Living with PCOS: How Diet and CGM Can Help

Shana Spindler PhD
Shana Spindler PhD
September 13, 2021

Imagine struggling with excess hair growth, irregular and painful periods, infertility, obesity, poor cholesterol levels, and insulin resistance. That’s a long list, but it’s every-day life for the estimated three to ten percent of the female population who live with a condition called polycystic ovarian syndrome (PCOS).

Considered one of the most common endocrine disorders in women, PCOS is indiscriminate. The syndrome appears in all groups of women of reproductive age, regardless of race and ethnicity.  

Signs and Symptoms of PCOS

PCOS is an endocrine disorder—meaning it involves the disruption of signaling molecules, called hormones, that are released from hormone-secreting glands in the body. For women who have PCOS, there is an imbalance in several reproductive hormones, which causes a wide range of symptoms.

A PCOS diagnosis requires two of the following: absence of ovulation, high levels of androgen testosterone (a type of hormone), and cysts on the ovaries. Many women don’t realize they have PCOS until they have difficulty becoming pregnant. Other women learn about their PCOS diagnosis when they see a doctor for unexplained hair growth or pelvic pain. These telltale signs are all associated with the criteria for PCOS diagnosis. For example, an irregular menstrual cycle suggests problems with ovulation. Excess facial and body hair can signify androgen imbalances, and pelvic pain might indicate the presence of an ovarian cyst.

For women with PCOS, becoming aware of their diagnosis allows them to focus on lifestyle changes that help prevent more serious PCOS complications, such as insulin resistance and metabolic disease, which can lead to diabetes and cardiovascular problems. According to one study, as many as 70% of women diagnosed with PCOS are insulin resistant, and another study reports that 35% have impaired glucose tolerance and 10% have diabetes.

Diet and Exercise Interventions for PCOS Symptoms

The need to monitor and regulate blood sugar levels is of particular importance for women with PCOS. In a Canadian study of 83 women with PCOS and normal glucose regulation, the researchers found that nearly a quarter of the women developed abnormal glucose regulation over just three years. Some physicians recommend that women with PCOS who have insulin resistance (which affects glucose control) should be counseled on lifestyle modifications.

Dietary interventions improve insulin resistance, glucose control, body mass index, weight, and waist circumference in women with PCOS, according to a 2020 analysis of 19 research studies (totaling over a thousand participants). The authors of the analysis report that DASH diets and calorie-restricted diets might be best for reducing insulin resistance and improving body composition, respectively, in women with PCOS. The authors also found that participants who followed dietary recommendations for the longest had the greatest improvements.

In a randomized and controlled trial in Argentina, researchers found that a daily nutritional plan of 1500 calories—50% from carbohydrates, 20% from proteins, and 30% from fat—combined with 40 minutes of brisk walking four times per week was enough to improve menstrual cycle-related symptoms in insulin-resistant women with PCOS. The participants followed the diet and exercise plan for four months and had improvements even without insulin-sensitizing drugs.

Some research studies on diets for PCOS have eliminated carbohydrates from the meal plan almost entirely. With very low-carbohydrate diets, the participants enter a state of ketogenesis, during which the body utilizes fat storage to create ketones that fuel the body in place of the missing glucose. In a 2020 study, a group of Italian researchers gave a ketogenic diet to 14 overweight women with PCOS. Over the course of 12 weeks, the study participants improved average glucose levels, insulin sensitivity, cholesterol profile, and reproductive hormone balance.

How CGM Can Help Women with PCOS

Some women with PCOS undergo routine oral glucose tolerance tests to monitor their glucose control. However, routine tests, even on a frequent basis, represent a snapshot in time. Given the high prevalence of metabolic problems observed in PCOS, continuous glucose monitoring (CGM) might help women stay on top of their glucose levels and avoid progression to diabetes.

The power of CGM is apparent in a study comparing glucose levels between 45 women with PCOS and normal glucose tolerance and 45 healthy women. Each group of women used CGM for three days, during which they ate three standardized meals per day. Surprisingly, even though average glucose levels were similar between the two groups, the post-meal glucose peaks took longer to reach in the PCOS group. According to the authors, this pattern could indicate an early stage of abnormal glucose metabolism. The authors also reported that glucose peaks went higher after breakfast in the PCOS group compared to the healthy women.

These post-meal differences in glucose control would not be seen during annual check-ups for glucose tolerance in PCOS. But a CGM device worn over several days can identify subtle problems with glucose control, even before a standard diagnostic test shows abnormalities. Early detection allows for early intervention.

Personalized, real-time data from CGM can help women with PCOS make lifestyle choices that are optimal for their unique bodies. The goal of any intervention for PCOS is to help women reduce their PCOS symptoms and maybe even prevent progression into metabolic and cardiovascular disease.

References

About Polycystic Ovary Syndrome (PCOS)

Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity

Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus

Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome

Clinically useful predictors of conversion to abnormal glucose tolerance in women with polycystic ovary syndrome

Assessing and treating insulin resistance in women with polycystic ovarian syndrome

Effect of Diet on Insulin Resistance in Polycystic Ovary Syndrome

Clinical, metabolic, and endocrine parameters in response to metformin and lifestyle intervention in women with polycystic ovary syndrome: a randomized, double-blind, and placebo control trial

Effects of a ketogenic diet in overweight women with polycystic ovary syndrome

Continuous glucose monitoring reveals abnormal features of postprandial glycemic excursions in women with polycystic ovarian syndrome

Imagine struggling with excess hair growth, irregular and painful periods, infertility, obesity, poor cholesterol levels, and insulin resistance. That’s a long list, but it’s every-day life for the estimated three to ten percent of the female population who live with a condition called polycystic ovarian syndrome (PCOS).

Considered one of the most common endocrine disorders in women, PCOS is indiscriminate. The syndrome appears in all groups of women of reproductive age, regardless of race and ethnicity.  

Signs and Symptoms of PCOS

PCOS is an endocrine disorder—meaning it involves the disruption of signaling molecules, called hormones, that are released from hormone-secreting glands in the body. For women who have PCOS, there is an imbalance in several reproductive hormones, which causes a wide range of symptoms.

A PCOS diagnosis requires two of the following: absence of ovulation, high levels of androgen testosterone (a type of hormone), and cysts on the ovaries. Many women don’t realize they have PCOS until they have difficulty becoming pregnant. Other women learn about their PCOS diagnosis when they see a doctor for unexplained hair growth or pelvic pain. These telltale signs are all associated with the criteria for PCOS diagnosis. For example, an irregular menstrual cycle suggests problems with ovulation. Excess facial and body hair can signify androgen imbalances, and pelvic pain might indicate the presence of an ovarian cyst.

For women with PCOS, becoming aware of their diagnosis allows them to focus on lifestyle changes that help prevent more serious PCOS complications, such as insulin resistance and metabolic disease, which can lead to diabetes and cardiovascular problems. According to one study, as many as 70% of women diagnosed with PCOS are insulin resistant, and another study reports that 35% have impaired glucose tolerance and 10% have diabetes.

Diet and Exercise Interventions for PCOS Symptoms

The need to monitor and regulate blood sugar levels is of particular importance for women with PCOS. In a Canadian study of 83 women with PCOS and normal glucose regulation, the researchers found that nearly a quarter of the women developed abnormal glucose regulation over just three years. Some physicians recommend that women with PCOS who have insulin resistance (which affects glucose control) should be counseled on lifestyle modifications.

Dietary interventions improve insulin resistance, glucose control, body mass index, weight, and waist circumference in women with PCOS, according to a 2020 analysis of 19 research studies (totaling over a thousand participants). The authors of the analysis report that DASH diets and calorie-restricted diets might be best for reducing insulin resistance and improving body composition, respectively, in women with PCOS. The authors also found that participants who followed dietary recommendations for the longest had the greatest improvements.

In a randomized and controlled trial in Argentina, researchers found that a daily nutritional plan of 1500 calories—50% from carbohydrates, 20% from proteins, and 30% from fat—combined with 40 minutes of brisk walking four times per week was enough to improve menstrual cycle-related symptoms in insulin-resistant women with PCOS. The participants followed the diet and exercise plan for four months and had improvements even without insulin-sensitizing drugs.

Some research studies on diets for PCOS have eliminated carbohydrates from the meal plan almost entirely. With very low-carbohydrate diets, the participants enter a state of ketogenesis, during which the body utilizes fat storage to create ketones that fuel the body in place of the missing glucose. In a 2020 study, a group of Italian researchers gave a ketogenic diet to 14 overweight women with PCOS. Over the course of 12 weeks, the study participants improved average glucose levels, insulin sensitivity, cholesterol profile, and reproductive hormone balance.

How CGM Can Help Women with PCOS

Some women with PCOS undergo routine oral glucose tolerance tests to monitor their glucose control. However, routine tests, even on a frequent basis, represent a snapshot in time. Given the high prevalence of metabolic problems observed in PCOS, continuous glucose monitoring (CGM) might help women stay on top of their glucose levels and avoid progression to diabetes.

The power of CGM is apparent in a study comparing glucose levels between 45 women with PCOS and normal glucose tolerance and 45 healthy women. Each group of women used CGM for three days, during which they ate three standardized meals per day. Surprisingly, even though average glucose levels were similar between the two groups, the post-meal glucose peaks took longer to reach in the PCOS group. According to the authors, this pattern could indicate an early stage of abnormal glucose metabolism. The authors also reported that glucose peaks went higher after breakfast in the PCOS group compared to the healthy women.

These post-meal differences in glucose control would not be seen during annual check-ups for glucose tolerance in PCOS. But a CGM device worn over several days can identify subtle problems with glucose control, even before a standard diagnostic test shows abnormalities. Early detection allows for early intervention.

Personalized, real-time data from CGM can help women with PCOS make lifestyle choices that are optimal for their unique bodies. The goal of any intervention for PCOS is to help women reduce their PCOS symptoms and maybe even prevent progression into metabolic and cardiovascular disease.

References

About Polycystic Ovary Syndrome (PCOS)

Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity

Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus

Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome

Clinically useful predictors of conversion to abnormal glucose tolerance in women with polycystic ovary syndrome

Assessing and treating insulin resistance in women with polycystic ovarian syndrome

Effect of Diet on Insulin Resistance in Polycystic Ovary Syndrome

Clinical, metabolic, and endocrine parameters in response to metformin and lifestyle intervention in women with polycystic ovary syndrome: a randomized, double-blind, and placebo control trial

Effects of a ketogenic diet in overweight women with polycystic ovary syndrome

Continuous glucose monitoring reveals abnormal features of postprandial glycemic excursions in women with polycystic ovarian syndrome