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Polycystic Ovarian Syndrome: The in’s & out’s

Polycystic Ovarian Syndrome (PCOS) is one of the most common hormonal conditions affecting a tremendous 1 in 10 women. The term “polycystic ovarian syndrome” is a bit deceptive since it implies that the condition is mainly affecting ovaries and that you may have multiple “cysts” on them.
However, the cause of PCOS is hormonal: it is not a problem that affects just the ovaries, as the name might suggest.

(LEFT) Normal Ovary
(RIGHT) PCOS

Increased insulin levels in the body are thought to cause the ovaries to work differently, resulting in excessive quantities of male-type hormones (androgens), which explain many PCOS symptoms. If the hormone levels can be controlled, the ovaries often function normally, and symptoms improve.

Sometimes the journey to a diagnosis of PCOS is a long and frustrating one. As it is a complex condition, diagnosis can be difficult. Many women with PCOS often report frustration over delays in diagnosis, made worse by lack of appropriate and helpful information.

WHAT ARE HORMONES

Hormones are chemicals made in your body that carry messages through your bloodstream. They help control many functions in your body, such as growth, energy, sexual function, reproduction, digestion and temperature. In a woman with PCOS, her body has an imbalance of two hormones, insulin and androgens. The higher levels of these hormones are responsible for the signs and symptoms of PCOS.

WHAT ARE THE OVARIES AND WHAT DO THEY DO?

The ovaries are small, oval-shaped organs located in the pelvis. The ovaries main job is to help a woman get pregnant. They produce an egg each month and when the egg is mature, it is released from the ovary at the time of ovulation and sent down the fallopian tube to be fertilised.

When a woman has PCOS, the eggs do not fully develop and this is the main cause for pregnancy difficulties.

In some women diagnosed with PCOS, an ultrasound image of their ovaries will show multiple follicles in the ovaries: these are not actually cysts, they are partially formed eggs that haven’t developed properly caused by the increased levels of androgens.

It’s good to note that there is no known link between these follicles in the ovaries of women with PCOS and either larger true ovarian cysts or the risk of ovarian cancer.

CAUSES OF PCOS

There’s a common belief that PCOS is caused by insulin resistance, however there are a few catalysts for PCOS. Determining which type help with the treatment and remission of PCOS reversal.

Insulin resistance

Around 85% of all women with PCOS have ‘insulin resistance’. If you are insulin resistant, your body’s cells stop responding normally to insulin, and instead block the entry of glucose into the cells. This means your body doesn’t use the available insulin effectively to help keep your glucose levels stable.

Because the insulin is not working effectively, the body reacts by producing more insulin. Higher levels of insulin increases the production of androgens, such as testosterone, in the ovaries. Typical drivers for insulin resistance are; sugar, smoking, stress, birth control, alcohol, trans fats, magnesium deficiency and bad gut bacteria.

Regular activity, weight training and healthy eating are very important in managing and reducing insulin resistance and can greatly improve the symptoms of PCOS.

Androgens

Androgens, also known as “male hormones,” are found in both men and women, although in women at far lower levels. Androgens are produced in small amounts by all women in body tissues, including the ovaries and adrenal glands.

Increased levels of androgens in women with PCOS cause symptoms such as excessive body hair growth, scalp hair loss and acne. They also contribute to symptoms such as irregular periods and irregular ovulation. 

Post birth-control PCOS

Coming off the pill can cause symptoms of PCOS since the pill can worsen insulin resistance. The pill suppresses ovulation and post birth-control can take a long time for a period to return qualifying you for a PCOS diagnosis.

Inflammatory PCOS

Inflammation can disrupt your hormones, suppress your ovulation, stimulate your ovaries and adrenals to promote androgens. Inflammation can be caused by smoking, inflammatory foods, environmental toxins and digestive problems.

SIGNS AND SYMPTOMS OF PCOS

PCOS symptoms manifest in many different ways. Some women will have only some, or mild symptoms, whereas others will have a number of severe symptoms. Symptoms can also change at different stages of a woman’s life. 

Periods and Fertility

If you have PCOS, your periods might be irregular, or stop altogether. In some girls, PCOS is a cause of periods failing to start. The average menstrual cycle is 28 days with one ovulation, but anywhere between 21 and 35 days is considered normal.

In women with PCOS, high levels of androgens and insulin can affect the menstrual cycle and prevent ovulation. Ovulation can stop completely, or it can occur irregularly. This can make it more difficult for women with PCOS to become pregnant naturally, however, this does not mean that all women with PCOS are infertile. Many women with PCOS have children without the need for infertility treatment but some women will require medical assistance to help them get pregnant.

  • No periods, or periods that are irregular, infrequent or heavy.
  • Immature ovarian eggs that do not ovulate.
  • Multiple ‘cysts’ on the ovaries.
  • Difficulty becoming pregnant or health challenges during pregnancy.
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Hair, Skin and Body

Excess hair growth on the face and body is known as hirsutism, and it is caused by excessive amounts of androgens activating hair follicles. This extra hair can be thicker and darker in colour than usual. Hair grows in the sideburn region, chin, upper lip, around the nipples, lower belly, chest, and thighs, which are more common places for males to grow hair.

If you have PCOS, the higher level of androgens can increase the size of the oil production glands on the skin, which can lead to increased acne. Acne is common in adolescence, but young women with PCOS also tend to have more severe acne. Rough, dark, velvety patches of skin can also develop in women with PCOS. These occur in the armpits or neck area, and are called acanthosis nigricans. 

  • Excess facial and/or body hair (hirsutism)
  • Scalp hair loss (alopecia)
  • Acne on the face and/or body that can be severe.
  • Darkened skin patches (acanthosis nigricans)
  • Weight gain.

Mental and Emotional Health

Coping with hirsutism, severe acne, weight changes and fertility problems can affect your body image, self-esteem, sexuality and femininity. This can add to depression and anxiety levels. Problems with fertility can have an impact on your mood, particularly if fertility has been a concern for a long time.

In addition, these emotional challenges can be particularly difficult if you are unaware that you have PCOS. A delayed diagnosis of PCOS, as well as problems with weight management, can make you feel discouraged and helpless. This is especially so if you do not have the knowledge and support you need to manage these symptoms. This creates a negative cycle, making it harder to take charge of your health and live the healthiest lifestyle you can.

  • Mood changes.
  • Depression.
  • Anxiety.
  • Low self-esteem.
  • Poor body image.
  • Impact on quality of life

Related Health Conditions

Women with PCOS appear to be at increased risk of developing the following health conditions during their lives, such as weight gain or obesity, insulin resistance (if they don’t already have it) Type 2 diabetes, cholesterol and blood fat abnormalities, cardiovascular disease, endometrial carcinoma (cancer) and sleep apnoea.

Sleep apnoea (a sleep disorder in which abnormal pauses of breathing occur during sleep)
Increased risk of diabetes, with early onset.
Sexual health challenges
Increased risk of cardiovascular disease

INCREASING YOUR MENTAL WELL-BEING WITH PCOS

One of the most effective approaches for treating symptoms of PCOS has been shown to be a healthy lifestyle. Consisting of eating a nutritious diet, being as active as possible and maintaining a healthy weight. Reduced or impaired mental and emotional health, on the other hand, might make it harder to look after yourself, live a healthy lifestyle, and make the best decisions about your health.

Being aware of the impact your mood has on your lifestyle management is one of the keys to successfully managing PCOS. It is critical to get assistance if you believe you feel you need it. With the right support, education about PCOS and appropriate treatment, your emotional health can be improved.

EMOTIONAL HEALTH AND FITNESS

Exercise can be a useful addition to treatment for mild to severe depression, since it can assist to reduce anxiety and prevent relapse. Physical activity should not be used in place of regular treatment, especially for people suffering from severe depression; nonetheless, many types of physical activity appear to be equally helpful in the treatment of depression.

There are also studies which say that weight and resistance training is effective to manage and maintain an equilibrium of healthy hormones.

Regular exercise seems to be most effective in improving insulin resistance, even without any noticeable change in weight or body fat measurement. Improving insulin resistance is very important as this is the cause of many of the symptoms of PCOS.

Regular physical activity will help to:

  • reduce androgens
  • improve insulin resistance
  • regulate menstrual cycles
  • induce ovulation
  • improve fertility
  • increase energy levels
  • improve self-esteem
  • reduce anxiety and depression.

These improvements are achieved even when weight loss doesn’t occur.

DEALING WITH BODY IMAGE AND PCOS

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The way a person thinks or feels about their body is referred to as body image. Many things can influence it, including a person’s perception of their own health, views about physical appearance, physical fitness, body size, and personal or cultural beliefs.

The physical changes caused by PCOS can have an impact on your body image. Many of the symptoms of PCOS contradict our perceptions of femininity and how women should appear. Many women with PCOS believe they are less physically appealing, fit, and healthy. Emotionally, this can be tough to deal with.

PCOS can make some women feel self-conscious, decrease their self-esteem and confidence, and influence their behaviour. For example, some women may find themselves restricting their meals, obsessing about food, or refusing to socialise with their friends. Talk to a health professional and/or someone you trust if PCOS is influencing your feelings about your body or your behaviour.

At different times of your life, different symptoms of PCOS can concern you more. If symptoms such as acne and excess hair growth are of concern to you and affect how you think about your body, it is important to seek treatment for these symptoms.

Each woman’s PCOS experience is unique, and it will change throughout her life. It is critical that your treatment be tailored to your specific needs at any given time. There are numerous therapies available for a variety of emotional health issues. Some women may benefit from a few sessions of counselling, while others may benefit from the continual support of counselling.

PCOS AND THE IMPORTANCE OF NUTRITION

The eating guidelines for PCOS management are the same as those recommended for the general public and persons with other metabolic conditions like diabetes or high cholesterol. Diet, what you eat, is critical in the treatment of PCOS. Weight management is the most important emphasis of diet: first, preventing weight gain, secondly, if you are overweight, decreasing some excess weight over time. This aids in hormone control, which helps to alleviate problems such as acne, excessive hair growth, cycle regularity, ovulation, and fertility.

In order to achieve a healthy weight, a nutritious diet is more helpful than exercise alone. There is no one diet – for example, a high-protein diet with an addition of healthy fats has been shown to be more successful in weight management or weight loss for women with PCOS.

It is recommended that women with PCOS eat regularly to help stabilise their insulin levels. It is suggested that they eat every three to four hours, which for most women means having three meals (breakfast, lunch and dinner) and a snack between each. Many women find it difficult to use appetite signals reliably, so a good start is to eat often but reduce the portion size.

Generally, meals and snacks need a balance of protein and high-fibre and/or low-glycaemic index, as well as plenty of vegetables and fruit. Generally, meals and snacks need a balance of protein and high-fibre and/or low-glycaemic index carbohydrates, as well as plenty of vegetables and fruit. For lunch and dinner, it is ideal for about half of the food you eat to be vegetables and salad.

  • eat regular meals including a wide variety of foods
  • include plenty of vegetables and salad (at least 5 serves every day, which is equivalent to 2.5 cups of cooked vegetables)
  • include some protein and a moderate amount of carbohydrate in each meal
  • eat unrefined carbohydrates, such as wholegrain cereals, legumes and fruit, rather than refined carbohydrates (eg, white bread, white rice, soft drinks, lollies, biscuits) to make your meals and snacks more nutritious
  • limit saturated fats, but instead use extra virgin olive oil, avocado, nuts and seeds, which are good sources of healthy fats
  • aim to eat more fresh foods and limit use of processed packaged food
  • be thoughtful of how much you eat and drink, not just what foods and drinks you choose

RECIPES FOR PCOS

Click here to discover new recipes!!

WHEN TO SEEK PROFESSIONAL MENTAL HELP

Your doctor in Australia can offer you support and, if necessary, refer you to a counsellor or psychologist for specialised psychological help. There are Medicare reimbursements available for up to ten sessions per year with a psychologist. More information can be obtained from your doctor.

After being diagnosed with PCOS, some women will experience depression and anxiety; others will accept the illness and cope well by learning about it. Women with PCOS are strongly encouraged to monitor their own emotional health by asking themselves questions such as:

  • Do I feel down, depressed or hopeless?
  • Have I lost interest or pleasure in doing things I usually enjoy?
  • Do I worry a lot about the way I look?
  • Do I feel guilty, depressed or disgusted about my eating?

Remember that progress is not always straightforward. Many things in our lives can stop our best efforts to be healthy, such as stress and emotional challenges. These can be hard to predict and can seem overwhelming at times. The important thing is to keep your eye on your goals and to keep going. Some days you will succeed in meeting your goals, and other days you will not do as well, but in the end, you will make progress!

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