Polycystic Ovary Syndrome (PCOS) is a complex and multifactorial endocrine disorder that affects approximately 5% to 15% of women of reproductive age globally.
It is defined by a combination of symptoms related to ovulatory dysfunction, hyperandrogenism (excess levels of male hormones), and the presence of polycystic ovaries.
The name “polycystic ovary syndrome” refers to the appearance of the ovaries, which often contain numerous small, fluid-filled sacs (follicles) arranged around the periphery though not all women with PCOS have these cysts. PCOS is recognized as the most common cause of anovulatory infertility and is associated with long-term health risks such as type 2 diabetes, cardiovascular disease, endometrial hyperplasia, and metabolic dysfunction. The syndrome typically emerges during puberty, though in some cases it may remain undiagnosed until adulthood when symptoms like irregular menstrual cycle, weight gain, or difficulty conceiving become apparent.
Clinically, PCOS is diagnosed using criteria such as the Rotterdam criteria, which requires the presence of at least two of the following three features:
1) Oligo/anovulation
2) Clinical or biochemical signs of hyperandrogenism
3) Polycystic ovaries on ultrasound.
PCOS is a diagnosis of exclusion other endocrine disorders such as congenital adrenal hyperplasia, thyroid dysfunction, or androgen-secreting tumors must first be ruled out. Research has shown that PCOS involves a complex interplay of genetic, environmental, and lifestyle factors.
Key drivers of PCOS include insulin resistance, hyperinsulinemia, chronic low-grade inflammation, and dysregulation of the hypothalamic-pituitary-ovarian (HPO) axis. Genetic predisposition may increase susceptibility, but environmental factors like diet, stress, and exposure to endocrine-disrupting chemicals also play a significant role in symptom expression and severity.
Management strategies often include lifestyle modification, balance blood sugar levels, Manage gut and liver health, Reduce low grade inflammation and targeted supplementation to address the root causes and symptoms specific to each woman.
How Common is PCOS?
Polycystic Ovary Syndrome (PCOS) is one of the most prevalent endocrine disorders affecting women of reproductive age.
According to the World Health Organization (WHO), PCOS affects an estimated 6% to 13% of women globally, with up to 70% of affected individuals remaining undiagnosed due to the complexity of symptoms and inconsistent diagnostic criteria.
Prevalence can also vary by ethnicity and geographic region, with some populations showing higher rates of insulin resistance and metabolic complications.
These numbers highlight the importance of raising awareness, improving diagnostic tools, and developing consistent international guidelines to support early intervention and effective management.
Causes of PCOS
Polycystic Ovary Syndrome (PCOS) is a heterogeneous endocrine disorder, meaning it can arise from a variety of underlying causes. It is not a single disease but a group of symptoms that may be triggered by multiple physiological and environmental drivers. Research and clinical observations have identified the following main contributors to the development of PCOS:
- Genetics play a foundational role in the development of PCOS. Women may inherit genes that predispose them to disrupted communication between the hypothalamus and ovaries, increased androgen production, or insulin resistance. These genetic traits may have once been adaptive during times of stress or famine, but in modern lifestyles, they can predispose women to hormonal imbalances.
- Insulin resistance is the most common driver of PCOS, affecting up to 70% of women with the condition. It occurs when the body’s cells become less responsive to insulin, causing the pancreas to produce more insulin. Elevated insulin levels stimulate the ovaries to produce testosterone instead of estradiol, disrupt ovulation, and lower sex hormone-binding globulin (SHBG), leading to elevated free androgens. This condition can persist even after menopause. Contributors to insulin resistance include:
• High sugar and fructose intake
• Hormonal birth control
• Chronic stress
• Poor sleep
• Smoking and alcohol
• Trans fats
• Gut dysbiosis
• Magnesium deficiency
• Exposure to environmental toxins
- Low-grade chronic inflammation can stimulate the adrenal glands and ovaries to overproduce androgens. It also impairs ovulation and disrupts hormonal signaling. Sources of inflammation include poor diet, food sensitivities, environmental toxins, smoking, and gut imbalances.
- Environmental Toxins Exposure to endocrine-disrupting chemicals (EDCs) such as bisphenol A (BPA), phthalates, PCBs, and certain pesticides can affect hormonal regulation. These toxins may alter how the brain communicates with the ovaries and how sensitive the body is to insulin. Multiple studies, including those by the American College of Obstetricians and Gynecologists and The Endocrine Society, highlight the long-term reproductive risks associated with toxic environmental exposures.
- Hormonal Imbalances and HPA Axis Dysfunction Disruption in the hypothalamic-pituitary-adrenal (HPA) axis can lead to overproduction of DHEAS, a type of androgen primarily secreted by the adrenal glands. This mechanism is particularly relevant in adrenal PCOS, often triggered by chronic stress, especially around puberty.
Understanding the root causes of PCOS is key to individualized treatment. Women may experience overlapping drivers and symptoms, making deep diagnosis essential for successful management.
Signs and Symptoms of PCOS
• Irregular or absent periods (oligomenorrhea or amenorrhea)
• Excess facial and body hair (hirsutism), especially on the chin, upper lip, chest, abdomen, and back
• Persistent acne, especially along the jawline and cheeks
• Thinning scalp hair or male-pattern hair loss (androgenic alopecia)
• Weight gain or difficulty losing weight, especially in the abdominal area
• Infertility or difficulty conceiving due to lack of ovulation
• Mood changes, anxiety, and depression
• Darkened skin patches (acanthosis nigricans), especially on the neck and underarms
• Fatigue and poor sleep
• Pelvic pain or heaviness, especially during ovulation
These symptoms are largely driven by hormonal imbalances particularly elevated testosterone, DHEAS, and LH/FSH ratios and worsened by insulin resistance and inflammation.
Clinical evaluations often reveal that even women who are not overweight may exhibit these symptoms, making weight an unreliable predictor. In some cases, PCOS symptoms may overlap with other disorders such as hypothyroidism, adrenal hyperplasia, or Cushing’s syndrome, which is why accurate diagnosis is essential.
How PCOS is Diagnosed?
Diagnosis typically involves a combination of medical history review, physical examination, blood tests to check hormone levels, and an ultrasound to examine the ovaries.
No single test can diagnose PCOS, so a process of elimination is often used. Blood tests often include insulin, testosterone, DHEAS, LH, FSH, SHBG, and 17-OH progesterone.
Different Types of PCOS
There are four primary types of PCOS, each with distinct characteristics. These classifications are based on the underlying driver of androgen excess and help determine the most effective treatment path.
Insulin-Resistant PCOS
This is the most common form, driven by insulin resistance. Too much insulin stimulates the ovaries to produce excess testosterone and reduces SHBG, increasing free androgens.
It causes irregular periods, acne, and weight gain. Risk factors include high sugar intake, poor sleep, stress, and magnesium deficiency.
Diagnosis involves checking waist circumference, fasting insulin, or a glucose tolerance test.
Treatment focuses on reducing sugar, improving diet, and taking supplements like magnesium, myo-inositol, and alpha-lipoic acid.
Post-Pill PCOS
This temporary condition appears after stopping birth control, especially low androgen index pills like Yasmin®. It’s often caused by a rebound increase in LH and androgens. Symptoms include acne and long cycles.
Diagnosis is made if you were fine before the pill, meet PCOS criteria now, and don’t have insulin resistance.
Zinc and a peony-licorice herbal combo can help restore ovulation. Avoid excessive carb restriction to prevent hypothalamic amenorrhea.
Inflammatory PCOS
Driven by chronic inflammation, this type is often missed. Diagnosis includes signs like fatigue, skin issues (eczema, psoriasis), headaches, and joint pain plus no insulin resistance or pill history. It’s worsened by inflammatory foods, environmental toxins, and digestive issues.
Treatment focuses on an anti-inflammatory diet (avoiding wheat, dairy, processed foods), probiotics, NAC, melatonin, and zinc.
Adrenal PCOS
It is caused by elevated DHEAS (from adrenal glands) but normal testosterone and androstenedione. It’s not linked to insulin resistance or pill use but triggered by stress and HPA axis dysfunction.
Diagnosis includes ruling out NCAH or high prolactin. Treatment includes stress management, magnesium, B-complex, zinc, and adaptogens like Rhodiola.
How to Determine Your PCOS Type (Selection Criteria):
To determine your PCOS type, consider the following steps:
- Review Lab Results: Check insulin, glucose, DHEAS, testosterone, LH, FSH, CRP, and cortisol.
- Symptom Pattern: Identify if symptoms are primarily metabolic (insulin), inflammatory, stress-related (adrenal), or triggered after stopping the pill.
- Medical History: Consider pill usage, digestive issues, chronic stress, or food intolerances.
- Body Measurements: Assess waist-to-height ratio and signs of apple-shaped obesity.
- Partner with a Specialist: A practitioner experienced in hormone disorders can interpret your labs and symptoms holistically. Correct classification of PCOS ensures targeted and successful treatment, whether through lifestyle adjustments, supplements, or supportive therapies.
PCOS and Mental Health
Many women with PCOS experience emotional struggles like anxiety, sadness, or feeling down. These feelings are not just because of the physical symptoms like acne or weight gain, but also due to changes in brain chemicals caused by hormones.
A large study found that women with PCOS are almost three times more likely to have depression and anxiety than women without it. In fact, about 1 in 3 women with PCOS may have depression. These emotional challenges can make everyday life harder and affect self-esteem and relationships.
Mental health effects are influenced by high levels of androgens, insulin resistance, and inflammation all of which can disrupt neurotransmitters such as serotonin and dopamine. Women with PCOS often report higher levels of stress, body image concerns, and low self-worth. These issues may be intensified by irregular periods, infertility, or the pressure to manage chronic symptoms. This is why it’s important for women with PCOS to take care of their mental health, not just their physical health. Talking to a counselor, joining a support group, or simply sharing how you feel with someone you trust can really help. Doctors should also ask about mood and emotions during checkups.
PCOS and Fertility
PCOS is one of the leading causes of fertility problems in women because it often disrupts regular ovulation (the process where an egg is released from the ovaries). Without regular ovulation, it becomes harder to get pregnant.
But the good news is, many women with PCOS can still have babies with the right help. According to a 2023 research article, fertility challenges in PCOS are mostly caused by hormonal imbalances, inflammation in the ovaries, and issues with the lining of the uterus. These problems can stop the body from releasing eggs or make it harder for a fertilized egg to grow.
Here are simple ways doctors help women with PCOS become pregnant:
• Healthy lifestyle changes like eating better and moving more can help some women start ovulating again.
• Ovulation medicines such as letrozole or clomiphene citrate help the body release eggs.
• Fertility treatments like IVF (in vitro fertilization) are also available if medicines don’t work.
New treatments like GLP-1 receptor agonists (e.g., semaglutide) are being studied because they help with weight loss and may also improve ovulation. Even though PCOS can make getting pregnant more difficult, many women with the condition go on to have healthy pregnancies with the right care and support.
Treatment Options for PCOS
There is no cure for PCOS, but symptoms can be managed through:
• Birth control pills to regulate periods
• Anti-androgen medications
• Metformin to improve insulin sensitivity
• Lifestyle changes (diet and exercise)
• Fertility treatments if needed Metformin is often prescribed to treat insulin-resistant PCOS and has shown effectiveness, though it may cause side effects like B12 deficiency.
Diet and Nutrition for PCOS
A balanced and personalized diet is one of the most important tools in managing PCOS symptoms. Diet plays a direct role in regulating hormones, reducing inflammation, and improving insulin sensitivity the root cause for many women with PCOS.
Nutrition for PCOS:
• Focus on whole, unprocessed foods
• Emphasize fiber-rich vegetables, especially leafy greens and cruciferous vegetables like broccoli and kale
• Choose low-glycemic index (GI) carbs such as quinoa, brown rice, oats, and sweet potatoes to avoid insulin spikes
• Incorporate healthy fats (avocados, nuts, seeds, olive oil) and lean proteins (chicken, fish, tofu, legumes)
Foods to Avoid or Minimize in PCOS:
• Refined sugar and high-fructose corn syrup
• White bread, pasta, and other high-GI carbohydrates
• Processed snacks and trans fats
• Dairy and gluten (especially in inflammatory PCOS types)
Add Anti-inflammatory food to your diets which can help reduce systemic inflammation and improve hormone balance. Examples include:
• Mediterranean diet rich in healthy fats, fiber, and antioxidants
• Dairy-free, wheat-free approaches for those with sensitivities
• Avoid skipping meals to keep blood sugar stable
• Stay hydrated and limit sugary drinks
• Include chromium, magnesium, and zinc-rich foods (e.g., pumpkin seeds, spinach, seafood)
• Consider working with a registered dietitian to develop a sustainable plan Making thoughtful food choices and focusing on whole-body nourishment can significantly improve PCOS symptoms over time and support long-term hormonal balance.
Exercise and Fitness Tips for PCOS
Regular physical activity is one of the most effective ways to manage PCOS. Exercise helps improve insulin sensitivity, balance hormones, support weight management, and reduce inflammation all of which are essential in addressing PCOS symptoms at the root.
Best Types of Exercise for PCOS:
• Strength Training: Builds lean muscle, boosts metabolism, and improves insulin response. Focus on bodyweight exercises or resistance bands if you’re just starting.
• Cardio (Aerobic Exercise): Walking, cycling, swimming, and dancing can help reduce belly fat and improve heart health.
• High-Intensity Interval Training (HIIT): Short bursts of intense movement followed by rest. Great for fat burning and insulin sensitivity.
• Yoga and Pilates: Help reduce stress, regulate cortisol levels, and support adrenal health especially useful in adrenal-type PCOS.
Tips for Success:
• Start small with activities you enjoy consistency matters more than intensity.
• Aim for at least 30 minutes of moderate exercise most days of the week.
• Don’t overtrain too much intense exercise may worsen symptoms for some women.
• Include recovery days to support hormonal balance. Exercise is not just about weight loss it’s about improving overall function and well-being. Moving your body regularly can enhance your energy, mood, and ability to regulate cycles naturally.
Common Myths About PCOS
• Myth: Only overweight women get PCOS
• Fact: PCOS can affect women of all body types
• Myth: PCOS means you can’t get pregnant
• Fact: Many women with PCOS conceive successfully
• Myth: Birth control cures PCOS
• Fact: It manages symptoms but doesn’t cure the condition
PCOS and Other Health Risks
Women with PCOS are at higher risk of developing type 2 diabetes, high blood pressure, cholesterol issues, and uterine cancer. Regular screenings and preventive care are essential. Insulin resistance can persist past menopause and must be addressed throughout life.
Natural Remedies and Supplements for PCOS
Some natural approaches include:
• Inositol (supports insulin sensitivity)
• Vitamin D
• Zinc
• N-acetyl cysteine (NAC)
• Melatonin
• Rhodiola
These support ovulation, reduce inflammation, and balance androgens. Always consult your doctor before starting supplements.
Conclusion:
Living Well with PCOS While PCOS is a complex condition, it is manageable. With awareness, timely treatment, and healthy lifestyle habits, women with PCOS can lead fulfilling, balanced lives. Empower yourself with knowledge, seek support, and take control of your health journey.
Msc. Human nutrition and Dietetics. Help women in losing weight with PCOS