PCOS, 150 min of exercise per week with 90 minutes being moderate to high intensity aerobic exercise is recommended to improve symptoms. For instance a good aim is for 30-40 min brisk walking most days with occasional more vigorous activity.
How do I start?
Start by looking at what you are doing already. Try using a pedometer to measure your steps each day. The National Heart Foundation recommends 10,000 steps a day for heart health. When you know your average daily steps you can set goals to slowly increase to this level. If you already do this many steps then it may be you need a different type of exercise to increase your strength or cardiovascular fitness.
What do you like to do?
Do you like to walk alone or meet with a friend and walk with company? Do you like a class or an individual workout? Could you build a walk around the park into your usual coffee shop visit? Can you walk to work from a car park or a tram stop a bit further away or use the stairs rather the lift? What do you like to do in winter and what do you like to do in summer?
What stops you exercising?
Some people are self-conscious about their bodies and are reluctant to be seen exercising for this reason or don’t have the right clothes to be comfortable. If you don’t know where to start or feel you might be at risk of injury consider seeing a physiotherapist or exercise physiologist for further advice.
Remember you can change your activity plans any time you want to help with staying motivated.
It is important you try to make physical activity a key priority in your life as it will affect your long-term health. If you have any concerns about your ability to participate in exercise because of injuries or other barriers, consider seeing an exercise physiologist for advice.
- Develop confidence in skills such as shopping, cooking, eating socially or choosing take away food. Find ways of managing these situations that suit both your lifestyle and your health.
- Reduce the size of meals and snacks so that you are satisfied but not overfull when eating. The hormone changes with PCOS can add to this increasing the difficulty of feeling satisfied when eating. This means you become accustomed to eating more food than you need
- Become aware of why you eat. Many people have forgotten how to eat when actually hungry and stop when just satisfied, not too full. We eat for many reasons such as grabbing meals when busy, bored or tired midafternoon, confusing thirst with hunger, or for more emotional reasons. This is normal occasionally but if it is leading to weight gain over time then this is an important area to work on.
- Occasionally having foods with more fat, salt and sugar is normal but be careful they are not an everyday part of life. They are high in energy, easy to overeat and don’t add much to your nutrition.
- Seek the advice of an Accredited Practising Dietitian (APD) if you need further help to identify which dietary approach is best for you.
Pasquali R et al. The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG. 2006 Oct;113(10):1148-59
Moran L et al. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab, 2003. 88:812–819
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at March 2014.