Polycystic ovarian syndrome (PCOS) is one of the most common reproductive endocrine disorders across the globe. Depending on which population was studied it was estimated that anywhere from 6-21% of the population had a diagnosis of PCOS. This is a dramatic percentage of the population, and considering how PCOS can affect various health parameters, its optimal management is absolutely crucial to simultaneously improve overall health and quality of life for patients and reducing costs/burden to the healthcare system.
There have been various studies investigating the role of dietary interventions in support not just symptoms of PCOS but improving reproductive outcomes for patients dealing with this multi-faceted diagnosis.
PCOS is very closely related to insulin resistance (decreased sensitivity of cells to the insulin hormone), increased inflammation, increased testosterone levels, decreased proteins that bind and temporarily deactivate testosterone (sex-hormone binding globulin - SHBG) and visceral adiposity. Visceral adiposity, regardless of overall weight, has been established to negatively affect insulin sensitivity and increase testosterone/androgen levels in the body for patients with PCOS.
Updated guidelines in certain locations across the Globe have now recommended dietary and lifestyle interventions as the first line of treatment for patients diagnosed with PCOS and are experiencing difficulty conceiving. However, there is limited guidance in many instances on what specific interventions have been shown to be beneficial. For example, caloric restriction in PCOS has not been found to improve reproductive outcomes for patients with PCOS that are struggling to conceive.
A recently published systematic review and meta-analysis reviewed 20 randomized clinical trials (RCTs) that evaluated for the impact of dietary modifications on symptoms of PCOS and fertility outcomes.
How do Dietary Changes affect Clinical Pregnancy Rates (CPRs)?
Twelve of the twenty RCTs evaluated for CPR. It was found that the correct and evidence-based dietary modifications led to a higher probability of conceiving compared to patients that were in the control group. More specifically, patients treated with evidence-based dietary modifications were 2.87 x more likely to have a positive clinical pregnancy compared to the control group. A pregnancy is considered to be a positive clinical pregnancy when there is a positive B-hCG test as well as a normal ultrasound confirming a fetal heartbeat. It is important to mention that caloric restriction was not associated with an improvement in reproductive outcomes.
Do Dietary Modifications Reduce Risk of Miscarriage with PCOS?
Only two RCTs evaluated for the miscarriage rate in the new systematic review, they found that dietary interventions were associated with a modest 3% reduced risk of miscarriage when compared to patients in the control group.
How do Dietary Modifications Support Ovulation Rates with PCOS?
The pooled results of 4 RCTs found that patients that followed evidence-based dietary changes were 30% more likely to ovulate compared to patients in the control group.
How do Dietary Changes affect Menstrual Regularity in PCOS?
Based on the poole results of 7 RCTs it was found that patients that followed dietary modifications were 75% more likely to experience menstrual regularity when compared to patients in the control group. However, significant changes in menstrual regularity were observed in patients that followed the dietary modifications for 12 months, but no obvious changes in patients following the changes for just 3-6 months.
How do Dietary Modifications Affect Hormone Levels with PCOS?
Evidence-based dietary changes were observed to help reduce anti-mullerian hormone (AMH) levels in PCOS patients. This is of significant importance as the elevated AMH in PCOS prevents follicles from joining the pool of follicles that can mature and grow in size. Dietary changes were also found to significantly improve the free androgen Index, lower total testosterone levels, improve SHBG levels, and reduce the Ferriman-Galleway score (score evaluating for the severity of hirsutism). Caloric restriction was more likely to help with the reduction in testosterone levels.
Reference:
Shang, Y., Zhou, H., He, R., & Lu, W. (2021). Dietary modification for reproductive health in women with polycystic ovary syndrome: A systematic review and meta-analysis. Frontiers in Endocrinology, 12.
This article is being shared as educational content and is in no way a replacement for medical advice or medical care, it is advised that anyone concerned about their Health should speak with their Naturopathic Doctor. Please discuss with your healtcare provider and only make changes to your medications regimen if recommended by your doctor and under their guidance.
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