Lifestyle changes for PCOS vs meds and weight loss

Best lifestyle changes for PCOS

With PCOS, there’s so much emphasis on weight loss over wholesome, sustainable lifestyle changes for PCOS. When I’m working with women, I hear the same thing again and again: my doctor said to lose weight and I’ll feel better. Hopefully, metformin will help me drop some pounds. But medication isn’t always the best (or only!) answer for managing symptoms of PCOS.

Why metformin and weight loss always get brought up for PCOS

Studies have indicated that, yes, a weight loss of 5% or more of your baseline body weight can have favorable responses in PCOS symptoms. But weight loss is not the only key. In fact, depending on the weight loss methods you try to use, you may end up worsening your PCOS symptoms.

Additionally, the cycle of chronic dieting, under-eating, heavy restriction, and over exercise can potentially push you further into imbalance.
The ability to have sustained weight loss through lifestyle shifts versus overhauls is the key to using weight loss as a pillar for PCOS management.

What about metformin for PCOS and fertility? Will it help me lose weight?

Metformin doesn’t treat PCOS. But it can help with symptoms and is right for some women. In PCOS, metformin can help with fertility because it can lower inflammation and blood sugar instability, which promotes ovulation through positive shifts in luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In addition, it can lower risk for things like gestational diabetes and cardiovascular conditions that can be seen in association with PCOS. If you do get pregnant, metformin can reduce your chances of miscarrying and also your risk for gestational diabetes.

Using metformin for PCOS may or may not help with weight loss. Some studies show up to a 10% reduction in BMI. For others, the changes are much more modest.

Lifestyle changes for PCOS that truly support your hormones

The ability to support your body and hormones through lifestyle is the key to feeling better with PCOS. As a pharmacist, I know all too well how medications like metformin and birth control affect the body and how many side effects can come with them. Even if you do decide to take these medications, research shows lifestyle changes enhance their benefits. So what are lifestyle changes for PCOS? Let’s look more closely at what you can do.

Stabilize your blood sugar

Glucose intolerance is a major part of the hormone shifts that contribute to PCOS. This means that your body has either too much sugar being released from your sugar storage spots (your liver) or you’re having trouble processing sugar from your nutrition. Regardless of which pathway serves as the source for difficulty managing sugar levels, there are some tactics you can integrate into your lifestyle that will support how your body metabolizes and uses blood sugar.

Hydrate, hydrate, hydrate

I know we all say that we drink plenty of water or drink water all day… but I’m challenging you to increase it healthfully. Aim for a gallon per day.

Give yourself permission to nourish your body

Stop with the drastic food overhauls. Don’t skip meals, cut out carbs, restrict healthy fats, or over-limit your calories. Many women, especially women who are told weight loss may help their symptoms or condition, employ dieting practices that dysregulate their metabolism. Over time, after years of these strategies, weight is usually higher than their initial starting point. Their adrenals are burnt out. And their metabolism is virtually stalled.

To help restore these oh-too-common imbalances? Start eating again. Use whole, actual foods. Have 3 meals each day. All the macronutrients should be represented in your day, and each meal should be enough to support you going at least 2–3 hours without being hungry. It may take you a while to find that balance for you. But start leaning into how your meals make you feel and research your response. You are the expert on you.

Increase your fiber

Utilizing fiber is a great way to get your metabolism rolling and pull out extra hormones that are hanging out in a “lazy” digestive tract and contributing to further imbalance. Try to have a dietary source of fiber in at least 2–3 of your daily meals. If it’s right for you, incorporating a prebiotic supplement is an easy way to add fiber and support your gut all at once. A 2019 study showed gut dysbiosis (an imbalance of gut microbiota) may be a factor in PCOS and that targeting specific aspects of gut health may help alleviate it.

Add healthy fats to your meals and sweet treats

Listen: it’s not realistic to always avoid sugar and treats for the sake of your PCOS. Life happens. Rather than get all sugar out of your life, let’s just set you up for success around sugar. A few tips about sweet treats? Don’t go into them crazy hungry. Fuel yourself with whole foods first. Going in hungry is like priming your body to be intolerant to the sugar.

Bring some healthy fats into your dessert. Add in a sprinkle of nuts to your ice cream or top it with warm nut butter. This helps make a single serving feel more satiating. This and helps “level out” the rise in your blood sugar from the treat. Also, do away with “sugar free” and “low fat” options. Artificial sugars can worsen your body’s ability to respond to sugar. Just have the actual sugar or fat and also support your body with nutrients, food, and fuel before or after so that it is equipped to metabolize it well.

Move with joy

Here’s what I mean: exercise can be harmful to your body and hormones or it can be extremely helpful. The determining factor in which purpose it serves is closely related to your mindset around why and how you move your body. Rigorous, daily, high-intensity workouts without rest days and restorative movement increase stress hormones, testosterone, and PCOS symptoms.

Ways to support your body with movement includes doing more mind-body
connective movements like yoga or pilates. Or, incorporate rest days if you love high-intensity or weight-lifting regimens. You can also use body weight for moderate-intensity workouts, lessen your cardio to 30 minutes or less 2–3 days per week, and make cooling down with breath work a priority. The breath work and turning “off” of your stress system after working out is extremely important in stabilizing blood sugar and boosting the benefits versus negative effects of exercise.

Support hormone production

Your body is the best at healing itself and you are capable of reducing symptoms. We forget that sometimes. But your body needs support, and the lifestyle changes above are important parts to that support. Another piece is making sure you have all the macro and micronutrients needed to make the the hormones your body needs and in the correct amount.

If nutrients and precursors (building blocks) for hormones are low, your body has to make a choice. If nutrients and building blocks for hormones are low, your body will prioritize cortisol and other stress hormone production because these hormones are essential to survival. This means sex hormones like progesterone, thyroid hormones, and many others become out of balance. In PCOS, having enough progesterone is really important. Along with high testosterone, many women with PCOS also have high estrogen. Having enough progesterone is needed to prevent estrogen dominance.

Knowing that you are working on your nutrition and slowly bringing in real foods (actual fruits, vegetables, whole grains, complete proteins, fiber) is a great place to start in getting your body everything it needs to make happy, healthy hormones. Vegetables are high in micronutrients, so adding them to smoothies, sauces, and sides is an easy shift.

Supplement your diet with the right vitamins, if needed

If you’re concerned you’re not getting enough nutrients through a balanced diet, you can support your body with nutrients through a multivitamin or supplement regimen. You want to be sure you have one that has activated forms of folate (and folate instead of folic acid), B vitamins, and vitamin D (as these are very important for making hormones).

Lower stress levels and support adrenals

Your adrenals cue production of stress hormones. If your body is busy making a lot of stress hormones, your other hormones will suffer. This is common in PCOS, including a type of PCOS called adrenal PCOS. A body that perceives stress often can shift hormone production in ways that cause PCOS symptoms (with or without the presence of cysts on the ovaries).

It is important to understand the difference in what we perceive as stress in our minds versus what our body interprets as stress. Things like noise, blood sugar, injury, food source, lights, social media, relationships, and our thoughts are all contributors to “stress” in our body. This means that our thoughts are just one way our body understands stress. The other sources for stress can cumulatively cause our body to overproduce stress hormones. After a while, that burns out our adrenals and shifts our hormones into total imbalance.

How to make lifestyle changes for PCOS by lowering your stress and setting boundaries

We have more than a few sources of stress in our everyday lives. Stress takes such a toll on hormones, and lifestyle changes to reduce it will help your PCOS. Here are some ways you can use boundaries to support balance and wellbeing.

Rework your thoughts

You can rewire your body’s response to a situation by re-channeling your thoughts. Replacing negative thoughts by learning to see the value in each situation can have a physical impact on your body and hormones. Start with this quick exercise. Next time you think a negative thought about your symptoms or PCOS, replace it with this instead: I have PCOS. With the right support, my condition can be managed. I am strong and making decisions to support my health.

Limit your screen time and environment

Set phone hours and boundaries. Social media is great. But over-engagement can send stress signals to the brain. Lower stress by incorporating 5 minutes of “white space” into your day. Two or three times daily, practice deep breathing and mindfulness while closing your eyes and ears.

Watch your blood sugar and your nutrition

Stop skipping meals! This is a hard habit to break, but one of the most important lifestyle changes for PCOS. Get out of the mindset of restriction and into one of nourishment. Keep calories up and consistent. Restricting food increases stress like crazy.

Make time for self-care and create stress strategies

Use strategies like journaling and brain dumps to clear mental and emotional stress. Before you are met with big stressors, work on little everyday ones. Learn how to cope, lower your stress response, and turn off your fight or flight center. When your body has patterns it can use to lower stress hormones throughout each day, you’ll build resilience.

Little steps make a big difference in PCOS

That definitely covers a lot. But remember: you are equipped with so many small and simple shifts to begin incorporating into your lifestyle. Each of them will support your body and help reduce symptoms. Do not get overwhelmed and try to “do it all.” This is usually why so many of us stay stuck. Pick one category of support and work your way through those suggestions for 2 weeks. Keep track of your progress and changes. You can move on to an additional category and begin with those shifts once you feel confident in the execution of your new strategies. Not only will you feel better, you will be on your way to feeling empowered in managing your health and PCOS.

Heather Rhodes, Pharm.D.
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