Helping Women with PCOS – What are the Challenges for Dietitians? How can Dietitians get support to work more effectively?

By Terrill Bruere APD & Tara MacGregor PACFA Reg Clinical & APD

Poly Cystic Ovary Syndrome (PCOS) is a common, complex condition, different for every woman who is diagnosed. Management is not a one size fits all proposition. From prepubertal girls, to adolescents with period problems, women with body image and mood concerns, reproductive to midlife women with metabolic risks – PCOS presents in many ways and many settings for Dietitians. It has been estimated that up to 25% of women in some groups may live with PCOS so if you are a Dietitian who works with women it is highly likely you will encounter clients with (frequently undiagnosed) PCOS. And these will most likely be your clients who struggle with stressful, weight management issues.

PCOS is a relatively recently described condition and understanding its management has a long way to go. The treatment lens for PCOS has typically focused on the physiology of the syndrome (hormones and insulin resistance), potentially at the cost of a woman’s lived experience of the many challenges of this condition. There are NHMRC National Guidelines for Management (that are currently under review) but for Dietitians to work well in this space we require more. Advice about what food to eat and how to exercise is not on its own going to be very helpful for most women with PCOS who are vulnerable to the latest diets and exercise plans. These factors can all contribute to a Dietitian feeling unsure how to offer the most effective and supportive care for clients with PCOS.

Many women with PCOS describe problems with their appetite such as ‘craving’ sweet foods or always being hungry and needing to eat a lot to be satisfied. Some of these issues are biological and hormonal, some are created by a dieting and food restriction history and some are habit. Managing these appetite problems and integrating more mindful or intuitive eating skills can be a challenge. Similarly, body image and mood concerns interfere with the ability to take care of the body and self, but they are a common feature of PCOS and are rarely adequately addressed. The result of these types of concerns being missed is the risk of tipping someone already vulnerable into a more debilitating eating or mood disorder.

The good news is that Dietitians can now have a much broader scope in this area than traditionally defined, but this requires further training with good counselling skills and a practice of self- reflection and supervision. Dietitians can develop a sophisticated skill base which works beyond the provision of advice on nutrition and food selection for PCOS management, to support the sound development of clients’ eating behaviours and body relationship for good health. By working at the intersection of physical biology, our culture, social attitudes, accepted beliefs about female bodies and the emotional world of the people we see, Dietitians can provide impactful, quality, client centred care that maintains our commitment to first do no harm.