PCOS is characterized by a wide range of features, including the inability to ovulate, infertility, weight gain, insulin resistance, and progression to type 2 diabetes. PCOS manifests as an imbalance in the female hormones – elevated levels of estrogen and anti-Mullerian hormone (AMH), and low levels of progesterone – and often times as very high levels of androgen. The imbalance in female hormones that is typically seen in PCOS results in immature follicles and to the formation of multiple cysts, or water-filled sacs, in the ovarian follicles. Normally, follicles release an egg during ovulation. But in PCOS, this conversion of the egg into a cyst prevents ovulation. In other words, there is no egg to be released and fertilized by sperm – ultimately conception cannot occur.
Lack of ovulation also disrupts the menstrual cycle, causing amenorrhea, or the absence of menstruation. Amenorrhea can be primary or secondary: primary is the inability to reach menarche (menstruation), and secondary amenorrhea is absence of menstrual cycle for 3 or more consecutive months. This can occur from high levels of the hormone prolactin. Excess prolactin disrupts the levels of FSH and LH, which are two hormones essential for the distinct phases of the menstrual cycle. In PCOS, as these hormones become limited, the egg is either not formed, or cannot be liberated from the follicle, in turn disrupting the cycle. Elevated levels of AMH are also involved in inhibiting follicle maturation, in turn preventing ovulation.
While a specific diet to improve chances of fertility has not yet been determined, research has shown that engaging in regular physical activity and adopting healthy eating habits help to manage PCOS. General recommendations include focusing on a diet rich in whole foods like fruits and vegetables, whole-grain foods like whole wheat bread and pasta and brown rice, and legumes like beans, peas, and lentils. Lean meats and low-fat or fat-free milk, cheese or yogurt can also help to normalize hormone levels. Research has also shown encouraging results in regaining menstrual cyclicity when women with PCOS followed an anti-inflammatory diet, which focused on high amounts of fiber and anti-inflammatory foods like fatty fish, green tea, legumes, low-fat dairy.
For women with PCOS who are trying to get pregnant, the following nutritional supplements have been well studied:
1) Vitamin D: Some studies show that vitamin D supplementation (100,000 IU/month) improves fertility in women with PCOS by increasing the number of mature follicles and improving menstrual regularity.
2) N-Acetylcysteine: a powerful antioxidant and amino acid, has also been shown to produce significant improvements in pregnancy and ovulation rates among women with PCOS compared with placebo.
3) Inositols: pseudovitamins found in foods such as fruits, beans, cereals, and buckwheat. The inositols myo-inositol (MYO) and D-chiro-inositol (DCI) are showing promising results as first-line treatments. These pseudovitamins regulate follicle-stimulating hormone, thyroid-stimulating hormone, and insulin. MYO has been shown to improve egg quality and ovulation. More recent research is suggesting that a combination of MYO and DCI in a 40:1 ratio that mimics the body’s tissue levels works better than inositol alone for restoring hormone balance. The therapeutic dosage is 2 to 4 g MYO daily with 50 to 100 mg DCI daily.
4) Fish oils: rich in omega-3 fatty acids, fish oil supplements have been found to regulate menstrual cycles in both overweight and lean women with PCOS.
