Polycystic ovary syndrome (PCOS) is a common endocrine disorder of unknown cause that is estimated to affect 3% to 12% of women of childbearing age in Western societies.

This syndrome is characterized by

• Amenorrhea or other menstrual irregularities

• Absence of ovulation of a large ovary with multiple cysts

• Infertility

More common symptoms of polycystic ovary syndrome include

• Acne

• Hirsutism (abnormal distribution of hair growth)

• Baldness with a male pattern

• Obesity

• Sleep apnea

Biochemical and metabolic abnormalities in women with polycystic ovary syndrome include a hyper-androgenic condition in which high concentrations of free androgens (dehydroepiandrosterone , testosterone, and androstenedione) and decreased hepatic production of sex hormone binding globulin (SHBG).
In addition to elevated levels of androgens, hyperinsulinemia (due to insulin resistance), impaired glucose tolerance, and hyperlipidemia may be observed.
Hyperandrogenism is responsible for many of the symptoms of polycystic ovary syndrome, such as menstrual and fertility disorders, hirsutism (abnormal distribution of hair growth), and acne.
In fact, it seems that the increase in androgen levels is partly due to hyperinsulinemia, which stimulates increased androgen production. Therefore, insulin resistance-modifying interventions and hyperinsulinemia may correct some manifestations of polycystic ovary syndrome.
Insulin resistance, which is seen in 50% to 70% of women with symptoms of polycystic ovary syndrome, is unique and somewhat independent of body weight, so it does not always improve with weight loss. 
This condition appears to be due to a defect in the insulin-mediated receptor pathway.
Common treatments for polycystic ovary syndrome include weight loss through exercise and diet modification.
In obese women, weight loss may correct insulin resistance, reduce androgen levels and hirsutism (abnormal and excessive distribution of hair growth), and in some cases restore ovulation.

Historically, diets with low glycemic index have always been recommended without evidence of their clinical effects.
However, in polycystic ovary syndrome, the capacity of dietary carbohydrates to increase the postprandial blood sugar response is of great importance in optimizing clinical and metabolic outcomes.
In addition, it seems that independent of weight loss, a diet with a low glycemic index, especially when its macronutrient and fiber content is exactly matched, leads to a greater improvement in health compared to a traditional low-fat diet. Its benefits include improved insulin resistance, regular menstruation, better emotional intelligence scores (based on a questionnaire designed to detect changes in quality of life), and reduced markers of inflammation.

Management and medical care of polycystic ovary syndrome

Hypothyroidism (hypothyroidism) occurs in some people with polycystic ovary syndrome. Laboratory tests of thyroid function are usually normal in patients with clinical evidence of hypothyroidism, but in many patients’ treatment with thyroid hormones improves clinical symptoms.
Therefore, experimental thyroid hormone testing should be considered in all patients with polycystic ovary syndrome and clinical evidence of hypothyroidism. In women with polycystic ovary syndrome, a small amount of thyroid antibodies should also be tested before starting experimental treatment with thyroid hormones.
Metformin is usually prescribed to improve insulin resistance and ovulation may resume when treatment with metformin begins.

Other treatments also include medications

• Clomiphene citrate (to induce ovulation)

• Spironolactone (anti-androgen)

• Contraceptive pills are used to treat menstrual irregularities and hirsutism (abnormal and excessive distribution of hair growth)

Nutrition and medical treatment regimen in people with polycystic ovary syndrome

In women with polycystic ovary syndrome, nutritional interventions include nutritional programs are designed to increase insulin sensitivity.

 These interventions include

• Limit consumption of purified carbohydrates

• Total calories

• Consume high fiber foods

• Consume small meals more often.

Some patients with insulin resistance respond better to diets containing more complex carbohydrates. Others respond better to low-carb diets (40% of total energy).
In addition, supplementation with vitamin D3 (more than 10,000 international units per day) and chromium picolinate (200 to 1000 micrograms per day) has been reported to improve insulin resistance and secretion and insulin sensitivity in human and animal’s samples.
Also in women with clomiphene citrate-resistant infertility, short-term treatment with N-acetyl-cysteine  (600 mg twice daily) may be helpful as an adjunct to clomiphene citrate.
In addition, thyroid hormone therapy may have benefits in women with clinical and laboratory evidence of hypothyroidism.

Nutritional therapy (nutritional therapy) for polycystic ovary syndrome

Obesity

Establish a weight management and control program along with diet and exercise modification

Insulin resistance

• Limit your intake of pure carbohydrates (low glycemic index diet) and total calories

• Increase consumption of high-fiber foods

• Advise to eat more meals with less volume

• Careful monitoring to demonstrate the benefits of a low carb versus high carb diet

• Pay attention to supplement therapy with chromium picolinate

Serum levels of 25-hydroxyvitamin D are low

Prescribing vitamin D (cholecalciferol)

Infertility resistant to clomiphene citrate

Short-term use of N-acetyl cysteine as an adjunctive therapy

Clinical and laboratory evidence of hypothyroidism (hypothyroidism) 

Thyroid hormone replacement
Use foods or iodine and selenium supplements

Thyroid Health Promoting Factors in Adults

Permissible and significant

• Protein 8 grams per kilogram of body weight per day

• Iodine (when rejecting autoimmune disease): 150 micrograms per day of selenium

• Zinc: 75 to 200 micrograms per day

• Vitamin D (Vitamin D3 or Calciferol): 400 IU per day

• Vitamin C (or ascorbic acid): 100 to 500 mg per day

• Gogolstrons: 100 mg per day

Reduce or remove

• Gluten: (found in rye wheat, judo, barley)

• Processed soy

• Excessive consumption of raw or uncooked goiter-causing foods