What is Poly Cystic Ovary Syndrome (PCOS)?
PCOS is the most common endocrine disorder in women of reproductive years, affecting 1 in 8 women worldwide (1), but despite its prevalence it is relatively poorly understood. What is known is important for coaches to appreciate, however, because women who have PCOS are at greater risk for being overweight, and so developing T2 Diabetes Mellitus, Metabolic syndrome, Cardiovascular risk, endometrial cancer and experiencing mood disorders such as depression and anxiety (2). PCOS is also the leading cause of infertility in women and impacts on a woman’s health well beyond her reproductive years (2). In short this is a population with which most coaches will have some contact during their career, because improving body composition and health are common goals.
It can be a complex condition for medical practitioners to diagnose because there are multiple signs and symptoms that may vary greatly between women. Indeed, the term PCOS is itself misleading because it doesn’t “fully represent the complexity of the disorder; the different manifestations and the associated co-morbidities”(2). This means that PCOS presents differently for different women. Both overweight and lean women can be diagnosed; some have the classic signs of ‘cysts’ on the ovaries whereas others do not. Some women may experience Hirsutism (male pattern body and facial hair growth) and acne, others may experience male pattern type hair loss. Lean woman with PCOS may have insulin resistance and other equally lean PCOS women may not. The same goes for overweight or obese women; they may or may not present with the classic ‘cysts’ on the ovaries or insulin resistance.
This complex nature is why diagnosis and treatment of the condition requires a multi-pronged, individualised approach. As fitness professionals we are in no position to diagnose or treat this condition, but much like other complications mentioned on this academy this does not mean we cannot have a profound impact while acting within our remit.
Even though there are different manifestations of symptoms, one of the key features of PCOS is an increase production of ovarian androgens (1). Androgens are the ‘male’ hormones that are found in both sexes, but to a far greater degree in men – when they present to elevated levels in women, issues can arise. The main androgen to be concerned with in this context is the hormone testosterone, and so when you see androgens mentioned within this context, think about this hormone.
As you have seen, the name PCOS suggests that multiple cysts appear on an ovary for everyone, but this is not entirely true. While some women may present with ‘cyst’ like structures as seen by a Sonogram, they are in actual fact immature follicles - a classic outcome of increased androgens in the ovaries. Each of these immature follicles contains an egg. As mentioned above, some women may present with a great number of these follicles on their ovary whilst others do not (3). To summarise, PCOS (despite the name) is not just a condition that impacts ovaries – in fact it is an endocrine disorder characterized by elevated androgens, with polycystic ovaries simply being a common symptom.
Lesson aims • To describe and explain PCOS to a level needed by coaches and personal trainers • To explain the impacts which PCOS have on weight management, and explain how this will increase likelihood of encountering PCOS in practice • To describe and explain common medications which clients will be taking and explain the contraindications which they may present • To give examples of psychological and physiological issues which a coach may need to consider • To give recommendation for exercise and lifestyle based support which is safe for use
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