Polycystic Ovarian Syndrome is the most common hormonal disorder in women of childbearing age, affecting 5-10 percent of the demographic. Though it is classified as a reproductive disorder, the symptoms affect a wide range of bodily processes.

Symptoms include

  • Infrequent menstrual cycles and unusually heavy periods
  • Weight gain and difficulty losing weight
  • Hirsutism (extra hair on extremities, face, chest, abdomen and back)
  • hair loss from scalp
  • Acne and oily skin
  • pelvic pain
  • difficulty conceiving
  • ovarian cysts
  • depression
  • increased skin tags
  • darkening of the skin

In women with PCOS, high insulin levels cause an increase in the production of male hormones, called androgens. High androgen levels in turn lead to symptoms such as increased body hair growth, acne, and irregular periods (due to dysfunction in the production of the LH and FSH hormones that control ovulation).

The high levels of insulin and androgens in PCOS patients can also cause their bodies to store more fat, especially in the abdomen, giving them an "apple" rather than a more traditionally feminine "pear" shape and making their obesity even more dangerous. Additionally, while much of the development of PCOS depends on genetic factors, obesity can sometimes be a contributing cause to PCOS rather than just a symptom.

PCOS can also sometimes be associated with other endocrine gland problems, and it increases the risk for many of the devastating health consequences that can come with weight gain. For example, more than 50 percent of women with PCOS develop diabetes or pre-diabetes before the age of 40.

Between 70 and 80 percent of women with PCOS also struggle with infertility, primarily due to infrequent ovulation. According to reproductive endocrinologist Mark Perloe, each point your BMI climbs over 28 adds a year to your age in terms of fertility. That means someone who is 29 but has a BMI of 36 would have the same chances of getting pregnant as a 37-year-old.

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However, shedding as little as 10 percent of your body weight can help bring your periods back to normal and dramatically improve your fertility. Since weight loss improves insulin sensitivity, it will also decrease androgen production.

Experts have suggested that women with PCOS may need up to 400 calories less a day than typical women. So if you have PCOS, losing weight will definitely be more difficult for you, but it isn't impossible—and weight loss may be far more important for you than someone with a more normal hormone profile.

But the advice experts suggest for you is much the same advice as they give the rest of us⁠—stay away from those carbs and sugars! One study found that a group of PCOS patients who went on a low-carb and low glycemic index diet had, on average, a three-fold greater improvement in insulin and better menstrual regularity than a control group.

Instead of the bad stuff, you should eat a diet high in clean, filling foods like protein, good fat, and fiber. You should also put special effort into including anti-inflammatory foods in you diet to combat the increased inflammation often associated with PCOS. Good options include berries, fatty fish, leafy greens, and olive oil.

Gut bacteria has also been shown to be dysregulated in many PCOS patients, which you can improve by increasing your probiotic intake. On the 123 Diet, you can use more of your dairy allowance on yogurt or try taking a probiotic supplement. You should also make an effort to eat more prebiotic foods; 123Friendly options include garlic, onion, asparagus, beetroot, fennel bulb, and savoy cabbage.

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Though avoiding overeating is undoubtedly important, it's also important not to undereat. That can negatively impact hormone and cortisol levels, which are also often dysregulated in patients with PCOS. It's best to stick to at least three healthy meals a day.

You should also try to do more exercise—experts recommend about 30 minutes a day. Exercising before a meal can also encourage your body to store calories as energy and muscle instead of fat. However, avoid overexercise, which could increase your cortisol levels further!

PCOS can also sometimes be controlled with medications, like metformin, which helps the body use insulin more efficiently, birth control pills, which can help regulate your hormonal levels, and anti-androgen medications, which block the effect of male hormones. Certain supplements, like Inositol and carnitine, have also been found to increase weight loss in women with PCOS.
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