Let’s be real: It’s hard being a woman, juggling career goals, side hustles, families, and relationships. And if you’re one of the five million US women of child-bearing years affected by polycystic ovary syndrome (AKA PCOS), throw in having to manage symptoms like irregular periods, excess body hair, weight gain, and acne, leading to shame, frustration, and isolation, and in some cases, anxiety and depression.
While PCOS affects 4-20% of women of reproductive age worldwide (and is more prevalent among Women of Color), it has yet to be recognized as an important global health problem. What’s more, its prevalence, diagnosis, and management remain some of the most confusing factors of PCOS. But thanks to celebrities like Keke Palmer and Victoria Beckham and the #pcoswarrior community openly sharing their personal experiences with PCOS and demonstrating the importance of prioritizing self-care and self-advocacy, there is now a greater awareness of the disorder and its typical symptoms. More good news: I asked PCOS specialist and hormone expert Dr. Anna Arabyan to give us a crash course on PCOS. Without further ado, The Everygirl’s guide to everything you need to know about PCOS.
Meet the expert
Dr. Anna Arabyan
PCOS Specialist, Hormone Coach, and Founder of NutraFemmeRX
Dr. Anna Arabyan is a faculty member at the USC Leonard Davis School of Gerontology. Her passionate advocacy for women’s hormonal health and palliative care guide her clinical and teaching interests relating to healthy aging, symptom management, and overall wellness.
In this article
What is PCOS?
While there are many definitions of it, Dr. Arabyan put it simply: “Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects women and can cause irregular periods, high levels of androgens (male hormones) leading to acne, excessive body/facial hair, and polycystic ovaries (enlarged ovaries with small fluid-filled sacs that surround the eggs).” Although the aforementioned are common telltale signs of PCOS, it can manifest differently from person to person. Also, Dr. Arabyan said it’s important to note that not all symptoms need to be present to diagnose PCOS. “The term ‘polycystic’ is a little misleading as not everyone with PCOS has polycystic ovaries,” she explained. “A missed ovulatory cycle (even with a bleed or period) can also indicate PCOS.” Therefore, it’s important to get to know your body and educate yourself on the four phases of the menstrual cycle.
What are common causes?
One symptom of PCOS that tends to come up more than others is insulin resistance. In fact, insulin resistance affects 50%–70% of women with PCOS, resulting in the simultaneous presence of two or more diseases or medical conditions including metabolic syndrome, hypertension, and diabetes. “PCOS is caused by a combination of genetic and environmental factors, with the most common underlying cause being insulin resistance,” Dr. Arabyan agreed. “This occurs when cells in the muscles, fat, and liver do not respond well to insulin, leading to hormone imbalances.” Physical signs of insulin resistance can come in the form of skin tags and dark, velvety patches of skin around the armpits, groin, and neck, but to confirm diagnosis, your healthcare provider may order blood tests to determine your glucose levels and cholesterol.
According to the National Polycystic Ovary Syndrome Association, an estimated 50% of the women with PCOS are undiagnosed because the symptoms have a variety of potential causes. For example, Dr. Arabyan cited other causes of PCOS like chronic inflammation, adrenal disorders, thyroid conditions, and high levels of prolactin, all of which can also cause symptoms similar to PCOS. Identifying the root cause is just as critical as the diagnosis. PCOS defines a grouping of symptoms, but the cause for one woman’s symptoms could be vastly different than another, and therefore, the treatment and management plan should be different as well. “The underlying cause is important to uncover,” she affirmed. “Multiple people with PCOS could present similar symptoms such as missed periods and excess facial hair, and each could have different underlying causes.”
The relationship between PCOS and mental health
Mental health disorders such as depression, anxiety, bipolar disorder, and binge eating disorder also occur more frequently in women with PCOS. “From my observations, PCOS can affect mental health in two ways,” Dr. Arabyan noted. “Firstly, being diagnosed [with PCOS] can lead to feelings of sadness, overwhelm, loneliness, fear of infertility, and low self-worth. Secondly, the hormonal imbalances can cause severe PMS-like symptoms, further contributing to low mood.” The silver lining? Dr. Arabyan conveyed that improving mental health can be addressed using a two-pronged approach: balancing hormones to reduce symptoms and relying on education, therapy, community support, and self-love practices.
Tips to help manage PCOS
Full disclosure: There is no cure or prevention for PCOS, but it can be treated and managed through healthy lifestyle habits. “Management is a combination of factors including mentality, community, nutrition, physical activity, and supplements if necessary,” Dr. Arabyan expressed. “Understanding that you are not less worthy for having this condition and being a part of a supportive community can go a long way in managing this disorder.” More specifically, Dr. Arabyan mentioned regular exercise, managing stress, seeking support from friends, a diet made up of whole foods, and taking supplements under the supervision of a healthcare practitioner as effective symptom management methods.
It’s only natural to feel alone and at a loss for what to do when you’re diagnosed with PCOS, but it’s more common than most women realize. “PCOS is a common condition and talking about it more openly has become more widespread only recently,” Dr. Arabyan voiced. Not sure where to start? Dr. Arabyan recommended the book Period Repair Manual as a great resource to learn more about PCOS. “Gather as much information as you can so that you can make the best informed decision on how to manage your condition, and above all, realize that you’re not alone.”
Focus on nutrition
Instead of approaching a healthy diet from a restrictive, “eat this, not that” mindset, Dr. Arabyan recommended focusing on including foods that can help the potential root causes such as insulin resistance. “I’m a huge fan of dark leafy greens, all vegetables, cleanly-sourced protein, legumes, beans, nuts and berries. Once you start eating more of these foods naturally, processed sugar, refined carbohydrates, alcohol, and fried foods will have less of a place in your diet.” In other words, stick with whole foods and focus on adding a variety of veggies, legumes, and clean protein sources.
Balance your exercise routine
We’ve been taught that exercise is good, but there is such a thing as too much of a good thing (everything in moderation!). Too much high-intensity exercise can disrupt your hormones, so finding the right balance of exercise for you is key. “I recommend mild strength training exercises like Pilates a few times a week, which can help build muscle,” Dr. Arabyan suggested. “I also love the many benefits of taking a daily walk or hike, including improved bowel movements (which is how our bodies remove excess hormones).” Bottom line: Always listen to your body, do what feels right for you, and prioritize movement and recovery equally.
Support your mental health
Stress plays a major role in PCOS, so keeping your cortisol (AKA the stress hormone) levels under control will aid in improving symptoms of PCOS. Try prioritizing good sleep hygiene and self-care (sound bath or cold plunge, anyone?), talking to a mental health professional, journaling, or practicing meditation. Dr. Arabyan concluded with one final piece of advice: “Remember that small steps toward your goals are key and avoiding guilt is important for maintaining a positive outlook and enjoying the journey.”
Please consult a doctor or a mental health professional before beginning any treatments. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical or mental health condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.
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