Working out with PCOS
Geraldine Campbell, MSc
June 6, 2018
Fertility. It’s a sensitive topic and not one that typically overlaps with the fitness industry. But PCOS (Polycystic Ovarian Syndrome) is not only common in the general population, affecting 5-10% of all women, it is also particularly prevalent in female athletes. PCOS is characterized by cysts on the ovaries, less frequent periods, and/or hormonal imbalances. Those with the condition usually have naturally higher levels of certain hormones, including testosterone, luteinizing hormone (LH) and insulin. These hormonal changes can lead to the development of androgynous traits, such as increased body and facial hair, higher sex drive and a greater ability to put on muscle. While it is a medical condition that needs to be managed in conjunction with a healthcare professional, PCOS can have its advantages, especially in the weights room!
Is PCOS genetic?
For the most part, yes. It is polygenic - there are many genes which contribute towards PCOS. Environmental factors, such as exposure to a few certain chemicals and poor diet, also play a role, often through complex interactions with genes. The severity of PCOS varies from person-to-person, depending on the pattern of genes they inherit and, to a lesser extent, environmental factors to which they’re exposed. Demonstrating the influence of genetics on the number or severity of symptoms suffered, one study following sisters of women with PCOS found that 22% had PCOS symptoms and 24% displayed hyperandrogenemia (increased androgynous traits), while still having regular periods. The genetic variations of this trait may be so subtle that PCOS goes undiagnosed within the same family.
There have been quite a few studies aiming to identify the specific genes that cause PCOS. The strongest link so far has been with the follistatin gene, FST, in which a rare mutation has been found more often in those with PCOS. A mutation in the FST gene causes a reduced level of FSH (Follicle Stimulating Hormone). FSH is involved in the development of ovarian follicles - small, fluid-filled sacs in the ovaries that secrete hormones such as estrogen. The FST gene also plays a role in regulating muscle growth and tissue repair. So, should nutrition or exercise regimes change with PCOS?
A significant concern for women with PCOS is an increased likelihood of insulin resistance, (when the body is less sensitive to the effects of insulin) making it more difficult for muscles and other tissues to use glucose from the bloodstream. Insulin resistance is associated with metabolic health conditions such as type 2 diabetes. The general advice to prevent insulin resistance is to keep body fat levels in a healthy range, often described as having a BMI of less than 25. So, how do you do this; and should your PCOS diet be different to that of the general population?
Those with PCOS are more likely to crave carbs, probably due to complex hormonal changes involving insulin and testosterone. Not that carbs are bad, but some are definitely superior to others. Avoiding simple and processed carbs (sugar, baby!) and incorporating complex, whole grain carbohydrates that are more slowly broken down should help. If you have PCOS, it might make it easier to resist simple, low-quality carbs by acknowledging that your body naturally wants to consume food and drink that, while providing short-term rewards, won't help long-term goals.
PCOS is also linked to a higher risk of weight gain, but a structured nutrition plan can help mitigate this risk. Increasing protein intake can help promote satiety after a meal. High protein snacks in particular (boiled egg, anyone?) are useful for lowering carb intake and upping protein intake - especially useful for post-workout refueling.
As previously mentioned, there can be advantages to having PCOS; a Swedish study found that female athletes benefitted from having slightly increased testosterone levels. They demonstrated enhanced muscle building and a higher rate of oxygen absorption into muscles from the bloodstream.
Increased muscle mass is beneficial to overall health. Muscle tissue consumes more energy than fat and resistance training can help not only to burn calories while working out but also boost metabolic rate in the long term. And don’t worry about looking too jacked from lifting weights - while elevated testosterone does lend itself to larger muscles, the amount by which muscle size increases is still small enough to have only a subtle visible effect.
Yes, PCOS is a life changer, but with some simple lifestyle alterations, the day-to-day life of someone with PCOS can be the same as the next woman’s. Given its prevalence, don’t be surprised if PCOS comes up in conversation and you learn that a friend, colleague or family member has it too!