What treatments are available for Polycystic Ovarian Syndrome (PCOS)?

Medical management of PCOS will depend on the symptoms experienced by each woman, and needs to be individualised. Lifestyle management (e.g. diet, exercise and weight loss or preventing weight gain) is recommended as the first line of treatment, but several further options are available for each symptom. It is important to balance the risks and benefits of each option in consultation with health professionals.

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Irregular periods: Medications such as a low-dose contraceptive pill, progesterone and metformin can be prescribed to help menstrual bleeding occur regularly.
 
Increased hair growth and acne: Cosmetic treatment is recommended as the first treatment option and includes waxing and laser hair removal. Topical preparations, antibiotics, contraceptives and anti-androgen drugs can also be used for the treatment of acne and excess hair growth.
 
Insulin resistance: Up to 80 per cent of women with PCOS have insulin resistance and being overweight can contribute to this. Healthy eating and regular physical activity offer the best approach to managing insulin resistance. Metformin can also reduce insulin resistance and decrease the risk of diabetes, speak to your health practitioner for more information.
 
Apart from medical management, lifestyle management is also critical. Even when not actively trying to lose weight, a healthy diet will ensure that you are getting a healthy and adequate intake of nutrients, vitamins and minerals. Loss of excess weight can reduce your risk of conditions such as type 2 diabetes and cardiovascular disease. Being physically active also increases energy levels, improves self-esteem and reduces anxiety and depression. Even small changes, such as 5 to 10 per cent weight loss can reap large benefits, including improved menstrual cycles, improved fertility and reduced risk of diabetes.

 
Lifestyle changes are one of the most important approaches to PCOS. Important considerations when making ‘lifestyle changes’ are – what and how much we are eating, and how physically active we are.
 
Like all women, those with PCOS need to eat a nutritious diet and a wide variety of quality foods. Women with PCOS need to be more mindful of eating a moderate amount of high fibre, low glycaemic carbohydrate based foods like grainy breads and wholegrain cereals and pastas. Their diet should be high in vegetables, legumes and fruit .They also need good quality protein from sources such as lean meat and fish or tofu. Low fat dairy products and small quantities of nuts and seeds also provide good quality sources of protein, carbohydrate and fat. Women with PCOS also benefit from monitoring their portions sizes, as well as favouring water based beverages.
 
Exercise is also vital for women with PCOS, who tend to be prone to glucose metabolism problems and insulin resistance even at normal weights. Women benefit from doing 30 to 60 minutes of gentle aerobic or moderate intensity exercise like vigorous walking, swimming or stepping exercises, preferably every day, to help reduce insulin resistance, manage abdominal body fat, and maintain health.
 
Strength training, using weights, is also beneficial for women to help maintain muscle mass and improve metabolism. In addition women should be aware of how much ‘incidental’ exercise they get each day. Incidental exercise is about being more active, for example using the stairs instead of the lift, or walking/cycling to local shops rather than driving. Australian guidelines recommend being active in as many ways as possible everyday, and viewing any activity as a healthy opportunity rather than inconvenience.

Kirsty
Women’s Health Educator
Health Information Line, Women’s Health Queensland Wide
 
Women living in Queensland can also call our Health Information Line - a free information and referral service for Queensland women - on 3839 9988 or 1800 017 676 (toll free outside Brisbane).
 
Please note that all health information provided by Women’s Health Queensland Wide is subject to this disclaimer

As an Accredited Practising Dietitian, I can give you the latest information on dietary and exercise treatment for Polycycstic Ovarian Syndrome. Firstly the aims of treatment is to shift your weight within the healthy weight range for your age and height. Healthy weight loss is ~0.5kg of weight a week. In addition you should aim to reduce your waist measurement to less than 80cm. 

Diet:

Since insulin resistance is a key characteristic of this syndrome, the management of diet would be similar to someone with Diabetes. A Low Glycemic Index Diet has shown to help improve insulin resistance. You can visit http://www.glycemicindex.com/ for a GI rating of different carbohydrates. A few examples - replace white bread with multigrain bread, replace jasmine rice with brown long grain rice. Incorporate other low GI grains such as quinoa, pasta, buckwheat, oats and barley in your diet.

The second thing to watch for would be your portion sizes. It is best for insulin sensitivity to avoid big carbohydrate loads. Therefore having a lean protein source at meals can help satiety and prevent this insulin response. Including adequate fruit, vegetables and good fats in your diet are also important. Most people find it is best to eat 5-6 times a day.

Exercise:

A combination of cardiovascular and resistance based training has been shown to help insulin resistance.

Cardio - Aerobic training at high intensity (eg 75% of VO2 Max) at least 3 times a week. You can google HIIT - High Intensity Interval Training which can be done on any form of cardio eg treadmill, running, swimming etc. Even 10 minutes of HIIT has shown to have benefits, start low and gradually build your way up.

Resistance Based - Aim for higher reptition and lower weights. For example a pump class a few times a week would be appropriate.

Medication / Supplements:

I would suggest if you have PCOS to supplement your diet with Chromium - this mineral helps with the breakdown of carbohydrates. So it is beneficial in treating insulin resistance.

There are some medications available that help to improve insulin sensitivity such as metformin as well. Speak to your GP for more information regarding these.


Aidan Ma
DNA Dietitians