Nutrition & lifestyle changes to support ovulation in PCOS

In PCOS, high levels of androgens and insulin can interfere with reproductive hormones that control ovulation and your menstrual cycle. As a result, you might often miss your period or have delayed or irregular periods.

This unpredictability can make it very frustrating when you’re trying to manage your PCOS symptoms, it can also be challenging if you're trying to conceive.

The good news is that nutrition and lifestyle play a vital role in managing PCOS effectively, which is why the International Evidence-based Guideline for the assessment and management of PCOS recommends that nutrition & lifestyle treatment should be recommended to all women diagnosed with PCOS (1).

There is no such thing as the “best” diet for PCOS. However, there is a way of eating that can benefit you and your unique symptoms and concerns. Adapting your nutrition and incorporating regular movement into your lifestyle can help to correct hormone imbalances, improve insulin sensitivity, regulate periods and improve your fertility (if this is your goal!) when you have PCOS (2).

This blog article will explore proven ways to help you support regular ovulation and manage your PCOS symptoms through diet and lifestyle.

Low Glycaemic Index Carbohydrates

Between 50-95% of women with PCOS will have insulin resistance. High insulin levels cause higher testosterone levels which further affect hormone balance and ovulation in PCOS. Eating foods that don’t spike insulin: moderate amounts of high fiber foods, paired with protein and fat foods, can help with ovulation.

All carbohydrate foods have an effect on your blood glucose levels. The glycaemic index (GI) refers to a ranking of carbohydrate foods from 1-100, and relates to how quickly these foods make your blood glucose levels rise after eating them.

Carbohydrates with a high GI rating, such as white bread, processed snacks and cereals, are refined and quickly broken down by your body. They cause a rapid rise in blood glucose, and to manage the sharp rise in blood sugar, your pancreas releases a large amount of insulin. Frequent consumption of high-GI foods results in more insulin being released more frequently, in larger amounts, which can disrupt ovulation (3).

After the initial spike, blood sugar levels often drop quickly (sometimes below normal levels), leading to what is known as a 'blood sugar crash'. This can result in feelings of hunger, fatigue, and irritability, as your body craves more food to restore glucose levels (4).

Foods with a low GI rating are digested more slowly, leading to more gradual increases in blood sugar and insulin. Examples of low GI foods include high fibre carbohydrates such as brown rice, oats, quinoa, wholegrain bread and pulses. These foods demand much less insulin and cause less of a rise on your blood glucose levels.

Choosing good quality, low GI, high fibre foods at each meal, along with some protein and healthy fats, (which slow down the release of glucose), can regulate blood sugar levels and reduce insulin resistance. Including more fibre in your diet can also increase satiety and help to regulate your appetite.

Several studies have found that women with PCOS who followed a low-GI diet experienced significant improvements in insulin sensitivity and ovulation frequency (4). When following a low GI diet, ovulation occurred in 24.6% of women which was significantly higher than the 7.4% ovulation rate found in in women who consumed traditional diets (5).

The Mediterranean Dietary Pattern

In addition to insulin resistance, the other part of the underlying mechanism driving the hormone imbalance in PCOS is due to inflammation. Women with PCOS have been shown to have higher levels of inflammatory markers such as increases in C-reactive protein (CRP), pro-inflammatory cytokines and chemokines, white blood cell count, oxidative stress, and various markers of endothelial inflammation. Higher levels of inflammation can cause excess androgen production as well as insulin resistance, which we know can disrupt the menstrual cycle (6).

The Mediterranean dietary pattern is a way of eating that focuses on fresh, seasonal fruits, vegetables, pulses, nuts, whole grains, fish, garlic, herbs, spices, and olive oil. It includes moderate amounts of high fat dairy, poultry, and eggs with red meat eaten less frequently. There’s a big focus on cooking, enjoying more meals at home, with minimal amounts of processed foods.

Ongoing studies strongly suggest that a Mediterranean way of eating can help reduce inflammation, and regulate ovulation in women with PCOS. If you’re trying to fall pregnant, this can be a great dietary pattern to follow as it promotes omega-3 fats (7). Omega-3 fatty acids, in particular, have been shown to improve insulin sensitivity and reduce androgen levels in women with PCOS, leading to better ovulatory function.

Moderate amounts of full fat dairy (1-2 serves per day) have also been shown to have a positive effect on ovulation. A study found that full-fat dairy products were shown to lower the risk of ovulatory infertility, with women having a 66% lower risk of ovulatory infertility, and a 27% lower risk of infertility (8).

The Mediterranean dietary pattern is also an overall 'anti-inflammatory' style of eating with lots of antioxidants from fruits, vegetables and high quality extra virgin olive oil, which helps to optimsie your egg health, as well as regulate ovulation.

Exercise for Ovulation

Studies show that both regular aerobic and resistance exercises can significantly improve insulin sensitivity in women with PCOS. It also helps lower androgen levels by improving overall hormonal balance. This reduction in androgens can lead to more regular menstrual cycles and better chances of ovulation. It can also improve mood and your overall well-being.

A study comparing a group of women with PCOS following a low-calorie diet to a group who exercised for 30 minutes on a stationary bike three times a week found that the exercise group experienced more regular periods and ovulation than those in the diet group (9).

Some examples of aerobic exercise include: Activities like walking, running, cycling, or swimming. Resistance exercises include weightlifting or bodyweight exercise.

Don’t have 30 minutes? Even 10 minutes of moderate walking can help improve ovulation.

Try to gradually build up your activity level, allowing your body to adjust slowly, making it easier to incorporate regular movement into your daily routine over time.

PCOS Supplements for Ovulation

Many women with PCOS want to consider alternative treatments to medication. There is substantial research supporting the use of the following supplements for enhancing ovulation in women with PCOS, either on their own or in combination with prescribed medications. You can read more about these in my previous blog post here.

Key Takeaways

Nutrition plays a vital role in regulating ovulation in women with PCOS by improving insulin sensitivity and balancing hormones. By focusing on diet quality and adopting a low GI, anti-inflammatory way of eating, you can optimise your menstrual cycle and your fertility. Regular movement and supplements can also offer additional support.

This blog post has presented some potential dietary pattern options that may help with managing your PCOS. These should be personalised to meet your unique needs and goals.

If you’re looking for more personalised support to make sustainable & realistic nutrition changes that will help you feel your best with PCOS, please feel free to contact me or book your FREE Discovery Call here.

References

1. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations From the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Hum Reprod (2018) 33(9):1602–18.

2. Shang Y. Dietary Modification for Reproductive Health in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Frontiers in Endocrinology. 202,

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3. Chavarro, JE et al. A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. Eur J Clin Nutr. 2009;63(1):78-86.

4. Marsh, K. et al. (2010). The optimal diet for women with polycystic ovary syndrome? British Journal of Nutrition. 2005; 94(2):154-165.

5. Hernandez, TL et al. Effect of a low glycemic diet in patients with polycystic ovary syndrome and anovulation: a randomized controlled trial. Clinical and Experimental Obstetrics and Gynaecology. 2016; 43(4):555-559.

6. Salama, A et al. Anti-Inflammatory Dietary Combo in Overweight and Obese Women with Polycystic Ovary Syndrome. N Am J Med Sci. 2015 Jul; 7(7): 310–316.

7. Yang K, Zeng L, Bao T, Ge J, Chen X. Effectiveness of omega-3 fatty acid for polycystic ovary syndrome: A systematic review and meta-analysis. Reprod Biol Endocrinol. 2018;16(1):27.

8. Chavarro, JE et al. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstet Gynecol. 2007;110(5):1050-1058.

9. Palomba, S. et al. Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study Hum Reprod. 2008 Mar;23(3):642-50.