Can the symptoms of Polycystic Ovarian Syndrome be improved without drugs?

Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder that affects 6-20% of women of reproductive age and can cause fertility problems. Reproductive problems usually occur because there is an alteration in the menstrual cycle and ovulation. In addition, there is an increase in the production of androgens (male hormones) and a greater number of follicles (ovarian structures that contain the eggs). To reduce symptoms and especially complications, both in adolescence and adulthood, it is advisable to do physical exercise, eat a healthy diet and maintain good sleep quality, especially for patients with obesity and insulin resistance.

There is no specific treatment for PCOS, but the symptoms can be controlled through different strategies, which vary with the stage of life and the needs of each woman. Thus, there are different strategies in the therapeutic approach to the different symptoms. There are drugs to treat menstrual disorders, insulin resistance or androgen excess, but the basic recommendation for all patients with PCOS is physical exercise and a healthy diet.

Physical exercise

The International evidence-based guideline for the assessment and management of Polycystic Ovary Syndrome recommends that adult women (of 18-64 years of age) perform moderate physical activity for 2 hours, 30 minutes each week, 1 hour and 15 minutes of vigorous exercise per week, or a combination of both and associated muscle strengthening activities on 2 non-consecutive days per week. Adolescents are recommended 1 hour of moderate to vigorous physical exercise and muscle strengthening activities 3 times a week.

Diet

Improving diet, and specifically adopting the Mediterranean diet, can make up for the deficiencies in fibre, omega 3, calcium, magnesium, zinc and vitamins (folic acid, vitamin C, vitamin B12 and vitamin D) suffered by many PCOS patients. It is recommended to maintain a moderate calorie intake, promote the consumption of foods of plant origin, and introduce whole grains such as quinoa, buckwheat or whole spelt, which contain a lower glycaemic index. Eat fruit daily, which are rich in antioxidants, such as polyphenols in grapes, strawberries, raspberries and blackberries, and vegetables, especially green leafy ones such as spinach, chard, artichokes and asparagus. Legumes are also very beneficial because they have a low glycaemic index and are an excellent source of fibre and protein.

Finally, the consumption of unsaturated fats rich in omega-3 is recommended, as it improves the cardiovascular profile and insulin sensitivity, and reduces low-grade chronic inflammation. Some examples are olive oil, nuts and oily fish. You should also avoid foods that contain refined sugars and saturated and trans fats, such as sugary drinks, pastries red meat and all processed meats.

The evidence so far suggests that specific vitamins (B-12, inositols, folate, vitamins D, E, and K), vitamin-like nutrients (bioflavonoids and α-lipoic acid), minerals (calcium, zinc, selenium and chromium picolinate) and other products (melatonin, ω-3 fatty acids, probiotics and cinnamon) could be beneficial for PCOS.

In this area, the Assisted Human Reproduction Section of the Clinical Institute of Gynaecology , Obstetrics and Neonatology (ICGON), as a reference centre in assisted reproduction techniques, is conducting a study to determine the possible positive effect of a nutritional supplement containing inositols, antioxidants and probiotics for In Vitro Fertilisation (IVF) in patients with PCOS who are overweight or obese.

Information documented by: Dr. Gemma Casals, gynecologist at the Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON) and member of the gynecological endocrinology and human reproduction research group at IDIBAPS, and Dr. Alba Andreu, dietitian-nutritionist at the Endocrinology and Nutrition Service.