Some polycystic ovary syndrome and endometriosis symptoms can be eased with diet and lifestyle changes. Consultant obstetrician and gynaecologist Anil Sharma explains how.
Polycystic ovary syndrome
PCOS is a very common condition affecting up to one in five women. It can lead to infertility, negative body image and quality of life issues, including depression.
PCOS is so common some doctors don’t see it as a ‘disease’, but as one type of ‘normal’.
What is PCOS?
PCOS is a group of symptoms or signs (see box). Some women have them all and some have only a few.
What causes PCOS?
This is the classic ‘What came first – the chicken or the egg?’ question. No one knows the exact cause. PCOS develops when a hormone released by the small pituitary gland at the base of the brain overacts, making the ovaries produce more testosterone than usual.
Women with PCOS tend to be insulin resistant, leading to them releasing more insulin. Insulin, a hormone made by the pancreas, helps manage how our bodies use blood glucose from carbohydrates. Obesity is more likely with insulin resistance.
Signs you could have PCOS
- No, occasional, or irregular periods
- Infertility (due to lack of ovulation)
- Hirsutism (more hair than normal on chin, tummy or chest)
- Male pattern hair loss (from the temples) or just hair loss. In rare cases, deepening of the voice or increased muscle mass
- Weight gain and obesity. Easy to gain but difficult to lose weight
- Typical polycystic ovaries on a pelvic ultrasound scan (usually more than 12 small cysts on, and enlargement of, one or both ovaries)
- Acne and oily skin
- Dark patches of skin in the armpits or under the breasts
- Diabetes (mostly type 2 but type 1 also)
- High blood pressure
- Abnormal cholesterol
How nutrition and weight loss can treat PCOS
The most important treatment is weight loss. This helps treat insulin resistance and is the only natural way to treat PCOS.
In women with obesity, whether due in full or in part to PCOS, the effect of weight loss (even 5-10 per cent) can be dramatic, leading to regular periods and ovulation, normal fertility, reduced hirsutism, wellness, confidence, preparedness for pregnancy and childbirth, and reduction in all obesity-related long-term risks, including heart disease, stroke and uterine cancer.
Portion size is key to weight loss, but eating foods that fill you up is equally important. And, as insulin resistance is an underlying factor for PCOS, swapping three large meals each day for smaller meals and snacks may help some women. Choosing an eating plan you can stick to long term will help keep the weight off.
Medical treatment of PCOS
Special types of oral contraceptive with an anti-testosterone drug, cyproterone, can help treat acne and hirsutism, regulate periods and reduce the risk of uterine lining issues. Having at least one period every three months reduces the long-term risk of uterine cancer.
More specialised drugs for hirsutism are available but can cause birth defects. Many women opt for hair removal services from beauty clinics.
Non-ovulating women with PCOS can have a drug called clomiphene to stimulate ovulation and should be referred to a fertility clinic early. Public (free) infertility services require a body mass index of lower than 32, so addressing PCOS weight gain early is vital.
Unfortunately, many women with PCOS also have pelvic pain, but the reasons for this are not always clear. Other conditions, such as endometriosis, can co-exist with PCOS.
How do doctors diagnose PCOS?
It is possible to have PCOS without any obvious symptoms, and even to have the condition and be underweight. Doctors will ask questions, do an examination (if needed), and arrange hormone tests and an ultrasound scan of the pelvis. They may also do diabetes and cholesterol tests.
What is endometriosis?
Endometriosis is an often painful condition (affecting10 per cent of women) where the lining of the uterus also exists in other places – mainly outside the uterus in the pelvis. These abnormally sited lining tissues respond to a woman’s hormones (such as when you get your period), so they can bleed, scar and cause pain.
What causes endometriosis?
There are many theories. Some doctors believe during a woman’s period some cells go the ‘wrong way’ into the pelvis via the fallopian tubes, implanting like seeds in the pelvis. But a more plausible explanation is that some cells outside the uterus change into ‘uterine-lining cells’ later in life, perhaps due to hormonal changes, hereditary factors or even environmental toxins. Since we all arise from two cells (egg and sperm) in the first place, and our early body cells have the potential to change into many different types of cells, such as bone, muscle, nerve and so on, potentially some of these early special cells turn into endometrial cells outside the uterus.
Signs you could have endometriosis
Painful periods (dysmenorrhoea), pain during sex (dyspareunia) and pain during a bowel motion (dyschezia) were conventionally thought of as signs of endometriosis. Endometriosis is commonly located in the tissues behind and around the uterus and pelvis and near the bowel so some or all of these symptoms are found in women with the condition, but not always. Endometriosis can cause pain at other or all times of the woman’s cycle, and other symptoms, such as tiredness, bladder problems, pain after intercourse and infertility can lead to a diagnosis.
How do doctors diagnose and treat endometriosis?
Recurrent pelvic infection, urinary tract infection, irritable bowel syndrome, gluten intolerance and constipation are all causes for suspicion. When these issues keep recurring despite usual treatment, endometriosis may be the cause. Surgery is the ‘gold standard’ treatment for endometriosis, but it’s not for everyone.
A diagnosis begins with questions, then an examination. A pelvic ultrasound can be helpful to see if there are any endometriotic, or ‘chocolate’, cysts in the ovaries. Chocolate cysts are so called because the blood that forms inside the ovary becomes thick and liquefied and resembles chocolate when surgically excised (cut away).
Scans, including MRI, on their own are not very helpful in diagnosing, or excluding, most endometriosis. Diagnostic laparoscopy (a ‘keyhole’ operation) is the only reliable way to diagnose endometriosis. It involves passing a telescope (under general anaesthetic) through the belly button to view the pelvis and abdomen.
If found, endometriosis can usually be treated the same day through excision. Laparoscopy is often performed as a day procedure or during an overnight stay and, if surgery is undertaken to treat the disease, full recovery can take two weeks. In cases of recurrent endometriosis, and when child-bearing is no longer relevant, other surgery, such as a hysterectomy (removal of the uterus), is an option.
Lifestyle changes for coping with symptoms
Being as healthy as possible is likely to have benefits all round and help women cope with symptoms. A balanced diet is probably best, though research on specific foods and food groups is not clear regarding endometriosis. Good hydration and reducing saturated fat, salt, sugar, caffeine and alcohol are likely to be beneficial. If bowel symptoms occur, such as diarrhoea, a specialist dietitian can help you identify foods that may trigger symptoms. Regular exercise leads to a sense of well-being and raises pain tolerance levels. Good restful sleep helps sufferers cope with symptoms, as does de-stressing. It can be useful to see a good pelvic floor physiotherapist, trained in pelvic pain management techniques, a trained counsellor, and/or a pain management clinic.
What else can help?
Surgery is not always the first line of management of endometriosis-type symptoms. Many women will get some relief (to varying degrees) with anti-inflammatory medications and simple painkillers, and/or the contraceptive pill, which can shrink endometriosis.
Simple techniques such as using hot water bottles, wheat bags and taking baths can also ease symptoms.
As with many medical problems, an understanding of the condition helps to ‘conquer fear’ and banish worrying myths. Make loved ones aware of how you are feeling, as they are far more likely to show empathy if they know what is going on. Finding a sympathetic GP who, if appropriate, makes a referral to a specialist gynaecologist is important, as are careful discussions prior to planning treatment.
Endometriosis is an enigmatic and complex women’s health issue. It is challenging for women and health care professionals, and often requires a multifaceted approach to treat it well.