What is PCOS? Advice for Polycystic Ovary Syndrome

Reviewed by way of Stephanie Paver, MS, RD

What is PCOS | Causes | Symptoms | PCOS Diet | Treatment | Weight Loss | For Coaches

Acne, hair in bizarre puts, weight achieve, wonky classes, and fertility struggles.

Those are simply one of the most signs of polycystic ovary syndrome (PCOS), a hormonal drawback that is affecting as much as 20 % of ladies international.1, 2

Because of its numerous signs in conjunction with the loss of a transparent diagnostic check, some girls will have to wait years—and spot a couple of well being execs—sooner than they get a correct analysis.3

Even with excellent recommendation, girls with PCOS might combat to do what they know is excellent for them:

▶ If fatigue is a matter, workout can really Feel as interesting as hauling rubbish on a sizzling day.

▶ If sleep is elusive, urge for food may accentuate, making processed meals appear all of the extra impossible to resist.

▶ If psychological well being is struggling, the whole thing may appear more difficult.

Also irritating: Trying to search out constant, evidence-based PCOS recommendation at the Internet. Seriously. Ugh.

That’s why we wrote this newsletter—so coaches and folks with PCOS can in finding relied on recommendation that in truth works.

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What is polycystic ovary syndrome (PCOS)?

Physicians diagnose PCOS when somebody reveals a minimum of two of the next:

✓ Irregular classes: They is also shorter than 21 days, longer than 35 days, or totally absent.

✓ “Cysts” within the ovaries: Confirmed by way of an ultrasound, those growths aren’t true cysts, however somewhat a build-up of egg follicles.

✓ High androgen ranges, like testosterone: This is showed by way of a blood check or visual indicators like facial hair, pimples, or male trend baldness.

Though no longer a diagnostic standards, excessive insulin ranges and a discounted skill to tolerate carbohydrates also are not unusual.

Biology lesson: The PCOS hormonal cascade

PCOS most probably originates within the hypothalamus, a small area within the mind which—amongst different issues—is in control of regulating hormones.

In a typical menstrual cycle, the hypothalamus releases a hormone known as gonadotropin-releasing hormone (GnRH) in common pulses, triggering the pituitary gland to liberate two different hormones:

• follicle-stimulating hormone (FSH)
• luteinizing hormone (LH)

FSH and LH commute to the ovary, prompting the discharge of estrogens, androgens, and progesterones. The proper ratio of those hormones stimulates ovulation, or the discharge of an egg.

In PCOS, the hypothalamus releases GnRH at a better frequency.

Faster and longer GnRH pulses disrupt the standard ratio of LH and FSH. Many (regardless that no longer all) girls with PCOS could have upper ranges of LH. More LH triggers the manufacturing of extra androgens—like testosterone—and inhibits ovulation.

High insulin—a not unusual function of PCOS—can additional give a contribution to androgen manufacturing in addition to lower any other hormone known as intercourse hormone binding globulin (SHBG), which can result in even upper quantities of circulating unfastened testosterone.

Women may additionally have dysregulated thyroid and adrenal serve as.

Just just like the ovaries, the thyroid and adrenal glands rely on commonplace hypothalamic and pituitary serve as.

It’s this hormonal circus that reasons the grab-bag of signs that seem throughout quite a lot of programs of the frame.

What reasons PCOS?

PCOS arises from a mix of 4 primary influences.

Genetics

Multiple genes give a contribution to an higher chance of PCOS, even supposing wearing a particular gene variant doesn’t ensure you’ll showcase signs.4, 5, 6

The fetal setting

If your mom has upper ranges of testosterone throughout her being pregnant with you, your chance of creating PCOS is going up.7, 8

Childhood trauma

Chronic pressure early in existence may end up in adjustments within the mind that modify hormone legislation, and build up the danger of many illnesses, corresponding to immune, metabolic, cardiovascular, and psychiatric issues.9, 10

Women with PCOS are two times as prone to have skilled youth trauma.11

Lifestyle conduct

A sedentary way of life, deficient vitamin, and weight problems give a contribution to insulin resistance and extra irritation.

This makes PCOS much more likely, in addition to worsens signs.

Getting ok motion, excellent vitamin, and managing weight gained’t treatment you in case you have PCOS, however they may be able to toughen signs, high quality of existence, and long term well being results.12

Several environmental pollution had been related to PCOS, too.13

These come with brominated diphenyl ethers, polychlorinated biphenyls, organochlorine insecticides, perfluorinated compounds, phthalates, and bisphenol A (BPA). Major hormone disruptors, those chemical compounds are present in air, water, soil, and meals, in addition to in family cleansing provides, meals packing containers, and attractiveness merchandise.

PCOS signs

Hormonal imbalances produce a constellation of signs, which range from individual to individual and vary from very delicate to serious.

▶ Menstrual irregularities: In addition to being longer or shorter than same old, classes can be tremendous heavy or very gentle.

▶ Infertility / anovulation: High ranges of androgens prevent the discharge of an egg, inhibiting ovulation.

▶ Ovarian “cysts” / follicles: Many—however no longer all—girls with PCOS have a build-up of immature ovarian follicles (regularly erroneously known as “cysts”).

▶ Changes in hair expansion: High androgen ranges may cause coarse hair to broaden at the face, chest, stomach, or again, a symptom referred to as hirsutism. Meanwhile, hair on the crown and frontline of the pinnacle might start to skinny.

▶ Weight achieve and / or cussed weight reduction: Weight can stick round like a cussed barnacle, most likely because of the combo of excessive androgens, excessive blood sugar and insulin, unregulated irritation, and/or a slow thyroid.

▶ Acne: High androgen and insulin ranges might give a contribution to oily pores and skin and cussed pimples—particularly across the chin, but additionally on different portions of the face, again, or chest. Painful, longer-lasting cysts too can seem across the underarms, below the breasts, or across the groin, a situation known as hidradenitis suppurativa or pimples inversa.

▶ Dark pores and skin patches: Also referred to as acanthosis nigricans, excessive insulin ranges may cause darkened, thickened, velvety pores and skin within the creases of the frame, specifically across the armpits, neck, and groin.

▶ Low power and carb cravings: Some girls with PCOS have a discounted skill to tolerate processed carbs. Translation: quarter-hour after you’ve eaten that scone, you’ve dozed off and your face is molding in your keyboard.

▶ Increased chance of diabetes: Compared to the overall inhabitants, girls with unmanaged PCOS are greater than 4 occasions much more likely to broaden kind 2 diabetes, and just about 3 times much more likely to broaden gestational diabetes.14

▶ Blood lipid imbalances: High blood sugar and insulin can give a contribution to low ranges of high-density lipoprotein (the “excellent” ldl cholesterol), excessive triglycerides, and a better chance of heart problems.

▶ Sleep problems: PCOS is related to sleep apnea, which is when respiring periodically stops throughout sleep.15

▶ Mood swings, nervousness, and despair: PCOS can build up the possibility of temper swings, nervousness, and despair.16 Because many ladies with PCOS combat with their weight, they’re additionally at an higher chance of disordered consuming.

Both the visual and invisible signs of PCOS can also be extremely distressing, taking a toll on vainness.

Thankfully, there’s lend a hand.

PCOS and Hashimoto’s thyroiditis.

Women with Hashimoto’s thyroiditis—an autoimmune situation of the thyroid—are greater than 3 times as prone to have PCOS, in comparison to the common inhabitants.17, 18

Why are the 2 similar? It’s nonetheless unclear.

What we do know:

• Both PCOS and Hashimoto’s thyroiditis have a robust genetic element. A handful of genes (FBN, GNRHR and CYP1B1) had been related to each, even supposing researchers aren’t assured those genes absolutely give an explanation for their affiliation.19
• Women with PCOS have a better estrogen to progesterone ratio, which will build up immune process. This is unhealthy information for autoimmune stipulations like Hashimoto’s, that are characterised by way of an already overactive immune machine.
• Women with PCOS will have much less intestine microbiome range.20, 21 This can additional compromise the immune machine.

This panorama in is like including fuel to an autoimmune hearth, expanding the possibility of Hashimoto’s.22

PCOS remedy

Out there at the Internet, you’ll in finding PCOS remedy plans that record dozens of “by no means devour” meals and sweat-til-you-drop health regimens.

You gained’t in finding that right here. In our revel in of running with over 100,000 purchasers, we all know something evidently: It takes a unprecedented consumer to constantly persist with an excessive vitamin and health plan.

The excellent information: Most folks see huge enhancements with simply 3 tiny and much-more-realistic way of life adjustments.

The PCOS vitamin: Be sensible with carbs

To arrange power and blood sugar, you don’t want to (and most certainly shouldn’t) keep away from carbs altogether, however a little analysis presentations that decrease carb—and most likely low dairy—diets can also be useful.23

The recommendation

Put the focal point on what to devour somewhat than what to not devour. Aim for roughly 10 grams of fiber and 20-30 grams of protein (more or less one palm-sized portion) in keeping with meal by way of development plates round those nutrient-rich meals.

• Lean proteins: meat and poultry, fish and shellfish, eggs, tofu and tempeh
• Colorful non-starchy greens: cruciferous veggies (suppose: broccoli, cabbage, and kale), lettuces, cucumber, celery, summer season squash, tomatoes, mushrooms, peppers, and asparagus
• Low-sugar end result: berries, apples, oranges, and plums
• Healthy fat: avocado, olives, nuts and seeds, and oils (olive and coconut)

With the above taking on probably the most house, fill out your plate with smaller quantities of dairy, starchy veggies, or complete grains.

For lend a hand making extra nutritious meals possible choices, take a look at this visible information: ‘What will have to I devour?!’

And for extra particular vitamin suggestions adapted in your frame, way of life, and targets—together with portion ideas for the above meals teams—see: The Precision Nutrition Calculator.

Are there any dietary supplements that lend a hand PCOS?

Below is an inventory of among the finest, evidence-based dietary supplements used to regulate PCOS.

If you’re a trainer, inspire your shopper to first communicate to their physician.

PCOS workout: Find blissful motion

Most beings take pleasure in common motion. (Even puppy hamsters are happier with a working wheel of their cage.)

In girls with PCOS, workout can:

• Improve ovulation and menstrual regularity31
• Improve insulin sensitivity
• Decrease androgens
• Decrease chance of heart problems
• Improve psychological health32, 33

These advantages display up without or with further adjustments in vitamin and without reference to weight adjustments. Meaning: Exercise is a superpowered software.

The recommendation

Aim for no less than 120 mins of moderate-intensity workout a week.34 That interprets to about 4 30-minute periods, with (preferably) part of the ones periods dedicated to resistance coaching.

But get started anyplace you might be.

▶ If you’re a standard fitness center go-er, stay at it. Resistance coaching is also particularly advisable, as it is helping toughen insulin sensitivity and the ratio of fats to lean mass.35 (Plus, lifting heavy issues feels badass.)

▶ If you get your motion most commonly from errands, like wearing your groceries or strolling to the bus prevent, check out including a bit of extra. Consider monitoring your steps to get a baseline, then set a function for a better quantity. Or, upload a a couple of times weekly on-line or in-person workout magnificence or exercise. (For a zero-equipment, 10-minute exercise see: How to stick in form while you’re busy.)

▶ If the phrase “workout” makes you wish to have to clean your mouth with cleaning soap, simply get started any place. Even a five-minute stroll or a dance birthday celebration counts. (Wagging your finger and announcing, “Nuh-uh,” doesn’t. Nice check out regardless that.)

What’s maximum vital: Find one thing that you simply in truth experience doing, since you’ll be much more likely to stay at it.

Choose the workout taste that the majority appeals to you. As you get comfy and in keeping with extra motion, reconsider, and upload a bit of extra if that aligns together with your skills and targets.

PCOS: Two differing types?

Women with PCOS will have fairly other hormonal profiles (and signs) relying on whether or not additionally they have extra frame fats. Recognizing the 2 subpopulations, mavens use those terms36:

• The reproductive kind (occasionally known as “lean PCOS”) has a tendency to have a decrease BMI and not more insulin resistance, however upper luteinizing hormone (LH) and intercourse hormone binding globulin (SHBG).37
• The metabolic kind has a tendency to have a better BMI, extra glucose and insulin dysregulation, and decrease LH and SHBG ranges.

With the exception of weight reduction, the way of life suggestions we advise on this article nonetheless observe to each teams.

Stress control: Self-kindness is the brand new cool

With PCOS, it may be simple to fall into self-criticism and pessimistic considering. That’s why, as you do your easiest to make wholesome adjustments on your existence, additionally herald an abundance of self-compassion.

The recommendation

Pay consideration in your ideas, and while you understand your self being unkind or overly crucial, apply talking to your self as you can your easiest pal.

Acknowledge that your situation generally is a actual combat occasionally.

And whilst it’s no longer your fault, it’s your duty to handle your self in the most efficient and kindest means you’ll.

It might lend a hand to take into account that many different girls are coping with PCOS too. Joining a PCOS fortify staff, and even simply excited about the opposite girls who’re “on this” with you’ll be useful.

In addition to a self-compassionate mindset, be sure you prioritize the ones stress-busting fundamentals.

▶ Get ok sleep. Good sleep is helping stability hormones and temper, makes it more uncomplicated to keep watch over weight and urge for food, and decreases the risk of “Tiredzilla” popping out to torment your family and friends. (For recommendations on how you can toughen sleep, learn: The energy of sleep.)

▶ Include day by day stress-relieving actions. Meditation, walks in nature, time with family members, and artistic leisure pursuits are stress-busting superstars. For much more pressure reducers, learn: Feel such as you’re failing at self care? 3 answers that may in truth lend a hand.

▶ Be aware of the way you body your PCOS tale. Are you a helpless PCOS sufferer? Or, can PCOS be a possibility to be told extra about your well being and take higher care of your self? Which tale feels higher? Which tale motivates you to take empowering motion?

Of route, occasionally you’ll “do the whole thing proper” and nonetheless really Feel totally beaten, possibly even hopeless. If that’s the case, achieve out. Talk to a relied on cherished one, your physician, or a psychological well being skilled.

Sometimes simply figuring out somebody else is in your staff could make the variation between “I’m in a black hollow and I will be able to’t get out” and “I see some gentle on the finish of the tunnel.”

PCOS and weight reduction

The reality is: It can also be more difficult to shed pounds when you’ve got PCOS.

That’s one reason it’s higher to concentrate on the way of life conduct we discussed within the earlier phase. After all, what you devour and the way you progress has a larger affect in your well being and signs than does your weight at the scale.

In many instances, fats loss will occur as a herbal facet impact of higher total well being. But if it doesn’t, you’ll nonetheless be consuming, transferring, feeling, and dwelling higher.

Advice for coaches

As a trainer, it’s simple to really Feel from your realm, questioning: “Am I actually certified to lend a hand somebody with PCOS?”

And whilst coaches can’t diagnose or deal with PCOS, you completely can fortify them—no particular certifications required.

Keep in thoughts: Your shopper most probably has get admission to to healthcare mavens who know the most recent PCOS analysis and coverings.

What’s lacking out of your shopper’s existence: Someone who can lend a hand them put what their physician recommends into apply.

Most most probably, their physician will counsel methods which are reasonably very similar to the methods you’ve already used with different purchasers: workout, wholesome consuming, and pressure reduction, all of which will toughen signs of PCOS significantly.

Stay inside of your scope, and be the most efficient cheerleader you’ll.

References

Click right here to view the guidelines assets referenced on this article.

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2. Sirmans, Susan M., and Kristen A. Pate. 2013. “Epidemiology, Diagnosis, and Management of Polycystic Ovary Syndrome.” Clinical Epidemiology 6 (December): 1–13.

3. Tomlinson, Julie A., Jonathan H. Pinkney, Phil Evans, Ann Millward, and Elizabeth Stenhouse. 2013. “Screening for Diabetes and Cardiometabolic Disease in Women with Polycystic Ovary Syndrome.” Diabetes & Vascular Disease Research: Official Journal of the International Society of Diabetes and Vascular Disease 13 (3): 115–23.

4. Crespo, Raiane P., Tania A. S. S. Bachega, Berenice B. Mendonça, and Larissa G. Gomes. 2018. “An Update of Genetic Basis of PCOS Pathogenesis.” Archives of Endocrinology and Metabolism 62 (3): 352–61.

5. Dunaif, Andrea. 2016. “Perspectives in Polycystic Ovary Syndrome: From Hair to Eternity.” The Journal of Clinical Endocrinology and Metabolism 101 (3): 759–68.

6. Vink, J. M., S. Sadrzadeh, C. B. Lambalk, and D. I. Boomsma. 2006. “Heritability of Polycystic Ovary Syndrome in a Dutch Twin-Family Study.” The Journal of Clinical Endocrinology and Metabolism 91 (6): 2100–2104.

7. Dumesic, Daniel A., David H. Abbott, and Vasantha Padmanabhan. 2007. “Polycystic Ovary Syndrome and Its Developmental Origins.” Reviews in Endocrine & Metabolic Disorders 8 (2): 127–41.

8. Tata, Brooke, Nour El Houda Mimouni, Anne-Laure Barbotin, Samuel A. Malone, Anne Loyens, Pascal Pigny, Didier Dewailly, et al. 2018. “Elevated Prenatal Anti-Müllerian Hormone Reprograms the Fetus and Induces Polycystic Ovary Syndrome in Adulthood.” Nature Medicine 24 (6): 834–46.

9. Kuras, Yuliya I., Naomi Assaf, Myriam V. Thoma, Danielle Gianferante, Luke Hanlin, Xuejie Chen, Alexander Fiksdal, and Nicolas Rohleder. 2017. “Blunted Diurnal Cortisol Activity in Healthy Adults with Childhood Adversity.” Frontiers in Human Neuroscience 11 (November): 574.

10. Felitti, V. J., R. F. Anda, D. Nordenberg, D. F. Williamson, A. M. Spitz, V. Edwards, M. P. Koss, and J. S. Marks. 1998. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. The Adverse Childhood Experiences (ACE) Study.” American Journal of Preventive Medicine 14 (4): 245–58.

11. Tay, Chau Thien, Helena J. Teede, Deborah Loxton, Jayashri Kulkarni, and Anju E. Joham. 2020. “Psychiatric Comorbidities and Adverse Childhood Experiences in Women with Self-Reported Polycystic Ovary Syndrome: An Australian Population-Based Study.” Psychoneuroendocrinology 116 (June): 104678.

12. Merkin, Sharon Stein, Jennifer L. Phy, Cynthia Ok. Sites, and Dongzi Yang. 2016. “Environmental Determinants of Polycystic Ovary Syndrome.” Fertility and Sterility 106 (1): 16–24.

13. Vagi, Sara J., Eduardo Azziz-Baumgartner, Andreas Sjödin, Antonia M. Calafat, Daniel Dumesic, Leonardo Gonzalez, Kayoko Kato, Manori J. Silva, Xiaoyun Ye, and Ricardo Azziz. 2014. “Exploring the Potential Association between Brominated Diphenyl Ethers, Polychlorinated Biphenyls, Organochlorine Pesticides, Perfluorinated Compounds, Phthalates, and Bisphenol A in Polycystic Ovary Syndrome: A Case-Control Study.” BMC Endocrine Disorders 14 (October): 86.

14. Joham, A. E., S. Ranasinha, S. Zoungas, L. Moran, and H. J. Teede. 2014. “Gestational Diabetes and Type 2 Diabetes in Reproductive-Aged Women with Polycystic Ovary Syndrome.” The Journal of Clinical Endocrinology and Metabolism 99 (3): E447–52.

15. Ehrmann, David A. 2012. “Metabolic Dysfunction in Pcos: Relationship to Obstructive Sleep Apnea.” Steroids 77 (4): 290–94.

16. Zehravi, Mehrukh, Mudasir Maqbool, and Irfat Ara. 2021. “Depression and Anxiety in Women with Polycystic Ovarian Syndrome: A Literature Survey.” International Journal of Adolescent Medicine and Health, August. https://doi.org/10.1515/ijamh-2021-0092.

17. Kowalczyk, Ok., G. Franik, D. Kowalczyk, D. Pluta, Ł. Blukacz, and P. Madej. 2017. “Thyroid Disorders in Polycystic Ovary Syndrome.” European Review for Medical and Pharmacological Sciences 21 (2): 346–60.

18. Ulrich, Jan, Julia Goerges, Christoph Keck, Dirk Müller-Wieland, Sven Diederich, and Onno Eilard Janssen. 2018. “Impact of Autoimmune Thyroiditis on Reproductive and Metabolic Parameters in Patients with Polycystic Ovary Syndrome.” Experimental and Clinical Endocrinology & Diabetes: Official Journal, German Society of Endocrinology [and] German Diabetes Association 126 (4): 198–204.

19. Gaberšček, Simona, Katja Zaletel, Verena Schwetz, Thomas Pieber, Barbara Obermayer-Pietsch, and Elisabeth Lerchbaum. 2015. “Mechanisms in Endocrinology: Thyroid and Polycystic Ovary Syndrome.” European Journal of Endocrinology / European Federation of Endocrine Societies 172 (1): R9–21.

20. Wang, Lan, Jing Zhou, Hans-Jürgen Gober, Wing Ting Leung, Zengshu Huang, Xinyao Pan, Chuyu Li, Na Zhang, and Ling Wang. 2021. “Alterations within the Intestinal Microbiome Associated with PCOS Affect the Clinical Phenotype.” Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie 133 (January): 110958.

21. Lindheim, Lisa, Mina Bashir, Julia Münzker, Christian Trummer, Verena Zachhuber, Bettina Leber, Angela Horvath, et al. 2017. “Alterations in Gut Microbiome Composition and Barrier Function Are Associated with Reproductive and Metabolic Defects in Women with Polycystic Ovary Syndrome (PCOS): A Pilot Study.” PloS One 12 (1): e0168390.

22. Arduc, Ayse, Bercem Aycicek Dogan, Sevgi Bilmez, Narin Imga Nasiroglu, Mazhar Muslum Tuna, Serhat Isik, Dilek Berker, and Serdar Guler. 2015. “High Prevalence of Hashimoto’s Thyroiditis in Patients with Polycystic Ovary Syndrome: Does the Imbalance between Estradiol and Progesterone Play a Role?” Endocrine Research 40 (4): 204–10.

23. Phy, Jennifer L., Ali M. Pohlmeier, Jamie A. Cooper, Phillip Watkins, Julian Spallholz, Kitty S. Harris, Abbey B. Berenson, and Mallory Boylan. 2015. “Low Starch/Low Dairy Diet Results in Successful Treatment of Obesity and Co-Morbidities Linked to Polycystic Ovary Syndrome (PCOS).” Journal of Obesity & Weight Loss Therapy 5 (2). https://doi.org/10.4172/2165-7904.1000259.

24. Monastra, Giovanni, Vittorio Unfer, Abdel Halim Harrath, and Mariano Bizzarri. 2017. “Combining Treatment with Myo-Inositol and D-Chiro-Inositol (40:1) Is Effective in Restoring Ovary Function and Metabolic Balance in PCOS Patients.” Gynecological Endocrinology: The Official Journal of the International Society of Gynecological Endocrinology 33 (1): 1–9.

25. Kamenov, Zdravko, and Antoaneta Gateva. 2020. “Inositols in PCOS.” Molecules 25 (23). https://doi.org/10.3390/molecules25235566.

26. Laganà, Antonio Simone, Simone Garzon, Jvan Casarin, Massimo Franchi, and Fabio Ghezzi. 2018. “Inositol in Polycystic Ovary Syndrome: Restoring Fertility thru a Pathophysiology-Based Approach.” Trends in Endocrinology and Metabolism: TEM 29 (11): 768–80.

27. Abedini, Maryam, Ehsan Ghaedi, Amir Hadi, Hamed Mohammadi, and Reza Amani. 2019. “Zinc Status and Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis.” Journal of Trace Elements in Medicine and Biology: Organ of the Society for Minerals and Trace Elements 52 (March): 216–21.

28. Jamilian, Mehri, Fatemeh Foroozanfard, Fereshteh Bahmani, Rezvan Talaee, Mahshid Monavari, and Zatollah Asemi. 2016. “Effects of Zinc Supplementation on Endocrine Outcomes in Women with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial.” Biological Trace Element Research 170 (2): 271–78.

29. Lin, Ming-Wei, and Meng-Hsing Wu. 2015. “The Role of Vitamin D in Polycystic Ovary Syndrome.” The Indian Journal of Medical Research 142 (3): 238–40.

30. Fazelian, Siavash, Mohamad H. Rouhani, Sahar Saraf Bank, and Reza Amani. 2017. “Chromium Supplementation and Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.” Journal of Trace Elements in Medicine and Biology: Organ of the Society for Minerals and Trace Elements 42 (July): 92–96.

31. Mikkelsen, Kathleen, Lily Stojanovska, Momir Polenakovic, Marijan Bosevski, and Vasso Apostolopoulos. 2017. “Exercise and Mental Health.” Maturitas 106 (December): 48–56.

32. Guszkowska, Monika. 2004. “[Effects of exercise on anxiety, depression and mood].” Psychiatria polska 38 (4): 611–20.

33. Harrison, Cheryce L., Catherine B. Lombard, Lisa J. Moran, and Helena J. Teede. 2011. “Exercise Therapy in Polycystic Ovary Syndrome: A Systematic Review.” Human Reproduction Update 17 (2): 171–83.

34. Patten, Rhiannon Ok., Russell A. Boyle, Trine Moholdt, Ida Kiel, William G. Hopkins, Cheryce L. Harrison, and Nigel Ok. Stepto. 2020. “Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.” Frontiers in Physiology 11 (July): 606.

35. Picchi Ramos, Fabiene Ok., Lúcia Alves da Silva Lara, Gislaine Satyko Kogure, Rafael Costa Silva, Rui Alberto Ferriani, Marcos Felipe Silva de Sá, and Rosana Maria dos Reis. 2016. “Quality of Life in Women with Polycystic Ovary Syndrome after a Program of Resistance Exercise Training.” Revista Brasileira de Ginecologia E Obstetrícia / RBGO Gynecology and Obstetrics 38 (07): 340–47.

36. Dapas, Matthew, Frederick T. J. Lin, Girish N. Nadkarni, Ryan Sisk, Richard S. Legro, Margrit Urbanek, M. Geoffrey Hayes, and Andrea Dunaif. 2020. “Distinct Subtypes of Polycystic Ovary Syndrome with Novel Genetic Associations: An Unsupervised, Phenotypic Clustering Analysis.” PLoS Medicine 17 (6): e1003132.

37. Toosy, Sehar, Ravinder Sodi, and Joseph M. Pappachan. 2018. “Lean Polycystic Ovary Syndrome (PCOS): An Evidence-Based Practical Approach.” Journal of Diabetes and Metabolic Disorders 17 (2): 277–85.

If you’re a trainer, or you wish to have to be…

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