PCOS Explained: Symptoms, Types, and How to Treat the Root Cause

Polycystic Ovarian Syndrome (PCOS) affects between 5-20% of women and is one of the most misunderstood hormonal conditions. If generic advice hasn't worked for you, there's likely an individual driver behind your symptoms - and understanding it is the first step to real results.

What is PCOS?

PCOS is diagnosed using the Rotterdam criteria: you need to meet two of these three factors:

1. Irregular ovulation

2. High androgen signs (excess hair growth, acne, hair thinning)

3. Polycystic ovaries on ultrasound, or high AMH levels on a blood test

Importantly, you don't need to have cysts on your ovaries to have PCOS - and you can have cysts without having the syndrome.

Common Symptoms

• Irregular or absent periods (cycles of 60–90 days)

• Acne (especially around the jawline, chest, and back)

• Hirsutism (dark facial or body hair)

• Hair thinning

• Weight gain or difficulty losing weight

• Energy crashes and blood sugar instability

• Inflammation and pain

People with PCOS have a four times higher risk of developing diabetes — making blood sugar regulation a critical focus.

The 4 Types of PCOS

Rather than a one-size-fits-all approach, it helps to understand which "phenotype" is most relevant to you:

1. Insulin Resistant PCOS (most common, 35–80%) - High insulin levels drive androgen excess, weight gain, acne, and energy crashes. Prioritise a low-GI diet, pair carbs with protein and fibre, and consider inositol supplementation.

2. Inflammatory PCOS - Often presents with gut issues, fatigue, and pain. Chronic low-grade inflammation worsens insulin resistance. An anti-inflammatory diet is key.

3. Adrenal PCOS - Driven by elevated DHEA from the adrenal glands, typically triggered by chronic stress. Managing cortisol through lifestyle and stress reduction is the primary treatment focus.

4. Post-Pill PCOS - Can occur after stopping hormonal contraception. Often temporary but may require support to address the androgen surge that follows.

Treatment Strategies

Diet:

• Eat balanced meals with protein and fibre at every sitting

• Avoid "naked carbs" (carbohydrates eaten without protein or fibre)

• Follow an anti-inflammatory, Mediterranean-style diet: olive oil, avocados, nuts, seeds, fish, and a wide range of colourful vegetables

Exercise:

• Regular, moderate movement is beneficial - but over-training is counterproductive

• Excessive high-intensity training can raise cortisol and worsen symptoms

• Align exercise intensity with your cycle

Gut Health:

• Prioritise fibre, probiotics, and polyphenols

• A healthy gut microbiome positively impacts hormone metabolism, nutrient absorption, and inflammation

Supplements with Evidence:

• Inositol (Myo-inositol): Improves insulin sensitivity and supports ovulation

• Vitamin D: Emerging research supports its role in PCOS

• Peony and Licorice: Herbal medicines that can reduce androgen levels (testosterone and DHEA)

Reduce Endocrine Disruptors:

• Avoid heating food in plastic

• Swap plastic storage for glass where possible

• Review personal care products for hormone-disrupting chemicals

Stress Management:

• Particularly important for adrenal PCOS

• Focus on sleep, nutrition, movement, and potentially herbal adaptogens

Testing for PCOS

A Day 2-4 hormone panel can assess:

• Testosterone and DHEA levels

• FSH and LH ratio

• Fasting insulin

• AMH

• Vitamin D and inflammatory markers

• Gut microbiome profile (if gut symptoms are present)

Final Thoughts

PCOS is not a life sentence - it's a manageable condition when you understand your individual driver. If you're overwhelmed by conflicting information or unsure where to start, booking a discovery call can help clarify the best path forward for you.