Nutrition Recommendations for Athletes With PCOS

female athlete eating toast with vegetables
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Polycystic ovary syndrome (PCOS) appears to be more common among athletes and could explain why a large percentage of female athletes don’t menstruate. A study published in Fertility and Sterility showed a higher number of cases of hyperandrogenism (high testosterone levels) in adolescent swimmers compared with non-swimmers.

Amenorrhea (lack of 3 consecutive menstrual cycles or more) and oligomenorrhea (irregular periods at intervals of more than 6 weeks) has been found to be more prevalent among athletes than in the general population and is primarily due to hypothalamic amenorrhea. One-sixth of Iranian female athletes with amenorrhea or oligomenorrhea were diagnosed as having PCOS according to findings published in Medicine and Science in Sports and Exercise.

How Athletes With PCOS Can Meet Their Nutritional Needs

Because of their unique nutritional needs, each athlete with PCOS should meet with a registered dietitian nutritionist with experience in sports nutrition and PCOS to develop an individualized meal plan to optimize performance while managing health. The following are some nutritional concerns for athletes with PCOS:

Balance Carbohydrates

Carbohydrates are the preferred fuel for athletes but can pose a challenge for athletes with PCOS if they have insulin resistance. This requires carbohydrates to be balanced to manage insulin and glucose levels, weight, and athletic performance. Depending on the sport, season, metabolic profile, and body composition, women with PCOS may require slightly fewer carbohydrates than their fellow athletes.

Processed and refined carbohydrates such as white bread, sugary cereals, bagels, crackers, candy, cakes, and cookies can increase insulin levels and worsen insulin resistance. Likewise, too many carbohydrates eaten in one setting can also spike insulin levels. Unprocessed whole grains such as fruits and vegetables, slow-cooked oats, quinoa, brown and wild rice, and sprouted grain bread tend to have more fiber and thus a slower impact on insulin levels.

Some athletes with PCOS may struggle with intense, almost urgent cravings for carbohydrate foods. This could be due to difficulty regulating blood sugar levels from exercise as well as an effect of high insulin levels which act as an appetite stimulant. Eating frequently, focusing on spreading carbohydrates evenly throughout the day, and combining carbohydrate foods with protein and fat-containing foods can help to manage cravings and blood sugar levels.

Eat Anti-Inflammatory Foods

There is evidence that women with PCOS have higher rates of oxidative stress and inflammation. Regular exercise can result in chronic oxidative stress on the muscles due to the increases in oxygen consumption.

Antioxidants may be helpful in reducing inflammation and muscle soreness. Eating a variety of anti-inflammatory foods such as nuts, fish, fruits, olive oil, vegetables, and legumes should be encouraged.

Maintain Iron Levels

Menstrual cycles in women with PCOS can vary and could occur at monthly intervals, several times a month, every few months, or not at all. Athletes, especially those in endurance sports, who have frequent or heavy bleeding are at an increased risk for iron losses and developing iron deficiency. Regular screening for iron parameters may be necessary.

Manage Vitamin B12 Levels

Oral contraceptives and metformin, a common insulin-sensitizing medication, are frequently prescribed to women with PCOS and are associated with interfering with vitamin B12 absorption.

Women who take these medications should supplement their diets with vitamin B12. Monitoring for a vitamin B12 deficiency is necessary, especially for athletes who eat vegetarian and vegan diets.

Monitor Vitamin D Levels

While many women with PCOS have high bone mineral density, vitamin D, which is important for bone formation, is low in as many as 73% of women with PCOS. Low levels of vitamin D in women with PCOS is associated with poor mood, worsened insulin resistance, and weight gain.

Low levels of vitamin D can decrease physical performance and increase the incidence of stress fractures. Since few foods contain vitamin D (dairy foods are the main source), supplementation of vitamin D may be needed depending on blood levels.

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  • Coste O, Paris F, Galtier F, Letois F, Maïmoun L, Sultan C. Polycystic ovary-like syndrome in adolescent competitive swimmers. Fertil Steril. 2011 Oct;96(4):1037-42.
  • Movaseghi S, Dadgostar H, Dahaghin S, Chimeh N, Alenabi T, Dadgostar E, Davatchi F. Clinical manifestations of the female athlete triad among some Iranian athletes. Med Sci Sports Exerc. 2012 Sep;44(9):1825.
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