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Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects a substantial number of women worldwide, estimated between 7% and 15% of all women (1). PCOS manifests with both physical and emotional symptoms, including excessive facial hair growth, acne, irregular or absent menstruation (amenorrhea), and infertility (2).


Why Does It Occur? What Are the Complications?

Obesity, Insulin Resistance, and Androgen Secretion

While the exact cause of PCOS remains unclear, it has been linked to obesity and insulin resistance (3). Obesity does not directly cause PCOS, but it can exacerbate its symptoms. Insulin resistance plays a significant role in PCOS pathogenesis (4). Excess insulin triggers the ovaries to secrete more androgens, causing symptoms such as acne, facial hair growth, and menstrual irregularities (2). This hormonal imbalance leads to disrupted ovulation and potential infertility.

Women with PCOS often have higher levels of visceral fat, even those who are not obese, increasing their risk of cardiovascular diseases (5,6).


Can It Be Treated?

Treatment Strategies

PCOS treatment should be individualized since symptoms vary among women (7). While we will not cover pharmacological treatments, proper counseling from healthcare providers such as physicians or pharmacists is strongly recommended.


Lifestyle Modifications

The most effective approach for managing PCOS includes lifestyle changes. Weight loss can significantly reduce metabolic and endocrine symptoms in overweight and obese women (8-10,12). Even without weight loss, exercise improves insulin sensitivity, highlighting its critical role in PCOS management (13-15).

Addressing psychological well-being is equally important. About 75% of women with PCOS experience symptoms of depression due to social stigmas, weight concerns, or infertility fears (20). Exercise can enhance mood and alleviate some PCOS-related issues (21).


Resistance Training

While there are no specific exercise guidelines for women with PCOS, a general recommendation is 150 minutes of exercise per week, including 90 minutes of aerobic training (22). Resistance training is beneficial for improving insulin sensitivity, increasing metabolic rate, and aiding fat loss (13,23-25).

Resistance training recommendations include targeting all muscle groups 2-3 non-consecutive days per week at 60-85% of 1RM. This regimen can be tailored to individual preferences and goals.


Takeaway Message

  1. Polycystic ovarian syndrome is a hormonal disorder linked to insulin resistance and high androgen levels.
  2. Symptoms include excessive facial hair, acne, and menstrual irregularities.
  3. Infertility is a common concern but can be managed with proper treatment.
  4. Lifestyle changes, including weight loss, aerobic activity, and resistance training, are key to managing PCOS symptoms.
  5. Exercise guidelines suggest combining 90 minutes of aerobic training with resistance training sessions.


Disclaimer:

This content is for informational purposes only and not a substitute for medical advice. Consult healthcare providers before starting any treatment.


References

  1. Aubuchon M, Legro RS. Polycystic ovary syndrome: current infertility management. Clin Obstet Gynecol. 2011 Dec;54(4):675-84.
  2. Azziz R, Carmina E, Dewailly D, et al. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab. 2006 Nov;91(11):4237-45.
  3. Diamanti-Kandarakis E, Kandarakis H, Legro RS. The role of genes and environment in the etiology of PCOS. Endocrine. 2006 Aug;30(1):19-26.
  4. Legro RS. Obesity and PCOS: Implications for Diagnosis and Treatment. Semin Reprod Med. 2012 Dec;30(6):496-506.
  5. Cascella T, Palomba S, De Sio I, et al. Visceral fat is associated with cardiovascular risk in women with PCOS. Hum Reprod Oxf Engl. 2008 Jan;23(1):153-9.
  6. Dumesic DA, Akopians AL, Madrigal VK, et al. Hyperandrogenism accompanies increased intra-abdominal fat storage in normal-weight PCOS women. J Clin Endocrinol Metab. 2016 Nov;101(11):4178-88.
  7. Ndefo UA, Eaton A, Green MR. PCOS: a review of treatment options focusing on pharmacological approaches. Pharm Ther. 2013 Jun;38(6):336.
  8. Hoeger KM. Role of lifestyle modification in managing PCOS. Best Pract Res Clin Endocrinol Metab. 2006 Jun;20(2):293-310.
  9. Mahoney D. Lifestyle intervention among infertile overweight and obese women with PCOS. J Am Assoc Nurse Pract. 2014 Jun;26(6):301-8.
  10. Nikokavoura EA, Johnston KL, Broom J, et al. Weight loss for women with PCOS following a very low-calorie diet. Diabetes Metab Syndr Obes Targets Ther. 2015 Oct 14;8:495-503.
  11. Mason C, Foster-Schubert KE, Imayama I, et al. Dietary weight-loss and exercise effects on insulin resistance in postmenopausal women. Am J Prev Med. 2011 Oct;41(4):366-75.
  12. Duncan GE, Perri MG, Theriaque DW, et al. Exercise training, without weight loss, increases insulin sensitivity in previously sedentary adults. Diabetes Care. 2003 Mar;26(3):557-62.
  13. Pericleous P, Stephanides S. Can resistance training improve PCOS symptoms? BMJ Open Sport Exerc Med. 2018;4(1).
  14. Cheema BS, Vizza L, Swaraj S. Progressive resistance training in PCOS: clinical outcomes. Sports Med Auckl NZ. 2014 Sep;44(9):1197-207.
  15. Kogure GS, Silva RC, Picchi Ramos FK, et al. Women with PCOS have greater muscle strength irrespective of body composition. Gynecol Endocrinol. 2015 Mar;31(3):237-42.