Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrine-metabolic disorders in women. PCOS occurs when a woman’s hormonal profiles are altered; there is a rise in testosterone and other male hormones, ovulation is suppressed and, in many cases, insulin resistance develops. The exact cause of PCOS and it’s associated hormonal imbalances is unknown. Women with PCOS can struggle with infertility and weight gain, as well as with excessive facial and body hair growth, hair loss, type II diabetes and, as importantly, irregularities in the menstrual cycles.
There are two subsets of PCOS: those that become overweight and those who retain normal body mass index. While nutrition and lifestyle changes are important in both, normal weight women pose a harder challenge in treatment of PCOS. If you suffer from PCOS, it’s important to work with your doctor to manage your condition!
Early diagnosis and treatment, along with nutrition and lifestyle, and weight loss in those that are overweight, may reduce the risk of long-term complications such as type 2 diabetes, heart disease and trouble conceiving. Research has shown the powerful role that lifestyle and the microbiome play in the development of PCOS, as well as in the management of it. When using lifestyle to treat PCOS, the primary focus is to alter our most basic habits: food and movement. We want to be eating foods that nourish the body – that contain fiber and nutrients – and developing an exercise routine that works for us. These changes help to lower insulin resistance (and reverse or better manage type 2 diabetes, if present), create a healthier microbiome, support hormonal balance and achieve weight loss.
When developing a healthier lifestyle pattern, we must avoid crash diets, diet pills that induce rapid weight loss and excessive exercise regimens, all of which can further inhibit our ovulation cycles. Though all these things can lead to dramatic changes in the short-term, they are unsustainable. Instead, we need to focus on our long term goal: real and sustainable changes that leads to better overall health.
How to start creating healthier eating habits:
  • Start by adding healthier foods to your plate. Fill your plate with colorful vegetables like beets, carrots, spinach, cucumber, tomatoes… anything that looks good! The more colorful your plate looks, the better!

  • Don’t think about what you’re giving up; instead, focus on how delicious the foods you’re adding in are going to be! Here are some replacements for common processed- and- unhealthy foods:
    • Store bought salad dressing → Olive oil with lemon! Some other options include avocado or hummus.
    • Store bought cookies → Homemade vegan oatmeal cookies with banana and cacao. No need for sugar! Want it sweeter? Add some dates!
    • Sodas and energy drinks → Sparkling water with blueberries or lemon, tea, black coffee or simple water.
    • Chocolate bar → switch to a dairy free 70% cacao bar when craving chocolate. Chocolate this pure offers cardioprotection due to its polyphenol content. Just don’t overdo it.
  • Remove processed foods from your diet: get store-bought pastries, potato chips, sugar, cookies and other baked or fried foods out of your pantry and kitchen! Fair warning: if you have processed foods in the house, you will eat them! Instead focus on making healthier treats at home, like dates filled with nut butter and chocolate pieces.
  • Add fruit to your plate for breakfast and as snacks; they are high in fiber and phytonutrients. You can pair them up with nuts or natural peanut butter for extra satiety.
  • Don’t fear soy products! The phytoestrogens in soy don’t act the same as our own endogenous hormones and are actually protective. If you’re worried about contaminants such as pesticides, choose organic soy products if you can! The best ways to consume soy are as edamame, tofu and tempeh (fermented soybeans)!
Exercise routine
Exercise increases insulin sensitivity while assisting in weight management. Studies have shown that exercise reduces total testosterone levels and body hair growth. Women who experience PCOS should aim for 30+ minutes of aerobic exercise 4-6 days per week, plus resistance training on 2 different days. The key in maintaining an exercise routine is finding a discipline that you enjoy doing.
If you like nature, try walking or jogging in a park near your house. You may enjoy swimming, rock climbing or crossfit- the sky’s the limit when it comes to your exercise routine. The key is finding an exercise you want to do for fun or leisure; not with a focus of weight loss or a specific body shape.
To see Dr. Mendez’s complete guide to optimizing your gut health, click here!

Microbiome and its link with PCOS

In several studies, patients with PCOS show a lower diversity in their gut microbiome compared to controls, with an increase in firmicutes species and a decrease in Bacteroidetes species. This imbalance, or dysbiosis, in the gut microbiome may lead to increased intestinal permeability, systemic inflammation and increased risk of insulin resistance.
Tips to begin increasing the diversity of your microbiome:
  • Add fermented foods to your everyday plate. Kimchi, miso paste, tempeh sauerkraut or coconut or water kefir are great ways to start.
  • Increase the variety of fruits and vegetables on your plate. Different bacterial species feed off of different types of fibers, so by eating a diversity of vegetables, you increase the diversity of bacteria that feed from these fibers.
  • Aim to eat at least 30 different plants during your week. These include different fruits, vegetables, whole grains and legumes! It’s okay if you are nowhere near that right now: slowly add new foods in, as tolerated.
In conclusion: Though the etiology of PCOS is not fully understood, lifestyle factors do play a crucial role in the treatment of polycystic ovarian syndrome. Developing healthier eating habits, creating a daily physical activity regimen and supporting the gut microbiome have been shown to improve metabolic and reproductive parameters in women who experience PCOS.
If you have PCOS, here are the top 4 habits you should adopt:
  1. Create a healthier eating pattern by including a variety of fruits, whole grains, nuts & seeds, vegetables and legumes. Aim for a colorful plate as often as you can.
  2. Choose an exercise that you enjoy doing and do it 4-6 days of the week. Adding 2 days of resistance training to your regimen is ideal.
  3. Include at least one fermented food several times per week. Kimchi, sauerkraut, tempeh, miso or kefir are some delicious examples.
  4. Add fiber rich and nutrient dense foods to your plate: flax seeds, brown rice, oatmeal, cashews and steel cut oats are just a few!
Written in collaboration with Natalia Diaz Villarreal.
Azziz, Ricardo. (2018). Polycystic Ovarian Syndrome. Obstetrics & Gynecology, 18, 321-336.
Xiaoxuan Zhao, Yuepeng Jiang, […], and Xiaoling Feng. (2020). Exploration of the Relationship Between Gut Microbiota and Polycystic Ovary Syndrome (PCOS): a Review. Geburtshilfe und Frauenheilkunde, 80, 161-171.
Norman, R., Davies, M., Lord, J., Moran, L. (2002). The role of lifestyle modification in polycystic ovary syndrome. TRENDS in Endocrinology & Metabolism, 13, 251-257.