PCOS: Steps You can take to manage PCOS 

PCOS, also known as polycystic ovary syndrome. One in 10 women suffers from it, and it can cause troubling complaints that can impact day-to-day life. An irregular cycle, excessive hair growth, and acne are some of the most common PCOS symptoms. Plus, women with PCOS are more likely to be overweight. The treatment of PCOS often consists of a prescription for the birth control pill or other forms of medication that prompt menstruation. Which medicine works best for you depends on many different factors: like if you have a child-wish, your age, and the way your body responds to hormones and medication. But, more can be done than just medication. There are plenty of things you can do to reduce your symptoms, or to make them manageable.

Cycle sat down with Dutch psychologist Geranne Jiskoot, who specializes in PCOS. She’s connected with the Erasmus MC in Rotterdam, where she coaches women with PCOS in a lifestyle program. Throughout a year, these women get intensive support to help them make lifestyle changes. And guess what: after a year of extensive coaching on exercise, diet, and behavior, the program reported that the women were healthier, with fewer complaints, both physically and mentally. 

‘For PCOS, the focus is often on the number on the scale, but that’s not the right way to tackle it’

Geranne: “Let me start by saying that not only women with PCOS struggle with their weight. A big group of the women with PCOS are at an average weight, or are even underweight. When women come to me for coaching, I notice that many of them are solely focused on the number on the scale. That’s a shame, since a more broad focus can have way better results. My treatment plan starts with some self acceptance, so that there isn’t a focus on weight. It sounds wooly, but self-love is the starting point for consistent change. Women with PCOS often have a negative self-image (more so than women without PCOS), and struggle with gloomy feelings. We start by treating that through cognitive behavioral therapy, for example. This method is quite well known, and can be carried out by a psychologist and/or psychotherapist. You can even go online to find self acceptance courses and self-help books with exercises. By learning to accept yourself the way you are (which includes your ‘lesser’ sides) you’ll become kinder, and will be able to handle the gloominess and stress differently. You’ll become more resilient, and it’ll be easier to shrug off bad experiences and emotions. Of course, the ease of doing so will differ from person to person. I know women with acne and excessive hair growth who deal with it very well. For other women, it’s a nightmare.”

Diet and losing weight, go for a healthy lifestyle that’s maintainable

For many women with PCOS, losing weight is an important topic. Very understandable, as being overweight happens frequently, and since losing weight can be a requirement for starting a fertility treatment. On the internet, you’re swarmed with recommendations for different diets like low-carb, the ‘PCOS diet’, and a sugar-free diet. All of them are supposed to help reduce PCOS symptoms.

Geranne: “You see well-intentioned advice everywhere about keto, low-carb, avoiding certain foods, etc. There is even a PCOS diet being made. Almost all diets work with a calorie restriction and eliminate product groups and/or specific products. You consume fewer calories, which makes you lose weight. My advice? Choose for alterations in your diet and exercise habits that you can maintain for the rest of your life. Simply scrapping carbohydrates from your diet is unwise, as is a diet with less than 1500 calories per day. Of course, they’ll make you lose weight, but it won’t stay that way. Passing on bread, pasta, and potatoes for the rest of your life? Or never having sugar or dairy products again? That’s impossible for most people, and won’t make life any more enjoyable. See what works for you, and don’t focus on the scale or certain diets too much. Besides, your body will start to produce varying hormones to encourage you to eat more. This hormone change will go on for a long time, up to 12 months, after a very strict diet. This creates a yo-yo effect that'll make most people gain weight. It’s better to take small steps towards making healthier food choices. Three nutritious meals a day (which includes carbohydrates!) can work well for insulin resistance, but I also know women who prefer to eat 7 small meals per day. So, what does and doesn’t work is very personal. Be sure to do what’s achievable for you, and slowly work your way up to it.

It’s good to be aware that eating disorders like compulsive (emotional) eating, bulimia, and anorexia nervosa occur more frequently among women with PCOS. Sadly, we aren’t aware why this is the case, but it might be that this group of women have a different relationship with food, combined with a worse self-image. The danger of (crash) diets is that they cause a distorted relationship with food, which actually promotes these types of disorders. That’s why we have to be very careful about advising women with PCOS to follow a (strict) diet.”

Exercise

“It’s true that weight training is good for women, and especially for women with PCOS. Just like running. But if you struggle to imagine yourself in the gym lifting dumbbells, then you shouldn’t do it. Do you like to dance? Go dance! Prefer to go on a walk with friends? Go for it. The goal is to have at least 150 minutes of moderate to vigorous exertion a week, plus muscle and bone strengthening exercises twice a week. That won’t be attainable (at first) for everyone. Set goals that suit you, and try to expand your selected activities slowly. You shouldn’t overexaggerate, either. Daily intense exercise without enough rest will also cause issues. Your hormonal balance will go haywire, with all the consequences of this.”

It’s harder for women with PCOS to handle stress.

“Women with PCOS appear to handle stress less easily. We aren’t sure what causes this, but research has shown that there certainly is a difference between women with and without PCOS. One of the ways of handling this better is through cognitive behavioral therapy. This will teach you how to handle feelings of stress and negative thoughts. Acceptation is an important aspect of this. You can also do certain exercises to relax, such as breathing exercises. Ask your GP for a referral to a good psychologist that can help you with this. This psychologist doesn’t need to have knowledge on PCOS, since this treatment method is a general one that’s used for behavioral changes. Yoga and mindfulness are also good methods of tackling this!”

The importance of sleep is underestimated

Good sleep is often forgotten in the age of mobile phones and social media. Such a shame, says Geranne. “Sleeping badly or not enough causes you to get a short fuse, makes it more difficult to concentrate, and decreases your general resilience. It can help to have good sleep hygiene. A cool, calm bedroom where it is dark enough. Make sure you’re at rest before you try to sleep. This means no television, work, or mobile phone! And try to get - give or take - 8 hours of sleep.”

A realistic goal is 5 to 10% of weight loss

Geranne sees many women in the program, who all receive intensive guidance in all these areas for a year. And it works! Most women are a lot healthier, feel mentally and physically stronger, and have fewer complaints. They can also deal with these complaints better, which helps them have a better outlook on life! But Geranne is also realistic: “Women in our program lose about 5 to 10% of their body weight during the year, it simply isn’t possible to lose any more. No matter how hard they train and work on it. They’re certainly healthier, but this does show that we have to adjust the expectations about losing weight with PCOS to be more realistic. You can’t expect a woman with a BMI above 35 to bring it down to a BMI below 30 before she can start a fertility program. That’s certainly something that we as practitioners need to think about more.”