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Primary Polycystic Ovarian Syndrome

by Kate Neil(more info)

listed in women's health, originally published in issue 71 - December 2001

Fiona first came to see me in the spring of last year feeling very distressed and depressed about her health. At that time she was 28 years old, working full time as a solicitor and planning on getting married later that year. Her main concern was increasing weight gain despite eating what she considered a healthy diet, particularly with a wedding in sight. Fiona thought that her symptoms could be due to food reactions and she had heard that food allergies might cause weight gain. There were a number of other symptoms that Fiona presented with that were upsetting her. These included acne, thinning hair, irregular periods, fatigue, depression, dark circles under her eyes, constipation and sometimes diarrhoea.

On Further Exploration

I explored Fiona's history further and found that she had taken the contraceptive pill for seven years for contraception but had stopped a year ago. Her periods had been irregular since stopping the pill. She had a history of thrush and cystitis. She had not experienced any obvious allergies and there was not a family history of allergy. Fiona suffered from constipation and diarrhoea and also experienced flatulence and bloating. Her stress levels were high at work and her increasing fatigue was giving her cause for concern at work. The thinning of her once thick head of hair was depressing her. Although Fiona was not planning on having children for some years, she did have an underlying concern about her fertility due to her irregular periods. A number of her close relatives were overweight and some were obese. Diabetes mellitus was also part of her family history. Fiona had discussed her symptoms with her GP, who thought that she had irritable bowel syndrome (IBS) that was likely connected to her high stress levels, and that high stress might be the basis of some of her other symptoms too. Her GP had suggested that her irregular periods were likely to regulate in time, as it can take time to regulate after stopping the contraceptive pill. She had had several courses of antibiotics over the years for cystitis and had used Canestan cream for bouts of thrush.

Clinical Interpretation

Clearly Fiona is experiencing many complex symptoms that could have several underlying causes. However, within this sea of symptoms I was keen to exclude the possibility that Fiona may be suffering with polycystic ovarian syndrome (PCOS), a common hormonal disorder affecting menstruating women. It is often not diagnosed because some of the classical symptoms are missing or are minor when the condition is in its early stages. The symptoms of PCOS include:

  • Irregular or non-existent periods and spotting between periods;
  • Infertility;
  • Weight gain and obesity;
  • Acne;
  • Male pattern hair growth (hirsutism) and male pattern hair loss;
  • Fatigue and depression.

As PCOS can be confirmed by ultrasound, I recommended that Fiona discuss this diagnosis with her GP and request an ultrasound examination.

Insulin Resistance

Insulin resistance syndrome (IRS) is a common problem and can be behind weight gain, obesity, diabetes mellitus and cardiovascular disease. IRS will lead to a rise in blood glucose, which causes the body to produce more insulin. Cell receptor sites for insulin become resistant and the glucose in the blood is inefficiently entered into cells and therefore remains high in the blood.

In the meantime, I suggested dietary changes for Fiona because, regardless of the test outcome for PCOS, her current eating pattern was conducive to IRS, which is closely linked with PCOS and is believed by some to be a primary cause of PCOS. Key features in the dietary advice and their benefits were:

  • Reduction in total carbohydrate from bread, pasta, biscuits, juices and alcohol, which convert to glucose and stimulate the production of insulin;
  • Increase in protein, which helps temper the insulin response and aids the burning of fat;
  • Increase in fish, which helps the action of insulin;
  • Removal of wheat, which was prolific in her diet and is a common allergen associated with IBS, flatulence and bloating;
  • Improved micronutrient intake through a varied and more balanced food intake;
  • Good levels of phytoestrogens, which can help regulate hormone balance and counter an excess of oestrogen. An excess of oestrogen can decrease the sensitivity of body tissues to insulin.


When Fiona returned six weeks later she said that her GP had agreed to send her for an ultrasound and PCOS was confirmed. Her GP had recommended that she take the contraceptive pill again to help control the symptoms. The pill is a popular way of treating PCOS.

Fiona was amazed at how quickly her health had improved. In fact, she had said that her fatigue and mood had begun to lift within days.

She had lost 91bs in the six weeks, her skin had improved, the dark black circles were going from under her eyes, her gut symptoms were much less and her hair was no longer falling out in handfuls.

Fiona's high stress levels, past history of smoking and use of the contraceptive pill and regular intake of alcohol plus past high caffeine intake all add a toxic load to the body and may have increased her risk of developing PCOS. Some schools of thought attribute high stress levels and chemical 'burn-out' of the ovarian follicles as part of the profile of PCOS.

Over the next year Fiona continued with her dietary programme. I included specific supplements including B vitamins and vitamin C, calcium and magnesium, chromium, vanadium, zinc and fish oils to support glucose balance, sex hormone balance and weight control.

When I last saw Fiona a few months ago her weight had stabilized at a comfortable level and her cycle had become much more regular.

Her skin and hair had improved. The flatulence, bloating, constipation and diarrhoea had gone. She was feeling bright and optimistic about the future.


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About Kate Neil

Kate Neil MSc (Nutritional Medicine) FBANT CNHC is Founding Director of CNELM (Centre for Nutrition Education and Lifestyle Management). CNELM has been teaching degree courses in nutritional science and personalised nutrition validated by Middlesex University, London since 2003. Prior to, Kate directed courses in nutritional therapy for other organizations. Kate’s practice focused on women’s health and in the mid-1990s was one of the first to publish articles and a book on balancing hormones naturally. Kate also supported parents with children within the learning disorder spectrum. She has published many articles and contributed chapters to books for nutrition professionals and is frequently asked for peer review. Kate’s early career was as a nurse and midwife. Kate is a Fellow of BANT, the Royal Society of Medicine and the Royal Society of Arts. She can be reached on Tel: 0118 9798686; 

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