Symptoms of PCOS and the Lifestyle Shifts That Help Alleviate Them

By Stacy Henigsman, DO

Polycystic ovary syndrome (PCOS) is a hormonal condition that affects 1 in 10 women. It’s characterized by elevated testosterone (hyperandrogenism), irregular periods, and polycystic ovaries. Symptoms of PCOS also include infertility, insulin resistance, weight gain, acne, hair loss, and facial hair.

1. Irregular Periods

The average menstrual cycle is 28 days, but anywhere between 21 and 35 days is considered normal. An irregular period is defined as either (1) eight or fewer menstrual cycles per year (or what’s called oligomenorrhea); (2) menstrual cycles shorter than 21 days; or (3) menstrual cycles longer than 35 days. Women with PCOS may have irregular periods or none at all.

2. Ovarian Cysts

An ovarian cyst is a sac or pouch filled with fluid (or other tissue) that forms in the ovary. An occasional ovarian cyst is common—they typically come and then go away without health concerns. But with PCOS, many cysts/follicles (12 or more per ovary) are present on the ovaries, and they are typically smaller in size and do not go away as non-PCOS cysts do. Ultrasounds are used to identify ovarian cysts, but external signs may include abdominal pain, pelvic pain, or bloating.

3. Infertility

Infertility is the absence of a pregnancy within 12 months of having unprotected intercourse or within six months for women older than 35. In women diagnosed with PCOS, infertility is typically caused by a lack of ovulation.

4. Insulin Resistance

Insulin resistance is a decrease in the cells’ ability to respond to insulin, which is needed to maintain healthy blood sugar levels. If cells do not respond properly to insulin, excess sugar can remain in the blood, leading to prediabetes and diabetes. Insulin resistance contributes to elevated testosterone, infertility, abnormal facial hair, acne, and weight gain in women with PCOS.

5. Weight Gain

Insulin resistance and hormonal imbalances play a significant role in weight gain in women with PCOS, who tend to gain weight very easily and have a difficult time losing it.

6. Acne

Cystic acne is a chronic acne condition that is associated with PCOS. This type of acne often flares up around the lower part of the face—jawline, chin, and upper neck—and tends to be larger, deeper, and slower to resolve. Treatment often includes medication that helps lower elevated levels of androgens and a balanced diet.

7. Hair Loss

Hair loss, or androgenic alopecia, is caused by elevated testosterone levels. It usually occurs in a distinct pattern—a Christmas tree or triangle shape—at the midline of the scalp.

8. Facial Hair

Abnormal facial hair growth—coarse, dark hair that appears on the chin and upper lip—is called hirsutism. These coarse hairs are caused by elevated levels of testosterone and are clinically referred to as terminal or androgenic hairs.

LIFESTYLE SHIFTS

Lifestyle shifts can help address the underlying causes of PCOS symptoms. Because every woman is different and has a different combination of symptoms and lifestyle, treatment plans must be tailored to each patient’s needs. But most women can benefit from a balanced diet and regular exercise. Here are some general guidelines:

Exercise

It’s generally recommended that adults do a minimum of 150 minutes of moderately intense physical activity or 75 minutes of vigorously intense physical activity per week, or an equivalent combination of both. This can include muscle-strengthening activities on two nonconsecutive days of the week. Any type of exercise is helpful, though—the best is the one that a patient enjoys and will regularly perform.

Diet

A nutrient-dense diet rich in whole foods, with lots of fruits and vegetables, is best. I recommend anti-inflammatory foods such as berries, leafy greens, eggplant, fatty fish, nuts, avocados, and olive oil. For hair loss, getting enough iron, zinc, and B vitamins is particularly important. And generally limiting refined carbohydrates, solid fats, processed meats, and sugary beverages is strongly advised.