Womens Health - PCOS

Question 1

Q: What is PCOS, and how common is it?

Answer 1

A: PCOS is an endocrine and metabolic pathology affecting 5–20% of reproductive-age women worldwide.

Question 2

Q: What are the hallmark features of PCOS?

Answer 2

A: Ovarian dysfunction (irregular/absent periods), hyperandrogenism, and polycystic ovaries.

Question 3

Q: List some common signs and symptoms of PCOS.

Answer 3

A: Amenorrhoea/oligomenorrhoea, weight gain, hirsutism, thinning hair or hair loss, oily skin, acne, and infertility.

Question 4

Q: What complications are associated with PCOS?

Answer 4

A: T2DM, gestational diabetes, hypertension, dyslipidaemia, NAFLD, metabolic syndrome, endometrial cancer, anxiety, depression, and autoimmunity (e.g., Hashimoto’s thyroiditis).

Question 5

Q: How does elevated LH affect ovarian function in PCOS?

Answer 5

A: Increased LH amplitude and pulses stimulate ovarian theca cells to produce more androgens, leading to reduced FSH levels and impaired aromatisation of androgens to oestrogen. This results in anovulation.

Question 6

Q: How does insulin resistance (IR) contribute to PCOS?

Answer 6

Decreases hepatic SHBG synthesis, increasing active testosterone and DHT.
Increases ovarian and adrenal androgen production.
Leads to leptin resistance, increasing obesity risk.

Question 7

Q: What percentage of women with PCOS exhibit insulin resistance?

Answer 7

A: 75% of lean women and 95% of obese women with PCOS exhibit IR.

Question 8

Q: How does obesity exacerbate PCOS symptoms?

Answer 8

A: Obesity increases insulin resistance, adipogenesis, inflammatory adipokines (e.g., TNF-α), and androgen production, which worsen PCOS symptoms.

Question 9

Q: What dietary and lifestyle factors contribute to chronic low-grade inflammation in PCOS?

Answer 9

A: A Western diet high in refined carbs, processed foods, trans-fats, low omega-3:6 ratio, lack of exercise, and metabolic endotoxaemia.

Question 10

Q: What role does gut dysbiosis play in PCOS?

Answer 10

A: Altered microbiota and reduced microbial diversity can influence hormone secretions, inflammatory pathways, and islet β-cell proliferation, further exacerbating PCOS.

Question 11

Q: What are some genetic and environmental risk factors for PCOS?

Answer 11

A:

Genetics: Polymorphisms in CYP genes (e.g., CYP11, CYP17).
Vitamin D deficiency: Linked to increased insulin sensitivity and reduced androgen levels.
Smoking: Associated with hyperandrogenism.

Question 12

Q: What are the therapeutic aims in managing PCOS?

Answer 12

Decrease insulin resistance, improve glucose tolerance, reduce central obesity, decrease inflammation and oxidative stress, support liver detoxification, and regulate the HPA axis.

Question 13

Q: How does weight loss improve PCOS symptoms?

Answer 13

A: A 5–10% weight loss can significantly improve insulin resistance, hormone levels, and overall symptoms.

Question 14

Q: What dietary changes support blood glucose balance and insulin sensitivity in PCOS?

Answer 14

A:

Focus on low GI, high-fibre foods.
Avoid trans fats and processed foods.
Optimise omega-6:3 ratio.
Include chromium-rich foods and quality protein.

Question 15

Q: What supplements can help address insulin resistance in PCOS?

Answer 15

A:

Cinnamon: Improves insulin sensitivity and reduces IGF-1.
Berberine: Insulin-sensitising (500 mg 3x daily).
Alpha-lipoic acid: Antioxidant, enhances glucose metabolism (600–1200 mg/day).
Vitamin D, magnesium, omega-3 fatty acids, and CoQ10.

Question 16

Q: What is seed cycling, and how can it help with PCOS?

Answer 16

A: Seed cycling involves eating 1 tbsp each of pumpkin and flax seeds during days 1–14, and 1 tsp each of sunflower and sesame seeds during days 15–28 to support hormone balance.

Question 17

Q: What herbal remedies support hormone balance in PCOS?

Answer 17

A:

Saw palmetto: Inhibits 5-α reductase, reducing DHT.
Liquorice: Inhibits conversion of androstenedione to testosterone.
Spearmint tea: Anti-androgenic.
Nettle root: Lowers DHT.
Green tea: Reduces insulin, testosterone, and inflammatory markers.

Question 18

Q: How can the microbiome be supported in PCOS management?

Answer 18

A: Use prebiotics, probiotics, fermented foods, polyphenols, fibre (30–45 g/day), and cruciferous vegetables.

Question 19

Q: What type of exercise is most effective for PCOS management?

Answer 19

A: High-intensity interval training (HIIT) or Tabata, which reduces insulin resistance, VAT fat, and HbA1C.

Question 20

Q: How does exercise affect SHBG levels in PCOS?

Answer 20

A: Regular exercise increases SHBG levels, correlating with improved hormone balance and muscle strength.

Question 21

Q: What is the role of Myo-inositol and D-chiro inositol in PCOS?

Answer 21

A: Improve insulin sensitivity, reduce LH and androgens, increase SHBG, improve menstrual cycle regularity, oocyte quality, and fertility.

Question 22

Q: How does chromium benefit women with PCOS?

Answer 22

A: Chromium picolinate reduces insulin resistance, cardiovascular risk, and T2DM by increasing enzyme sensitivity (tyrosine kinase).