Updated: Sep 23, 2019
Let's celebrate for countries coming together with their finest experts and research to come up with the newest international guidelines for polycystic ovary syndrome. There were 37 PCOS professional societies and organizations across 71 countries, addressed 60 clinical questions involving 40 systematic and 20 narrative reviews before issuing 166 recommendations!
Here is a link to the official PCOS Evidence Based Guidelines, updated 02/2018.
Here is a brief overview of important points. If you have questions or would like to know how working with an experienced nutrition professional can help you to implement changes, you can reach out to me at any time. I would love to talk with you! Get in Touch
Diagnosis was agreed upon the Rotterdam PCOS diagnostic criteria. This criteria requires adult women to have at least two of the following three signs or symptoms:
1. Elevated Androgen (male hormone) levels via blood work or physical signs
2. Irregular or Lack of Ovulation
3. Ultrasound showing Polycystic Ovaries
With introduction of birth control methods eliminating menstruation, such as the IUD, it is becoming more difficult to identify PCOS symptoms early. One of the best clinical methods for knowing your risk and preventing symptoms is to have annual blood work completed. If you are wondering what lab tests should be ordered to determine risk of hormone imbalance, blood sugar irregularities, thyroid health, and overall health prevention. Here is a free guide on what labs to have ordered, download this handout.
Diagnosis is tough. We are in need of a serious name change and I was hoping they would update that in this document, but we are still calling it polycystic ovary syndrome - even though you do not need to have any cysts on your ovaries to be diagnosed AND having cysts on your ovaries doesn't mean you have PCOS...confusing, right?
The psychological impact of this diagnosis cannot be ignored either. The risk of anxiety, depression, eating disorders, negative body image, and reduced psychosexual function. It is all connected and it is all important for you and your support team to discuss. You are not alone in how you feel and you do not need to take all of this on by yourself.
You may be told by your doctor that you need to lose weight, but how? It may be tempting to jump on a bandwagon of the newest diet, supplement, or say yes to "drink these shakes daily and lose 20 pounds in a month" ad. But if you are diagnosed with PCOS, your body has been going through a lot of stress, fluctuations and likely run low on nutrient stores.
Metformin is recommended in addition to a healthy diet for metabolic control and weight loss. This is because of the high incidence of insulin resistance and elevated blood sugar levels in those with PCOS. The good news is working with a registered dietitian, a nutrition expert, will be able to provide an effective and specific plan that fits you and your lifestyle.
As a dietitian, I also make sure when I meet with clients to go through a full health history, current diet, lifestyle and environment recall. I want to identify any other underlying triggers that may be preventing you from healing your body and losing weight.
"Education, self-empowerment, a multidisciplinary team of health professionals, and lifestyle intervention for prevention or management of excess weight are important."
Oral contraceptives (birth control) pills are still the first line pharmacological management for menstrual irregularity and hyperandrogenism. There are no specific recommended preparations for the use of oral contraceptives. It is important to keep in mind the effects that oral contraceptives can have on the body, including depletion of vital nutrients, damage to gut lining, increase the toll on the liver to excrete medication and exogenous hormones.
Common nutrient deficiencies associated with oral contraceptives include: B Vitamins (Folic acid, B12, B6, B2), Magnesium, Zinc, Vitamin C, Vitamin E, and Selenium.
There are many other updates that were made and I encourage you to read through the document. You can skip around to the sections that apply to your symptoms or situation, such as that on fertility and IVF.
I think the most important line in all of this to remember is: "Overall evidence is low to moderate quality, requiring significant research expansion in this neglected, yet common condition." There is much to be learned in this condition and education, support and working with a professional are strongly encouraged for all women diagnosed with PCOS.
Ready for clear guidance, recommendations and support? Yes, Let's Do This!
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Stay Happy, Healthy, and Confident!
Liz Riesen, RD