By Carol Ann Head, MS, RDN 

Polycystic Ovary Syndrome, or PCOS, is one of the most common endocrine disorders in females. Women with PCOS experience hormonal imbalances, which can lead to reproductive, metabolic, and psychological consequences. PCOS affects overall health, fertility, appearance, and metabolism. Managing PCOS is complex, and the best treatment is supported by a multidisciplinary team focused on addressing your specific symptoms and concerns. 

A Challenging Diagnosis 

PCOS is a syndrome defined as “a condition characterized by a group of symptoms that consistently occur together,” as opposed to a disease with distinguishing signs and symptoms with a defined cause, process, and treatment. In contrast to a disease, the direct cause of symptoms related to syndromes is not necessarily understood. 

The wide range of symptoms associated with PCOS has led to confusion and controversy surrounding diagnosis. Major health organizations around the world tend to disagree on how to best confirm whether or not a person has PCOS. While some women experience many telltale signs, others may have only two or three symptoms. Current international guidelines, called the Rotterdam Criteria, state that a woman may have PCOS with two out of three major symptoms: high androgen levels, polycystic ovaries, or irregular menstrual cycles. Diagnosis also requires ruling out other potential medical conditions that cause similar symptoms. 

Generalized Recommendations, Distinct Experiences 

No single cause or defined cure for PCOS has been identified. Though women who experience PCOS have unique sets of symptoms, the same general recommendations tend to be provided across the board: lose weight (or don’t gain weight), restrict carbohydrates, and exercise. Due to the distinct experiences of women with PCOS, guidance for managing it cannot come from an instructional pamphlet or a Google search. Instead, an individualized approach that supports the whole person — physically, mentally, emotionally, socially — is crucial. 

Understanding Cravings 

Insulin resistance occurs when cells in the body don’t take up as much energy from carbohydrates, resulting in too much sugar circulating in the blood. Women of all sizes with PCOS who experience insulin resistance report intense carbohydrate cravings, and these cravings become even harder to manage when carbohydrates and total calories are restricted. Rather than resisting, restricting, or relying on willpower alone to cope with cravings, consider: 

  • Eating frequently throughout the day 
  • Including a variety of food groups at meals 
  • Pairing carbohydrates with a source of fat or protein to stabilize blood sugar and boost satisfaction 
  • Honoring cravings when they occur 
  • Mindfully to enhance satisfaction 

Starting Fresh with Managing PCOS 

It may be time for a different approach to PCOS management, and we have some suggestions for the next steps: 

STOP DIETING. 

Many women with PCOS feel their diagnosis sentences them to a lifetime of dieting. At Memphis Nutrition Group, we believe life doesn’t have to be this way and that dieting inevitably backfires with PCOS management. Studies clearly show that diets don’t work and can lead to disordered eating behaviors. Binge eating is a common and protective biological response to intensified cravings due to restriction. Sadly, approximately 86% of individuals with PCOS present with a subclinical eating disorder. Low-calorie dieting increases cortisol, which is linked to insulin resistance and weight gain. Weight cycling or yo-yo dieting is also connected to higher insulin levels, testosterone, cholesterol, and blood pressure. In other words, dieting worsens the symptoms of PCOS. 

PUT THE SCALE AWAY. 

The scale connects us to a number and disconnects us from our bodies. With weight at center stage, losing sight of how we feel can be easy. Putting the scale away allows the focus to shift to life-enhancing behaviors and away from weight loss at any cost. Stop tracking your weight and ignoring your quality of life! You are the expert on your body. By putting concerns about weight on the back burner, you can reconnect and say “hello” to PCOS symptoms, allowing them to signal areas that may need more focused attention. 

FOCUS ON ADDING, NOT SUBTRACTING. 

Effective management of PCOS centers around working with your body, not against it. Rather than subtracting carbohydrates or obsessing about decreasing the number on the scale, focus on adding joyful movement, adequate sleep, and self-care. Managing PCOS may mean ensuring you’re eating enough, being strategic with nutrition timing and protein planning, or incorporating supplements to enhance health and improve symptoms. 

STAY FULLY INFORMED ABOUT WEIGHT LOSS DRUGS. 

Because of the recent surge in GLP-1 (Ozempic, Mounjaro) prescriptions and usage, it’s important to be fully informed about the effects of these drugs. The longest current trials of GLP-1s are over a two-year period, meaning long-term effects are not yet known. Research indicates that, like all other weight loss interventions, weight lost from GLP-1s will likely be regained long-term, even for people who continue to take the drug. For people without type 2 diabetes, there is no evidence that taking GLP-1s improve markers of health like triglycerides, cholesterol, or HB-A1C (a marker of blood sugar); however, research has shown that weight cycling worsens these metabolic health markers. 

Registered Dietitians – Valuable Members of the Multidisciplinary Team 

Since diet and lifestyle are the primary treatments for PCOS along with medication, Registered Dietitians play an important role in helping women with PCOS optimize their health and quality of life. Need guidance in managing your PCOS? The dietitians at Memphis Nutrition Group support women in reconnecting with their bodies, becoming their own best advocates, and living a fulfilling life despite PCOS. 

PCOS Symptoms 

Common symptoms may include, but are not limited to: 

  • INSULIN RESISTANCE 
  • IRREGULAR OR ABSENT PERIODS 
  • INFERTILITY 
  • PREGNANCY COMPLICATIONS 
  • EXCESS HAIR GROWTH ON THE FACE AND BODY 
  • ACNE 
  • MOOD CHANGES 
  • HEADACHES 
  • SLEEP PROBLEMS 
  • PELVIC PAIN 
  • WEIGHT GAIN 
  • FATIGUE 
  • DARKENING OF SKIN 
  • ALOPECIA (HAIR LOSS FROM HEAD) 

Carol Ann Head, MS, RDN is a Nutrition Therapist at Memphis Nutrition Group, a nutrition and lifestyle counseling practice offering in-person and virtual nutrition therapy specializing in a non-diet, weight-neutral approach. Contact Memphis Nutrition Group at 901.343.6146 or visit MemphisNutritionGroup.com for more information.