PCOD is a disease with an enlarged ovary & small follicular cysts which has the potential to grow into PCOS. PCOS is a condition where more follicles are produced than those released, because of which ovaries produce higher levels of androgen. PCOS is the focus of this article.

If a woman has any two or all three of the following features, she is diagnosed with PCOS:

  • A number of cysts that develop around the edge of the ovaries
  • A failure in the release of eggs from the ovaries
  • A higher level of androgen than normal or it is more active than normal

Excess androgen is a main defect in PCOS patients, but it is triggered by factors like obesity and Insulin Resistance (IR). Studies demonstrated that all women with PCOS, both lean and obese have IR. In another study, it was found that all females including children have polycystic ovaries, but they had normal levels of circulating androgens. This suggests that in certain circumstances, IR alone can cause polycystic ovaries. But it is difficult to separate the independent and interactive effects of hyper-androgenism, IR and obesity in women with PCOS. Simple obesity can result in acquired IR after a weight gain of as little as 15% above ideal body weight. Clinical evidence suggests that IR causes hyper-androgenism and not the other way. But excess androgen at any stage of life starting from fetal life can cause body fat deposition in the abdomen and around the abdominal organs favouring the occurrence, later in life of IR and hyperinsulinemia.

This suggests that the relationship between Hyper-androgenism and IR is that of chicken and the egg i.e., which comes first? Does this really matter, because good nutrition can correct both of these? But, providing good nutrition to ward-off PCOS is bit tricky, because some patients may need monounsaturated fat rich diet, whereas for the others, their carbohydrates may have to be increased. Following is short list of diets with different effects that illustrate this point: 

Monounsaturated fat-enriched diet
Reduces weight.
Low Glycemic Index Diet
Improves menstrual regularity
High carbohydrate diet
Increases free androgen index
Low carbohydrate diet
Reduces IR and fibrinogen and improves Lipid profile
High protein diet
Reduces depression and improves self-Esteem

In PCOS, hyperinsulinemia is a bigger problem than hyperandrogenemia, because long-term complications of the syndrome, such as cardiovascular disease and development of Diabetes are caused by hyperinsulinemia. So, weight loss and control of IR should be targeted in all women with PCOS through reducing caloric intake coupled with adequate nutrition and healthy food choices, irrespective of diet composition.

To treat PCOS, it is more important to diagnose and control IR than suppression of hyperandrogenism and ovulation induction.

For more information on Insulin Resistance, refer to Insulin Resistance

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