Polycystic ovarian syndrome (PCOS) affects one in ten women of reproductive age. In the US alone, that equals about five million women. As your health coaching business grows, it is likely that you will encounter at least one client who has PCOS.
As a health coach, it is essential that you are prepared to support your clients in achieving their health and wellness goals, in addition to supporting them through health obstacles and empowering them to retain a general sense of well-being throughout their lifetimes.
For some of your clients, PCOS might be a condition they consider an obstacle to achieving their health goals, or they might simply want to learn to manage it more effectively. It might also be true that they have PCOS, but it isn’t of primary concern to them.
In these different cases, how can health coaches be of support? What information can health coaches offer to their clients with PCOS to help them feel well and fulfilled?
In this health coach’s guide to PCOS, we provide you with the most important information about PCOS, and we review the research behind how fitness, nutrition, weight, and stress can impact PCOS risk and symptoms. Finally, we offer concrete tools and recommendations for coaches to support their clients with PCOS.
What Is PCOS?
PCOS is a health condition that results from an imbalance in hormones that support the ability to have regular menstrual cycles and get pregnant.
In women without PCOS, hormones send signals to the ovaries to release an egg each month during the ovulation period of the menstrual cycle.
In women with PCOS, lower-than-normal estrogen and progesterone levels and higher-than-normal androgen levels cause the egg to either not develop as it should or not be released into the fallopian tubes. The lack of ovulation changes levels of estrogen, progesterone, follicular stimulating hormone (FSH), and luteinizing hormone (LH).
As a result of the effects on egg development and release into the uterus, a woman may have missed or irregular periods. This can lead to infertility and the development of small fluid-filled sacs in the ovaries called cysts.
Common PCOS Symptoms
Some of the most common symptoms of PCOS include:
- Irregular menstrual cycles, including missed or irregular periods.
- Excess hair on the face, including on the chin, cheeks, and upper lip. This is called hirsutism and affects up to 70% of women with PCOS.
- Chronic acne on the face but could also extend to the neck, chest, and upper back.
- Thinning hair or hair loss.
- Weight gain.
- Difficulty losing weight.
- Darkening of the skin, especially where the skin creases.
- Skin tags, which are small excess skin flaps.
While these are some of the most common symptoms, keep in mind that every woman may experience PCOS differently and in different severities. It is also possible for women not to experience any symptoms at all.
Causes of PCOS
The exact cause of PCOS is not known. There is also nothing that a woman can do to definitively prevent the development of PCOS. Some factors that experts know influence the development of the condition include:
- Genetics: When a woman has a family history of PCOS, it is more likely that she, too, will develop PCOS. However, the exact gene linked to PCOS has not been identified.
- High levels of androgens: While women naturally have low levels of androgens, in high concentrations, they are the hormones that control the appearance of male traits, like male-pattern baldness and hair growth on the face. Women with PCOS have higher androgen levels than women without PCOS.
- High levels of insulin: Many women with PCOS have higher-than-normal insulin levels as a result of the cells’ inability to respond normally to the hormone.
- High levels of the amino acid homocysteine: This is correlated with low levels of vitamin B12 and increased risk of heart disease in women with PCOS.
- Environment: While research is still in the early stages, it is clear that our bodies are exposed to endocrine disrupting chemicals through the foods we eat, beauty and cleaning products we use, ground our food is grown in, and water we drink. Unfortunately, consumers have little control over these factors on an individual level, but government and private-sector regulations can reduce our exposure.
- Other conditions: Women with heart issues, diabetes, obesity, and autoimmune diseases are more likely to develop PCOS, especially if there have been disease management issues.
The culmination of these factors causes oxidative stress, which results in free radicals in the body. Free radicals cause cell damage and can worsen these factors, resulting in a vicious cycle of oxidative stress and free radical production and, ultimately, disease progression. The vicious cycle can be slowed or stopped through lifestyle changes, like diet and exercise, and some medications.
Key Facts about PCOS
Here are some important facts to keep in mind about the biological impact of PCOS:
- PCOS is the most common cause of infertility in women.
- Women with PCOS are often insulin resistant; their bodies make insulin, but their cells have difficulties reading insulin to optimize glucose uptake.
- Women with PCOS are more likely to develop other health problems, including:
- Type 2 diabetes
- Gestational diabetes
- Heart disease
- High blood pressure
- High LDL “bad” cholesterol and low LDL “good” cholesterol
- Sleep apnea
- Depression and anxiety
As you review the list above, remember one thing—an increased risk is not the same thing as a diagnosis.
In other words, if your client has PCOS, in no way does it mean that they will also develop type 2 diabetes, heart disease, high blood pressure, and so on. There are multiple factors that determine their individual risk for each of these conditions, and it is completely possible for a woman with PCOS to effectively manage the condition without ever developing another.
One of the most important elements to reducing risks of other health conditions and improving wellness is by managing PCOS through a healthy lifestyle and following through with physician-prescribed treatment.
What Might a PCOS Diagnosis Mean for Your Client?
There are two things that are true of every PCOS diagnosis.
- Even though there are a number of signs and symptoms that women must have to have a PCOS diagnosis, no one experiences PCOS in the same way.
- PCOS may have vastly different meanings for different women. When for one woman, it might have a minimal impact on her life; for another, it could raise serious fears about fertility and the ability to have children.
As health coaches, it is essential that you keep both of these in mind when you work with a client who has PCOS.
PCOS may affect your client’s well-being in many interconnected ways. We’ve summarized some of the potential impacts PCOS could have on your client’s health and general well-being in three different areas: physical impacts, social impacts, and emotional and mental impacts.
The physical impact of any condition refers to how a person experiences the biological effects on how the body looks and feels.
Most symptoms are reported as physical impacts on the body.
In terms of PCOS, this may mean:
- Irregular menstrual cycles, including heavy or very painful periods.
- Excess facial and body hair.
- Chronic acne on the face but could also extend to the neck, chest, and upper back.
- Thinning hair or hair loss.
- Weight issues, including weight gain or difficulty losing weight not related to diet or exercise.
- Skin issues, including darkening of the skin, especially where the skin creases, and skin tags, which are small excess skin flaps.
It is common for the physical impacts of a condition to be the root cause of the effects on other areas of a person's life. In other words, symptoms that cause pain or a negative self-image could have negative impacts on mental health and even on a person’s willingness or ability to socialize.
Emotional and Mental Impact
The emotional and mental impact of PCOS could come about in two main ways.
First, as a direct impact of hormonal changes brought about by PCOS. For example, the same hormones that cause heavy or painful periods (dysmenorrhea) may also cause changes in mood.
Second, the experience of the symptoms of PCOS could have an impact on how a woman sees herself, feels in her body, and carries out day-to-day activities. Here are a few examples:
- A woman with PCOS eats healthy and exercises regularly, but she is gaining undesired weight. This can be frustrating and impact motivation.
- Your client has extreme pain around her period. She may want to cancel her sessions with her health coach, eat irregularly, and have trouble sleeping. The pain causes major anxiety.
- A woman and her partner have been trying to conceive for almost a year. She feels depressed that her PCOS is likely the cause of her infertility.
- PCOS has caused the growth of thick, dark facial hair on a woman’s chin and cheeks. She waxes and shaves, but it causes ingrown hairs. The unwanted facial hair deeply affects her self-image.
These are just a few of the mental and emotional impacts PCOS can have on women. The examples above are not unusual circumstances. According to research, women with PCOS are more anxious and depressed than the general population, and women with PCOS who reported infertility often report depression.
One study found that of women with PCOS who reported depression, 66% were caused by negative body image. Thus, emotional support and physical support should be closely linked when working with women with PCOS.
Lastly, PCOS may have an impact on a woman’s feminine identity and group identity. If fertility is linked to a woman’s core identity, and PCOS has had an impact on her fertility, she may face some trauma linked to identity adjustment. PCOS may also be at odds with her core identity, or it may have taken an important place in her identity.
When a woman with PCOS has both physical symptoms and impacts on her mental health, her relationships are often negatively impacted as well.
If a woman has a negative body image, she is more likely to feel anxious when spending time with her friends and going out in public.
If a woman is depressed about her infertility, her relationship with her partner may suffer, as she feels anxiety and guilt.
What Health Coaches Can Do to Support a Client with PCOS
Once your client is diagnosed with a health condition and may be undergoing treatment as directed by their physician, health coaches can be essential in supporting their clients affected by PCOS through life changes and adopting lifestyle changes that can improve their quality of life and overall health and well-being.
Remember that there is important information for you to keep in mind regarding what you can and can’t do as a health coach. Plainly, health coaches cannot make recommendations that go against physician treatment, diagnose, or treat conditions; you can, however, support clients in implementing lifestyle advice proven to support their condition as approved by your client’s primary care team.
More specifically, health and wellness coaches can help to facilitate key discussions with clients pertaining to five different areas: fitness, nutrition, weight loss, stress management, and general health.
Remember, only focus your coaching on PCOS management if your client has expressed this need. If your client mentions that she has PCOS in passing, but that is not of concern to her and it is not the primary reason she has come to you for support, it should not be the focus of your wellness coaching plan.
If you have, together with your client, identified PCOS management as a goal, you can work with her in each of the areas in which health and wellness coaches are experts. Below, we discuss each of these areas as they pertain to PCOS to support you with the knowledge and evidence to be of support for your clients.
Fitness and Exercise
Exercise is one of the most beneficial lifestyle options for women with PCOS. It can help to manage symptoms significantly and even improve inflammation and help to manage hormone levels.
What the Research Says
- Exercise is one of the most effective ways to help manage period pain and dysmenorrhea, and research shows that it is even more effective than taking analgesics.
- The most well-studied benefits of exercise on women with PCOS include improved ovulation, reduced insulin resistance, and weight loss. These benefits were independent of the type, frequency, or length of exercise.
- Regular exercise can reduce inflammation and improve autonomic function (heart rate and insulin levels) in women with PCOS.
- However, women with PCOS are more likely to be sedentary than women without PCOS and are unaware of the benefits of regular exercise for managing their symptoms.
- Exercise must be sustained consistently for women to benefit from its effects on PCOS symptoms. In other words, exercise will only benefit them as long as they keep it up. In the weeks after becoming sedentary, the symptoms will go back to normal.
- Women who are sedentary and have PCOS are more likely to become obese, which can complicate PCOS symptoms.
- Women who have PCOS and are obese have more difficulty losing weight by exercise than non-obese women with PCOS. Research suggests that there are hormonal differences that influence weight loss in women with PCOS of greater BMIs.
Key Exercise Recommendations for Clients Who Have PCOS
- Build a realistic exercise regimen with your client. The goal is to build up to carrying out 150 minutes of moderate aerobic exercise a week, 75 minutes of vigorous aerobic exercise per week, or a combination of the two. They should also aim to carry out moderate-to-vigorous muscle training at least 2 days a week.
- Go through some of the main research findings of the benefits of exercise for PCOS symptoms. Match your client’s goals with the research as a way to motivate them to exercise regularly.
- If your client’s goal is weight loss, let her know that because of her PCOS, she may have more trouble losing weight by exercise. However, that isn’t to say that exercise isn’t benefiting her body in other ways, and be open to adjusting goals as necessary to demonstrate your client’s progression. It may also be beneficial to construct non-weight loss goals.
What a person chooses to eat has a significant impact on metabolic hormones, some of which are altered in women with PCOS. A greater understanding of the role of their diet on their PCOS symptoms and progression and the adoption of food choices that help to regulate hormones that are out of balance in women with PCOS are an important part of the holistic treatment of PCOS.
However, keep in mind that the dietary regimen for the treatment of PCOS, as for most other chronic illnesses, is not an exact science. The research should be considered together with your clients preferences and possibilities.
What the Research Says
- In general, the role of diet for helping to manage PCOS is two-fold: to help manage insulin and blood glucose levels and to assist in healthy weight loss, when needed. When a dietary regimen is successful in doing this, the risk for related chronic diseases, like type 2 diabetes, cardiovascular disease, and certain cancers, is also reduced.
- Researchers have summarized research to make recommendations on macronutrient intake and food choices for women with PCOS:
- Fat should be restricted to less than 30% of total calories, and saturated fat should be limited.
- Carbohydrates should contribute about 45-55% of the diet initially, and most of those calories should come from complex carbohydrates.
- A diet high in protein can improve insulin sensitivity and satiety. Aim for about 20% of the calories to come from protein, and increase over time.
- Limit or avoid red meat, and choose fish or plant-based proteins instead.
- Some research suggests that women with PCOS should eat smaller, frequent meals throughout the day to help manage insulin levels.
- Other research suggests the benefits of intermittent fasting for insulin levels.
- Plant-based diets are effective for helping to manage insulin resistance, one of the hallmark effects of PCOS, and they can help to promote healthy weight loss while also preventing nutrient deficiencies.
- The population of bacteria in the gut can affect hormone balance. Probiotics and prebiotics can help to support gut health and hormone health.
- Dietary changes suggested for preventing and managing type 2 diabetes are very similar to those that should be recommended to women with PCOS. This includes the adoption of a diet rich in dietary fiber, low in refined carbohydrates, rich in omega-3 and omega-9 fatty acids, and low in trans and saturated fats. These diets should also be rich in foods with anti-inflammatory compounds like fiber, omega-3, and vitamin E.
- Vitamin D deficiency is common in women with PCOS, and it may play a role in exacerbating PCOS symptoms.
- Inositol (vitamin B7) deficiencies are also known to exacerbate symptoms of PCOS. Inositol supplementation has been shown to be effective in some women for managing PCOS.
- Women with PCOS tend to have high levels of the amino acid homocysteine, which is correlated with a higher risk for heart disease. Homocysteine levels can be regulated with vitamin B12 supplementation.
Key Nutritional Recommendations for Clients with PCOS
- Recommend your clients eat a variety of colorful, whole foods that support hormone health and base their diet on unadulterated foods.
- Focus on understanding your client’s cultural, social, and gastronomic priorities while you consider research. All lifestyle recommendations should be culturally appropriate to achieve long-term success.
- Note that there are multiple dietary strategies that may benefit your client with PCOS. Consider the research mentioned and work with your client to identify a dietary regimen that will be most effective.
- Remind your client how refined carbohydrates and saturated and trans fats worsen insulin resistance, so these should be limited, when possible.
- Suggest nutritious, low-cost, and flavorful food and meal options within the recommendations you provide.
- Suggest foods that are high in anti-inflammatory compounds, like omega-3, vitamin E, and fiber.
- Explore whether a plant-based diet composed mainly of healthy unsaturated fats and plant-based proteins and controlled amounts of complex carbohydrates is realistic for your client. A well-balanced plant-based diet that is complemented with supplementation could help to reduce insulin resistance and keep your client nourished.
- Discuss the possibility of supplementation with your client’s primary care physician to help manage some of the underlying factors of PCOS pathogenesis. Make sure to read this information about what you need to know before recommending a supplement.
Not all of your clients with PCOS may have the goal of losing weight. In fact, women with PCOS may want to gain muscle weight while being indifferent to body fat. Unless your patient has been informed that their weight is affecting their PCOS symptoms, fitness and exercise should be prioritized over general weight loss, as weight loss is usually the result of an effective and directed nutrition and exercise regimen.
What the Research Says
- Obesity is not likely a cause of PCOS, but it does exacerbate some of the symptoms.
- Obesity in women with PCOS is often paired with glucose intolerance, which compounds the effects.
- Even when a person has a normal BMI, they may still have abdominal obesity, which is linked to insulin resistance.
- A higher body fat is associated with higher levels of androgenic hormones. Androgenic hormones are linked to symptoms like acne, facial hair, and body hair. Weight loss, together with pharmacological treatment, helps to improve the quality of life of women with PCOS.
- In women whose goal is to improve fertility, women who lost weight via lifestyle modification can help to improve the outcome of pharmacological treatment.
- As little as a 5% weight loss could be beneficial for the insulin resistance and PCOS symptoms and health effects.
Key Weight Loss Recommendations for Clients with PCOS
- When a person with PCOS is overweight or obese, it may exacerbate their PCOS symptoms. Weight loss may help them manage those symptoms.
- Look at abdominal obesity (via waist circumference) and body fat percentage, as BMI is not always an accurate indicator of body distribution.
- If weight loss is a goal that the client, the primary physician, and the health coach agree on, it should be achieved through adopting a healthy diet and exercise.
- Clients should avoid short-term fad diets adopted to achieve weight loss, as the effects are short-lived.
- Work with clients to adopt sustainable lifestyle modifications. These will likely result in steady weight loss that is easy to maintain over a lifetime.
- Remind clients that every person should be looked at individually. While weight loss is one element that can help them to manage symptoms, there isn’t a “goal weight” where they will start to see improvements. Remind them that the ultimate goal is to manage PCOS symptoms and improve health, not the weight loss in itself. This means that they may see improvements in hormone levels and PCOS symptoms before reaching their goal weight. Make an effort to recognize these improvements.
What the Research Says
- Women with PCOS are more likely to experience depression and anxiety than the general population. This has to do with a negative body image and infertility in many cases. Both women who are and aren’t overweight experience negative body image issues.
- Social exchange between women who have been diagnosed with PCOS has been shown to help women manage symptoms of depression and anxiety.
- Negative body image can have a negative impact on your client’s relationships, since a low self-esteem can lead to a tendency toward introversion and withdrawal from others.
- Exercise has been shown to help improve symptoms of depression and quality of life in women with PCOS.
- Yoga and meditation may be effective tools to help women with PCOS manage anxiety and mental health effects of the condition. Teams of researchers are currently carrying out studies to better understand how yoga and meditation can be used as tools to manage PCOS.
Key Recommendations to Offer Clients to Help Manage PCOS-Related Stress
- Be aware of your client’s self-image, regardless of BMI or weight gain. All women with PCOS are more at risk of having a negative body image, and this has an impact on mental health and sociability.
- Help your client build a regular exercise regimen, as this can help your client manage her anxiety.
- If your client is facing self-image issues due to hair loss, you can suggest alternative hair options, including wigs, hairpieces, semi-permanent solutions that are secured to the scalp, and permanent solutions like hair implants.
- Suggest your client connect with other women who are affected by PCOS on social media and online discussion forums. If you have several clients with PCOS, you may want to work with a certified mental health specialist to form a support group.
- Suggest yoga or meditation when clients are experiencing anxiety due to PCOS.
- If you notice a client has severe symptoms of depression and anxiety, and they are not being effectively managed with lifestyle changes and a physician-supported treatment regimen, you should recommend that your client see a professional mental health specialist.
Here are some other recommendations you can make to your client for managing some of the symptoms associated with PCOS and avoiding PCOS progression. Always make sure that these are in-line with your client’s primary care physician’s treatment plan.
- Acupressure: Research shows that acupressure has a moderate effect on reducing period pain, which can be quite intense in women with PCOS.
- Heat: Like acupressure, applying heat to the cramping area has a moderate effect on alleviating menstrual pain.
- Supplements: Some herbal supplements, like panax ginseng, punica granatum, curcuma longa, cocus nucifera, paeonia lactiflora, and others, may be considered as part of a holistic treatment of PCOS. Additionally, however, nobody with PCOS should take herbal supplements without consulting with their doctor first, as some supplements may counteract with or compound other treatments they may be taking.
PCOS is common in women, and it can affect multiple areas of a woman’s health and well-being. Women with PCOS should be seeing a physician specialist to monitor the symptoms and effects of PCOS and to determine if pharmacological treatment is necessary. However, lifestyle modifications are considered essential for the long-term management of PCOS and for improving the effectiveness of pharmacological treatment.
Lifestyle modifications are often much more difficult for people to adopt than remembering to take a pill. Health and wellness coaches are especially trained to assist their clients in making effective lifestyle changes in a way that works best for them. If your client would like your support with their PCOS, you can facilitate discussions with them about how their PCOS is affecting their body and mind, and how lifestyle modifications, like regular exercise, finding emotional support, and adopting a plant-rich diet could help to improve symptoms and overall well-being.
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