PCOS And Fish Oil
PCO - what?!
PCOS or polycystic ovarian syndrome, is the most common endocrine disorder among reproductive-age women, affecting approximately 6 to 10% of females. PCOS is the most frequent cause of irregular periods, and one of the condition’s defining features is multiple cysts on the ovaries (1). This name can be misleading however, as PCOS is more than simply a reproductive condition, but a complex metabolic condition thought to be rooted in increased androgens and insulin resistance (1,2). 
When using the term insulin resistance, it is synonymous with what is often happening in type 2 diabetes, meaning that your body is increasingly becoming less sensitive to the effects of insulin - the hormone that takes glucose out of our blood and re-directs this energy into our cells for storage (this definition becomes important later)(2). In an insulin resistant state, your pancreas is having to work overtime to keep your blood glucose levels stable, resulting in a constantly higher than normal amount of insulin circulating in your body. This can manifest in many outwardly noticeable symptoms such as abdominal weight gain, extreme fatigue, acne and irregular periods, but it can also have wide ranging health implications for the systems that we can’t see - largely your cardiovascular, metabolic, psychologic and hormonal axes.
Although PCOS is the most common cause of irregular periods, it is much more than that. Women with PCOS are 2x as likely to have metabolic syndrome, 4x higher risk for type 2 diabetes, and approximately 50% of this population is considered overweight or obese (3). The metabolic dysfunction associated with PCOS is far-reaching, with an increased prevalence of fatty liver disease, mood disorders, cardiovascular disease and dyslipidemia, making this unfortunately very common, multi-faceted metabolic disorder one of great importance to effectively treat (3).
What's happening in my body?
Starting at the level of the pituitary, the gland responsible for much of the hormonal release in our bodies, women with PCOS are associated with an increased secretion of something called luteinizing hormone (LH). LH is responsible for the production of androgens, commonly referred to as “male hormones” and their release from ovarian cells (2). Although not necessary for a diagnosis of PCOS, polycystic ovaries are present in about 20-30% of this population, and are actually not true “cysts”, but multiple immature ovarian follicles (2).
Baseline levels of increased androgens in the ovarian cells prevent the conversion of androstenedione (an androgen) to estradiol, the “female” hormone critical for maturation and growth of an egg. Excess levels of insulin further compound this inhibition, as hyperinsulinemia promotes increased androgen production (testosterone & androstenedione), while simultaneously making testosterone more bioavailable in our body via decrease of SHBG (sex hormone binding globulin) production from the liver.
This duo works together to inhibit follicles from fully maturing, halting regular ovulation and consequently preventing mature egg release from the ovaries, resulting in what we commonly know as “cysts” (2).
How do I know if I have PCOS
The Rotterdam Criteria is a set of criteria widely accepted and used by clinicians to diagnose PCOS. According to the Rotterdam criteria, diagnosis requires the presence of at least two of the following three findings
- abnormal periods: either absent periods (three to six months with no period), or irregular periods (periods that start more than 35 days apart on average)
- evidence of high male hormones (this can be either elevated male hormone levels on tests, or physical symptoms of high male hormones such as acne, loss of hair on the scalp, or male-pattern hair growth on the body or face (aka hirsutism)
- polycystic ovaries seen on ultrasound
Common Signs and Symptoms of PCOS
-irregular or absent periods -infertility or difficulty getting pregnant -excessive hair growth (hirsutism) – typically in areas thoughts to be male dominant - usually on the face, chest, back or buttocks -weight gain or difficulty losing weight -thinning hair (aka androgenic alopecia) -acanthosis nigricans - darkened, velvety skin patches in folds of skin (neck, groin, armpits) -oily skin or acne -depression, low self-esteem and negative self-image -insulin resistance - due to the high prevalence of glucose and insulin dysfunction, PCOS is often associated with the classic signs of metabolic syndrome, including fatty liver, dyslipidemia & increased abdominal fat
So, what can I do to most effectively manage my PCOS? What can omega-3’s do?
Fortunately, the first line treatments for managing PCOS are all lifestyle based, with evidence telling us that making healthier dietary choices, increasing daily exercise and a weight loss of as little as 5-10% showing to restore proper ovulation, regulate menstrual cycles and improve fertility rates (2,3).
To complement positive lifestyles changes, supplementation can be instrumental achieving your health goals, especially when considering PCOS and the multiple areas of metabolic and hormonal dysregulation that come hand-in-hand with this diagnosis. This is where omega-3’s swoop in as the MVPs. They are ideally suited for any condition rooted in insulin resistance, as their anti-inflammatory effects have such wide-reaching effects throughout the body, that they have the unique ability to help many areas of dysfunction in just one supplement. 
1. Improvements in mental health parameters (4) Women with PCOS are associated with having higher rates of depression, anxiety and negative self-image, often due androgenic symptoms (hair growth, acne) and struggles with infertility. 2,000mg of fish oil per day (containing 240mg EPA + 160mg DHA) for 12 weeks was shown to significantly improve depression scores in those with PCOS.
2. Reduction in androgenic profiles & regulation of menstrual cycles (5) Evidence to support consistent reduction of androgenic profiles in women with PCOS is mixed, but one interesting study published in 2013 found that 8 weeks of supplementation with 3g (mixed EPA+DHA) per day resulted in significantly lower testosterone levels and a higher return to regular menstruation, compared to placebo (47.2 vs 22.9%).
3. Insulin sensitizing effects & favourable impacts on dyslipidemia (6) Enhancing ability to use glucose and insulin is critical in those with PCOS, to both treat underlying metabolic dysfunction, but also to reduce the effect that insulin has spurring on androgen production. Altered lipid metabolism is also a hallmark co-morbidity of PCOS, making it an important target when considering whole body-health and reducing risk of cardiovascular disease in the future. A meta-analysis and systematic review published in 2018, looked at nine trials dosing omega-3’s anywhere from 900mg-4000mg, and found consistent significant improvements in insulin sensitivity (measured via HOMA-IR), and a decrease in serum triglycerides, total cholesterol and LDL-C (AKA “bad cholesterol”).
*As always, please speak to your health care practitioner about what dose of omega-3’s would be best for you as an individual.
