Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting women of reproductive age. Approximately 5-8% of women in Canada are diagnosed with PCOS, most commonly in their 20s or 30s, often when trying to conceive. On a worldwide scale, it’s estimated that 1 in 10 women experience PCOS and its challenges before reaching menopause (Sadeghi et al., 2022). Managing PCOS requires a multi-disciplinary approach, combining lifestyle changes, medical treatment, and physiotherapy. In some cases, medication medication may be necessary to treat hormone imbalances, lower excess androgen, and improve insulin response.
Please note that while this post uses the term ‘woman’ throughout, we recognize that not everyone who menstruates or has a uterus identifies as a woman. Our aim is to provide information relevant to anyone affected by PCOS, regardless of gender identity.
What is PCOS?
According to Singh et al. (2023), PCOS is a condition that impacts hormone balance and metabolism. It is often marked by symptoms such as irregular ovulation, difficulty getting pregnant, weight gain, insulin resistance, and cysts on the ovaries. Factors such as lifestyle, diet, exposure to pollutants, genetics, gut health, and obesity can increase the risk of developing PCOS.
The condition often results in symptoms like:
- Irregular or absent periods
- Weight gain, particularly around the abdomen
- Difficulty conceiving
- Insulin resistance/difficulty losing weight
- Mood swings, anxiety, or depression
- Thickening of endometrial lining as there is no consistent shedding
- Symptoms of extra androgenic sex hormones (hyperandrogenism) include acne, extra facial or body hair, and hair loss from the head.
Addressing these symptoms often may require medical interventions, but pelvic health physiotherapy has emerged as a valuable complementary tool in PCOS management. Keep reading to discover how physiotherapy may make a difference.
How Pelvic Health Physiotherapy Supports PCOS Management
1. Exercise to Improve Insulin Sensitivity
One of the key components in managing PCOS is controlling insulin resistance. Women with PCOS often struggle with elevated insulin levels, which can worsen hormonal imbalances. Pelvic health physiotherapists create personalized exercise plans, including both strength training and cardiovascular activities, to support insulin sensitivity. According to research, regular exercise can improve insulin resistance by as much as 25%, even in the absence of significant weight loss (Moran et al., 2011). A moderate weight reduction of 5-10% has been shown to improve symptoms like irregular periods, elevated androgen levels, and even fertility issues (Teede et al., 2010). This can help lower blood sugar levels and reduce the risk of type 2 diabetes. Physiotherapists may help patients develop sustainable exercise habits that can effectively manage insulin levels.
2. Pelvic Floor Rehabilitation for PCOS
Some women with PCOS may experience pelvic floor dysfunction due to hormonal imbalances or changes to posture and body mechanics. Pelvic health physiotherapists can help strengthen these muscles, improving bladder control and reducing abdominal and pelvic pain. Physiotherapy options include pelvic floor muscle training, biofeedback, soft tissue mobilization, trigger point therapy, and breath and pressure management. This approach may be beneficial for those experiencing pelvic discomfort as part of their PCOS symptoms.
3. Breathing for PCOS
Breathwork is a technique that a pelvic floor physiotherapist can teach and help you implement as part of your PCOS management.
Breathwork can be a powerful tool for managing pelvic and abdominal pain, including cramping often associated with PCOS. Deep breathing exercises help increase circulation and improve visceral movement, promoting better blood flow to the pelvic area. This can reduce pain and discomfort by relaxing tense muscles and enhancing oxygen delivery to tissues. Incorporating breathwork into a daily routine can be a simple yet effective way to manage symptoms and support overall pelvic health.
4. Reducing Inflammation
Low-grade inflammation is a feature of PCOS that can contribute to fatigue and other metabolic issues. Physiotherapy incorporates low-impact aerobics, stretching, and flexibility training, which can help reduce inflammation and enhance overall health. Studies like Giallauria et al. (2008) have shown that regular aerobic exercise decreases inflammatory markers, improving well-being in women with PCOS.
5. General Movement
Pelvic floor physiotherapy can play a significant role in managing PCOS symptoms through gentle movement. Activities like walking, yoga, and pelvic stretching are often more effective than sitting, helping to alleviate discomfort. A pelvic health physio can provide personalized education on how movement supports your body, while creating a gentle program that targets the abdominal, pelvic, glute, and thigh areas. These stretches and movements increase space and mobility in the abdomen and pelvis, helping to relieve PCOS-related symptoms.
For a more personalized movement program tailored to your needs, book an appointment with a pelvic floor physiotherapist.
6. Supporting Mental Health
PCOS impacts both physical and emotional health which may lead to depression and anxiety (Sadeghi et al., 2022). While not a treatment, physiotherapy supports mental well-being through exercise, which is known to boost mood, self-esteem, and reduce stress. Regular physical activity also enhances brain chemicals that improve pleasure and reduce pain (Mahindru et al., 2023).
A study by Szafarowska et al. (2024) tracked women with PCOS undergoing fertility treatments. The findings revealed that 82.2% experienced reduced anxiety related to infertility and pregnancy, 97.3% reported an overall boost in well-being, and 95.9% felt a stronger connection with their bodies after the sessions.
7. Period Management
Pelvic floor physiotherapy can be an important tool in managing PCOS, especially when it comes to period management. For those experiencing heavy bleeding and cramping, heat packs applied to the abdominal wall can provide relief, while pelvic physio techniques may help reduce discomfort.
Additionally, switching to natural period products, like menstrual cups or period underwear, can decrease exposure to harmful chemicals commonly found in traditional products. Many individuals notice a positive change in symptoms—such as lighter flow, less cramping, and reduced dryness—within 3-4 months of using a menstrual cup.
Period underwear, like Charlie Boxer (for heavy flow), is another great option for minimizing tissue irritation, offering comfort and support while promoting pelvic health. These small adjustments can make a big difference..
Period underwear we love:
Revol Cares Charlie Boxer Brief (Ultra Protection)
Revol Cares Sleep Short (Super Plus Protection)
8. Addressing Musculoskeletal Pain and Fatigue
PCOS can lead to increased fatigue and musculoskeletal discomfort, particularly in areas like the lower back and joints. A pelvic health physiotherapist can help manage these symptoms through targeted exercises that build strength, improve posture, and reduce pain. Programs designed to enhance muscle tone, flexibility, and endurance can improve energy levels and physical comfort.
9. Education
PCOS is a complex condition that affects multiple areas of the body, and many people lack a full understanding of how to manage it. Evidence shows that education on physical activity, dietary adjustments, and stress management is essential for effective symptom control. In fact, a study by Moran et al. (2011) found that lifestyle education significantly improves symptoms like insulin resistance and weight management. Physiotherapists play a crucial role in empowering clients with the knowledge and practical strategies needed to make sustainable changes. Beyond that, being well-informed about their condition can give clients a sense of control and confidence in managing their PCOS symptoms.
Comprehensive Approach to PCOS Management
1. Lifestyle Changes
International guidelines for managing PCOS suggest that lifestyle changes, such as exercise and diet, should be the first approach to enhance overall health, hormone levels, and quality of life (Patten et al., 2020).
2. Medications
Treatments often focus on improving insulin sensitivity and regulating menstrual cycles, while medications can help manage symptoms like acne and excess hair growth.
3. Fertility Treatments
For women with PCOS who are trying to conceive, medications may be prescribed to induce ovulation. In some cases, assisted reproductive technologies, such as in vitro fertilization (IVF), may be necessary.
4. Mental Health Support
Given the emotional and psychological challenges that often accompany PCOS, seeking support from a clinical counsellor can be incredibly beneficial. A counsellor can provide coping strategies to manage anxiety, depression, and stress related to PCOS.
5. Gut Health
Singh et al. (2023) explain the gut microbiome as a vast community of microorganisms that can impact overall health. In PCOS, imbalances in gut bacteria, influenced by factors like insulin resistance and obesity, can worsen symptoms. To support gut health and manage PCOS, focus on a fiber-rich diet, probiotics, reducing processed foods and sugars, staying hydrated, exercising regularly, and managing stress (Singh et al., 2023).
Last Thoughts
Managing PCOS is achievable with a treatment plan tailored to your specific needs. By incorporating lifestyle changes, following prescribed medications if needed, and seeking mental health support, you can significantly improve your quality of life.
Remember, you don’t have to navigate this alone—reach out to your healthcare provider or visit a specialized clinic like Bump Physio & Co. for personalized care and guidance. We’re here to support you every step of the way on your journey to better health.
~the Bump team
Bump Physio & Co is a community of health care providers dedicated to changing the way pelvic health and obstetrical services are delivered. Our two clinics locations are Port Moody and Langley BC, where we treat beyond the Bump and welcome clients from all stages and phases of life. Our team has advanced training in Pelvic Health, Orthopedics, Obstetrics, Clinical Pilates, and Active Rehabilitation.
Please follow us along on our socials @bumpphysio.co keep updated on all that is going on and for more information about how the Bump Community can help YOU!
Resources
References
Giallauria, F., Palomba, S., Maresca, L., Vuolo, L., Tafuri, D., Lombardi, G., Colao, A., Vigorito, C., & Francesco, O. (2008). Exercise training improves autonomic function and inflammatory pattern in women with polycystic ovary syndrome (PCOS). Clinical endocrinology, 69(5), 792–798. https://doi.org/10.1111/j.1365-2265.2008.03305.x
Mahindru, A., Patil, P., & Agrawal, V. (2023). Role of Physical Activity on Mental Health and Well-Being: A Review. Cureus, 15(1). https://doi.org/10.7759/cureus.33475
Moran, L. J., Hutchison, S. K., Norman, R. J., & Teede, H. J. (2011). Lifestyle changes in women with polycystic ovary syndrome. The Cochrane database of systematic reviews, (2), CD007506. https://doi.org/10.1002/14651858.CD007506.pub2
Patten, R. K., Boyle, R. A., Moholdt, T., Kiel, I., Hopkins, W. G., Harrison, C. L., & Stepto, N. K. (2020). Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Frontiers in Physiology, 11. https://doi.org/10.3389/fphys.2020.00606
Sadeghi, H. M., Adeli, I., Calina, D., Docea, A. O., Mousavi, T., Daniali, M., Nikfar, S., Tsatsakis, A., & Abdollahi, M. (2022). Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Repurposing. International Journal of Molecular Sciences, 23(2). https://doi.org/10.3390/ijms23020583
Singh, S., Pal, N., Shubham, S., Sarma, D. K., Verma, V., Marotta, F., & Kumar, M. (2023). Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. Journal of Clinical Medicine, 12(4).https://doi.org/10.3390/jcm12041454
Szafarowska, M., Rosiński, M., Segiet-Święcicka, A., Jędrzejczyk, S., Jerzak, M., & Jerzak, M. (2024). Effect of physiotherapy on infertility treatment in polycystic ovary syndrome patients. Przegla̜d Menopauzalny = Menopause Review, 23(1), 14-20. https://doi.org/10.5114/pm.2024.136439
Teede, H., Deeks, A., & Moran, L. (2010). Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC medicine, 8, 41.https://doi.org/10.1186/1741-7015-8-41