Living PCOS Free: How to regain your hormonal health with polycystic ovary syndrome

Praise for Living PCOS Free

This is a much-needed book that should have been written many years ago. It addresses an important and often neglected women’s health problem in clear and reader-friendly language. Nitu and Rohini have a holistic approach to health which empowers women. It is excellent.

Dr Adeola Olaitan, MD FRCOG, Consultant Gynaecologist and Gynae Oncologist

Educate, energise and empower your hormonal health for Living PCOS Free with the transformative knowledge, delectable recipes and 21-day plan found in this book!

Dr Will Bulsiewicz, Gastroenterologist and New York Times Bestselling Author of Fiber Fueled

Living PCOS Free is the companion that every person with PCOS (and their providers) need in order to fill the gaps we currently have in PCOS management. The authors form a dynamic duo of multi-dimensional expertise that is matched by their inclusive, compassionate approach to making sustainable lifestyle changes.

Dr Dylan Cutler, PhD, Holistic Health Content Creator

One can only hope this book reaches as many people living with PCOS as possible. A critically important resource packed with evidence-based lifestyle advice and tools to help those suffering from this debilitating condition resume control of their health and restore their quality of life.

Simon Hill, Nutritionist, Author and Host of The Proof Podcast

A wonderfully thorough, inclusive and compassionate resource for anyone living with PCOS - I’ll be recommending it to patients and colleagues alike!

Dr Hannah Short, GP Specialist in Menopause & Premenstrual Disorders

This wonderful book gives you the tools by which to live a healthier life. Although aimed at those with PCOS, it is relevant to all who want to dramatically reduce their risk of chronic illness. After all, the same healthy habits support us all to thrive. Written from decades of personal and clinical experience, Nitu and Rohini share what they know will work as it has done for their countless patients and themselves. The 21-day plan, which includes healthy and delicious plant-based recipes, is a true gift to support you to regain your health, vitality and hormonal health.

Dr Shireen Kassam, Consultant Haematologist, Lifestyle Medicine Physician, Author and Founder of Plant-Based Health Professionals UK

This book covers the complex condition of PCOS in an accessible way while also discussing the latest research and evidence-base. Nitu and Rohini are a mother-daughter duo clearly striving to write with compassion and are inclusive in their language. A rich and comprehensive must-read for those affected by PCOS, their loved ones and health professionals interested in lifestyle medicine.

Dr Linda Karlberg, NHS Junior Doctor and Host of WIDLIMS podcast

The two authors – one an experienced ObGyn and the other a health professional who has confronted PCOS herself – have created a masterwork on the condition. They present clear explanations and hopeful, effective strategies to optimise the body’s function on every level, despite PCOS. But, as they state in their Conclusion, ... this isn’t just a book about PCOS. The nutrition and lifestyle approaches we have detailed ...are the building blocks for living a long and healthy life. Indeed, they are – and in this welcoming and authoritative book, you will find guidance for healthy eating, delicious recipes galore, and guidance for lifestyle practices that will bring balance and health into anyone’s life. It’s hard to ask more of a book on PCOS! I will recommend it to my patients.

Dr Michael Klaper, MD, Primary Care Physician and Director of the Moving Medicine Forward Initiative

An insightful, sensitive, wonderful book that deep dives into all aspects of PCOS and healing from it, giving the reader a 360 view of the problem. It will be extremely useful when put into practice.

Dr Sheela Nambiar MD, ObGyn, Lifestyle Medicine Physician & Fitness Consultant; President of the Indian Society of Lifestyle Medicine (ISLM)

When I was diagnosed with PCOS at the tender age of 11, it was life-changing. Finally, I had an answer for why I felt how I felt. That was just the start though, then it led to more questions, questions no doctor could really answer for me. This sparked a 20-year independent research crusade that has cost thousands, just to try to understand the condition that plagued me, a little better. If Living PCOS Free had been available then, it would have transformed the way I felt. It is why I am glad it has been written in such an easy and accessible way. No one should have to be diagnosed with a lifelong condition without knowledge. Knowledge is power and that is why this book is so powerful for all of us living with PCOS.

Elisha Deol, patient living with PCOS

Contents

Cover

Title Page

Contents

Foreword by Brenda Davis RD

About the Authors

Acknowledgements

Preface – When your periods stop: Dr Nitu’s story

Introduction

Part One: Understanding polycystic ovary syndrome

1. Periods: A vital sign – Know your body

2. Demystifying PCOS – Understanding the condition

3. PCOS: What to look out for – Signs and symptoms

4. Solving the PCOS puzzle – Diagnosis of PCOS

5. The missing link – Insulin resistance and PCOS

6. Androgen excess – Hyperandrogenism

7. One size does not fit all – Body weight and PCOS

8. Not just teenage angst – Adolescent PCOS

9. It’s not fair – How PCOS affects people of colour

Part Two: Making informed health choices

10. You are in the driving seat – Lifestyle Medicine

11. The domino effect – The six pillars of lifestyle in PCOS

12. Full of beans – The benefits of plant-based nutrition for PCOS

13. You cannot meditate away a broken leg – Lifestyle Medicine complements conventional medicine

Part Three: Managing PCOS – The use of lifestyle approaches and nutrition to manage the condition of PCOS

Section 3.1: Symptoms of anovulation in PCOS – periods, fertility

14. When your periods go missing – Periods in PCOS

15. Getting pregnant – Fertility, preconception and pregnancy advice in PCOS

Section 3.2: Symptoms of androgen excess in PCOS

16. Spot the symptom – Acne

17. Treating the root cause – Excessive facial and body hair growth

18. It’s not all down the drain – Female-pattern hair loss

Section 3.3: Addressing lesser known symptoms of PCOS

19. Making your peace with PCOS – Anxiety, depression, sexual problems and mood disorders

20. Healing the war with your body – Disordered eating in PCOS

21. From counting sheep to a good night’s sleep – Disturbed sleep

22. It’s getting hot in here – PCOS and menopause

23. Living longer, living better – Long-term consequences of PCOS

Part Four: The 21-day PCOS programme with Rohini Bajekal, Nutritionist

From self-loathing to self-acceptance – Rohini’s story of living with PCOS

Introduction – How to live PCOS free

24. Mind the gap – How to transition to a plant-based way of eating

25. Skip the SOS for PCOS – Salt, oil and sugar

26. Soya: Healthy or not? – The role of soya in PCOS

27. Food first approach – The role of supplements for PCOS

28. Daily affirmations for PCOS

29. Self-care activities

30. Forms of movement

31. The plant-based PCOS pantry

32. The 21-day programme for living PCOS free

33. Recipes for living PCOS free

34. It is never too late – What we eat is bigger than just personal health

Conclusion: Our hopes and future outlook

Resources

Glossary

References

Index

Copyright page

To everyone living with PCOS

Being inclusive

There are health issues that affect people assigned female at birth (AFAB), including some who identify as non-binary, intersex or transgender. This book is written for all people with polycystic ovary syndrome (PCOS) and is meant to include each and every one of you with this condition, however you choose to identify. We will use the terms woman/women but wish to include anyone who identifies as a woman or has female reproductive organs, irrespective of gender. This book is also for those who have loved ones with PCOS in their lives.

Advisory note:

The advice in this book is not meant to be taken as individualised medical guidance. It is a guide for you to learn more about the condition of PCOS. This book is about using plant-based nutrition and lifestyle approaches so you are better equipped to make changes to manage your PCOS, under the appropriate medical advice from your own trusted doctor.

Dr Nitu Bajekal, MD DNB FRCOG Obs Gyn, Dip IBLM

Rohini Bajekal, Nutritionist, MA Oxon, MSc, Dip IBLM

Foreword

It was on a Holistic Holiday cruise that I became acquainted with the Bajekal family. I was smitten. They seemed to me what every family strives to be – connected, loving and joyful. When Dr Nitu Bajekal shared her plans to write a book on PCOS, I was elated. I could not imagine a more competent person to tackle this topic. Dr Bajekal has extensive experience, both professional and personal, but beyond that, she is a gifted and compassionate communicator. To add to the integrity of the manuscript, she engaged a brilliant plant-based nutrition expert, her own dear daughter, Rohini Bajekal.

As a registered dietitian and author/coauthor of 13 books on plant-based nutrition, I understand the personal and professional commitment that is required to write a book that is evidence-based, innovative and relevant. I have been privy to many exciting book-writing dreams that failed to materialise. But I had a good feeling about this one, so when the manuscript landed on my desk, it felt like a gift… to me, to my colleagues, and to all those who are touched, directly or indirectly, by PCOS.

PCOS affects about 10% of women worldwide. The world’s number one killer, heart disease, affects about 6% of women. Yet if you ask almost anyone if they know a woman with heart disease, chances are their answer will be yes. If you ask that same person if they know a woman with PCOS, chances are their answer will be no. This is not because they do not know anyone living with PCOS, but rather that those they know often suffer in silence. They may be unaware that their symptoms are linked to the condition or have been unfairly dismissed. In some cases, women go years without an accurate diagnosis, and those who have received a diagnosis are often uncomfortable about sharing that diagnosis with family and friends.

I will always remember my first experience working with a client who had PCOS. The year was 1998. The client was a 29-year-old woman named Sally. Sally had many of the usual tell-tale signs – irregular menstrual cycles, acne and even a little dark facial hair. But the most devastating for her was infertility. She and her husband had been trying to get pregnant for almost three years. Sally wondered if fine-tuning her diet could help. When she came to me, PCOS was barely on my radar. I was grateful for the opportunity to learn more about this syndrome but was taken aback by the lack of information around diet and lifestyle. Knowing that insulin resistance was part of the equation, I decided to ask Sally if she would be willing to experiment with a nutrient-dense, whole-food, plantbased diet, and other simple lifestyle changes, such as daily exercise and stress management. Sally agreed, saying that she was willing to try almost anything. She was a quick learner, following the protocol to a tee. I was gobsmacked by the outcome. Within six months, Sally’s skin had cleared, her menstrual cycles had become regular and her facial hair was diminishing. Before the end of the year, she was pregnant. I was convinced that this was no mere coincidence, but I had no solid proof. While I kept my finger on the pulse of the PCOS literature, it took over two decades before the resource the world needed was written.

Living PCOS Free is not just another book – it is a game-changer. This is the book that needs to be read by every person who lives with PCOS, who treats PCOS patients, or who is concerned about someone with PCOS. I love everything about Living PCOS Free – its scope, its content and its capacity to make a real difference in tens of thousands of lives. This book is inclusive, culturally sensitive, astonishingly comprehensive and entirely evidence-based. It is beautifully organised, with four distinct parts. Part One takes you on a deep dive into the details of PCOS and the workings of the female reproductive system. It explores the causes of the disease, its common signs and symptoms, the particulars regarding diagnosis and the condition’s unique impacts on adolescents and different ethnic groups. Part Two provides the information you need to make lifestyle choices that are effective in treating PCOS. In this section, you will become acquainted with Lifestyle Medicine – a vital partner of conventional medicine. You will learn about the Six Pillars of Lifestyle Medicine and why each pillar is critical to health. An entire chapter is dedicated to the first pillar which is nutrition.

Part Three addresses the symptoms of PCOS and how best to manage them, including many lesser-known symptoms such as depression, sleep disturbances and eating disorders. It also examines the impact that PCOS has on menopause. In Part Four, Rohini steps in with the 21-Day PCOS Programme. This section offers a blueprint for navigating the wonderful world of plant-based nutrition and Lifestyle Medicine. It answers many pressing nutrition questions and delivers solid lifestyle guidance. It also provides practical shopping strategies, a 21-day meal and lifestyle plan, and a set of delicious plant-based recipes.

Throughout the book, there are Case Studies that bring real life experiences into the conversation, Myth Busters that tackle controversial issues and misconceptions and PCOS Pointers that summarise the key points of each section.

If you have picked up this book because you or someone you love is suffering from PCOS, you can rest assured that you are in very capable hands. This is the resource that will free you from the grips of this distressing condition. Living PCOS Free brilliantly, thoughtfully and compassionately provides a simple approach to a complex problem. Read it. Embrace it. Share it.

Brenda Davis, RD

Plant-based pioneer, author, speaker

About the Authors

Dr Nitu Bajekal, MD is a Senior Consultant Obstetrician and Gynaecologist in the UK with over 35 years of clinical experience in women’s health. Her special interests include, PCOS, menopause, endometriosis, period problems, precancer, complex vulval problems and lifestyle medicine.

She is a Fellow of the Royal College of Obstetricians and Gynaecologists in the UK and recipient of the Indian President’s Gold Medal. An experienced keyhole and robotic surgeon, she applies a holistic approach, offering a range of appropriate treatment options in each case.

In 2018, she became one of the first board-certified Lifestyle Medicine Physicians in the UK and has written the women’s health module for the first plant-based nutrition course at a UK university.

Dr Bajekal is passionate about education, providing reliable medical and lifestyle information for the general public, doctors, workplaces and schools.

www.nitubajekal.com

Rohini Bajekal is a nutritionist and a board-certified Lifestyle Medicine Professional. She provides evidence-based nutrition and lifestyle advice to her clients around the world and has previously worked in India and Singapore.

A keen recipe developer, Rohini is passionate about making delicious and nourishing plant-based meals. In her spare time, she volunteers as a cookery teacher at Made in Hackney, the UK’s only eco-community cookery school and charity.

Rohini is the communications lead at Plant-Based Health Professionals UK, an organisation that provides education around whole-food plant-based nutrition for the prevention and management of chronic diseases. She also provides expertise around South Asian diets as part of the Dietitian and Nutritionist Advisory Committee at Diet ID.

www.rohinibajekal.com

Acknowledgements

Dr Nitu Bajekal

For years, I dreamt of writing a book, but it always seemed like something other people could do, not me. A busy career and family life meant it took a pandemic for me to finally write my first draft.

Thank you to Georgina, the publisher of Hammersmith Health Books and our wonderful editor. When we first spoke, you immediately understood what we wanted to convey. I can’t thank you enough for your thoughtful edits and your guidance throughout the publication process. As first-time authors, we couldn’t have asked for anyone more supportive. The entire team has been brilliant, especially Madeline Meckiffe who gave life to our vision for the book cover, and Julie Bennett and Daniel Baty for the medical illustrations and typesetting. Thank you to Hayley Smith and Caroline Burgess-Pike at Eden Green PR for getting us such amazing opportunities to publicise our work.

A special thank you to our hero, Brenda Davis, for reading the proof and writing such a wonderful foreword. We are truly honoured.

My original idea had been to write a general book on women’s health issues but it was on the advice of Rohini, my daughter and co-author, that I should use my expertise in specific health conditions, that I decided to focus on PCOS. This was an area in which my experience has helped many patients and it was a topic close to both our hearts as Rohini herself has the condition. Rohini wanted others to benefit from my knowledge just as she felt she had. Thank you, dear Rohini, for patiently reading, editing and rereading countless versions, and always pointing out when I used too much medical jargon. This book would not be here without you.

Thank you to Linda Karlberg, now a medical doctor, for her incredibly helpful comments and input.

Thank you to some of our dear friends in the plant-based world for their support: Dr Michael Klaper, Dr Shireen Kassam, Dr Gemma Newman, Dr Sheela Nambiar, Dr Alan Desmond, Dr Hannah Short, Klaus Mitchell, Robbie Lochie, Dr Dylan Cutler, Drs Ayesha and Dean Sherzai, Dr Will Bulsiewicz and Simon Hill. I so admire your work and am grateful for this community.

To my soulmate of 40 years, Rajiv. I love how you would enthusiastically say, ‘I never knew that’ or ‘I wish I had known that!’ after reading every chapter. It kept me going and was the best motivation to finish the book. Thank you for your continued love and belief in me and for fuelling me with delicious plant-based meals throughout the pandemic.

A very big hug and thank you to Naina, our wonderful younger daughter. You were firm yet so encouraging, making me think beyond the ordinary. You took the time out of your schedule as a busy editor in your day job to read my work in your scarce free time. I love you. To Siddhant, my son-in-law, I am so grateful to you for helping me refine the message and think about all aspects of the book.

I would also like to acknowledge Dr Adeola Olaitan, my extended family, especially Simon Tinsley, my friends and my book club group, for your positive encouragement throughout the process. I feel so blessed.

To my adorable dogs, Kappu and Tippu, who waited patiently near my feet for their walks, while I finished a paragraph. While watching them chase squirrels in the woods during lockdown, I was able to think of my next chapter.

To my beloved parents, Vimala and Venkataraman, my fantastic parents-in-law, Manorama and Atmaram, and to Gontu, our first dog. You are always in my heart.

I am grateful to so many people for making this book happen but most of all to you, my dear readers. If you are living with PCOS or have a loved one with the condition, I hope this book helps you. I also want to express my gratitude to each and every one of my patients over the last 35 years of my practice as an Obstetrician and Gynaecologist. Without the experience of caring for you, this book would never have seen the light of day.

Rohini Bajekal

Writing a book about a condition you’re living with is both harder than I thought and a far more rewarding experience than I could have ever imagined. It has been a privilege to share this experience with my mother, Dr Nitu Bajekal.

This book would not have been possible without our phenomenal publisher, Georgina Bentliff, and her team at Hammersmith Health Books. Your keen insight and editorial support made this book eminently more readable and accessible.

A heartful thank you to Dr Shireen Kassam for your continued support and mentorship, as well as the entire team at Plant-Based Health Professionals UK and MAD Ideas.

Thank you to Dr Gemma Newman for sharing your wisdom and encouraging me from day one. To Dr Dylan Cutler, thank you for creating such an inclusive community for those of us living with PCOS and for your generous support.

To my family and dearest friends, thank you for being by my side and for being so excited for me. A big hug to my sister Naina for your expertise and editing skills, honest feedback and bravery. To say I’m proud of you is an understatement. To my father, Rajiv, for being so kind and reliable, and for the best sprouted porridge deliveries. I would also like to express my gratitude to my mother-in-law, Mamta, and my sisters-in-law, Nivedita and Niharika, for your emotional support and encouragement.

Elisha Deol, thank you being so enthusiastic about the manuscript and for sharing your PCOS story with me all those years ago. To Catherine Lough, not only did you make the time to read the draft but you also suggested immensely helpful changes. Thank you for your friendship over the last two decades.

To my partner-in-life, Siddhant. Thank you for making me feel special and loved every day, and for your brilliant advice around the structure of our book. You helped me unravel so many thoughts while writing, kept me grounded and made me laugh when I took myself too seriously.

Lastly, thank you to my mother. I’m so lucky to have a parent, co-author and friend in you. You are a constant source of strength and inspiration. It makes me so happy that others will benefit from your wisdom in these pages, as I have throughout my life.

Preface

When your periods stop

Dr Nitu’s story

The early morning winter air rushed toward my face as I wound down the car window. It was an ordinary day in the year 2000 and I was on my way to work at the hospital. All of a sudden, I felt an intense sensation of heat and a creeping wave of fear wash over me. I was having a hot flush and a panic attack at the same time. Unknown to me, I was going through premature ovarian insufficiency, a condition where the ovaries stop working properly.

I had an almost academic detachment to begin with, but as I joined the dots, I became rather upset. I couldn’t shake the indignation that this simply couldn’t be happening to me, a fit and healthy woman who was only 38 years old. My menstrual cycle had always run like clockwork. This was the last thing I could have expected.

It’s getting hotter

The start to the new millennium was notable for me, as this was the year that my periods started to hop, skip and fade away, accompanied by frequent hot flushes, panic attacks and a low mood that was sometimes difficult to shake. I was used to being in control as a doctor. This loss of control over my body and not knowing where to turn had a profound effect on me.

Premature ovarian insufficiency (POI) affects one in 100 women under the age of 40. It is now the globally preferred description over previously used terms for the same condition such as ‘premature ovarian failure’ or ‘premature menopause’. Menopause is when the eggs in a woman’s ovaries are depleted enough for menstrual cycles to stop completely, with no periods for more than 12 months. The average age of menopause is around 51 years all over the world. My periods had stopped much earlier and, as in most cases of premature ovarian insufficiency, there was no obvious reason why. There can be an autoimmune link in some cases, where the body’s natural defence system can’t tell the difference between our own cells and foreign cells. The body then mistakenly attacks normal cells in various organs. There does not appear to be any robust connection between POI and PCOS.

I had specialised in Obstetrics and Gynaecology and was considering medical hormone replacement therapy. Like most doctors, I did not receive any nutrition education during my medical training in India and in the UK. I had no idea where to access reliable lifestyle information that could help me. This meant I had to find out everything for myself.

The ostrich effect

I did what many people do in stressful situations. I buried my head in the sand. Doctors do tend to be the worst patients and I was no exception. I put my symptoms down to stress. At the time, I was applying for consultant posts, while holding down an extremely busy job not to mention caring for our young family with a limited support network in England. I was being bullied at work and I was unsure if it was all in my head, a not-uncommon assumption by many women in toxic work environments. By the time I turned 40, I had not had a period for over a year. This was not a fun birthday present.

Looking back, my advice to my younger self (and to anyone in a similar situation) would be to seek specialist medical advice. Qualified help is increasingly available on both medical and lifestyle fronts, with impressive recent developments in the latter.

The role of lifestyle

My experience of premature ovarian insufficiency ignited my interest in the power of lifestyle changes, not just for myself but also for my patients and loved ones. I consider myself a highly committed doctor, putting my patients’ interests first. However, in many situations, I noted that nothing seemed to work until my patients turned their diet and lifestyle around. I saw first-hand the devastation created by lifestyle-related chronic diseases such as type 2 diabetes, not just for my patients but also for their families. After extensive research, I came to understand the critical role played by plantbased nutrition and lifestyle interventions alongside conventional medicine. It seemed that many of my patients grappling with these illnesses would benefit from lifestyle changes. I now regularly see amazing improvements in my patients’ health, improvements that seemed out of reach in my clinical practice a few years ago. Simply put, lifestyle was much more important than I had previously realised.

I have always been deeply passionate about all areas of women’s health. I felt I would not be fulfilling my primary role as a doctor if I did not share more widely the knowledge I had gained over the years about lifestyle and nutrition. I wanted these evidence-based lifestyle and nutrition interventions to be available to people of all ages and from all walks of life.

In 2018, I studied and passed an international examination to become one of the first board-certified Lifestyle Medicine physicians in the UK. I now use this expertise alongside decades of gynaecological experience to guide and advise my patients, doctors and the public.

Looking back, it seems almost fortuitous that I became menopausal all those years ago. I didn’t know then that this event would shape the course of the rest of my life. That over the course of the next decade, it would spark my interest in the power of plants and the significant role that lifestyle factors play in women’s health. It would make me who I am today. Most importantly, it has given me my life’s purpose – to make a positive impact in so many more people’s lives than ever before.

Dr Nitu MD, The Plant-Based Gynae

(For a longer version of my story visit www.nitubajekal.com)

Introduction

Dear Reader,

You may have picked up this book because you have already been diagnosed with polycystic ovary syndrome (PCOS), or you may be wondering if you have it. Perhaps you have a loved one living with the condition, or you’re simply interested in learning more about reproductive health? You may be trying to manage the symptoms of endometriosis, fibroids, infertility, menopause or painful or heavy periods. Whatever the reason, I hope what we have to say will help you and your loved ones. We have added a glossary to explain some of the key medical terms commonly used in the book (page 385).

As a senior Consultant Obstetrician and Gynaecologist and Board-Certified Lifestyle Medicine Physician, with over 35 years of clinical experience looking after thousands of women, I understand the importance of treating people holistically rather than focusing on a single issue or symptom.

No one knows your body better than you

Many of us struggle to listen to the cues our body gives us. It’s easy to feel overloaded by external stimuli and a dizzying amount of advice about how to lead a better life. In reality, no one knows your body better than you do. And the good news is that it’s never too late to get to know your body better.

It’s easy to underestimate how intimately the mind is connected to the physical body and ignore the signals the body sends throughout the day. Your body may be stressed, bloated, tired or weak, with your brain pleading with you: ‘Slow down. It’s okay to take a day off. You don’t have to say yes to everything. You will not miss out if you turn your phone off for a few hours.’

But you may not hear your body crying for help, because somewhere along the way you have forgotten how to trust yourself. By reading this book, you have taken the time to educate and empower yourself. Now is as good a time as any to strengthen your relationship with your body and enjoy your life to the fullest.

How can you find a solution for your PCOS, if you don’t have a diagnosis to start with?

Let’s talk about polycystic ovary syndrome, also known as PCOS, PCOD and polycystic ovarian syndrome. PCOS is the most common endocrine (hormone)1, 2 disorder worldwide, affecting at least one in 10 women of reproductive age.3, 4, 5 The true incidence of PCOS is likely to be higher as it depends on how carefully doctors look for the condition, the criteria used to define it and how often women are encouraged to seek help for their symptoms. Unfortunately, the vast majority of those who have PCOS never get a diagnosis.5, 6

PCOS is a complex hormonal condition that affects the way the ovaries function. Hormonal imbalances in PCOS appear to be triggered through a number of mechanisms, the most important of which seems to be insulin resistance.

The most commonly recognised reproductive, metabolic and psychological symptoms of PCOS, some better known than others, are:

•Menstrual irregularities

•Excessive hair growth on face and body

•Adult acne

•Infertility

•Pregnancy complications

•Acanthosis nigricans

•Anxiety

•Depression

•Disordered eating

•Excess weight gain

•Body image issues

•Sleep disturbances

The social stigma associated with many PCOS symptoms means people with PCOS often struggle to talk about it openly or to seek the help they deserve. PCOS is the commonest cause of infertility in women and the condition has other far-reaching consequences. The long-term consequences of living with it include increased risk of type 2 diabetes, womb (endometrial) cancer,7 likely increased heart