Eating Disorders and PCOS 2023

The pituitary gland and ovaries balance hormones to regulate the female reproductive cycle. FSH from the pituitary gland encourages the ovaries to form a follicle, or egg sac. The pituitary gland releases LH when this follicle releases estrogen. LH pushes the egg from the follicular sac to the fallopian tube for fertilization. Egg formation and fertilization require hormone balance.

PCOS impairs female reproductive cycles.1 People born female have increased androgen (e.g., testosterone) and LH levels in PCOS, a common but heterogeneous disorder.2;3 Ovarian cysts form when these hormonal abnormalities prevent eggs from maturing and leaving the follicles for fertilization. PCOS symptoms include irregular periods, increased body hair, scalp hair loss, weight gain, acne, and fertility issues.

PCOS reasons are unknown, and symptoms vary.2;3 Insulin resistance affects 70% of PCOS patients.3 Insulin opens cells to eliminate blood sugar. These cells “consume” sugar and produce energy. However, insulin-resistant people’s cells don’t open, causing blood sugar to build up. To get blood sugar into cells, the pancreas produces more insulin. Extra insulin releases testosterone from the ovaries, disrupting egg formation.

Chronic, low-grade inflammation4 and excess pituitary LH, which raises androgen levels, may induce PCOS.PCOS may be inherited.6


PCOSers often have BED.7 BED is uncontrollably eating a big amount of food in a short time, like an hour.7 BED requires weekly binge eating for three months.

BED prevalence in PCOS is unclear. A recent research analysis indicated that women with PCOS are almost three times more likely to have eating disorder symptoms and up to 58% binge eat.8 PCOS patients can also develop bulimia nervosa (BN), a purging-based binge-eating disorder.12;13;14

Why PCOS patients have binge-eating issues is unknown.9;10;11 High androgen levels promote appetite, anxiety, sadness, body dissatisfaction (i.e., increased body hair, weight gain, and scalp hair loss), and binge eating.8;21 Insulin increases carbohydrate desires and hunger, which may explain why many PCOS women binge.8

Thus, hormone imbalances and appearance dissatisfaction (distress) cause binge eating in PCOS.

Polycystic Ovary Syndrome Eating Disorder Treatment Challenges

PCOS treatment rarely addresses binge-type eating disorder avoidance, despite its prevalence.15;16;17 Weight loss is indicated to reduce PCOS symptoms like androgen levels and prevent future health issues like diabetes and cardiovascular disease, so these conversations are crucial.

PCOS makes weight loss difficult, therefore encouraging weight loss is risky.18;19 Insulin resistance makes PCOS weight reduction difficult.18;19 PCOS patients may maintain or gain weight despite rigorous diet and exercise. These people may binge eat due to weight loss failure.

PCOS patients may also restrict their diets to lose weight, which can lead to anorexia nervosa (AN).20 Food restriction, weight loss, and fear of weight gain characterize AN. Weight gain treats AN, unlike PCOS. PCOS and AN patients should gain weight, but not too much.20 Weight monitoring stimulates calorie tracking and fear of weight gain, which can impede AN recovery.

Polycystic Ovary Syndrome and Eating Disorder Treatment

PCOS is incurable. PCOS treatment aims to relieve symptoms including irregular periods, infertility, and hormonal imbalance, improve patient well-being, and prevent medical problems like diabetes and cardiovascular disease. Thus, non-weight loss PCOS treatment should be holistic.

Nutrition, gynecology, endocrinology, fertility, eating disorders, and cognitive behavioral therapy professionals are needed to treat PCOS holistically. Since PCOS symptoms vary, individualized treatment is best. Not all PCOS patients are infertile or seek fertility treatment.2;3 Only 70% of PCOS patients are insulin resistant.2;3

Drugs can treat PCOS symptoms. High-androgen patients are often administered spironolactone. Spironolactone reduces androgen levels by blocking excess release.22 Spironolactone lowers PCOS bloating. Insulin-resistant PCOS patients may receive metformin. Metformin reduces insulin levels by preventing the liver from generating too much glucose.23 PCOS medications can reduce acne and body hair growth.24

Psychologists and nutritionists should help PCOS sufferers. PCOS sufferers must learn how to deal as there is no treatment. Counseling may involve recognizing fertility issues or addressing body dissatisfaction and unhealthy eating. A dietitian can assist PCOS patients identify foods that aggravate or relieve symptoms. Lifestyle modifications should improve health, not weight.

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