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What causes PCOS and how is it best managed?

Polycystic ovary syndrome is primarily caused by impairments in hormone synthesis, insulin resistance, or excess body fat. Nutritional interventions (diets featuring reduced calories and low glycemic index foods), physical activity, and sleep interventions are effective in its management, and some supplements and herbs show promise.

Background

Polysystic ovary syndrome (PCOS), the most common endocrine disorder among women of reproductive age, is associated with obesity, insulin resistance, dyslipidemia (abnormal levels of blood lipids), infertility, and elevated testosterone levels.

The study

This narrative review described the factors leading to PCOS development and lifestyle interventions for PCOS management.

The results

Causes of PCOS:

  • Impairments in gonadotropin hormone synthesis: Increased concentrations of luteinizing hormone (LH) relative to follicle-stimulating hormone (FSH) result in excessive androgen production among women with PCOS.

  • Insulin resistance: Insulin acts synergistically with LH by increasing the production of androgens and decreasing the synthesis of sex hormone-binding globulin (SHBG), a key testosterone-binding protein, resulting in a greater circulation of unbound testosterone.

  • Excess body fat: Fat cells produce hormones such as resistin and leptin, as well as inflammatory cytokines, which can contribute to PCOS development.

Lifestyle interventions:

  • Nutrition: Reduced-calorie diets with a low glycemic index are effective for PCOS management.

  • Physical activity: The authors recommended a minimum of 120 minutes of aerobic exercise per week to improve insulin sensitivity in PCOS.

  • Sleep: Evidence suggests that melatonin synthesis might be reduced in women with PCOS and that sleep disorders can intensify the pathways associated with insulin resistance.

  • Supplementation: Some evidence suggests that supplementation with vitamin B1, coenzyme Q10, vitamin D, inositol, berberine, chromium, zinc, selenium, or omega−3s might benefit some patients with PCOS.

  • Herbs: Some evidence suggests that herbs such as Aloe vera, Cinnamomum verum (cinnamon), Camellia sinensis (tea), Matricaria chamomilla (chamomile), Morus alba (white mulberry), Mentha spicata L. (spearmint), Glycyrrhiza glabra (licorice), curcumin, Urtica dioica (stinging needle), Silybum marianum (milk thistle), Tarazacum officinale (dandelion), and Nigella sativa (black cumin) might benefit metabolic parameters in patients with PCOS.

Note

Although lifestyle change is the first line of treatment for PCOS management, the authors point out that it is not an alternative to pharmacological management. In addition, several of the supplements and herbs noted by the authors can have adverse effects. As such, prioritizing nutrition, exercise, and sleep interventions is warranted, and people with PCOS should consult a physician before considering supplementation or herbal treatments.

There are 16 more summaries in the Women’s Health category for October 2021 including ...

  • Probiotics, prebiotics, and synbiotics for improving metabolic parameters in women with polycystic ovary syndrome
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