How To Manage PCOS: Lifestyle Changes for Better Health

Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting women worldwide. It increases the risk of infertility, type 2 diabetes, obesity, acne and excess hair growth.

But, there's good news regarding how to manage PCOS. Proper treatment, including lifestyle changes, can make a big difference — so you can feel your best and stay healthy.

What Is PCOS?

By definition, PCOS refers to having many (poly) cysts on the ovaries; yet, some women with this condition don't have cysts. Not ovulating regularly — irregular periods are one clue — and having higher-than-normal levels of androgen hormones in your blood are also hallmarks of this condition.

According to the Centers for Disease Control and Prevention (CDC), PCOS impacts up to 5 million women of reproductive age in the U.S. and is one of the leading causes of infertility. Individuals with PCOS are often insulin-resistant, meaning their bodies don't properly respond to insulin, putting them at greater risk for type 2 diabetes. More than 50% of women with PCOS develop type 2 diabetes by age 40, though it's unclear whether that's caused by PCOS itself. Many women with this condition also experience co-factors, like obesity, high blood pressure and high cholesterol.

Studies have found that women with PCOS are at higher risk of developing sleep apnea compared to those without PCOS. This disorder, which stops or reduces breathing for several seconds at a time while asleep, should be properly treated. If not, it may worsen other PCOS symptoms such as tiredness, difficulty losing weight, high blood pressure and insulin resistance.

Women with PCOS often develop coarse hair on the face, chest or back, as well as acne. These problems stem from abnormally high levels of androgens, which are "male" hormones, like testosterone. While all women have some androgens, those with PCOS produce more.

How To Manage PCOS With Dietary Choices

Making certain changes to your diet can help alleviate some symptoms of PCOS. A healthy, balanced diet that emphasizes whole foods and limits inflammatory items is key. One well-recognized example might be the Mediterranean diet, which includes a wide variety of foods from all categories but cuts out saturated fats, processed meats and refined sugar.

Studies have shown that those who follow a PCOS diet often lose weight, improve their blood sugar and cholesterol levels, and even reduce both acne and excess hair. Menstrual cycles may begin to occur regularly, which can be extremely important if you're trying to get pregnant.

Some key tenets of a PCOS diet:

• Eat plenty of fruits and non-starchy vegetables that are relatively low on the glycemic index to avoid blood sugar spikes. Most fresh, whole fruit (rather than dried fruit or fruit juice) is recommended due to fiber content, which can help you feel full and slow down the absorption of its sugars into the bloodstream.
• Opt for lean protein, especially fish high in omega-3 fatty acids, like salmon and mackerel.
• Choose whole grains over refined grains; they're higher in fiber and other nutrients.
• Limit or avoid highly processed food, added sugar, excess salt and saturated fat (including fried foods).

In addition to relieving symptoms, these dietary changes may also help reduce levels of inflammation throughout the body and support weight loss efforts.

The Importance of Exercise

If you have PCOS, set your workout goal to 150 minutes (or more) of activity per week. You may reap more benefits from this than just weight management. Studies have shown that women with PCOS who increase their activity often experience improvements in their menstrual cycle and/or ovulation frequency.

You might also consider HIIT (high-intensity interval training), which combines short bursts of strenuous activity with less intense recovery periods. One study found that women with PCOS who did HIIT for 10 weeks had improvements in insulin resistance.

Cardiovascular health also gets a major boost, which is crucial because PCOS increases the risk of heart attack and stroke.

Vigorous activity may be the most beneficial, but any movement is worthwhile. The CDC urges all Americans to simply "move more and sit less," so start where you're comfortable and gradually increase intensity. Find a gym or enjoy outdoor activities, such as running, cycling, swimming or hiking.

The Importance of Sleep

Everyone needs quality sleep to feel their best. If you have PCOS, getting adequate rest is crucial. Women with PCOS, who fall short on sleep or don't sleep soundly, are more apt to be insulin-resistant and obese. Unfortunately, having PCOS might make it harder to sleep well. To try and combat this, adopt good sleep hygiene habits. Be consistent in your bedtime routine, stop using electronics at least an hour before going to bed and don't consume caffeine in the afternoon or evening.

One study showed that women with PCOS are at a higher risk of developing sleep apnea compared to those without PCOS. Sleep apnea can be dangerous if left untreated. Talk to your doctor if your partner says you snore loudly, you often wake during the night feeling like you're gasping or choking, or you feel very fatigued despite spending ample hours in bed. Sleep apnea could be at fault.

How To Stress Less With PCOS

Although the connection is not fully understood, stress is common among women with PCOS. Stress may not only worsen PCOS symptoms, but it may also be a contributing factor. If you're chronically stressed, hormones like cortisol are elevated in your body. This can cause more inflammation and worsen PCOS symptoms.

Practicing good habits — including eating a healthy diet, staying active and prioritizing sleep — will blunt some of the damage that stress causes.

Other stress management strategies, like mindfulness and meditation, may also be beneficial. Engaging in such practices can help lower stress hormones as well as protect your mental health and overall well-being.

Medical Interventions for PCOS

Lifestyle changes can have a great impact on your health, but regular checkups with your healthcare provider are still essential. If you have elevated blood sugar, blood pressure or cholesterol (all common in PCOS patients), you might require medication. This may also be the case if you're having trouble getting pregnant. A prescription could help if you're struggling with excess hair, acne or uncomfortable periods.

Some medications used to treat PCOS may include the following:

• Metformin lowers blood glucose and reduces insulin resistance. It also treats prediabetes and type 2 diabetes. Metformin is not approved by the FDA to treat PCOS, but has been found to help improve weight loss, decrease cholesterol levels, regulate the menstrual cycle and slightly reduce PCOS-associated infertility in those with PCOS.
• Spironolactone can help to decrease androgen levels, reduce excess hair growth and help clear acne. Although not FDA-approved to treat these PCOS symptoms, it may be prescribed by your physician.
• Oral contraceptives can assist in regulating your periods and reduce the amount of androgens circulating in your bloodstream.
• Clomiphene citrate (Clomid) or letrozole (Femara) are medications that promote ovulation, which is important if you're having a hard time getting pregnant. (Letrozole is often used for women who have tried metformin and clomiphene unsuccessfully.)

Improving Quality of Life

There's no simple, one-stop solution when it comes to the treatment of PCOS, but making healthy lifestyle choices can help manage both the condition and your well-being. Improving your diet, getting more exercise, sleeping better and actively managing stress can serve to bolster any medical treatments that your doctor might recommend and enhance your overall quality of life.

Clinically reviewed on Sept. 13, 2024.