Eating Disorders and PCOS

How Are They Connected and How Are They Treated?

PCOS and Eating Disorders

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What is PCOS?

PCOS stands for Polycystic Ovary Syndrome, the most common endocrine disorder found in women of reproductive age. Its classic features include irregular menstrual periods, elevated levels of male sex hormones, and polycystic appearing ovaries on ultrasound. It is associated with reproductive, metabolic, and psychological problems. There also appears to be a strong link between PCOS and eating disorders or disordered eating.

Despite its relatively high prevalence rate, PCOS is one of the most poorly funded and researched health conditions. Originally known as Stein-Leventhal Syndrome, it was first recognized in 1935. Once thought to be a gynecologic and dermatologic problem, it is now understood to be a multisystem disorder. It has no cure. Many women with PCOS don’t realize they have it.

Common Symptoms and Assessment

Physical Symptoms

  • Menstrual symptoms: irregularity, cramps, and heavy bleeding
  •  Infertility and increased rates of miscarriage
  • Elevated male sex hormones and thyroid irregularities
  • Higher weight accompanied by abdominal fat
  • Increased appetite
  • Back pain
  • Pre-diabetes and insulin resistance
  • Ovarian cysts and endometriosis
  • High blood pressure, high cholesterol and increased risk of heart disease
  •  Fatigue
  • Abdominal bloating
  • Male-pattern hair loss on the head and excess hair growth on the face and body
  • Acne and skin tags

Psychological Symptoms

PCOS is most often diagnosed by a medical doctor. The doctor will usually assess menstrual patterns and weight, insulin resistance, hair patterns, and acne. Blood tests are conducted to measure hormone levels, glucose tolerance, fasting insulin levels, and related markers.

Prevalence of PCOS and Eating Disorders

PCOS is believed to affect up to 18 percent of reproductive-aged women. While research on eating disorders among women with PCOS is scant, the prevalence of eating disorders appears to be higher than among the general population. One study of women with PCOS reported a high prevalence of overall eating disorders (21 percent) versus the prevalence among women without PCOS (4 percent).

In another study, the prevalence of disordered eating in women with PCOS was over four times the rate of disordered eating behaviors among women without PCOS. The women with PCOS exhibited significantly higher rates of shape and weight concerns. This study also found a high prevalence of bulimia nervosa (6.1 percent), binge eating disorder (17.6 percent), and night eating syndrome (12.9 percent) among their PCOS cohort. The women with PCOS reported significantly more binge episodes and more frequent episodes of compulsive exercise in the prior month than did the controls.

In her book, The PCOS Mood Cure, psychologist Gretchen Kubacky, who specializes in treating women with PCOS, estimates the prevalence of eating disorders and disordered eating among women with PCOS in her practice to be close to 100 percent.

The Link Between PCOS and Eating Disorders

PCOS is often associated with higher weights and a predisposition to weight gain; as a result, women with PCOS are often advised to diet. The symptoms of depression and negative body image associated with several aspects of PCOS, such as excessive facial hair or higher weight, can contribute to the urge to diet. As we know, dieting is a well-established risk factor for developing an eating disorder.

“Most women with PCOS have insulin resistance. Of important note, insulin levels are tremendously higher in PCOS compared to folks with type 2 diabetes... Insulin is a growth hormone, so when it is high a person’s weight will not go down unless something drastic is done. I refer to this as extreme dieting…. I do witness women with PCOS losing weight from these methods, yet the weight always comes back. This sucks; what is even worse is it starts a diet-binge cycle. And an eating disorder is born.” —Julie Duffy Dillon, RD

Treatment for PCOS

Treatment for PCOS is often treated in an uncoordinated fashion with a different specialist treating each aspect of the disorder. This course of action is generally far from ideal. Treatment is usually led by an endocrinologist, a doctor who specializes in the treatment of the endocrine system. Gynecologists are commonly involved in the treatment of PCOS, especially when fertility is a concern. People with PCOS may also have an internist for general non-PCOS-related medical care.

Lifestyle Changes

Lifestyle changes are often the primary treatment recommendation for PCOS. Since many of the symptoms of PCOS are related to insulin resistance, this is the target of most of the suggested PCOS treatments. Weight loss is often advised. As mentioned previously, such guidance can merely aggravate problems and contribute to disordered eating or the development of an eating disorder. Further, weight loss often leads to weight regain. Weight cycling can lead to increased insulin, which only exacerbates the problem the weight loss was attempting to solve.

Similarly, women with PCOS are often instructed to restrict carbohydrates (also referred to as starches) in order to lower glucose and insulin. But the problem with most of these recommendations is that these restrictions are usually not sustainable and can lead to increased preoccupation with food and binge eating—once this happens, the recommended levels are exceeded anyway.

A better recommendation is to eat regular balanced meals, including adequate starches, throughout the day. Eating starches as part of a balanced meal that also includes protein and fat causes glucose to be released more slowly into the bloodstream than when starches are eaten alone. Fortunately, many meals (e.g. sandwiches, pizza, stir-fry with rice) traditionally include the major different macronutrient groups. Ensuring that carbohydrates are accompanied by protein and fats helps to create satiety, and with it a lower likelihood of bingeing.

Health at Every Size

We know that most diets don’t work in the long term and people with PCOS have a harder time losing weight.

A better approach when treating PCOS is to focus not on weight loss but instead on healthy behaviors, including eating regularly from a range of enjoyable foods, planning meals, and engaging in moderate physical activity for the sake of health rather than weight loss.

Health at Every Size® offers an alternative paradigm to the diet worldview. This approach focuses on eating enough to feel satisfied and prevent binge eating, not on the number on the scale. It advocates for finding some type of movement that is enjoyable and something you will want to sustain, not on punishing intense exercise.

Medication for PCOS

Medications are commonly used for the treatment for PCOS. These often include birth control pills to help regulate periods, metformin (an insulin sensitizer) to decrease insulin resistance and prevent early-onset type 2 diabetes, and spironolactone for excessive facial hair and acne.

Treatment for PCOS and Eating Disorders

It will come as no surprise that there are no established researched treatment protocols specifically for a combined diagnosis of PCOS and Eating Disorders. Eating disorder treatment ideally involves a multidisciplinary team including dietitians, psychotherapists, and physicians.

In the case of a combined diagnosis of PCOS and an eating disorder, this recommendation is of even greater significance. Given the risk that traditional weight management practices for PCOS will exacerbate an eating disorder when PCOS co-occurs with an eating disorder, an anti-diet approach is even more critical. Patients will benefit when a team of medical professionals well-versed in PCOS works closely with a dietitian and therapist experienced with both eating disorders and a HAES ® approach. 

A Word from Verywell

If you have PCOS and are experiencing symptoms of an eating disorder, it’s important to let your medical professionals know and to seek help for your eating problem. With the proper support, your eating disorder can be fully resolved and your PCOS symptoms adequately managed.

Resources

Kubacky, Gretchen, Psy.D., The PCOS Psychologist, a psychologist specializing in PCOS

Dillon, Jule Duffy, RD, a registered dietitian with several HAES ®- based PCOS resources

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Article Sources

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