Can PCOS affect eating disorders?

By Rebecca Jaspan, MPH, RD, CEDS, CDCES

What is PCOS?

In PCOS, women’s ovaries produce high levels of androgens, male sex hormones. To receive a PCOS diagnosis, individuals must meet two of three criteria. Those criteria include irregular ovulation, as evidenced by an irregular menstrual cycle or lack of a cycle, signs of increased androgen levels or a blood test confirming increased levels, and multiple cysts on the ovaries. Symptoms of increased androgens typically look like increased body and facial hair, thinning scalp hair, and acne. Other symptoms of PCOS include pelvic pain, abdominal bloating, insulin resistance, high blood pressure and high cholesterol, and severe mood fluctuations.3

You may also get blood tests to measure levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and progesterone as well as testosterone, insulin, and DHEA-S. A pelvic ultrasound to look for ovarian cysts may also be recommended by your doctor.

Many women with PCOS also have insulin resistance. Chronic low-grade inflammation contributes to rising glucose levels and higher insulin levels. High insulin levels not only drive androgen production, but they also contribute to infertility and type 2 diabetes.4 With insulin resistance, there is an increase in hunger and fat storage because the body’s cells are not efficiently metabolizing the glucose from food. One study measured insulin, glucose, and hunger levels in women with and without PCOS. There was a significant increase in hunger one hour after eating in the PCOS group compared to the control group.5 This difficulty in regulating hunger cues and frequent hunger is one factor that contributes to disordered eating patterns in women with PCOS.

How Is PCOS Associated with Eating Disorders?

PCOS is strongly associated with disordered eating and eating disorders. The most prevalent eating disorders in PCOS populations are bulimia nervosa and binge eating disorder.6 The body’s hormone production and regulation play a role in eating behaviors, such as restriction or binge eating. When insulin levels are high and the individual feels hungry frequently, it can be difficult to listen to hunger and fullness cues and respond in a timely and appropriate manner. There is also an increased craving for carbohydrate foods. Additionally, women with PCOS and insulin resistance have a predisposition to weight gain and have significantly higher rates of shape and weight concerns. Many women with PCOS are advised to restrict their calories or carbohydrates to lose weight by medical professionals, which can be a risk factor for eating disorder behaviors.7 Encouraging women with PCOS to lose weight may lead them to restricting food intake followed by episodes of binge eating.

Treatment

PCOS treatment with co-occurring eating disorders require an individualized and team approach to support the client’s well-being as well as prevent medical complications and manage symptoms of PCOS. A multifaceted approach with a treatment team that includes medical doctors specialized in gynecology or endocrinology, a registered dietitian, and a therapist is critical.

Nutritionally, meal plans and recommendations need to be individualized according to the client’s specific needs and lab values. While no foods are off limits, the client may need to ensure they include more protein and fat and smaller portions of carbohydrates in order to stabilize blood sugar and feel full and satisfied. Additionally, research shows that undergoing cognitive behavioral therapy and practicing mindfulness are helpful in reducing carbohydrate cravings for individuals with binge eating disorders.6

PCOS nutrition can certainly be confusing, and even discouraging, especially when struggling with disordered eating. Your LCWNS dietitian will work with you to establish an individualized plan that includes all foods and helps you to honor your hunger and cravings while also managing your PCOS.

1. Polycystic ovarian syndrome (PCOS) and diabetes. Centers for Disease Control. Retrieved from https://www.cdc.gov/diabetes/basics/pcos.html.
2. Kolnikaj TS, Herman R, Janež A, Jensterle M. Assessment of Eating Disorders and Eating Behavior to Improve Treatment Outcomes in Women with Polycystic Ovary Syndrome. Life (Basel). 2022;12(11):1906. Published 2022 Nov 16. doi:10.3390/life12111906
3. https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/diagnosis/
4. Purwar A, Nagpure S. Insulin Resistance in Polycystic Ovarian Syndrome. Cureus. 2022;14(10):e30351. Published 2022 Oct 16. doi:10.7759/cureus.30351
5. Japur CC, Diez-Garcia RW, de Oliveira Penaforte FR, das Graças Pena G, de Araújo LB, de Sá MFS. Insulin, ghrelin and early return of hunger in women with obesity and polycystic ovary syndrome. Physiol Behav. 2019;206:252-258. doi:10.1016/j.physbeh.2019.03.013
6. Krug I, Giles S, Paganini C. Binge eating in patients with polycystic ovary syndrome: prevalence, causes, and management strategies. Neuropsychiatr Dis Treat. 2019;15:1273-1285. Published 2019 May 16. doi:10.2147/NDT.S168944
7. Barber TM, Hanson P, Weickert MO, Franks S. Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies. Clin Med Insights Reprod Health. 2019;13:1179558119874042. Published 2019 Sep 9. doi:10.1177/1179558119874042