Medical Edge Newspaper Column

Managing Health Problems in Polycystic Ovary Syndrome

May 13, 2007
Dear Mayo Clinic:
A friend of mine was diagnosed with Polycystic Ovary Syndrome. Is there a specific diet she should follow to manage health problems associated with the disease?

Answer:
While there's no specific diet for women with Polycystic Ovary Syndrome (PCOS), we do know that when obese women with PCOS lose weight, symptoms improve. An estimated 52 to 64 percent of women with PCOS are obese.

As many as 10 percent of premenopausal women have PCOS, the most common cause of female infertility. Most women with PCOS have large ovaries with numerous cysts -- thus the condition's name. It also is characterized by irregular menstrual periods, excess hair growth and acne. Obesity is a co-existing condition that can induce or exacerbate these characteristics.

The ovaries of women with PCOS produce an excess of androgens, the male hormones, which can cause coarse hair growth as well as acne on the face, chest and other areas. The hormones produced by the pituitary gland that help regulate the menstrual cycle also are imbalanced, so the ovaries release eggs irregularly, or sometimes not at all.

While doctors don't know the exact cause of PCOS, there appears to be a connection to excess insulin, the hormone that helps clear sugar from the bloodstream following a meal. This excess insulin promotes the excess androgen production by the ovaries. About 70 percent of women with PCOS have insulin resistance, meaning the body can't utilize insulin effectively for blood sugar control. The body compensates by producing even more insulin. However, it takes longer to clear sugar from the bloodstream, which is a risk factor for many health problems: diabetes, heart disease and decreased HDL (good) cholesterol.

PCOS treatment focuses on each woman's primary concern, such as infertility, obesity, excess hair growth or acne. For all women, reducing the risk of complications is a priority and maintaining a healthy weight is part of the treatment strategy.

Weight loss has many benefits for women with PCOS. When the condition is related to obesity, losing as little as five percent of body weight may result in normal menstrual cycles. Other benefits include:

• Decrease in insulin secretion
• Improved utilization of insulin
• Decrease in androgens (male hormones)
• Decreased risk of developing type 2 diabetes and early onset heart disease

Generally, a low-calorie, low-fat diet is recommended for women who need to lose weight. High-protein diets haven't been proven more effective than a low-fat approach.

Another approach is a low-glycemic index diet, which ranks carbohydrate-containing foods based on how much they raise insulin levels following a meal. Low-index carbohydrates break down more slowly, helping to reduce hunger and prevent weight gain. The South Beach Diet follows this model. A low-glycemic index diet could reduce risk of heart disease more than a low-fat diet does, but we need more research to confirm this.

High insulin levels due to insulin resistance can also occur in normal weight women with PCOS. It remains to be shown whether eating a low-glycemic index diet also can improve symptoms and decrease health risks in this group.

-- Frank González, M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.