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Lifestyle Strategies for Managing Polycystic Ovary Syndrome (PCOS)

Written by
Team Nutrisense
Reviewed by
Kara Collier
RDN, LDN, CNSC
someone holding a knot with "PCOS" written on it

PCOS is a mixed endocrine and reproductive condition, but it is fortunately amenable to a series of lifestyle adjustments that can pay dividends. We should start by emphasizing that food is a crucial part of any healthcare management plan. Although the focus of this article is non-dietary lifestyle techniques, we certainly don’t mean to short-change the value of a balanced diet as part of a holistic wellness plan. 

a person jumping outdoors

Lifestyle Strategy #1: Regular Exercise

We would recommend that most people do some exercise throughout the week. Generally, a mix of moderate-intensity aerobic exercise and light to moderate strength training would be ideal for most circumstances. As a basic starter plan for someone with a sedentary lifestyle, we would suggest moderate workouts around three times per week as well as walking or standing more frequently throughout the day.

However, it can be frustrating for people with PCOS because they can exercise and not see any results, or only slow effects disproportionate to the amount of exercise they do. If someone in this situation over-exercises, say doing seven intense aerobic workouts per week without seeing progress, this can increase stress hormone levels in the body and exacerbate the other symptoms of PCOS.

 In this case, we would recommend a modified basic regimen of workouts, three per week but of either moderate or high intensity if the person is already used to them. Alternatively, some more intense exercises could also be replaced with more relaxing ones like a walk or stretching. As for anyone, walking and moving throughout the day is recommended where possible.   

a person sitting on a sofa, looking stressed out

Lifestyle Strategy #2: Stress Management

Lower intensity exercises can be a valuable form of stress management, but there are many stressors and strategies for coping with them. Of course, there are other ways to manage stress, and combining them will usually produce an additive effect. The most comprehensive way to “audit” your stress levels, in our opinion, is to make a checklist.

Major stressors like moving from one house to another or a medical emergency in the family can be traumatic and are usually apparent to the person suffering them. In these cases, it’s important not to blame yourself, as such things are generally out of any one person’s control. But there are other minor stressors that (1) you may have more control over than you think and (2) can start to add up if they are repeated.

Work stressors can be things like not getting along well with colleagues (even if it’s just one, it can feel like your whole day!), having an unreasonable workload, feeling unappreciated by a supervisor or boss, etc. Non-emergent health stressors can be things like fatigue or anxiety, which can all too easily become a toxic feedback loop. Finally, there are some general life stressors like being stuck behind a slow walker in a narrow hallway – the right amount of perspective and collection can work wonders here.

In terms of the following steps, a blood test for cortisol levels is always available and can help your clinician figure out if there’s a role for medical management. Stress hormones are elevated in PCOS, but it can be good to take snapshots now and again. At the end of the day, if high stress levels and cortisol are the main issues, then stress management is the front-line treatment.

Other steps include reducing caffeine intake if you drink 4 or 5 coffees per day or if you’re unusually sensitive to it. Breathing exercises can help recenter your equilibrium in a particularly stressful situation, and meditation can be helpful as a longer-term reset when practiced regularly. Keeping a journal can also be beneficial for processing the ups and downs of daily life or for committing thoughts about a stressful event to paper instead of letting them bounce around. 

a person sleeping in bed

Lifestyle Strategy #3: Sleep Hygiene

Stress hormones are essential for the sleep/wake cycle, so PCOS is unfortunately and unsurprisingly associated with sleep disturbances. These include sleep apnea, excessive daytime sleepiness, and various forms of insomnia like difficulty getting to sleep, difficulty staying asleep, or waking earlier than intended.

PCOS is associated with higher testosterone levels and lower progesterone levels. In women, low progesterone is also associated with sleep irregularities. So, both stress hormones and sex hormones likely have a role to play here. Likewise, poor sleep quality is associated with insulin resistance and obesity even in people without PCOS. Sleeplessness can lead to increased stress, which can, in turn, lead to higher blood glucose levels.

Sleep hygiene, or the practice of only using your sleeping space to sleep (instead of scrolling on your phone in bed), is also an essential behavioral step. Sleep hygiene also refers to consciously winding down your day before trying to sleep, as well as making sure your sleep is free from interruptions like notifications or work obligations. Food and coffee intake, as well as their timing, are important factors at work here.

Lifestyle Strategy #4: Intermittent Fasting

This last strategy is more of a recent development or area of interest than a specific fixed and proven recommendation for PCOS. In general populations, intermittent fasting is associated with improved outcomes for weight loss, stress hormone levels, and blood glucose levels. In people with PCOS associated with insulin resistance, it may be more beneficial. As this is an evolving area of research, and since PCOS is associated with several hormonal irregularities not related to the general population, it’s best to take any steps in this direction with the close advice of a medical professional and in consultation with your primary care provider.

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