PCOS and Eating Disorders

Polycystic Ovary Syndrome (PCOS) and Eating Disorders

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting up to 15% of women. It is characterized by excessive androgen production, leading to symptoms such as irregular menstrual cycles, excessive hair growth, abdominal weight gain, acne, and fertility issues. PCOS is often linked to a higher prevalence of eating disorders (EDs) due to hormonal imbalances and weight concerns, which can exacerbate PCOS symptoms and create a challenging cycle to break without appropriate intervention.

Symptoms of PCOS

The symptoms of PCOS include:

• Irregular or absent menstrual cycles
• Excess body hair
• Pelvic pain
• Weight gain, particularly around the abdomen
• Abdominal bloating
• High blood pressure and high cholesterol
• Acne
• Keratoses and acanthosis nigricans (darkened skin areas)
• Mood swings
• Infertility

Links Between PCOS and Eating Disorders

Research indicates that individuals with PCOS are approximately three times more likely to develop eating disorders than those without PCOS. This correlation may be due to insulin resistance and frequent concerns about weight and body shape, often exacerbated by medical recommendations for weight loss.

Types of Eating Disorders and Their Prevalence in PCOS

• Bulimia Nervosa (BN): Bulimia is characterized by episodes of binge eating followed by compensatory behaviors such as vomiting, laxative use, or excessive exercise. Women with PCOS have a significantly higher prevalence of bulimia, possibly linked to hormonal fluctuations and weight concerns.

Insulin resistance, common in PCOS, leads to blood sugar fluctuations, triggering cravings and binge episodes. These hormonal fluctuations can also disrupt mood and psychological well-being. Hormonal imbalances increase the risk of depression and anxiety, conditions often associated with eating disorders. Excess androgens exacerbated by these imbalances can heighten body concerns. These factors create an environment conducive to the development and maintenance of eating disorders.

• Binge Eating Disorder (BED): BED involves episodes of binge eating without compensatory behaviors (no vomiting or excessive exercise to counteract food intake). This disorder is also more frequent in those with PCOS, often worsened by insulin resistance that increases carbohydrate cravings and binge episodes.

• Anorexia Nervosa (AN): Anorexia involves severe food restriction and intense fear of weight gain. Although less common in PCOS, anorexia may arise in response to body concerns and medical weight loss recommendations.

Risk Factors for Eating Disorders in PCOS

Risk factors include:

• Body Dissatisfaction: Concerns about weight and body shape are common among those with PCOS, exacerbated by physical symptoms of the syndrome. When a woman is diagnosed with PCOS and is overweight, she is often advised primarily to lose weight to alleviate symptoms, even though this weight loss may be difficult or obstructed by insulin resistance.

• Depression and Anxiety: Mood disorders are common in PCOS, increasing the risk of developing eating disorders.

Impact of Eating Disorders on PCOS

Eating disorders can significantly worsen PCOS symptoms in the following ways:

• Insulin Resistance: Cycles of food restriction followed by binge eating can disrupt glucose and insulin levels. Severe restriction often leads to compensatory responses from the body, increasing insulin levels when food intake resumes. This fluctuation can worsen insulin resistance, a common PCOS symptom, making glucose management more challenging and increasing the risk of type 2 diabetes.

• Hyperandrogenism: Excessive production of male hormones can be exacerbated by eating disorders. Disordered eating patterns can increase androgen production by the ovaries or adrenal glands, worsening symptoms such as acne, excessive hair growth, and hair loss.

• Ovulatory Disorders: Irregular or absent menstrual cycles are a common PCOS symptom, often worsened by eating disorders. Severe caloric restriction and rapid weight loss or gain can disrupt ovulation, leading to anovulatory cycles (lack of ovulation). Binge eating and compensatory behaviors, such as vomiting or excessive exercise, can also disrupt hormonal balance necessary for regular ovulation.

• Complexity of Treatment: Managing PCOS becomes more complex with eating disorders. Weight loss recommendations for PCOS may conflict with the treatment of eating disorders, which often requires halting restrictive behaviors and developing a healthy relationship with food. Eating disorders can also reduce the effectiveness of medical and dietary interventions aimed at managing PCOS due to constant weight fluctuations and eating behaviors.

• Psychological Effects: Eating disorders can have negative psychological effects, exacerbating depressive and anxious symptoms often associated with PCOS. Body dissatisfaction, low self-esteem, and mood disorders can become more pronounced, creating a vicious cycle where food and body concerns exacerbate PCOS symptoms and vice versa.

Treatment for Eating Disorders and PCOS

Treating eating disorders and PCOS requires a multidisciplinary approach, including psychiatric, medical, nutritional, and specialized naturopathic support for PCOS. Common approaches include:

• Psychiatric Support:

  • Cognitive-behavioral therapy (CBT) for treating disordered eating behaviors and body image issues.
  • Treatment for mood disorders such as depression and anxiety, which are often present in PCOS.

• Medical Support:

  • Medications to regulate hormonal levels and treat PCOS symptoms, such as oral contraceptives or anti-androgen medications.
  • Managing insulin resistance with medications like metformin.

• Micronutrition and PCOS: Micronutrition can play a crucial role in managing PCOS and eating disorders by helping to rebalance hormonal levels and improve metabolic health. Key nutrients include:

  • Inositol: Myo-inositol, a naturally occurring compound, can help improve insulin sensitivity and regulate hormonal levels. It has shown promise in reducing PCOS symptoms, including menstrual disorders and hyperandrogenism.

  • Vitamin D: Essential for hormonal regulation and bone health, vitamin D deficiency is common in PCOS and can worsen insulin resistance and PCOS symptoms. Vitamin D supplementation can improve insulin sensitivity and ovarian function.

  • Omega-3 Fatty Acids: Found in fatty fish, nuts, and seeds, omega-3s have anti-inflammatory properties and can help reduce systemic inflammation associated with PCOS. They may also improve insulin sensitivity and lower androgen levels.

  • Magnesium: Involved in many metabolic processes, including glucose regulation and energy production. Magnesium deficiency is common in PCOS and can worsen insulin resistance. Supplementation may help improve insulin sensitivity and reduce PCOS symptoms.

  • Zinc: Essential for hormonal production and immune function. Zinc deficiency can exacerbate hyperandrogenism and skin issues associated with PCOS, such as acne. Zinc supplementation can help regulate androgen levels and improve skin health.

Conclusion

If you have PCOS and struggle with your relationship to food or your body, it is essential to work with healthcare professionals who adopt a comprehensive approach to weight management. Seek specialized treatment for eating disorders and support for mental health issues such as depression, anxiety, or other mental disorders. You deserve compassionate and inclusive support for your physical and mental well-being.