The role of the dietitian in the management of PCOS
Samantha Bailey, Specialist Dietitian
I currently work part time at Bedford Hospital NHS Trust where we run specific multidisciplinary PCOS clinics. Any
referrals from primary care to gynaecology that mention a diagnosis of PCOS get filtered in to the dedicated clinic and
others who are diagnosed at a general gynaecology or infertility appointment get transferred.
Mrs. Rosemary Wallace, consultant gynaecologist and obstetrician, and myself do one clinic a month together and the
ladies can be assessed by both of us, any bloods can be arranged, prescriptions can be given if needed and I try to
spend what time I can doing the education and dietary/lifestyle assessment. I often do not have enough time to cover
everything but I can introduce myself, make a start, give written information and then arrange for them to come back
to my dietetic clinic. I do 2-3 dietetic/PCOS clinics a month where I can review the ladies and see new patients
referred directly by their GP.
Weight loss is often the main agenda whether to access fertility treatment, improve symptoms, self-esteem or long-
term health. It can be frustrating for consultants when ladies do not seem to make any progress between appointments
and it often leaves the ladies tearful when they feel they have not achieved anything. I take over the
management of many ladies and try to tackle weight and lifestyle before they get re-referred back to the consultant
when there is often more treatment options. This helps with waiting times and prioritises the consultant’s time
to those with other symptoms to tackle. Doing the MDT clinics also helps improve referrals, transfer of information,
helps us understand each other's role and also reduces my DNA rates (can be a patient group which DNA often as
apprehensive about being judged, however, having met me the MDT clinic they feel more comfortable coming back).
I have a special interest in PCOS which stems from my own diagnosis and need for fertility treatment in 2001. At this
time I conducted a comprehensive literature review which surprisingly provided little practical guidance on specific
dietary management. I combined my knowledge of the syndrome with my skills and knowledge in dietetics to
formulate guidelines and resources. I was also very fortunate to fall pregnant with my daughter during my second
cycle of clomiphene citrate and went on to have a son 2 years later without fertility treatment.
I am delighted to be representing dietetics at PCOSUK as I believe we can be a very useful resource in the
management of PCOS. Lifestyle intervention is integral and is an area where women can take back some control with
the right support and guidance.
The bulk of my NHS post and private/freelance clinics is now working in this area and it has become a specialist role.
There are currently limited PCOS specialist dietitians but I believe that with levels of obesity rising and more
diagnosis of PCOS being made, referrals to dietetics will continue to rise and as a profession we need to be
developing. I am very committed to driving this forward by developing a network of dietitians with an interest in
PCOS and sharing information and resources. This interest group now has around 100 members.
I have written 2 patient information booklets which are included in the PCOSUK resource pack. Packs of 25 or 50 are
also available directly from me.
If you have any queries or if you are a dietitian who would be interested in joining the informal interest group, please
email me at email@example.com
PCOSUK conference presentation slides
Aims of dietary management
Achieve/ maintain healthy BMI
Reduce insulin resistance
Nutritionally adequate diet
Detect dysfunctional eating
Weight reduction and PCOS
Symptomatic improvement with 5% wt loss in overweight women with PCOS
No quick-fixing diet
Healthy diet will address other health concerns
Insulin resistance makes it more difficult to lose weight
Current diet and activity
Consider other factors such as family life, work, social life
Healthy eating, Balance of good health model, variety of foods from each food group, at least 5 portions of
fruit and vegetables a day
Regular meal pattern
Low fat, low sugar
Adequate fluid intake (>8 cups)
Importance of exercise
Women who do even a little more will be more successful with weight management
Improves insulin sensitivity
Lots of other benefits
Lots of barriers
Must be realistic and practical
Aim 5 x 30 minutes moderate intensity
Avoid low carbohydrate diets
Carbohydrate cravings common in PCOS
Glycaemic index (GI) or glycaemic load (GL)?
High GI = quick digestion = rapid rise in blood sugar and insulin
GL combines GI with standard portion size
GI or GL?
GI May be a useful ranking system Affected by other factors, limited number of foods tested, can limit
healthy foods, inter-person variation, variation in measurements, high
fat foods can be low GI, difficult to predict effect in mixed meal. No
relation to serving size
GL Does not limit fruits and vegetables Can encourage overall low carbohydrate diet
Considers average portion size Portion size perception
GL analysed from GI data therefore same limitations
So what should we advise?
Women with PCOS should try to swap some foods to lower GI foods
A regular 3 meal pattern and limit any snacking (choose low GI, low calorie snacks)
Don’t get too hung up on following GI strictly
Don’t restrict normal portions of fruits and vegetables
Try to use more pulses and legumes (beans and peas)
Reducing insulin resistance
Regular meal pattern
Choose lower GI foods where possible
Eat more oily fish
(omega 3) 1-2 portions or fish oil capsules
Eat plenty of fruit and vegetables
Watch the amount and type of fat you eat
Limit saturated fats
Choose monounsaturated fats
Cholesterol lowering products?
Limit sugar and alcohol
Prevention of diabetes
Lifestyle intervention can reduce incidence of diabetes mellitus by up to 58%
Reducing fat esp. saturated fat. Choosing monounsaturated fats.
Adequate fibre, wholegrains, fruit and veg
30 minutes of moderate exercise per day
Nutritional supplements and obesity medications
Not enough evidence to support roles of supplements (except omega 3)
Some good results with Orlistat and Silbutramine with right diet/exercise changes and support
What helps a successful change?
Just knowing what to eat and what foods to limit is only part of what helps us choose and maintain a healthier
I believe there are 3 important areas which affect how successful an individual is: knowledge, environment and
What am I aiming for in terms of lifestyle?
What is PCOS?
How will my lifestyle affect my symptoms?
What has worked well before?
What have I found difficult before?
Relationships, home, family, work, finance
Timing is crucial
The right support
Do your best when you can
Belief that change can lead to better things
Confidence and determination
Low self-esteem very common in PCOS
Ban negative thoughts!!
Bringing it all together
Can be really difficult and may not be in your control always
Cravings and uncontrolled eating
Very common in PCOS
Reasons not fully understood
Binge eating is big problem
Regular meals pattern and lower GI foods can help
Food and Feelings
There are close links between PCOS, symptoms and binge eating. Vicious cycle of uncontrolled eating, weight gain,
further insulin resistance and worsening symptoms leading back to low self esteem and continued uncontrolled
Pressures of fertility issues
Can be very distressing
Can put huge amount of pressure on themselves
Frustration can add to sadness
Turn negative thoughts into positive thoughts
Start to feel good about yourself
Be clear about what you want
Self help groups
Making plans and sticking to them
How can I make it easier to stay on track?
Remind yourself of goals/benefits
Make changes gradually
Tackling uncontrolled eating
Be strong when shopping
Are you hungry?
Stop eating when full
Patient centred approach
Can be young, distressed, confused, frustrated
Summary of dietitian’s role
Can have expert knowledge of syndrome and diet therapy
Have clinical and counselling skills to be able to take on an extended role in the management of PCOS
Listening post, a source of information, a guide to help reach goals
Currently limited number of specialists but interest is growing
Ongoing work with Verity and PCOSUK
Coordinating dietitian’s interest group
Promotion within profession
Clinic protocol update