PCOS Part 2: Treating the Real Problem

In my last post I tackled the complex diagnosis of PCOS, compacting a 60 page text book chapter into an 800 word blog post that, hopefully, the average woman could understand. Good thing our readers are above average, right? This post will discuss the common treatment strategies, and next time we will look at attempting pregnancy and addressing infertility.

The root cause of PCOS is insulin resistance. The best treatments are those that help your body process insulin better. Exercise, diet and the medication Metformin are key to accomplishing this goal.

Exercise

If you have PCOS, exercise is not a suggestion but a command. It is the single best thing you can do for your body. Exercise helps your body process insulin better, revs up your super sluggish metabolism and helps maintain your weight. Getting at least 30 minutes of aerobic exercise 5 times a week is a MINIMUM. Weight training is also key. Building muscle can help boost your metabolism. PCOS increases your risk of diabetes, but regular exercise reduces your risk by 50%.

If you have trouble finding the motivation to exercise, then find a buddy or accountability partner; join a class or consider personal training. If you live here in Franklin, I recommend Temple Fitness (not a paid advertisement, just my honest opinion) as several of my patients have had great results there, and this is where I go to get my butt in gear.

Diet

The metabolism of  PCOS is really just not fair. Your girlfriends can pig out on pizza on the weekend and still fit in their skinny jeans, meanwhile, you walk past a bag of Oreos and gain 5 pounds. Acceptance that this is how your metabolism works is a key first step. You must learn to treat yourself like a diabetic. A higher protein, lower carb diet is going to be your best bet.

The first step to losing weight is determining how many calories a day you needDieticians recommend for PCOS patients to distribute these calories as : 40% carbohydrates/ 30% fat/ 30% protein.  The carbs should be complex, not simple.  Avoid eating carbs alone, instead pair them with a lean protein.  To track your daily intake, try an phone app like “My Fitness Pal“.  As you enter your food throughout the day, it gives you a pie chart graph of carbs, protein and fat so you can actually see how your percentages are tracking each day.  It also has a bar code reader so you can easily scan in your foods (on that rare occasion that you are eating packaged food).  If you are continuing to have difficulty determining what your diet should be, meet with a dietician.

Metformin

Metformin (Glucophage) is a diabetic medication that decreases the amount of sugar (glucose) excreted by the liver, which reduces the amount of insulin your body needs. While not a weight loss drug, it helps put PCOS women back on the level playing field with everyone else. When they are following a lower carb diet and exercising, it helps them lose and maintain their weight. In addition to weight loss effects, Metformin will help up to 60% of women return to regular periods and ovulation. It must be stressed the Metformin works well WITH diet and exercise, but cannot replace it.

Side effects of Metformin are mainly GI upset. When first starting the medication, you can have serious diarrhea. Usually, the symptoms will resolve within a couple of weeks. If the stomach discomforts last longer than that, notify you doctor.

Birth Control Pills

For those women not wishing to conceive, birth control pills are ideal to treat the symptoms of PCOS. They increase the protein in the blood that binds the male hormone, reducing acne and unwanted hair growth. They also induce monthly cycles, preventing the heavy, crampy, unruly periods that sometimes accompany PCOS.

It is important to have a period at least every 3 months to help prevent the build up of endometrial tissue and the possibility of endometrial cancer. If you don’t like taking birth control pills, then taking progesterone every 3 months to induce a period is also an option.

Healthy Weight Women with PCOS

For the 20% of women with PCOS who are not overweight, these same principles still apply. Change the composition of your diet to the recommended percentages, just set your overall calorie goal to maintain rather than to lose.  We do not have a great laboratory test for insulin resistance.  Only 50% of PCOS patients show elevated insulin levels.  Often patients with normal insulin levels will still respond to Metformin, so it continues to be recommended as the treatment of choice.

For those women attempting pregnancy, often instituting exercise, diet and Metformin will lead to ovulation and pregnancy.  My next post will consider what happens when this is not enough.

For those of you living with PCOS, which do you find more challenging: diet or exercise?  What strategies have you incorporated to help overcome your challenges?

About Dr. Heather Rupe

Dr. Rupe is a mom, wife and OB/GYN. She is the co-author of The Pregnancy Companion book and blogs at www.ThePregnancyCompanion.com. Her heart is to help guide women through as peaceful a pregnancy as possible. In her spare time she loves to run and laugh whenever she can.

Comments

  1. I have PCOS, but I also cannot take birth control because of having a Factor 2 mutation. I’m still taking metformin and it helps regulate me greatly. However, can I remain on metformin when not trying to conceive?

  2. Both are hard to keep up with, but diet is hardest for me. I feel like lunch is the real problem, finding time to make a healthy lunch before work, if I can come up with something better than PB&J, is hard! And of course there’s the constant invitations to ‘do lunch’. As if making lunch was hard, finding a healthy lunch in down town nashville seems next to impossible!

    • I agree Sarah. Lunch has gotten easier for me now that I’m working from home. But then there is snacking all day! : )

  3. I have PCOS and am not overweight. My PCOS only rarely resulted in anovulatory cycles, but they were very long and irregular, and 4 pregnancies ended in early miscarriage.
    I implemented a 40/30/30 diet, weight lifting 3x week and C25K for 3 months and for the first time in my life I started getting “normal” cycles with ovulation between day 13 and 16.
    I got pregnant again and I am due in a month!
    I used to scoff at the idea of diet and exercise because I was thin and ovulating anyway, but I believe that this is what made the difference for me between a healthy ovulation and early pregnancy and one that just can’t last for some reason.

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