PCOS is a handy acronym for for polycystic ovarian syndrome, a condition which affects around one in ten women. To add to that stat, an estimated 70% of all PCOS cases are missed, with many women thinking their PCOS symptoms, which can include PCOS bloating, cramping, irregular periods, chin acne and excessive facial or bodily hair, are normal.
If you think you might have PCOS, or have any other health concerns, seek expert advice from your GP.
Living with these debilitating symptoms, is, of course, challenging. That said, there are some lifestyle changes such as doing the correct exercise for PCOS and which can work wonders to help manage your symptoms.
It's believed PCOS can be caused by a number of things, including hormone imbalances [high levels of androgens, the 'male' hormones in your body, including testosterone], a resistance to insulin or genetics. Sometimes PCOS is joined by other conditions such as: IBS, insulin resistance, depression. The condition cannot be cured, but its symptoms can be managed with lifestyle changes and various medications. When it comes to those who want to conceive but experience PCOS-linked fertility issues, surgeries are available.
'PCOS (Polycystic Ovary Syndrome) is a condition which can affect the female reproductive organs,' explains Mr Sachchidananda Maiti, a Consultant Gynaecologist and Obstetrician at Pall Mall Medical, when discussing the symptoms of PCOS.
'A women's ovaries contain immature eggs surrounded by a follicle. For women with a healthy menstrual cycle, each month an egg and its follicle matures and is released into the fallopian tube around mid-cycle, after competing with other few follicles, where it remains in the hopes of becoming fertilised.
'For women with PCOS, the eggs with multiple follicles remain underdeveloped, and none are able to be released. Instead, the follicles remain in the ovary as small cysts.'
A quick note to say that bloating from PCOS is totally natural and normal and you do not need to try and stop it. But know that if it's playing with your confidence, there are ways to help. First though, what is PCOS bloating and why does it happen?
PCOS bloating (when your stomach feels swollen and painful after eating) can often be aggravated by certain foods. Whilst everyone digests foods differently, there are certain culprits that can often lead to bloating.
Foods that contains the carbohydrate called raffinose often lead to increased gas production in many people. These include foods such as beans, broccoli, cabbage, asparagus, whole grains and cauliflower.
'Studies have shown that those with PCOS [often] have dysbiosis of the gut microbiome -an imbalance of the gut bacteria which includes a lack of diversity and low levels of "good" gut bacteria,' shares Jodie Relf, a PCOS Dietitian and spokesperson for MyOva. 'Research also indicates those with PCOS have a higher prevalence of irritable bowel syndrome (IBS) in comparison to those without PCOS,'she adds.
'The exact reasons for this are not clear, however, we know that both gut dysbiosis and IBS can result in symptoms such as bloating, diarrhoea, constipation, increased gas and cramping.'
Many women are finding that simple lifestyle changes, such as doing effective exercise for PCOS, can make a massive difference in the severity and how regular the symptoms come - particularly PCOS bloating.
One such woman - Maeve Madden - previously shared her years of trial and error experiences (along with the knowledge amassed from her PT and nutritional qualification) with others in her book Beat Your Bloat, so they can benefit, too.
'I haven't always eaten the way I do today,' says Madden, referring to the dishes in her book. 'When I was at uni, I followed every the faddy diet going from only eating strawberries and prawns to living off juices. All those eating plans that aren't sustainable. I didn't understand nutrition and the impact what I ate could have on my body. That's why I think Instagram is amazing - it's given us this giant encyclopedia of knowledge and access to what real women - not solely celebrities - around the world are doing. And that's really inspiring.'
'When I was diagnosed with PCOS in my final year of uni, it was a real shock for me. Having put up with cramping, PCOS bloating, adult acne and irregular/no periods, I realised my fertility could be at risk. So I decided to research nutrition more and find out how I could heal myself - or at least manage my symptoms - through food, as opposed to relying on medication.'
But Madden's 'bloating bible' isn't solely for those experiencing PCOS bloating. It's a useful resource for anyone with hormonal imbalances, conditions such as IBS and fibroid growth, or just wanting a sustainable approach to healthy living.
Yes, your diet has a significant impact on PCOS, says Relf. 'It can both worsen and improve symptoms depending on the food choices you make.'
That's because two of the biggest drivers of PCOS symptoms are inflammation and insulin resistance. 'Both are largely influenced by our diet and the foods we eat. In addition to this, studies have shown that an imbalance in gut microbiota plays a role in the development of PCOS through triggering low grade chronic inflammation and insulin resistance.'
She adds: 'Both inflammation and insulin resistance play a role in increasing testosterone levels, and it's these elevated testosterone levels (hyperandrogenism) that cause many of the symptoms of PCOS such as acne, male pattern hair growth, anovulation and imbalances in sex hormones, such as LH and FSH.'
Our top tip? Keep a diary of all food and drink you eat, this can help identify the ones that seem to be correlated with bloating.
The first port of call is to try and restore the balance of good and bad gut bacteria, says Relf. 'To do this it's important that you consume foods which contain good bacteria and eat foods that nourish those bacteria. The bacteria in our gut are live organisms and therefore require good nourishment to keep them alive.'
As gut health scientist Dr Megan Rossi says, start by eating 30+ different plant foods a week. This spans fruit and veg, nuts, seeds, extra virgin olive oil, legumes and herbs and spices. In doing so, you create an environment in which your gut microbiome can thrive.
'It's important to feed the good bacteria with lots of fibre by including plenty of fruits and vegetables in your diet, as well as wholegrain foods,' says Relf. 'When increasing fibre intake remember to increase your fluid intake as well, as fibre draws water into the bowels.'
'It doesn't have to be a full-on HIIT class; a 30-minute walk around the park will suffice.'
Read why strength training is good for PCOS weight loss.
'This year, I've been exploring different forms of exercise and doing more Barre classes, Pilates and swimming, as opposed to repeatedly lifting weights at the gym. My body doesn't feel under as much pressure, as a result, and, thanks to focusing on more functional movements, I feel more mobile - especially first thing in the morning.'
'PCOS can leave you feeling constantly tired. By doing more yoga and Pilates, which are both mentally and physically challenging, I find myself more balanced and, because they help me sleep better, more energised.'