Polycystic ovary: omega-3s may be a simple and safe strategy for treating the disease

Regular consumption of omega-3 fatty acids may have a beneficial effect in the treatment of polycystic ovary syndrome and its many associated complications; chief among them insulin resistance, dyslipidemia, and excess body weight. 

According to the most recent research, underlying the effects of omega-3 would be numerous biological mechanisms, including the ability to reduce inflammation and hormonal regulation. A diet rich in omega-3 combined with a healthy lifestyle, together with adequate supplementation could, therefore, be an efficient strategy for the treatment of a condition that affects millions of women of childbearing age, with serious physical, reproductive and psychological effects.

What exactly is polycystic ovary?

Polycystic ovary syndrome (PCOS) is a very common endocrine disorder, affecting between 8 and 13 percent of women of reproductive age, and is a major cause of infertility.There is no universally accepted definition of PCOS, because the syndrome presents with a rather heterogeneous variety of symptoms, and this often causes delay and confusion in diagnosis.According to the so-called Rotterdam criteria, developed in 2003, the diagnosis of PCOS depends on the identification of at least two of the following symptoms: oligo-anovulation (irregular or absent ovulation), excess male hormones, and polycystic ovaries on ultrasound analysis.

The condition is precisely characterized by increased production of androgens and insulin resistance, two conditions that prevent the proper maturation of ovarian follicles, preventing ovulation and causing the most visible signs of the syndrome (acne, hirsutism).Insulin resistance is that condition in which the body's cells decrease their sensitivity to the action of insulin and, therefore, its release causes a lower biological response than normal.

Insulin resistance contributes to the accumulation of adipose tissue with the risk of developing obesity and related disorders, such as metabolic syndrome, type 2 diabetes mellitus, hypertension, dyslipidemia-high triglycerides and elevated LDL cholesterol-atherosclerosis, and endometrial carcinoma.The effects of PCOS are numerous, indeed, and manifest themselves reproductively, metabolically, and psychologically. The most common are:

• Amenorrhea
• Hirsutism
• Obesity at the visceral level
• Acne
• Alopecia 
• Fertility disorders
• Anxiety and depression

The onset of symptoms occurs at a very young age, and the condition is often associated with early puberty. It is also estimated that 40% of adolescent girls with menstrual irregularities have PCOS.Polycystic ovary syndrome arises due to a combination of factors including genetic ones, intrauterine exposure to high levels of androgens, and environmental factors such as diet.

Although the optimal treatment for PCOS has not yet been fully determined, multiple approaches are often recommended, including a combination of multiple strategies involving changes in diet and general lifestyle, the use of pharmaceuticals and hormonal products. 

Supplements based on inositols, a group of plant-derived molecules with insulin-sensitizing action, often seem to help.

Polycystic ovary and nutrition: proper diet can improve symptoms

Among the strategies for the treatment of PCOS, modification of eating habits and increased physical activity are definitely those that have shown the best effects, probably due to the resulting decrease in weight.Although there are cases of normal-weight women suffering from PCOS, most patients are overweight or obese, but in contrast to the average female, those with polycystic ovaries accumulate predominantly abdominal fat, which is known to be a powerful cardiovascular risk factor.

In cases of excess weight, weight loss leads to a marked improvement in PCOS symptoms, even a decrease of 4-5% is enough to notice an improvement in the pathology at different levels.It is clear, therefore, that diet should aim at a reduction in daily caloric intake, but paying special attention to foods with a high Glycemic Index, so as to improve insulin resistance, and reduce cardiovascular risk. 

The Glycemic Index measures the ability of carbohydrates to raise blood sugar after a meal, and it is very high in foods containing simple and refined sugars.In the case of PCOS, but not only, it may be advisable to improve the quality of fat intake by choosing vegetable fats and reducing saturated fats (meat, cheese, butter, etc.).In addition, it is good to favor foods with anti-inflammatory effects and vegetables rich in antioxidants.The main advice in this direction can be summarized as follows:

• Maintaining the right body weight
• Follow a balanced diet rich in vegetables
• Consume whole grains and legumes
• Limit simple sugars (sweets,, candy, carbonated drinks) 
• Limit fat intake, preferring vegetable fats 
• Increase consumption of omega-3 rich fish
• Prefer fat-free cooking methods 
• Don't skip meals
• Prefer one-dish meals, combining whole-grain carbohydrates, protein, and polyunsaturated fats
• Avoid alcohol
• Do not smoke
• Carry out physical activity on a regular basis

The role of omega-3 fatty acids in the management of polycystic ovary syndrome

Concerning the action of a healthy diet on the symptoms of polycystic ovary, foods rich in polyunsaturated fatty acids, particularly those containing omega-3, are of particular interest.The latter have been studied in recent years mainly for their protective role on cardiovascular disease, inflammatory diseases, and metabolic syndrome. In particular, diets in which omega-6 intake is much higher than omega-3 intake have been shown to be related to chronic diseases. 

This evidence has suggested a role of omega-3s toward symptoms related to polycystic ovary syndrome.Some studies have shown that a low-calorie, omega-3-rich diet is recommended to reduce complications of PCOS, especially in the presence of high insulin resistance and with elevated triglyceride and cholesterol levels.More numerous studies have investigated the effect of omega-3 supplements, revealing that in women with PCOS, supplementation is associated with improvement in numerous complications, including insulin resistance, dyslipidemia, and hyperandrogenism.

By what mechanism do omega-3s act?

The mechanism of action underlying the effects is not yet well elucidated, but it seems established that it arises from a combination of synergistic activities.The impact of omega-3s on PCOS appears to be related to their anti-obesity action, anti-inflammatory action, regulation of insulin and hormonal response in general, and ability to regulate the production of adipokines, i.e., those molecules that are produced by adipose tissue.

Omega-3s as regulators of inflammation

The omega-3s contained in foods may be exerting their favorable effects through modulating the amount and type of eicosanoids, a group of molecules derived from polyunsaturated fatty acids that regulate the inflammatory response.Eicosanoids derived from omega-3s are able to perform several functions such as:

• Inhibition of platelet aggregation
• Improved vasodilation
• Inhibition of cell proliferation
• Stimulation of the immune response

These effects can positively influence different aspects of PCOS, including of course inflammation, but also the regulation of blood pressure and heart rate.Similarly, it has been shown that consumption of foods rich in omega-3 fats can reduce the risk of other inflammatory-based chronic diseases. In particular, the main effect seems to be exerted precisely by improving those metabolic risk factors that are also observed in patients with polycystic ovary syndrome, such as dyslipidemia and insulin resistance.

In 2019, a meta-analysis, that is, a study pooling the results of other scientific studies, conducted to investigate the possible effect between omega-3s and PCOS complications, showed how treatment with EPA and DHA supplements in different amounts, and combined or not with vitamin E supplements, can improve the clinical picture of women with polycystic ovary disease.

The antioxidant action of omega-3s

Omega-3s also have strong antioxidant power, and in women with PCOS, a significant increase in oxidative stress levels is evident.A study was recently published in the journal Archives of Gynecology and Obstetrics, involving 60 women with polycystic ovaries, investigating the effects of supplements containing antioxidants of different kinds: omega-3, folic acid, selenium, vitamin E, catechin, and coenzyme Q10. 

The results showed a significant improvement in the ratio of LH (luteinizing) hormone to FSH (follicle-stimulating) hormone, which is known to be altered in this condition.It seems obvious that the positive effect shown in the above study could be due to the combination of different antioxidant nutrients. However, this approach makes it impossible to attribute the positive impact of the treatment to one of the ingredients.The molecules involved could affect the specific parameters of PCOS through different mechanisms. 

In particular, omega-3 fatty acids, selenium, vitamin E, and even coenzyme Q10, are known to scavenge free radicals and inhibit lipid and protein oxidation.In any case, these data support the evidence on the beneficial effects of micronutrients with antioxidant activity on the specific hormonal profile of polycystic ovary syndrome.

The effect of EPA and DHA on body weight

Numerous scientific evidences suggest that omega-3 EPA and DHA could improve body composition by modulating energy metabolism and promoting body weight reduction, which is established to be one of the main strategies for managing PCOS.Marine-derived omega-3s and particularly EPA and DHA , in fact, regulate the number and size of adipocytes, the cells of adipose tissue, promoting weight loss.In 2013, a study showed a decrease in Body Mass Index in patients following a daily supplementation of 1,500 milligrams of omega-3s for 6 months. 

Similarly, other scientific work has shown a link between omega-3 consumption and a decrease in waist circumference, and waist to hip ratio. In 2015, it was shown through a paper published in the Journal of Reproduction and Infertility that omega-3 treatment in women with PCOS was associated with a significant improvement in Luteinizing Hormone levels and the concentration of adiponectin, a substance with anti-inflammatory and insulin-sensitizing properties, which is produced in low amounts in obese people.

Effect of omega-3s on insulin resistance

Another evidence in favor of the importance of omega-3s taken in the diet comes from their ability to modulate the permeability and sensitivity of cell membranes to insulin, thereby improving insulin resistance and reducing the risk of diabetes.Some studies also show this effect following the use of omega-3 supplements: in Oner and Muderris' 2013 study, insulin levels were found to be significantly decreased after 6 months of consumption of fish oil supplements.

Similarly, a 2018 research study involving 30 women with PCOS found that those who had consumed 2 grams per day of fish oil for 12 weeks showed a significant increase in insulin sensitivity and related laboratory parameters.

What foods are the richest in omega-3s

Omega-3s are polyunsaturated fatty acids, that is, they contain double bonds in their structure, and are distinguished according to their chemical form and classified into:

• EPA, which contains 20 carbon atoms, and is particularly abundant in fish and seaweed. Fish products with the highest EPA content certainly include roe, sardines, and nori seaweed.
• DHA, with 22 carbon atoms, is also abundant in fish, and in products of algal origin. In fact, foods containing higher amounts of DHA include: roe, sardines, tuna, mackerel, and salmon. 
• ALA (alpha linolenic acid) with 18 carbon atoms which, unlike the other two, is exclusively of plant origin, and is present in high concentrations in nuts, some oilseeds and vegetable oils (canola or rapeseed, soybean) and to a lesser extent in green leafy vegetables and legumes.

Adequate dietary intake of ALA, EPA, and DHA can be achieved by consuming oily fish at least 2 times a week, and eating green leafy vegetables frequently, and weekly small portions of nuts or oil seeds.

Omega-3s, whether of marine or plant origin, in the event that dietary intake is inadequate for requirements, can be taken through supplements readily available on the market. In the management of polycystic ovary, supplementation with omega-3 products is quite common, and is supported by many studies that have demonstrated the effect of supplementation by showing improvement for numerous complications and comorbidities, including insulin resistance, dyslipidemia, hyperandrogenism, and regulation of metabolic indicators.

There is, however, a distinct lack of scientific research on the dietary consumption of these types of fatty acids. Therefore, further studies are needed to investigate the effect of omega-3 contained in foods on the complications of PCOS.The use of EPA and DHA supplements, together with an appropriate dietary style and constant physical activity could therefore be a safe, simple and inexpensive strategy, even supportive of pharmacological one, for the management of the condition.

Which omega-3 supplements to choose?

Along with a healthy lifestyle and proper diet, the choice of fish oil supplements, should be oriented toward quality products and made following high safety standards. In this regard, Omega products guarantee thorough purification processes allowing for important certifications.Omega Vitality 1000: is a supplement based on concentrated fish oil, rich in omega-3 in the form of triglycerides, the form best absorbed by the body. 

Omegor Vitality 1000 is a product that obtains on each batch the 5-star IFOS (International Fish Oil Standards) certification, which certifies on the concentration of EPA and DHA, purity and freshness.This supplement, can be particularly indicated in case of PCOS, thanks to the combination of EPA, DHA and vitamin E, which as supported by the most recent studies, can synergistically reduce some symptoms of the pathology. Vitamin E, in fact, helps protect cells from oxidative stress and preserves the characteristics of fish oil. To stay up to date with the latest news from Omega-3 scientific research, subscribe to our newsletter.

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