In PCOS, high levels of androgens and insulin can interfere with reproductive hormones that control ovulation and your menstrual cycle. As a result, you might often miss your period or have delayed or irregular periods.

This unpredictability can make it very frustrating when you’re trying to manage your PCOS symptoms, it can also be challenging if you’re trying to conceive.

The good news is that nutrition and lifestyle play a vital role in managing PCOS effectively, which is why the International Evidence-based Guideline for the assessment and management of PCOS recommends that nutrition & lifestyle treatment should be recommended to all women diagnosed with PCOS (1).

There is no such thing as the “best” diet for PCOS. However, there is a way of eating that can benefit you and your unique symptoms and concerns. Adapting your nutrition and incorporating regular movement into your lifestyle can help to correct hormone imbalances, improve insulin sensitivity, regulate periods and improve your fertility (if this is your goal!) when you have PCOS (2).

This blog article will explore proven ways to help you support regular ovulation and manage your PCOS symptoms through diet and lifestyle.

Low glycaemic index carbohydrates

Between 50-95% of women with PCOS will have insulin resistance. High insulin levels cause higher testosterone levels which further affect hormone balance and ovulation in PCOS. Eating foods that don’t spike insulin: moderate amounts of high fibre foods, paired with protein and fat foods, can help with ovulation.

All carbohydrate foods have an effect on your blood glucose levels. The glycaemic index (GI) refers to a ranking of carbohydrate foods from 1-100, and relates to how quickly these foods make your blood glucose levels rise after eating them.

Carbohydrates with a high GI rating, such as white bread, processed snacks and cereals, are refined and quickly broken down by your body. They cause a rapid rise in blood glucose, and to manage the sharp rise in blood sugar, your pancreas releases a large amount of insulin. Frequent consumption of high-GI foods results in more insulin being released more frequently, in larger amounts, which can disrupt ovulation (3).

After the initial spike, blood sugar levels often drop quickly (sometimes below normal levels), leading to what is known as a ‘blood sugar crash’. This can result in feelings of hunger, fatigue, and irritability, as your body craves more food to restore glucose levels (4).

Foods with a low GI rating are digested more slowly, leading to more gradual increases in blood sugar and insulin. Examples of low GI foods include high fibre carbohydrates such as brown rice, oats, quinoa, wholegrain bread and pulses. These foods demand much less insulin and cause less of a rise on your blood glucose levels.

Choosing good quality, low GI, high fibre foods at each meal, along with some protein and healthy fats, (which slow down the release of glucose), can regulate blood sugar levels and reduce insulin resistance. Including more fibre in your diet can also increase satiety and help to regulate your appetite.

Several studies have found that women with PCOS who followed a low-GI diet experienced significant improvements in insulin sensitivity and ovulation frequency (4). When following a low GI diet, ovulation occurred in 24.6% of women which was significantly higher than the 7.4% ovulation rate found in in women who consumed traditional diets (5).

The mediterranean dietary pattern

In addition to insulin resistance, the other part of the underlying mechanism driving the hormone imbalance in PCOS is due to inflammation. Women with PCOS have been shown to have higher levels of inflammatory markers such as increases in C-reactive protein (CRP), pro-inflammatory cytokines and chemokines, white blood cell count, oxidative stress, and various markers of endothelial inflammation. Higher levels of inflammation can cause excess androgen production as well as insulin resistance, which we know can disrupt the menstrual cycle (6).

The Mediterranean dietary pattern is a way of eating that focuses on fresh, seasonal fruits, vegetables, pulses, nuts, whole grains, fish, garlic, herbs, spices, and olive oil. It includes moderate amounts of high fat dairy, poultry, and eggs with red meat eaten less frequently. There’s a big focus on cooking, enjoying more meals at home, with minimal amounts of processed foods.

Ongoing studies strongly suggest that a Mediterranean way of eating can help reduce inflammation, and regulate ovulation in women with PCOS. If you’re trying to fall pregnant, this can be a great dietary pattern to follow as it promotes omega-3 fats (7). Omega-3 fatty acids, in particular, have been shown to improve insulin sensitivity and reduce androgen levels in women with PCOS, leading to better ovulatory function.

Moderate amounts of full fat dairy (1-2 serves per day) have also been shown to have a positive effect on ovulation. A study found that full-fat dairy products were shown to lower the risk of ovulatory infertility, with women having a 66% lower risk of ovulatory infertility, and a 27% lower risk of infertility (8).

The Mediterranean dietary pattern is also an overall ‘anti-inflammatory’ style of eating with lots of antioxidants from fruits, vegetables and high quality extra virgin olive oil, which helps to optimsie your egg health, as well as regulate ovulation.

Exercise for ovulation

Studies show that both regular aerobic and resistance exercises can significantly improve insulin sensitivity in women with PCOS. It also helps lower androgen levels by improving overall hormonal balance. This reduction in androgens can lead to more regular menstrual cycles and better chances of ovulation. It can also improve mood and your overall well-being.

A study comparing a group of women with PCOS following a low-calorie diet to a group who exercised for 30 minutes on a stationary bike three times a week found that the exercise group experienced more regular periods and ovulation than those in the diet group (9).

Some examples of aerobic exercise include: Activities like walking, running, cycling, or swimming. Resistance exercises include weightlifting or bodyweight exercise.

Don’t have 30 minutes? Even 10 minutes of moderate walking can help improve ovulation.

Try to gradually build up your activity level, allowing your body to adjust slowly, making it easier to incorporate regular movement into your daily routine over time.

PCOS supplements for ovulation

Many women with PCOS want to consider alternative treatments to medication. There is substantial research supporting the use of the following supplements for enhancing ovulation in women with PCOS, either on their own or in combination with prescribed medications. You can read more about these in my previous blog post here.

Key takeaways

Nutrition plays a vital role in regulating ovulation in women with PCOS by improving insulin sensitivity and balancing hormones. By focusing on diet quality and adopting a low GI, anti-inflammatory way of eating, you can optimise your menstrual cycle and your fertility. Regular movement and supplements can also offer additional support.

This blog post has presented some potential dietary pattern options that may help with managing your PCOS. These should be personalised to meet your unique needs and goals.

If you’re looking for more personalised support to make sustainable & realistic nutrition changes that will help you feel your best with PCOS, please feel free to contact me or book your FREE Discovery Call here.

References

1. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations From the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Hum Reprod (2018) 33(9):1602–18.
2. Shang Y. Dietary Modification for Reproductive Health in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Frontiers in Endocrinology. 202, Vol 12.
3. Chavarro, JE et al. A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. Eur J Clin Nutr. 2009;63(1):78-86.
4. Marsh, K. et al. (2010). The optimal diet for women with polycystic ovary syndrome? British Journal of Nutrition. 2005; 94(2):154-165.
5. Hernandez, TL et al. Effect of a low glycemic diet in patients with polycystic ovary syndrome and anovulation: a randomized controlled trial. Clinical and Experimental Obstetrics and Gynaecology. 2016; 43(4):555-559.
6. Salama, A et al. Anti-Inflammatory Dietary Combo in Overweight and Obese Women with Polycystic Ovary Syndrome. N Am J Med Sci. 2015 Jul; 7(7): 310–316.
7. Yang K, Zeng L, Bao T, Ge J, Chen X. Effectiveness of omega-3 fatty acid for polycystic ovary syndrome: A systematic review and meta-analysis. Reprod Biol Endocrinol. 2018;16(1):27.
8. Chavarro, JE et al. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstet Gynecol. 2007;110(5):1050-1058.
9. Palomba, S. et al. Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study Hum Reprod. 2008 Mar;23(3):642-50.

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With PCOS, high levels of androgens (male-type hormones) and unmanaged insulin resistance can disrupt your monthly cycle of ovulation and periods. This means that your periods may be irregular or stop altogether.

An irregular and unpredictable menstrual cycle is one of the most common and frustrating symptoms of PCOS. However, tracking your menstrual cycle is a powerful way to understand your body and it can help you to better manage your symptoms.

In this blog post, we’ll explore what happens during ovulation, the relationship between PCOS and ovulation, how tracking your cycle can help, and the different methods of ovulation tracking.

What happens during ovulation?

Your ovaries contain a number of follicles, which contain eggs. Ovulation is part of the menstrual cycle when there’s a spike in luteinizing hormone (LH) levels, which triggers the release of the most mature egg from the ovary. The egg then moves along a fallopian tube towards your uterus (1).

This process is a key part of the menstrual cycle and typically occurs about midway through the cycle, around day 14 in a 28-day cycle (although women with PCOS tend to ovulate later) to be fertilised with sperm. If the egg has not been fertilised, it is re-absorbed by the body, the hormone levels drop, and the womb lining is shed, which results in the start of your next period.

How does PCOS affect ovulation?

Hormonal imbalances seen in PCOS (high testosterone and elevated baseline LH levels), can disrupt the maturation of the follicles. The follicles don’t grow or release eggs every month, leading to missed ovulation or delayed cycles. Instead, the follicles remain on your ovaries and can look like lots of cysts on a scan. This is why PCOS is called polycystic (meaning ‘many cysts’) ovary syndrome (2).

What are the benefits of tracking your cycle if you have PCOS?

If you have PCOS, you can get a better sense of your cycles and whether or not ovulation is happening regularly by tracking your cycle.

Tracking ovulation can provide several benefits:

• Understand when you’re most likely ovulating: Tracking ovulation can give you a benchmark to help you understand where you may be in your cycle. You may even discover that you’re likely not ovulating at all, which is important to discuss with your doctor and/or specialist.

• Getting to know your body: Learning about your body’s patterns and what’s normal for your cycle so you can identify changes. Changes in the timing or symptoms that come with your cycle can indicate whether hormone levels are balancing with lifestyle changes or treatments (3).

• Improved chances of conception: Knowing when ovulation occurs can help you time intercourse during your fertile window.

• Better treatment planning: Keeping a record of your cycle (using an app or other recording tool) can be helpful information to share with your doctor and/or specialist. They can use that information to help better manage your symptoms with the most appropriate treatment plan.

How to track ovulation with PCOS

The starting point for all ovulation tracking is to monitor your menstrual cycle. Whether it’s regular or irregular, knowing the pattern by keeping a record can help.

During ovulation, some people may experience breast tenderness, a mild ache, cramp or pain in one side of the lower abdomen (where the ovary is releasing the egg) and bloating. The symptoms can vary, and it’s not a reliable way of predicting ovulation, but noting your symptoms might help to get to know your cycle better.

The symptoms of PCOS can also vary from person to person. Therefore, some of the following methods might work better for your body than others, and you might need to experiment with several ways until you find what works for you.

Here are the main ways that you can try to track and predict ovulation:

Cycle tracking apps

Cycle-tracking apps can help you to establish a record of the timing and length of your cycle. Some apps can make predictions about when your next period or ovulation is likely to come. However, if you have irregular or very long cycles, an app might not be able to predict ovulation.

Ovulation predictor kits

Ovulation predictor kits (available from chemists) work by identifying the level of LH in your urine. Since LH levels surge between 24 and 48 hours before ovulation, tracking LH is one of the best predictors for when you’re likely to ovulate. However, one of the characteristics of PCOS is consistently higher than average LH levels. Therefore, some kits may give false ‘positives’ even when you are not about to ovulate. Fertility experts recommend that with PCOS, you should aim to use a kit which has a threshold well above your baseline to increase the chances of accuracy.

Cervical mucus monitoring

Your cervical mucus changes in consistency throughout your menstrual cycle. Around ovulation, it becomes clear, slippery, and stretchy, similar to raw egg whites. Monitoring these changes can help you to track ovulation.

Basal body temperature (BBT) monitoring

Ovulation causes a slight increase in BBT due to the rise in progesterone following the release of an egg. BBT tracking involves measuring your body’s temperature every morning (at the same time) before getting out of bed, to help you to understand if ovulation has occurred.

Lifestyle changes to support ovulation

Beyond tracking ovulation, dietary and lifestyle modifications play significant roles in regulating insulin levels and restoring hormonal balance, which may lead to more regular ovulation. I’ll be exploring these in greater depth in my next blog article!

Key takeaways

Ovulation tracking with PCOS presents challenges, but it is still achievable with the right methods and patience. Tools such as advanced OPKs, BBT monitoring and cervical mucus observation can help you to better understand your cycles and help to predict ovulation. Whether you’re trying to conceive or simply want to better understand your body, ovulation tracking with PCOS is a powerful tool for managing your reproductive health.

References

1. NHS (2023) Periods and fertility in the menstrual cycle. Accessed at: https://www.nhs.uk/conditions/periods/fertility-in-the-menstrual-cycle/
2. Tommys (2024) PCOS and fertility: everything you need to know. Accessed: https://www.tommys.org/pregnancy-information/planning-a-pregnancy/fertility-and-causes-of-infertility/pcos-and-fertility-everything-you-need-know#pcosovulation
3. Wright, H (2010). The PCOS Diet Plan. Ten Speed Press.

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If you’ve been diagnosed with gestational diabetes, you may be feeling worried about how it will affect your pregnancy and your baby. It might be reassuring for you to know that gestational diabetes is a fairly common condition, and with careful monitoring and treatment, it can be managed, and you can have a safe pregnancy and a healthy baby.

Here’s what you need to know to help keep you and your baby healthy if you’ve been diagnosed.

What is gestational diabetes?

Gestational diabetes is a form of diabetes that can develop during pregnancy where there’s too much sugar in your blood, and in most cases, it goes away after your baby is born.

The glucose (sugar) in your blood is controlled by a hormone called insulin. During pregnancy, hormonal changes can occur, and it can be difficult for your body to use insulin, this is called insulin resistance. Your insulin needs are also 2-3 times higher in pregnancy than at other times. If your body can’t make enough insulin to meet this increased need and overcome the insulin resistance, your blood glucose levels become too high. If left unmanaged, it can cause problems for you and your baby.

Who does gestational diabetes most affect?

Gestational diabetes is common. It affects at least 1 in 20 pregnant women. Any woman can develop the condition during pregnancy, but you’re at an increased risk if:

• You’re overweight or obese.
• You had gestational diabetes in a previous pregnancy.
• You had a baby who weighed 4.5kg or more at birth.
• You have a family history of diabetes (a parent or a sibling).
• You have a South Asian, Black, African Caribbean or Middle Eastern background.

What are the symptoms of gestational diabetes?

Many women don’t experience any symptoms, but some symptoms to look out for include:

• Excessive thirst.
• Going to the toilet more often.
• Tiredness and lethargy.
• Blurred eyesight.

Many of these symptoms are like those experienced in pregnancy, but they can also be signs of gestational diabetes.

How do I know if I have gestational diabetes?

Screening tests for gestational diabetes usually occur between 24 and 28 weeks of pregnancy. If you’re at increased risk of gestational diabetes you’ll be offered a test earlier in your pregnancy, which is then repeated later. The screening test is called an oral glucose tolerance test (OGTT). On the day of the test, you’ll have a blood test taken after fasting overnight. You’ll then be asked to drink a very sweet glucose drink and you’ll have another blood test 2 hours after drinking this. The test will look at how your body and insulin are coping with the glucose.

What effects does gestational diabetes have on my pregnancy and my baby?

If poorly controlled, gestational diabetes can cause problems for you and your baby. These include having a big baby, which can make the birth difficult. It can also put you at increased risk of high blood pressure and pre-eclampsia. You could also have an increased risk of developing diabetes in the future. Uncontrolled gestational diabetes could also lead to potential problems for your baby at birth, such as breathing difficulties, low blood sugar levels and jaundice. The good news is that if your blood glucose levels are well controlled during pregnancy then it can reduce the chances of these problems occurring.

How is gestational diabetes treated?

Most women can manage their gestational diabetes with healthy eating, exercise, and regular blood glucose monitoring. You’ll also be more closely monitored by your diabetes and antenatal team during your pregnancy and birth to check for any potential problems.

I’ve been diagnosed with gestational diabetes, what changes can I make to my diet before I see my diabetes and antenatal team?

Eating a healthy balanced diet is important for you and your baby. When you have gestational diabetes your dietary choices affect your blood glucose levels.

Here’s my 5 top tips to help control your blood glucose levels:

• Eat regularly. Have regular meals (usually 3 meals a day). Try not to skip meals.
• Eat smart carbohydrates. Good options include wholegrain breakfast cereals or oats, wholegrain bread, wholemeal pasta, pulses such as chickpeas, beans and lentils, brown rice or basmati rice. These contain higher amounts of fibre, vitamins, and minerals. They also have a lower glycaemic index (GI). This means they are slow-digesting carbohydrates and raise your glucose level slowly, which can help to control blood glucose levels.
• Limit sugary foods and drinks including soft drinks, cordials, sweets, chocolates, biscuits and desserts.
• Limit foods which are high in saturated fat such as fried foods, pastries, crisps, biscuits and cakes.
• Keep moving. Enjoy being active each day.

If you’ve been recently diagnosed with gestational diabetes, working with a dietitian will help you to make the best nutritional choices for you and your baby.

Book your free 20-minute Discovery Call today and we can discuss ways in which I can optimise your pregnancy health.

References

1. Diabetes.org.uk. Accessed 23rd November 2023 from: https://www.diabetes.org.uk/diabetes-the-basics/gestational-diabetes
2. National Institute for Health and Care Excellence (NICE) Diabetes in pregnancy: management from preconception to the postnatal period: NICE Guideline (NG3). 2015. Accessed 23rd November 2023 from: https://www.nice.org.uk/guidance/ng3/chapter/Recommendations#gestational-diabetes-2
3. Scottish Intercollegiate Guidelines Network (SIGN) Management of diabetes in pregnancy: from contraception to postnatal period. SIGN Guideline (116, 7). 2017. Accessed 23rd November 2023 from: https://www.sign.ac.uk/assets/sign116.pdf
4. Star A, Vandervliet L 2018. Growing Baby Bean: A Complete Guide to Pregnancy Nutrition. Dr Anita Star Nutrition Consultant: Albury, Australia.

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Following a healthy, balanced, nutrient-rich diet in the pre-conception period will not only boost your chances of becoming pregnant, but it can also influence your pregnancy outcomes and the lifelong health of your baby.

So, let’s take a look at some of the key changes you may need to consider during the pre-conception period as a woman.

Folate

This vitamin is essential to support the healthy development of your baby’s neural tube, which is your baby’s brain and spinal cord, during the first 12 weeks of pregnancy. Therefore, it is crucial that you get lots of folate both before and during pregnancy.

Folic acid may also increase your chances of becoming pregnant. A study by Gaskins (2012), found that optimal folic acid intake may stimulate regular ovulation by increasing the progesterone levels needed for pregnancy.

Folate can be found in many foods, including green leafy vegetables (such as spinach and broccoli), avocados, and lentils. However, folate is easily lost from your body, and low folate levels in women are common. Therefore, taking a supplement containing 400ug of folic acid at least 12 weeks before, and 12 weeks into pregnancy is essential.

Vitamin B12

This vitamin plays a key role in fertility. If you are deficient in vitamin B12, you may have difficulty becoming pregnant. Inadequate levels can cause changes in the blood which can in turn affect egg development and ovulation.

You can find vitamin B12 in any animal-based foods such as meat, poultry, fish, eggs, and milk. If you follow a strict vegetarian or vegan diet, you will need to take a supplement. You can ask your GP to check your current levels, and a dietitian can recommend the most appropriate pre-conception supplement regime for you.

Vitamin D

Vitamin D is well known for its role in bone and immune health, but it also plays a key role in pre-conception health, where it supports hormone balance, ovulation, egg development, and embryo quality.

Vitamin D is found in small amounts in foods such as oily fish, eggs, and fortified foods. UV light from sunlight is the best source of vitamin D.

Vitamin D deficiency is common, due to less time spent outdoors, (especially during the current COVID-19 pandemic) and when sunlight exposure is low during the winter months. A vitamin D intake of 10mcg (400UI) per day is recommended from the month of October to March and exposure to sunlight of at least 5-15 minutes/ day during the summer months is recommended to avoid deficiencies.

Iron

This mineral’s main role is to carry oxygen around our body. When iron levels are low, oxygen supply is decreased. If you have an iron deficiency (anaemia) it can leave you feeling exhausted and weak. Iron deficiency can also have a big impact on your fertility.

Researchers (Chavaro et al., 2006) found that women with inadequate iron stores are more likely to suffer from anovulation, (meaning they fail to ovulate). Furthermore, when our iron stores fall into an unhealthy range, there is insufficient oxygen delivery to our reproductive organs, and this can affect egg quality.

It is crucial to make sure your iron levels are within the normal range during the preconception period to avoid ovulation issues and to help prevent anaemia once you become pregnant.

The best source of iron comes from lean red meat, but it is also found in chicken, fish, eggs, green leafy vegetables, and legumes.

Zinc

Zinc is a trace mineral and has a number of functions, including assisting our immune system, regulating insulin, and acting as a building block for new cells. It’s so important that your body has enough zinc in the pre-conception period to support rapid cell growth that is required for the health of your eggs, and for successful embryo development.

You can find zinc in a range of foods including beef, chicken, fish, oysters, milk, pulses, nuts and seeds.

Omega 3

Omega-3 is a type of fatty acid that has strong anti-inflammatory properties and is a powerhouse nutrient to include in your diet, particularly during the pre-conception period.

A study by Gaskins et al. (2018) found that diets rich in omega-3 fatty acids can improve fertility where they can reduce oxidative stress and improve egg quality. Additionally, omega 3, particularly the docosahexaenoic acid, (DHA) type is vital for your baby’s brain and eye development.

Fish is the best source of omega 3, with oily fish such as salmon, trout, sardines, and mackerel being excellent sources, fish should be eaten at least twice a week in a pre-conception diet. If you don’t eat fish, try to include the plant-based version of DHA which is found in walnuts, flaxseeds and chia seeds, or consume a supplement.

If you’re looking for more personalised support to help you to optimise your pre-conception diet and prepare your body for pregnancy, please feel free to contact me.

References

1. Chavarro, J. E., Rich-Edwards, J. W., Rosner, B. A., & Willett, W. C. (2006). Iron intake and risk of ovulatory infertility. Obstetrics and Gynecology, 108(5), 1145–1152. https://doi.org/10.1097/01.AOG.0000238333.37423.ab
2. Gaskins, A. J., & Chavarro, J. E. (2018). Diet and fertility: a review. American journal of obstetrics and gynecology, 218(4), 379–389. https://doi.org/10.1016/j.ajog.2017.08.010
3. Gaskins, A. J., Mumford, S. L., Chavarro, J. E., Zhang, C., Pollack, A. Z., Wactawski-Wende, J., Perkins, N. J., & Schisterman, E. F. (2012). The impact of dietary folate intake on reproductive function in premenopausal women: a prospective cohort study. PloS one, 7(9), e46276. https://doi.org/10.1371/journal.pone.0046276

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Oxidative stress is an important cause of infertility. As a woman ages there is a gradual increase in the levels of oxidative stress within the ovarian follicular fluid. High levels of oxidative stress correlate with poor egg quality and diminishing embryo development.

The good news is that high-antioxidant foods are widely used to detoxify excess free radicals that can cause inflammation and affect fertility. A study published in the Journal of Fertility and Sterility, suggested that women who had at least one previous IVF cycle had an improved outcome after taking high levels of the antioxidant-rich Acai berry prior to their next attempt. Despite the small sample size, 81% of study participants achieved ongoing clinical pregnancies.

For more information: https://www.fertstert.org/article/S0015-0282(20)31374-1/fulltext

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