PCOS (polycystic ovary syndrome) is a common endocrine disorder affecting females of reproductive age. It is characterized by a range of symptoms related to hormonal imbalances, metabolic issues, and reproductive challenges. The exact cause of PCOS is not fully understood, but it is considered a complex, multifactorial condition involving genetic, hormonal, and environmental influences.
Types of PCOS
PCOS is typically categorized into four phenotypes based on the combination of symptoms:
- Phenotype A: Frank PCOS (oligomenorrhea, hyperandrogenism, and PCO) (66% of cases)
- Phenotype B: ovulatory PCOS (hyperandrogenism, PCO, and regular menstrual cycles) (11% of cases)
- Phenotype C: Non-PCO PCOS (oligomenorrhea, hyperandrogenism, and normal ovaries) (13% of cases)
- Phenotype D: Normoandrogenic PCOS, which is defined by oligomenorrhea, PCO, and normal androgens (9% of cases)
Who is Impacted by PCOS?
Prevalence: PCOS is the most common endocrine disorder in women of reproductive age, affecting approximately 6% to 10% of women worldwide, though some estimates are higher.
Age: While PCOS typically presents during adolescence or early adulthood, its symptoms can persist across the lifespan.
Ethnic and Genetic Factors: The incidence and severity of PCOS symptoms can vary among different ethnic groups, and family history plays a significant role, suggesting a genetic predisposition.
Potential Symptoms of PCOS
PCOS manifests with a wide variety of symptoms, which can affect reproductive, metabolic, psychological, and dermatological health. Common symptoms include:
- Reproductive Symptoms:
- Irregular periods (oligomenorrhea or amenorrhea): Infrequent or absent menstrual cycles due to ovulatory dysfunction.
- Infertility: Difficulty in conceiving due to anovulation or irregular ovulation.
- Polycystic Ovaries: Enlarged ovaries containing multiple small cysts visible on ultrasound.
- Hormonal Symptoms:
- Hyperandrogenism: Elevated levels of male hormones (androgens), which may cause physical symptoms such as:
- Hirsutism: Excessive hair growth, particularly on the face, chest, and back.
- Acne: Persistent acne, especially along the jawline.
- Androgenic Alopecia: Thinning or loss of scalp hair.
- Metabolic Symptoms:
- Insulin Resistance: A common feature in up to 70-95% of women with PCOS, leading to increased insulin production.
- Weight Gain or Obesity: Many individuals with PCOS struggle with weight gain, particularly in the abdominal area.
- Increased Risk of Type 2 Diabetes: Due to insulin resistance and impaired glucose tolerance.
- Dyslipidaemia: Abnormal cholesterol levels, including low HDL (good cholesterol) and high LDL (bad cholesterol).
- Psychological Symptoms:
- Anxiety and Depression: Women with PCOS are at an increased risk for mood disorders due to hormonal imbalances, body image concerns, and fertility issues.
- Disordered Eating: Emotional or binge eating is more common in those with PCOS, often related to body image and weight struggles.
- Dermatological Symptoms:
- Acne: Persistent acne due to elevated androgens.
- Hirsutism: Excessive facial and body hair.
- Acanthosis Nigricans: Dark, velvety patches of skin, often found in skin folds such as the neck, armpits, or groin, associated with insulin resistance.
The variability in symptom presentation means that PCOS is often underdiagnosed, and its management requires a multidisciplinary approach involving lifestyle changes, medical treatments, and psychological support.
Exercise Recommendations based on ESSA’s Position Statement
The key exercise recommendations for individuals with PCOS include:
- Aerobic Exercise: 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic activity per week, or a combination of both, spread throughout the week.
- Muscle-Strengthening Activities: Recommended on two non-consecutive days per week.
- For greater health benefits and modest weight loss, a minimum of 250 minutes of moderate-intensity or 150 minutes of vigorous-intensity aerobic activity per week is suggested.
| FIIT Principle | Aerobic Training | Resistance Training |
| Frequency | 3–5 days per week | 2 non-consecutive days per week |
| Intensity | Moderate to vigorous (e.g., 150–300 minutes moderate, 75–150 minutes vigorous) | Moderate to high intensity |
| Time | 150–300 minutes of moderate or 75–150 minutes of vigorous activity per week, with a minimum of 250 minutes for greater benefits | 8–10 exercises, 1–3 sets per exercise, 8–12 repetitions per set |
| Type | Aerobic activities (e.g., walking, cycling, swimming) | Muscle-strengthening activities (e.g., resistance training, weightlifting) |
What are the Benefits of Exercise for PCOS?
Aerobic Exercise:
- Improved Insulin Sensitivity: Enhances glucose uptake and reduces insulin resistance.
- Cardiometabolic Health: Lowers waist circumference and can improve lipid profiles.
- Weight Management: Helps prevent weight gain and supports weight loss efforts.
- Mental Health: Reduces symptoms of depression and anxiety, improving quality of life.
Resistance Exercise:
- Muscle Mass: Increases lean muscle mass, which can improve metabolic rate and insulin sensitivity.
- Hormonal Regulation: Enhances androgen balance by increasing sex hormone-binding globulin (SHBG) levels.
- Body Composition: Aids in reducing central adiposity and improving body composition.
- Bone Health: Promotes bone strength, reducing the risk of osteoporosis.
By combining aerobic and resistance training, individuals with PCOS can experience comprehensive benefits, improving both metabolic health and overall well-being. If you are managing a An Accredited Exercise Physiologist can help you individualise your exercise plan to better manage your symptoms and improve quality of life.
GLOSSARY:
- Oligomenorrhea:
- Definition: A condition where menstrual periods are infrequent, typically occurring at intervals of more than 35 days apart or having fewer than 8 periods in a year. It is a common symptom of PCOS due to irregular ovulation.
- Hyperandrogenism:
- Definition: A condition characterized by excessive levels of androgens (male hormones, like testosterone) in the female body. This can lead to symptoms such as hirsutism (excessive hair growth), acne, and androgenic alopecia (hair loss).
- PCO (Polycystic Ovaries):
- Definition: The presence of multiple small, fluid-filled sacs (cysts) within the ovaries. Polycystic ovaries are often seen on ultrasound in women with PCOS but can also be present without the syndrome.
- Normal Androgens:
- Definition: Refers to typical or expected levels of androgens (such as testosterone, androstenedione, and DHEA-S) in the female body. Normal androgen levels are essential for regulating various bodily functions, including reproduction, libido, and muscle mass.
