PCOS

What’s the Best Diet to Follow for PCOS?

July 7, 2025 by William Haas Leave a Comment

Confused about what to eat when battling with PCOS?

“Cut out gluten…”

“Ditch the dairy…”

“Stick to keto…”

There’s no shortage of opinions on social media and the internet when it comes to this topic.

Notice we said opinions…

Most of what you read is not much more than well-intentioned advice from those who have seen positive results after making a certain trendy dietary change that has worked for them.

That’s great! But…

Does one person’s dietary success apply to ALL the other women out there with PCOS?

All too often, we’ve seen women with PCOS who have tortured themselves trying to stick to the latest fad or whatever has worked for their friend. Ready to break that cycle?

Here’s a quick overview of what you’ll discover:

Pharmacology versus food for PCOS
Choosing a PCOS diet that actually works
Low glycemic load foods for PCOS
Navigating trendy diets

Pharmacology vs. Food for PCOS

As we discussed in last week’s post, lifestyle changes are the first-line treatment for women with PCOS. In doctor-speak, that means don’t just throw medications at the problem!

Unfortunately, we know that’s not what most women struggling with PCOS experience when they go to the doctor…

We strongly believe that women with PCOS should be provided knowledgeable information about incorporating certain dietary changes (and exercise too) to help improve their symptoms… all while allowing enough time for these interventions to make a difference.

Of course, when symptoms are severe (e.g., hair growth on your face, uncontrollable cystic acne, or other medical issues like insulin resistance), pharmacologic treatment (prescription medications) may be required alongside lifestyle modifications.

When it comes to prescription medications, we always tell our patients, the treatment depends on the goal. But no matter what you and your physician decide, optimizing your diet plan will help improve your symptoms and increase the chance of treatment success (more on that in just a moment!).

But before jumping into all things nutrition, we thought it might be helpful to briefly review the prescription medications most commonly prescribed for PCOS.

The goal here is to give you a balanced view of the risks and benefits of each, so you can make your own decision as to what is best for you as an individual. This means making sense of the information your doctor gives you as well as the “knowledge” social media influencers present in your feed.

Please know that we never recommend using medications to simply cover up your PCOS symptoms. Taking a holistic approach that addresses the root cause of your unique situation is what our programs at OvulifeMD are all about.

Combined oral contraceptive pills (OCPs)

Birth control pill packet as a treatment for PCOS

Benefits:

Often considered by many providers to be the first-line treatment for PCOS, oral contraceptive pills (OCPs) can help manage symptoms in multiple ways.

Firstly, they regulate menstrual cycles, which means you can say goodbye to that unpredictable bleeding pattern and prolonged endometrial exposure to unopposed estrogen (which is associated with a higher risk of endometrial abnormalities as we discussed last week).

Further, the estrogen component within OCPs actually increases protein production of sex hormone-binding globulin (SHBG), which does exactly what the name says – it binds up sex hormones. Physiologically, when a hormone is bound to a carrier and not circulating freely in the blood its effects aren’t nearly as strong. In this case, when the amount of SHBG increases, the amount of circulating free testosterone decreases. This means fewer hyperandrogenic symptoms including hair growth and acne that are commonly associated with PCOS.

Of note, while the menstrual cycle regulation is experienced immediately, it takes at least 6 months to see the full effects of OCPs in terms of improving hyperandrogenic symptoms. So before you think it’s not working, you have to give it time!

Risks:

Now if you’ve spent any amount of time researching the topic, you know that OCPs do have some side effects. The most commonly mentioned side effects include an increased risk for blood clots and stroke. More recent evidence has also noted increased rates of depression among women taking OCPs (1).

Finally, as you know OCPs prevent pregnancy, which isn’t necessarily a side effect per say, but it will certainly impact your fertility. There are those that suggest OCPs can disrupt your fertility upon discontinuation, but that is a topic for another day…

Antiandrogens

Spironolactone pill bottle as a treatment for PCOS

Benefits:

Whereas the anti-androgen effects of OCPs occur via a secondary mechanism of action, there are drugs that specifically have anti-androgen effects by way of blocking hormone receptors (thereby blocking the androgen function directly) or inhibiting enzymes that prevent the conversion of certain hormones into more potent androgens.

Some of these include drugs like spironolactone, flutamide, finasteride (all oral medications), and the topical cream, eflornithine.

These are typically used for excessive, bothersome hair growth and treatment-resistant acne.

Risks:

Although each of these can be incredibly effective, particularly when used in conjunction with lifestyle modifications and OCPs, they are also teratogens (meaning they can cause birth defects). So, again when pregnancy is the goal, these are not an option.

Another thing to be aware of is the ability of some of these medications to cause electrolyte imbalances along with breast swelling and tenderness.

Insulin sensitizers

Metformin pill bottle as a treatment for PCOS

Benefits:

Given that insulin resistance is known to play an important role in the pathophysiology of PCOS, researchers initially thought medications that reduce insulin resistance would help.

Metformin is a medication that not only makes your body more sensitive to insulin but also acts to decrease the liver’s production of glucose.

While early data was promising and suggested higher ovulation rates and improved metabolic features in women with PCOS, large well designed randomized controlled trials confirmed that metformin alone was inferior to standard ovulation induction agents like clomiphene citrate or letrozole (2).

When metformin was used in combination with clomiphene citrate, ovulation rates were higher than with clomiphene alone but were no better than letrozole alone which has been shown to have the highest live birth rates in women with PCOS (2,3).

So where has the data left us with recommendations for metformin use in women with PCOS?

Expert recommendations suggest that:

In addition to lifestyle modifications, metformin may be considered for the treatment of weight, hormonal and metabolic outcomes related to PCOS (4).

Risks:

Although metformin is considered by many to be a miracle drug, due to its insulin-sensitizing properties (among others), it doesn’t come without its own side effects and risks. Common side effects include gastrointestinal (GI) upset including nausea, vomiting, and diarrhea (which may play into its role in weight loss) and abdominal discomfort.

Long-term use has also been associated with vitamin B12 deficiency so it’s important to keep that in mind as well, particularly if the goal is pregnancy.

Food As Medicine

As you can see, medications have their time and place when treating PCOS. However, they are certainly not without their potential adverse effects.

Dietary changes, on the other hand, don’t come with these worrisome side effects – not to mention they can improve your overall health and fertility too!

But how are you supposed to go gluten-free, dairy-free, low-carb, high-protein with a splash of grapefruit juice every day for life?

Well… you’re not!

That’s why we’re going to cover which diets have actually been shown to be effective for PCOS, and in more than just one person (yes, we are implying that just because one woman cut out dairy, doesn’t mean it will work for all women with PCOS).

Choosing a Diet That Actually Works for PCOS

First of all, we think it’s important to start by pointing out that everyone is different.

That may sound cliche, but it’s true.

Just because the ketogenic diet or going gluten-free worked for your friend, doesn’t mean it’s going to work for you. Yes, we’ve been there too… It’s completely normal to get excited when you see positive results in someone else’s life.

So when it comes time to choose an optimal PCOS diet plan, our goal here is to discuss which diets have been backed by actual scientific data and explain why one diet may be more effective than another.

And remember from our initial post in this series, an effective diet should ultimately check 3 boxes:

Improved clinical outcomes (everything from weight, body composition, degree of insulin resistance, and androgen symptoms to menstrual cycle regularity and pregnancy)
Ability to maintain (did women gain all the weight right back once the study was over?)
Improved quality of life (reduced anxiety/depression scores, etc.)

The reality is we have a lot left to learn but we don’t want you believing every new fad you see on the internet, or torturing yourself counting calories and eating food that doesn’t taste good or make you happy.

Because guess what? It doesn’t have to be that way.

A full literature review is outside the scope of this blog post… and it would likely make your eyes completely glaze over, so we’re going to summarize the high points here.

When looking at the data regarding diet and PCOS, the types of diets studied include things like:

Low-carb, high protein
High-carb, low protein
Low-fat
Calorie restriction
Keto
Low glycemic index/load

Unfortunately, most of these diets all have one thing in common – they are quite difficult to maintain over the long term… anyone who’s tried a low carb diet knows just how tempting bread, pasta, and baked goods can be after just a week.

And the liquid meal replacement eating plan? Been there, done that, and personally, we think they’re miserable.

So which diet has been shown to improve clinical outcomes AND is actually easy to AND has been associated with an improved quality of life?

Say hello to the low glycemic load diet.

Low Glycemic Load Foods for PCOS

As we reviewed back in our Decoding the Fertility Diet Series — the one about carbohydrates — glycemic index basically refers to how a particular carbohydrate affects your blood sugar over time compared to sugar.

Glycemic load simply takes into account the serving size of a particular carbohydrate making it a more practical measure to use.

In the general population, low glycemic index diets have been associated with a lower risk of (5):

Cardiovascular disease
Type 2 diabetes
Metabolic syndrome
Endometrial cancer

Does that list look familiar?

It’s essentially the list of associated comorbidities that women with PCOS are at risk for. So in this context, it seems to make sense to consider a low glycemic load diet to optimize PCOS outcomes.

When looking at studies that simply altered JUST the quality of carbohydrate consumed (not calorie restricting in any way, data has shown that increased intake of low glycemic load carbohydrates in women with PCOS has resulted in (6):

Improved insulin sensitivity
Higher % body weight lost
Improved menstrual regularity
Improved emotion and quality of life scores

This study was a non-randomized control trial of PCOS women with overweight or obesity and had a macronutrient breakdown of about 50% carbohydrate, 23% protein, 27% fat. Women in the study also engaged in physical activity 30 minutes per day for 5 days per week or aimed for 10,000 steps per day, which certainly may have potentiated some of the effects.

Needless to say, that seems doable, right?

Another study found that as little as 12 weeks of this type of intervention has shown improved insulin sensitivity in women with PCOS without any calorie restriction! By simply swapping out high for low glycemic load carbs, clinical benefit was achieved (7).

Further supporting these findings, a more recent study showed that women with PCOS who had the highest intake of high-glycemic-index carbs had a higher body mass index (by nearly 6 points) and waist circumference (difference of over 10 cm), regardless of the same daily caloric intake, compared to women who consumed the least amounts of high glycemic index carbs (8).

Simply swap out high and medium glycemic load foods with low glycemic load foods… could it really be that easy?

Well, we think that is one of the biggest parts of optimizing diet for PCOS as elevated insulin levels and insulin resistance is thought to be a central part of the pathophysiology of PCOS and this is one of the most effective ways to mitigate that.

These carb swaps should be incorporated as a part of an otherwise whole foods-based diet that’s rich in fruits, vegetables, plant-based proteins, omega-3 rich fish, and the occasional high-quality, high-fat dairy.

In terms of relative amounts of macronutrients, benefits have also been shown with about 40% of calories coming from carbohydrates, 30% from protein, and 30% from fat in women with PCOS with improved:

Androgen parameters (9)
Insulin sensitivity (9)
Menstrual cyclicity (9)
Anxiety & Depression Scores (9)
Lipids (10)

The majority of “low carb” studies in women with PCOS have also implemented caloric restriction (up to 1000 calorie deficit per day) which must be taken into account when interpreting the above findings. Regardless, this relative macronutrient breakdown is a good target to keep in mind when starting with swapping out the quality of your carbohydrate (10). Basically, don’t just consume 100% of your calories from low glycemic load carbs. Fat and protein are important too.

So give it a try- start by simply swapping out the type of carbohydrate you eat! Give it one month and see how you feel. We’ve included a quick reference graph here so you can make some simple food swaps starting today.

And again, remember… focus on nutrition, NOT “dieting.” This is a lifestyle change, not a short-term fix. Let’s make it count!

Navigating Trendy Diets for PCOS

We totally understand if you haven’t seen or heard much about a low-glycemic diet in the past. It’s certainly not as sexy as other diets and it doesn’t get much love on social media.

So before we wrap up our conversation on nutrition and PCOS, we wanted to address some of the more trendy diets we commonly get asked about from our patients…

What about gluten? Should I go gluten-free too?

To date, there’s NO evidence-based research that demonstrates a clear connection between PCOS and gluten-free or gluten-laden foods (type it into PubMed and see how many results come up). With that said, we recognize that just because there aren’t any papers published at this time, doesn’t mean there’s not something worth looking at.

We promise to tackle a full review of gluten later, but from an integrative/functional medicine standpoint, here’s what we know…

PCOS is thought to be partially a state of increased inflammation and insulin resistance. And it has been suggested that regular consumption of gluten-containing products can contribute to chronic inflammation (11). Therefore, the theory is that reducing gluten consumption (or avoiding it altogether) could potentially lessen inflammation in PCOS. However, more research is definitely needed before making broad recommendations that all women with PCOS should go gluten-free.

One more quick point about gluten, if not appropriately executed, consuming strictly gluten-free foods can result in deficiencies of key nutrients, including pro-fertility nutrients iron and folate. So please do your homework and speak with a nutritionist before you decide to go gluten-free.

Bottom line… There’s a significant lack of evidence to support a gluten-free diet for all women with PCOS. The best nutritional approach in this situation, as with most, is a personalized one – if eating gluten doesn’t make you feel good, stay away from it. Make a plan that works for you.

Isn’t keto best for women with PCOS?

The next most common question we hear is, “but I heard keto was best for women with PCOS?”

You’ve probably seen this one all over your social media account.

If you need a quick refresher on the ketogenic (“keto”) diet- you can find that here.

But what has the data actually shown when it comes to keto and PCOS?

First of all, it’s important to note that, similar to gluten, data is limited in this area. Second, using keto for weight loss versus using it to boost your fertility are two different goals and this should be taken into consideration when examining the literature and considering it for yourself.

With that said, let’s take a look at what we found…

A small study looked at 11 women with PCOS (BMIs > 27) who limited their carbohydrate intake to 20 gram/day or less for 6 months (12). Of the initial 11 women, only 5 completed the study. And although researchers found an overall improvement in body weight, testosterone levels, and insulin levels, the individual outcomes of the 5 women were less than exciting (1 experienced an increase in testosterone, 1 experienced no change in the diabetes marker A1c, and 1 experienced an increase in their A1c).

We have to admit, it’s hard to make any sweeping generalizations or conclusions based on 5 women.

A more recent study of 14 women underwent a modified ketogenic Mediterranean diet (KEMEPHY diet) supplementing with “food supplements and liquid herbal extracts” for 12 weeks (13). This study also noted reduced body weight as well as improved androgen levels and measures of insulin resistance. However, the effects of the Mediterranean-type diet, “food supplements”, or “herbal extracts” cannot be disentangled from the “keto” portion of this diet and limits its generalizability. Another small study of 18 women suggested improvement in fatty liver symptoms in women with PCOS but didn’t assess pregnancy-related outcomes (14).

We’re not saying this data isn’t helpful, it’s just important to keep in mind the primary outcome wasn’t pregnancy in either of these studies and these small numbers of women were followed for relatively short periods of time. Additionally, quality of life, anxiety, and depression scores were not assessed which are vitally important to any lifestyle change you might take on.

Bottom line: Data is severely lacking when it comes to keto for PCOS.

Final Thoughts on the Best PCOS Diet

Although pharmaceutical medications have their time and place, dietary lifestyle modifications are some of the best first-line treatments for PCOS.

To quickly recap, the right dietary choices for PCOS can help with:

Weight loss
Menstrual regularity
Decreased androgen levels
Improved quality of life
Improved reproductive outcomes

Focus on consuming a diet rich in low glycemic load carbohydrates including things like whole grains, fruits, and vegetables. In terms of relative amounts of macronutrients, benefits have also been shown with about 40% of calories coming from carbohydrates, 30% from protein, and 30% from fat. And although we say “diet” we really want you to focus on nutrition and eating patterns. NOT “dieting” in this traditional sense of the word. This is a lifestyle change, not a short-term fix. Let’s make it count.

And if you want to boost your fertility too, follow a pro-fertility diet with increased intake of plant-based proteins and food sources rich in omega-3 fatty acids.

It’s also important to note that any amount of exercise can help too, but more on that in an upcoming post… but start by making a plan that works for YOU.

References:

Skovlund CW., et al. Association of Hormonal Contraception with Depression. JAMA Psychiatry. 2016;73:1154-1162.
Legro RS., et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med. 2007;356:551-566.
Legro RS., et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014;371:119-29.
Teede et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018;110:364-379.
Salmeron J.et al. Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA. 1997;277:472-7.
Marsh KA. et al. Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Am J Clin Nutr. 2010;92:83-92.
Barr S, Reeves S, Sharp K, Jeanes YM. An isocaloric low glycemic index diet improves insulin sensitivity in women with polycystic ovary syndrome. J Acad Nutr Diet. 2013;113:1523-31.
Graff SK, Mario FM, Alves BC, Spritzer PM. Dietary glycemic index is associated with less favorable anthropometric and metabolic profiles in polycystic ovary syndrome women with different phenotypes. Fertil Steril. 2013;100:1081-8.
Moran LJ, Noakes M, Clifton PM, Tomlinson L, Galletly C, Norman RJ. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2003;88(2):812-9.
Stamets K, Taylor DS, Kunselman A, Demers LM, Pelkman CL, Legro RS. A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome. Fertil Steril. 2004;81(3):630-7.
Punder K, Pruimboom L. The dietary intake of wheat and other cereal grains and their role in inflammation. Nutrients. 2013;5:771-87.
Paoli et al. J Transl Med. 2020;18:104.
Mavropoulos JC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond). 2005;2:35.
Li J. et al. Ketogenic diet in women with polycystic ovary syndrome, and liver dysfunction who are obese: a randomized, open-label, parallel-group, controlled pilot trial. J Obstet Gynaecol Res. 2021;47:1145-1152.

Exercise for PCOS?
Workout & Exercise Strategies that Actually Work for PCOS

July 7, 2025 by William Haas 3 Comments

“Spinning classes cause PCOS…”

“Don’t lift weights if you have PCOS… it will make your hair growth worse”

“You need to exercise more and eat less…”

The topic of exercise and polycystic ovary syndrome (PCOS) is a maze of myths and misinformation.

Some of you may already know how ridiculous these statements are, while others are just starting to explore how exercise can help manage PCOS and might be wondering if they’re really true.

And no matter where you are on your PCOS journey, this post will help deepen your understanding of how exercise can help you manage your PCOS successfully.

Here’s a quick overview of what you’ll discover:

Why exercise is important for PCOS
Tips for overcoming exercise challenges
Choosing the right type of exercise for PCOS
How much exercise is enough when you have PCOS
Keep your goals in mind

Why Exercise is So Important for Women with PCOS

Here’s where you’ll learn all the wonderful things exercise can do to help with your PCOS symptoms…

But before we jump into all the benefits, it’s important to note that studies have consistently shown that dietary changes alone OR dietary changes plus exercise produce better outcomes than JUST exercise alone (1).

As much as you can, try not to get yourself in the rut of overeating or eating filler foods… only to punish yourself later with exercise. We’ve all been there, and truth be told, there’s no amount of exercise that can make up for poor dietary choices on the regular.

So if you’re just starting out or you’re feeling a little overwhelmed, take a deep breath, start slow, and optimize your diet first!

Of course, we’ve also got you covered with some tips for getting started with exercise in the next section, so don’t just skip to the summary 🙂

Infographic about the benefits of exercise for PCOS

Improved body composition

We know that we said it’s not just about weight loss, but even small amounts of weight loss (5-10% of your body weight) can make a difference in PCOS outcomes (1).

With that said, keep in mind that the number on the scale might not budge while you are achieving positive changes in your body composition because the fact is, muscle weighs more than fat.

So even if you’re not seeing immediate improvements on the scale, you’re still taking steps to improve your symptoms and overall health by engaging in exercise on a regular basis. Pay more attention to how your clothes fit you and how you feel. That’s far more valuable than any number on the scale.

Increased insulin sensitivity

Many women with PCOS, including lean women, have insulin resistance or hyperinsulinemia (too much insulin in the blood.)

As we discussed previously, high insulin levels can cause your ovaries to increase the production of testosterone while also decreasing the protein that binds up free-floating testosterone. This combination of things can then disrupt your menstrual cycle and ovulation, cause acne, and result in hirsutism.

Exercise, especially strength training, increases insulin sensitivity in both healthy women and women who have polycystic ovarian syndrome which can help mitigate this vicious cycle.

Reduced inflammation

Even though it’s not part of the official diagnostic criteria for PCOS, research indicates that women with PCOS suffer from chronic inflammation (2).

The good news is that regular exercise improves markers of inflammation (3). This is especially important because chronic inflammation is also a driving force for insulin resistance (4).

Once again, even if you’re not seeing the benefits of your exercise right away, rest assured that positive things are happening in your body!

Decreased risk for heart disease

We know that heart disease is probably not top of mind compared to your reproductive health, but it’s the number one killer of women. And if that didn’t catch your attention, women with PCOS have a higher risk for developing cardiovascular disease (5, 6).

The good news is that regular exercise can help improve many of the risk factors contributing to heart disease including things like type 2 diabetes, hypertension, and high cholesterol.

Elevated mood

It’s not talked about as often as it should, but women with PCOS are more likely to develop symptoms of depression and anxiety (7).

Luckily, when you exercise, your body releases endorphins – a special type of chemical messenger released in the brain that promotes feelings of wellness.

Who doesn’t want that?

Tips for Overcoming Exercise Challenges

Getting started or even continuing with an exercise program is tough…

Even as the endorphin-junkies that we are, we encounter roadblocks that can get in the way of workouts… lack of time and motivation are two that come to mind.

We thought it might be helpful to break down some common exercise challenges we have experienced ourselves and encounter with our patients most often with some tips to get started with a plan that works for YOU.

Infographic with 4 tips for overcoming exercise with PCOS

Ditch the all-or-nothing mindset

Following an unrealistic workout program can be so destructive…

In fact, nothing can derail your progress faster than falling short of unreasonable expectations. And even though exercising 3-5 days a week is recommended, it doesn’t mean that you have to start there or stick with that schedule.

Any day you exercise gets you one step closer to your goals!

So start with what’s realistic and build from there.

Choose a workout plan that feels good

It might sound obvious, but seek out activities and environments that make you feel good and bring you joy.

If joining a gym gives you anxiety… then workout at home (we promise, you don’t need that fancy equipment to make significant gains). If you hate running but love to spin… hop on a stationary bike. If you enjoy brisk walking most… then do that! Have you been wanting to give yoga a try? Then start there!

Exercise will hopefully become a part of your life for years to come, so you have plenty of time to explore new methods.

And remember, consistency is what leads to results, so never feel pressured into a form of exercise intervention that feels like a chore or you won’t stick to it. Mix and match so you don’t get bored and do what you LOVE.

Connect with a coach

It’s easy to feel overwhelmed with the amount of information out there these days…

… and going to the gym with no plan (or even the wrong plan), can leave you feeling lost or frustrated, especially if you don’t get the results you want.

We’re big fans of having a coach. Even though Dr. Haas holds advanced certifications as a strength coach, he always works with a coach to develop and guide his own workout plans.

Make sure to connect with a few coaches before settling into a routine.

Just because someone is a fitness expert does not mean that you will connect with them. More importantly, you should work with someone you trust and who is willing to customize your program for the unique needs of someone with PCOS.

Start where you are

Don’t be ashamed, embarrassed, or discouraged by your current fitness level…

Where you are today will not be your final destination.

And even if you’ve been exercising for some time, do what you can at the moment. You will continue to improve and advance your exercise ability over time.

Remember, it’s always better to start small… and if you feel like doing more, let it be because you enjoy your workout, not because of any preconceived expectations or external pressures.

What Type of Exercise is Best for PCOS?

Now is a good time to dispel a common myth about physical exercise and PCOS…

No one type of exercise is going to cure, cause, or worsen your PCOS symptoms.

That means lifting weights and doing squats won’t automatically drive up your testosterone levels and flare your hyperandrogenic symptoms…

Similarly, sticking to cardio or high-intensity interval training (HIIT) won’t cause you to gain weight and store body fat.

As with most things, there’s not a one size fits all approach here. Our goal in this section is to present the evidence so you can modify your exercise plan to suit your individual circumstances.

So, let’s dive in…

A meta-analysis of 10 randomized control trials including 533 women with PCOS concluded that aerobic exercise alone was effective in reducing body mass index (BMI). It’s also interesting to note that neither aerobic exercise nor aerobic exercise combined with resistance training appeared to have a dramatic effect on testosterone levels (8).

Although this same study didn’t assess quality of life measures, other small studies have shown that aerobic training for as little as 150 minutes per week (30 minutes, 5 days per week) not only improves cardiometabolic outcomes but also improves mental health-related quality of life (9).

And as an added benefit, aerobic exercise has also been shown to improve insulin sensitivity and PCOS morphology (10).

Now if aerobic activity isn’t your thing, then you can consider taking up resistance training.

Progressive resistance training alone for 1 hr per day, 3 times per week for 4 months in women with PCOS (11) has been shown to increase lean muscle mass, while:

Decreasing androgen levels
Decreasing fasting glucose levels
Decreasing waist circumference

So please don’t be afraid of lifting weights!

Unfortunately for our fellow yogis, the data on yoga or other forms of flexibility training in women with PCOS is sparse. With that being said, yoga is an excellent complement to any lifestyle modification and is another great way to help improve your overall quality of life.

As you can see a variety of different types of exercise have shown clinical benefits in PCOS so there’s no one right way to go about it.

How Much Exercise is Enough?

The question of how much exercise is enough is definitely an important one.

Not only do you want to make sure that you’re not wasting your time, but you want to make sure that you’re not overdoing it too!

The ‘right’ amount of training will vary according to your unique needs and circumstances, but there are some general recommendations that apply well to most women with PCOS.

According to the Department of Health and Human Services (DHHS) (12), to achieve substantial health benefits from exercise:

“Adults should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity.”

So that could look like: 30 – 60 minutes of moderate exercise 5 days per week OR 15 – 30 minutes of vigorous activity 5 days per week.

These recommendations are actually in line with the findings in a meta-analysis of 19 studies that indicated 120 min of vigorous activity per week was needed to provide favorable health outcomes for women with PCOS (13).

And in case you are wondering, vigorous physical activity is defined as “activities that take hard physical effort and make you breathe much harder than normal,” which include things like heavy lifting, aerobics, and fast cycling.

One recent study in Fertility & Sterility has suggested that vigorous exercise may be associated with improved metabolic profiles in women with PCOS independent of total exercise output (14).

In fact, when compared to those who were inactive or those who engaged in moderate physical activity only, those who engaged in vigorous exercise had a lower BMI, improved insulin sensitivity and lipids. What’s even more exciting is that for every hour of vigorous exercise, a woman’s odds of metabolic syndrome were reduced by 22% (14).

Ultimately, we think the important message here is that you get enough cumulative exercise throughout the week without overdoing it.

And that last point is important…

Over-training can definitely undo the progress and benefits you’ve worked so hard to achieve.

This is a good place to briefly talk about cortisol as we see this topic come up a lot. Too often we see claims that long bouts of aerobic exercise drives up cortisol levels and results in weight gain and increased body fat.

Cortisol is a stress hormone that does many things in your body, including raising blood sugar in the short term and storing fat in the long term. Obviously, if your body is already struggling with insulin resistance, additional increases in blood sugar or body fat are not good for your PCOS.

But here’s the thing…

Cortisol production is elicited at exercise intensities between 80% – 90% of your VO2 max, which doesn’t describe your typical bout of cardio (15). This is also an acute response, meaning if you’re not exercising to the point of near exhaustion on a regular basis, then cortisol levels should not become persistently elevated.

With that said, if you start doing two workouts a day or spend 2 hours grinding it out on the elliptical machine every day, then cortisol levels can become chronically elevated… and under these conditions, exercise can contribute to fat storage.

So just remember, chronic cortisol production is less about the type of exercise and more about the amount and intensity.

Bottom line… more isn’t always better, regardless of the type of exercise you choose – so don’t overdo it! And as with most things in life, balance is key.

Keep Your Goals in Mind (Not Just Your Weight)

Before you jump feet first into your exercise plan, we always suggest you stop and set some goals.

Yes, we know…

Goal-setting, snooze. But…

It’s so easy to lose motivation if you don’t know what you’re working toward, especially on those days that you just don’t have the motivation or you’re completely stressed out.

So take the time to get clear about your PCOS goals!

Every woman has different goals, which is exactly the way it should be.

Improved menstrual regularity?

Weight loss?

Better blood sugar?

Stress relief?

Healthy pregnancy?

And just one more thing about goal-setting… As women, we must look beyond the unrealistic expectations marketed to us about the effects of exercise. We must remember that each of us is unique and that we are each beautiful in our own way.

That means remembering most of us are not genetically programmed to get 6-pack abs in 6-weeks, no matter what the flashy magazine covers promise.

Your exercise plan is about so much more than appearances… It’s about improving quality of life, enhancing fertility, and decreasing cardiometabolic risk... and not just for the next 3 months or until we get pregnant, but for the rest of your life.

Final Thoughts

So where does all this talk about exercise leave us?

For the average woman trying to manage PCOS, here are some basic guidelines:

Choose the form of exercise that best suits you
Try to mix and match different types of exercise (i.e., strength, flexibility, and cardio)
Shoot for 120-150 minutes of vigorous exercise per week
Don’t overtrain your body, regardless of the form of exercise
Set your goals and don’t judge your progress or self-worth by the numbers

Most importantly, forget what you saw that other person doing on social media, avoid the comparison trap, and do what feels right for YOU!

References:

Nybacka A, Carlstrom K, Stahle A, Nyren S, Hellstrom PM, Hirschberg AL. Randomized comparison of the influence of dietary management and/or physical exercise on ovarian function and metabolic parameters in overweight women with polycystic ovary syndrome. Fertil Steril. 2011;96(6):1508-13.
Riley JK, Jungheim ES. Is there a role for diet in ameliorating the reproductive sequelae associated with chronic low-grade inflammation in polycystic ovary syndrome and obesity? Fertil Steril. 2016;106(3):520-7.
Giallauria F, Palomba S, Maresca L, et al. Exercise training improve autonomic functions and inflammatory pattern in women with polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf).2008;69:792-8.
Dadona P, Aljada A, Bandyopadhyay A. Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol. 2004;25:4-7.
https://www.cdc.gov/heartdisease/women.html.
Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018;110(3):364-79.
Cooney LG, Lee I, Sammel MD, Dokras A.High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2017;32:1075-1091.
Dos Santos IK, Ashe MC, Cobucci RN et al. The effect of exercise as an intervention for women with polycystic ovary syndrome: A systematic review and meta-analysis. Medicine (Baltimore). 2020;99:e19644.
Costa EC, DE Sa JCF, Stepto NK. Aerobic training improves quality of life in women with polycystic ovary syndrome. 2018;50(7):1357-1366.
Redman LM, Elkind-Hirsch K, Ravussin E. Aerobic exercise in women with polycystic ovary syndrome improves ovarian morphology independent of changes in body composition. Fertil Steril. 2011;95:2696-2699.
Kogure GS, Mirando-Furtado CL, Silva RC et al. Resistance exercise impacts lean muscle mass in women with polycystic ovary syndrome. Med Sci Sports Exerc. 2016;48:589-98.
https://health.gov/our-work/nutrition-physical-activity/presidents-council
Patten RK, Boyle RA, Moholdt T et al. Exercise interventions in polycystic ovary syndrome: a systematic review and meta-analysis. Front Physiol. 2020;11:606.
Greenwood EA, Noel MW, Kao CN. et al. Vigorous exercise is associated with superior metabolic profiles in polycystic ovary syndrome independent of total exercise expenditure. Fertil Steril. 2016;105:486-93.
Hill EE, Zack E, Battaglini C, et al. Exercise and circulating cortisol levels: the intensity threshold effect. J Endocrinol Invest. 2008;31:587-91.

The Top Foods to Avoid with PCOS and What Foods to Eat Instead

July 7, 2025 by Olha Hutsman 1 Comment

As you probably know, there’s an overwhelming amount of well intended yet misguided information on the internet when it comes to the best diets for PCOS.

Recommendations that often lead to more questions than answers…

Should you avoid gluten… ? Refined sugar… ? Alcohol… Dairy?

Should you go vegan or vegetarian?

What about keto?

At OvulifeMD, we are big believers in adopting a diet and lifestyle that:

Doesn’t require cutting out entire food groups
Makes YOU feel good
Is backed by real facts and evidence
Improves your PCOS symptoms
And is sustainable

So with that, let’s dive in!

Here’s a quick overview of what you’ll discover:

How Your Diet Affects PCOS
Foods to Avoid with PCOS
Foods to Eat with PCOS
Other Changes to Help Your Symptoms
When to See a Fertility Specialist

How Diet Affects Polycystic Ovary Syndrome

Polycystic ovarian syndrome (PCOS) is a complex condition that impacts everything from fertility to egg quality to metabolism to mental health – all of which often go undiagnosed or unaddressed until women have difficulties trying to conceive.

And while all the mechanisms that contribute to the vast and variable constellation of symptoms with PCOS are not fully understood, chronic inflammation has emerged as a common theme (1). Additionally, scientists know that hyperinsulinemia and insulin resistance are central to the pathophysiology of PCOS. In fact, nearly 40-50% of women with PCOS also have some sort of insulin resistance (2).

It only stands to reason that the best diet for PCOS is one that lessens the vicious cycle of elevated blood sugar → elevated insulin → insulin resistance → elevated androgens.

So at this point, you might be asking, “which foods should I avoid to help keep my inflammation levels low and my blood sugar balanced?”

Okay maybe you’re not thinking exactly that… but maybe more of “whats the best diet for PCOS?” so let’s explore which foods can worsen and improve PCOS.

Foods to Avoid with PCOS

Pro Inflammatory Foods

Pro-inflammatory foods including foods that are higher in trans-fat such as pre packaged baked goods (cookies, cakes, sweet rolls, etc.), frozen pizzas, fried foods (french fries, doughnuts, fried chicken, etc.) and powdered non-dairy coffee creamer have been associated with a higher risk of ovulatory infertility (3). Sadly, htis is much of what makes up the traditional Western diet.

Beyond that, trans-fats also raise your bad cholesterol, lower your good cholesterol, and increase your risk of type 2 diabetes mellitus. As women with PCOS are already at a higher risk for cardiovascular disease, metabolic syndrome and insulin resistance are definitely something we don’t want to add to the mix (4, 5).

Bottom line, foods that contain trans fats are definitely at the top of the list of foods to avoid for PCOS! You can find specific information about trans fats on your nutrition label, so be sure to check that out before consuming. Other pro-inflammatory foods to avoid include refined carbohydrates, sugary drinks and processed foods. We’ll dive a little deeper into each of these below.

Foods High in Refined Carbohydrates

Refined carbohydrates (or simple carbohydrates) are primarily found in foods that have been processed to remove most of the other nutrients they naturally contain like bran and fiber. These commonly include foods like white bread, white flour, white rice, pizza dough, pastas and actually many breakfast cereals (again, staples in the Western diet).

These ‘simple’ carbs are appropriately named as the body quickly digests them resulting in high glucose (blood sugar) and insulin spikes. You know that ‘post carb crash’ you’ve felt after a quick snack? You’re feeling the effects of simple carbs on your body there.

Simple, refined carbs have been associated with insulin resistance, elevated cholesterol levels, and metabolic syndrome – conditions that a female patient with PCOS is already at a higher risk for (6, 7, 8). Higher intake of simple carbs has also been associated with a higher risk for ovulatory infertility and lower IVF success rates (9, 10).

When looking at studies that simply altered JUST the quality of carbohydrate consumed as a part of diet (not calorie restricting in any way), data has shown that increased intake of low glycemic load carbohydrates in women with PCOS has resulted in (11):

Improved insulin sensitivity
Higher percentage body weight lost
Improved menstrual regularity
Improved emotion and quality of life scores

Take home message… An occasional carb-rich treat is certainly OK in any diet– but for the most part swapping out simple or refined carbohydrates for whole grains and those naturally rich in fiber and antioxidants is the best choice for a delicious and sustainable PCOS diet.

Sugary Snacks and Drinks

Everyone loves to satisfy a sweet tooth, right?

No matter your favorite indulgence, it’s important to remember that the highest sugar intake doesn’t always come from what we eat, but from what we drink.

One of the top ingredients in most sodas (second to carbonated water of course) is high-fructose corn syrup (i.e., sugar). High-fructose corn syrup, as well as other sweeteners, can wreak havoc on your body by spiking your blood sugar and driving up insulin levels which over time can contribute to insulin resistance – something that’s central to worsening symptoms in PCOS and increasing the risk of type 2 diabetes even further.

Consumption of as little as one sugar-sweetened soda per day has been associated with a 25% reduced fecundability (probability of getting pregnant in a single menstrual cycle) for females (12). And as little as one serving per day has been associated with poorer IVF outcomes as well, including a 12% reduction in cycles resulting in a live birth (13).

We aren’t just calling out soda here… Other sugar-sweetened beverages like sweet tea and ‘fruit juice’ should also be avoided.

And in terms of sugary snacks, consume them sparingly. Eating an occasional cookie or scoop of ice cream here and there is fine… just be mindful of what you reach into the cabinet for most often. Opt for snacks that have naturally occurring sugars (e.g., berries), but avoid foods with unnecessary added sugars. Many labels will read ‘no added sugar’ which is helpful, but looking at the ingredients label to see how much sugar is contained in one serving size is equally important for optimizing a PCOS diet.

Foods to Eat with PCOS

Antioxidant-Rich Produce

Fruits and vegetables are at the base of our fertility foods pyramid… which means we should eat the most of them! Naturally rich in antioxidants, phytonutrients and fiber produce provides much in the way of nutrients while leaving out all the extra additives. They make a great base for meals, are filling and help reduce inflammation.

Not a “fruits and veggies” person? Well, long gone are the days of the mushy, wilted tasteless vegetables we were forced to eat as children (anyone else?). Look for different fun ways to prepare vegetables to make them a staple in your diet. Add in new spices and seasonings… or maybe throw them on the grill for different flavor. You can find some great recipes for free online (one of our favorite ways to explore new dishes) or reference your favorite cookbook.

However you choose to incorporate them just make sure you do as a part of your PCOS diet!

Plant Based and Seafood Sources of Protein

In general eating a diet higher in protein and complex carbohydrates has been most consistently associated with improved outcomes in women with polycystic ovary syndrome… including everything from improved menstrual cycle regularity to improved quality of life and lower anxiety and depression scores (14).

When looking at the specific type of protein consumed researchers have found that a diet with increased intake of plant based proteins (like beans, nuts, legumes, tempeh, tofu etc) has been associated with a lower risk of ovulatory infertility. Simply replacing 25 grams of animal protein with 25 grams of plant protein was associated with a 50% lower risk of ovulatory infertility… which is huge (15)!

And although data looking at the types of protein consumed and outcomes in women with PCOS specifically is lacking, other research has shown that couples who consumed an average of 2 servings of seafood per week in a given menstrual cycle had a 60% shorter time to pregnancy as well as a 13% lower incidence of infertility compared to couples who consumed one or fewer seafood servings during the same period (16). Yes, these findings remained significant even after controlling for intercourse frequency.

More recently, findings from the Environmental and Reproductive Health (EARTH study) showed that women who adhered to a “Pro-Fertility Diet” characterized by increased protein intake from seafood and soy (along with a few other healthy dietary habits) had a 43% higher chance of clinical pregnancy and a 53% higher chance of a live birth following IVF (10).

And not to worry, despite what you read on the internet… a diet with moderate tofu and soy consumption won’t mess with your estrogen levels. Plant based sources of protein are also naturally packed with those antiinflammatory antioxidants, phytonutrients and fiber while many seafood sources of protein are rich in anti-inflammatory omega-3 fats (more on that in a moment). And we’re not saying that you have to be a vegetarian or pescaterian, but swapping out just a few servings of chicken, turkey or beef a week in favor of eating plants and seafood as a part of your PCOS diet can make a big impact!

So go ahead and add plant based proteins and seafood to the PCOS list of foods to eat.

Healthy Fats

Fats are not the enemy!

And just like carbs, not all fats aren’t created equal. Fats are essential for our body and brain to function appropriately and to help us absorb important vitamins like vitamin A, D, E and K… which means it comes down to not eliminating, but simply eating the healthy types of fat!

In contrast to increased intake of the proinflammatory, trans-fats mentioned above, data from the Biocycle study has shown that women who consumed the highest amounts of omega-3 fats had a 58% reduced risk of anovulation and higher serum luteal progesterone levels (the hormone that increases after ovulation and supports pregnancy) (17).

Examples of healthy anti-inflammatory omega-3 fats include things like fatty fish (e.g., salmon, mackerel, herring, etc.), or nuts and seeds including chia and hemp seeds (a staple for our Fertility Boosting Smoothie recipes). Avocados, avocado oil , nd olive oil are other great sources of healthy monounsaturated fatty acids which can be added to almost any dish in our opinion 🙂

Other Changes to Help Your Symptoms

Beyond eating a well balanced diet that’s rich in anti-inflammatory fats, whole grains, and plant-based or seafood sources of protein, any amount of physical activity can be beneficial in terms of improving PCOS symptoms as well.

While the specific type of exercise is up for debate, it’s important to note that studies have consistently shown that dietary changes alone OR dietary changes plus exercise produce better health outcomes than JUST exercise alone (18). In fact, exercise combined with dietary changes can result in:

Improved insulin sensitivity
Reduced inflammation levels
Reduced risk of heart disease

And even though it’s not about a number on the scale, small amounts of weight loss (5-10% of your body weight) in those with a body mass index (BMI) > 25 kg/m2 can make a significant difference in PCOS outcomes. No matter your weight loss goals, we recommend that you tap into how you feel. A regular exercise routine has been associated with a whole host of mood boosting benefits as well.

Finally, adding a prenatal vitamin with folic acid (even if you’re not actively TTC) can be beneficial for reproductive health as well. And if you’re looking for a deeper dive on supplements, we’ve got you covered in another post on PCOS Supplements That Deserve a Closer Look.

When to See a Fertility Specialist

One of the most common questions we get is “when should I see a fertility specialist?”

It’s a GREAT question!

Infertility is typically defined by having regular unprotected intercourse without conceiving for one year in women 35 years of age or younger OR for more than 6 months among women 35 years or older.

Do you have to wait that long to make an appointment?

Absolutely not.

If your cycles are irregular or you have a known diagnosis of PCOS, make an appointment as soon as you decide you want to start trying.

Even if you’re not trying to conceive and you have irregular periods, or other symptoms like bothersome male type hair growth, cystic acne or hair loss or are concerned about PCOS, it’s good to go ahead and make an appointment so you have appropriate baseline testing and a better understanding of treatment options.

Final Thoughts on Food and PCOS

More than focusing on what foods to avoid with a PCOS diet we want you to focus on all the food you CAN and should eat. Choosing a diet that is rich in complex, low glycemic load carbohydrates, fruits, and vegetables, plant-based proteins and healthy fats have been associated with favorable outcomes in women with PCOS including:

Weight loss
Menstrual regularity
Decreased androgen levels
Improved quality of life
Improved reproductive outcomes
Improved general health outcomes

And although we say “diet” we really want you to focus on nourishing foods and eating patterns NOT dieting in this traditional sense of the word. This is a lifestyle change, not a short-term fix. Let’s make it count!

P.S. Be sure to check out our prior posts for a deep dive on how to accurately diagnose PCOS.

References:

Riley JK, Jungheim ES. Is there a role for diet in ameliorating the reproductive sequelae associated with chronic low-grade inflammation in polycystic ovary syndrome and obesity? Fertil Steril. 2016;106:520-7.
McCartney CR. Clinical Practice. Polycystic ovary syndrome. N Engl J Med. 2016;375:54-56.
Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Dietary fatty acid intakes and the risk of ovulatory infertility. Am J Clin Nutr. 2007;85(1):231-7.
Dumesic DA. et al, Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocr Rev. 2015;36:487-525.
Wild RA. et al.Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab. 2010;95:2038-49.
Willett W., Manson J., Liu, S. Glycemic index, glycemic load, and risk of type 2 diabetes. Am J Clin Nutr. 2002;76(1):274S-80S.
Parks, EJ. Effect of dietary carbohydrate on triglyceride metabolism in humans. J Nutr. 2001;131(10):2772S-2774S.
McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PWF. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care. 2004;27(2):538-46.
Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. Eur J Clin Nutr. 2009;63(1):78-86.
Gaskins AJ, Nassan FL, Chiu Y, Arvizu M, Williams PL, et al. Dietary patterns and outcomes of assisted reproduction. Am J Obstet Gynecol. 2019;220(6):567.e1-567.e18.
Marsh KA. et al. Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Am J Clin Nutr. 2010;92:83-92.
Hatch EE, Wesselink AK, Hahn KA, Michiel JJ, Mikkelsen EM, Sorensen HT, Rothman KJ, Wise LA. Intake of sugar-sweetened beverages and fecundability in a North American preconception cohort. Epidemiology. 2018;29(3):369-378.
Matchinger R, Gaskins AJ, Mansur A, Adir M, Racowsky C, Baccarelli AA, Hauser R, Chavarro JE. Association between preconception maternal beverage intake and in vitro fertilization outcomes. Fertil Steril. 2017;108(6):1026-1033.
Moran LJ, Noakes M, Clifton PM, Tomlinson L, Galletly C, Norman RJ. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2003;88(2):812-9.
Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Protein intake and ovulatory infertility. Am J Obstet Gynecol. 2008;198(2):210.e1-7.
Gaskins AJ, Sundaram R, Buck Louis GM, Chavarro JE. Seafood intake, sexual activity and time to pregnancy. J Clin Endocrinol Metab. 2018;103(7):2680-2688.
Mumford SL, Chavarro JE, Zhang C, Perkins NJ, Sjaarda LA et al. Dietary fat intake and reproductive hormone concentrations and ovulation in regularly menstruating women. Am J Clin Nutr. 2016;103(3)868-877.
Nybacka A, Carlstrom K, Stahle A, Nyren S, Hellstrom PM, Hirschberg AL. Randomized comparison of the influence of dietary management and/or physical exercise on ovarian function and metabolic parameters in overweight women with polycystic ovary syndrome. Fertil Steril. 2011;96(6):1508-13.

Supplements for PCOS…
3 Supplements Commonly Overlooked for PCOS

June 30, 2025 by William Haas Leave a Comment

Every day it seems like there’s a new miracle supplement out there for PCOS.

Probiotic supplements…

Fish oil supplements…

Supplements for gut health…

And simply consulting Dr. Google on what to take can lead to disappointment as well as a needless drain on your bank account.

So which supplements have evidence and which ones are actually worth your time and money?

It depends on who you ask….

And much like a diet, what works for one person, may not work for everyone.

But knowing the evidence (even if it’s limited at times) is a good place to start. That’s why we’re dedicating this post to a few PCOS supplements we believe deserve a closer look.

Here’s a quick overview of what you’ll discover:

Nutritional supplements vs. prescription medications
3 PCOS that deserve a closer look
How to choose a quality PCOS supplement
When to consider Metformin for PCOS

Nutritional Supplements vs. Prescription Medications for Polycystic Ovary Syndrome

Choosing which nutritional supplement to take for polycystic ovary syndrome (PCOS) isn’t an easy task, right?

For starters, most physicians aren’t trained in botanical medicine or have the time to read the literature on supplements… Unfortunately, that means you likely won’t be getting the medical advice you desire at your next doctor’s appointment.

And searching Amazon for supplement reviews seems like such a risky way to pick out your next supplement…

Then there’s the bigger issue that supplements aren’t even regulated by the Food and Drug Administration (FDA)… meaning they might not even contain what’s on the bottle – yikes! Don’t worry, we’ll teach you how to choose quality supplements towards the end of this post.

So why do some women choose nutritional supplements over prescription medications?

More often than not, it comes down to the perceived lower side effect profiles of supplements compared to medications. And although this may certainly be true for some supplements, this is not always the case. (Yes, that means supplements should be treated with the same caution and respect as prescription medication… but more on that momentarily)

On the other hand, some women reach for supplements as an economical alternative to prescription medications. When compared to the cost of infertility medications, supplements certainly are more friendly on your bank account. Of course, high-quality supplements can certainly add up in cost too.

Finally, given the difficult-to-treat nature of some conditions such as PCOS, supplements are often seen as a more effective treatment option compared to medications such as birth control or Metformin. And yet again, sometimes this is the case and other times it’s far from the truth…

None of these considerations are mentioned to dissuade you (or any cyster) from taking supplements. We are simply here to help you make educated and empowered decisions!

Many supplements studied for women with PCOS have actually been shown to have positive effects on insulin sensitivity, hormonal imbalance, and inflammation – all of which are important factors to control to keep your symptoms of PCOS in check.

The Role of Insulin in PCOS

And as you may recall from part 1 of our mini-series on the proper diagnosis of PCOS, elevated insulin levels and insulin resistance are thought to contribute to hyperandrogenism and PCOS symptoms in 3 interrelated ways:

Decreased liver production of proteins that bind up testosterone
Increased ovarian production of androgens (male-like sex hormones)
Increased adrenal production of androgens

Elevated insulin levels are also thought to contribute to inflammation in women with PCOS (1). Therefore, any supplement with anti-inflammatory properties that can also support insulin resistance and hormonal balance is potentially a good treatment option for polycystic ovarian syndrome.

Of course, as you probably know, there are SO MANY supplements to consider – things like chromium, magnesium, omega-3 fatty acids, n-acetyl cysteine (NAC), and melatonin. And just so we don’t disappoint anyone, this is NOT going to be an all-inclusive literature review of every supplement. But fear not… we’ll cover additional PCOS supplements over subsequent posts.

Here, we’re going to stick to the supplements that have been actually studied in women with PCOS, not animals or cells in petri dishes. More specifically, we’ll look at one that’s widely acknowledged (but somewhat misrepresented) as well as two that are lesser-known yet still important!

With that, let’s jump in!

3 PCOS Supplements That Deserve a Closer Look

If you’re jumping right into this section of the post, it’s worth reiterating that this is NOT one of those “Top 10 Supplements to Take If You Have PCOS” kind of posts…

… you know the ones we are talking about – the posts with lots of superficial information that references any old study on PubMed and calls it a day after 2-3 sentences.

That’s why for the purposes of this post we’ve decided to go deep and focus our attention on 1 commonly misrepresented supplement (inositol) and 2 lesser talked about supplements (cinnamon & vitamin D).

All this to say, there are certainly other dietary supplements to consider and we promise to cover them in depth elsewhere… But for now, we wanted to provide a little clarity around 3 supplements for PCOS that aren’t adequately (or accurately) being discussed.

Cinnamon:

First up is cinnamon!

Wait, what?

Cinnamon… like the spice you occasionally put on desserts?

Yes, that one.

As you may have guessed, cinnamon is one of the lesser talked about supplements that we believe to have some good evidence supporting its use.

Among individuals with metabolic syndrome, cinnamon supplementation has been shown to improve (2):

Fasting blood glucose
Blood pressure
Lean body mass

And in individuals with type 2 diabetes it’s been shown to improve (3):

Fasting blood sugar
Fasting Insulin
Hemoglobin A1c
Cholesterol levels

Given that women with polycystic ovary syndrome are at risk for these health conditions, it’s not surprising that cinnamon supplementation has been evaluated for PCOS too.

One small double-blind randomized controlled trial (RCT) of 15 women with PCOS took 333 mg of supplemental cinnamon extract for 3 weeks (4). Researchers noted a significant reduction in:

Fasting glucose
Measures of insulin sensitivity

And this was just after 8 weeks! Although this study was too small to make any sweeping recommendations, the results certainly warranted further investigation.

A more recent double-blind RCT examined the effects of cinnamon after 6 months of supplementation and noted a significant improvement in menstrual cycle regularity with 1.5 grams daily (5). Researchers didn’t find a significant difference in serum androgens, weight, or waist circumference. However, these are important findings given that regulating menstrual irregularities play an important role in optimizing PCOS.

Another double-blind RCT noted a significant improvement in lipids and total antioxidant capacity with just 8 weeks of supplementation at 1.5g daily in women with PCOS (6).

Dosing in these clinical trials ranges anywhere from 1.0 – 1.5 grams daily for the PCOS patients who participated. If you prefer cinnamon in its natural form, you can certainly sprinkle some on your next batch of homemade granola or bake it with apples and enjoy 🙂

Although adverse effects are rare, headache, heartburn, nausea, and diarrhea have been reported. Caution should be used when also taking other antidiabetic drugs due to concerns for hypoglycemia.

Inositol:

Next up is inositol…

We are passionate about this supplement as it’s a tricky one that often gets misrepresented.

Considered to be a B-vitamin-like compound, inositol is naturally occurring in our bodies. However, most of what we actually need comes from dietary intake or supplements.

The 2 forms of inositol that are most relevant when it comes to supplementation for polycystic ovary syndrome include Myo-inositol (MI) and D-chiro-inositol (DCI).

In the body, MI and DCI typically exist in a 40:1 ratio and they carefully balance one another via different mechanisms of action. Of note, MI gets converted to DCI via an enzymatic reaction that is actually inhibited by insulin resistance.

Despite their different concentrations, MI and DCI both act as messengers inside our cells that can balance some of the metabolic disruptions that occur with insulin resistance. They also help direct the function of critical hormones, including follicle-stimulating hormone (FSH) and thyroid-stimulating hormone (TSH). And within your ovaries, DCI is involved in insulin-mediated androgen synthesis, while MI mediates glucose uptake and FSH signaling.

Now if you haven’t already, you’ll probably see inositol touted as a PCOS miracle supplement on social media…

But is inositol really that good for PCOS?

Before answering that question, data surrounding inositol for polycystic ovary syndrome must be approached with appropriate caution due to inherent limitations in the research.

Limitation #1: The dosage and duration of treatment vary widely among RCTs.
Limitation #2: Not all the studies use the same diagnostic criteria for PCOS.
Limitation #3: Studies have been done in different populations of women with PCOS. (Infertile women with PCOS undergoing IVF vs. overweight women with PCOS not trying to conceive vs. normal-weight women with PCOS without proven fertility but not trying to conceive)

Obviously, it’s challenging to compare the results from different studies when women, who may or may not meet the diagnosis for PCOS, are given a supplement at differing doses for different periods of time.

It’s also important to mention that many of the studies involving specific formulations of MI:DCI have been industry-sponsored (meaning that the manufacturer is likely invested in a positive outcome).

Okay, okay, limitations notwithstanding, there is definitely some compelling data for inositol and PCOS… Let’s review some of the higher-quality studies and see what you think for yourself.

An early double-blind randomized controlled trial (n=44) assessing DCI supplementation in women with PCOS showed (7):

No significant difference in insulin sensitivity, HDL, or LDL
Significant decrease in plasma TG
Improved ovulation

Since then, a few other studies have looked at DCI supplementation alone, however, evidence has suggested that MI is superior when compared directly with DCI (8). As we mentioned previously, MI occurs in a naturally higher ratio in the body, so most studies have focused on either MI alone or MI + DCI which is the more common supplemental pattern.

So what about MI supplementation then?

Another double-blind, placebo-controlled trial (n=50) of overweight women with PCOS undergoing IVF were treated with 2 grams of MI plus 200 mcg of folic acid vs. 400 mcg of folic acid alone for 12 weeks and showed (9):

Improved insulin sensitivity
A higher number of oocytes retrieved
Higher clinical pregnancy rates & live birth rates

Interestingly, when compared to metformin, 12 weeks of MI supplementation resulted in significantly decreased androgen levels, improved hirsutism (unwanted hair growth), and decreased markers of inflammation (10). And another study even found improved mental health with MI compared to metformin (11).

Now if you recall, we mentioned that MI and DCI exist in a 40:1 ratio within the body. So what has evidence shown in terms of relative amounts of combined MI & DCI supplementation?

Well, an RCT of 46 women with obesity and PCOS looked at 550 mg MI + 13.8 mg DCI + 200 mcg folic acid versus folic acid alone for 6 months (12). Researchers found that the MI + DCI group had significantly improved:

Insulin sensitivity
Androgen levels

These findings have been potentiated by findings from two separate meta-analyses evaluating inositol supplementation. One showed improvement in insulin sensitivity and SHBG, but no significant difference in testosterone levels (13). While the other noted significantly higher ovulation rates, menstrual cyclicity, and improved androgen levels.

Remember, these studies must be interpreted with some caution for the reasons we mentioned earlier including differing interventions (either DCI, MI, or a combination), treatment duration, medication dose, and population being studied.

One final point…

It’s important to note that NONE of the studies above mentioned significant differences in weight loss and there’s a reason for that…

… data has NOT consistently shown weight loss as an added benefit with any formulation or duration of treatment when taking inositol. We highlight this point not to be discouraging, but because we see social media commonly touting this as one of the benefits of taking inositol and the date simply does not support the claim.

Inositol is generally well tolerated with minimal side effects (it’s occasionally been noted to cause dizziness, fatigue, headache, and nausea).

Bottom line… Most data support supplementation of MI alone, whereas a combination of MI:DCI is okay too (the latter is just typically much more costly). DCI alone is generally not recommended.

Vitamin D:

One of our favorite vitamins… Not only because it’s best obtained from the sun, but because of all the various health and wellness benefits it has been shown to have.

This is the other supplement that we think doesn’t get enough attention for women with PCOS.

There are 2 forms of vitamin D that are physiologically important, ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3 – the one you see in supplemental form).

Vitamin D2 actually comes from ergosterol (a plant sterol), whereas vitamin D3 is synthesized in the body. Both vitamin D2 and vitamin D3 are biologically inactive and require hydroxylation to form the active metabolite, calcitriol.

Okay, enough basic science talk…

Similar to the other dietary supplements we’ve discussed, vitamin D3 is thought to modulate insulin activity. Interestingly enough, population-based research has shown that people with lower vitamin D levels have a higher risk of developing type 2 diabetes (14).

When we look at vitamin D levels among women with PCOS, we discover some pretty striking results… Based upon a secondary analysis from one of the largest clinical trials of women with PCOS (PPCOS II), those who were vitamin D deficient had an 18% lower likelihood of ovulation and a 37% lower likelihood of live birth compared to those with normal levels (15).

Vitamin D deficient women with polycystic ovary syndrome have also been shown to have a higher likelihood of moderate and severe insulin resistance as well as elevated androgen levels.

Now let’s turn our attention to vitamin D supplementation in women with PCOS…

Most research regarding supplementation has only shown benefits when used among women with vitamin D deficiency. On the other hand, routine supplementation in the absence of deficiency hasn’t been shown to be as beneficial. With that said, vitamin D deficiency is fairly common.

Risk factors for vitamin D deficiency include:

Higher BMI
Darker skin tones
Living far from the equator
Staying indoors during the daytime (nightshift, anyone?)

After 12 weeks of daily supplementation with 12,000 IUs of vitamin D3, women with polycystic ovary syndrome were noted to have improved markers of insulin sensitivity and blood pressure. And despite these positive findings, we should point out that this RCT was fairly small (only 22 women finished the study) (16).

Another RCT of 70 women with PCOS noted that those who received 50,000 IU of vitamin D3 every 2 weeks vs placebo had significantly lower fasting glucose and insulin levels (17).

Studies assessing the seasonal effects on vitamin D status have been shown to influence outcomes in women with PCOS who struggle with excess body weight or obesity (18). According to a study in Fertility & Sterility, an inverse correlation was noted with vitamin D3 levels and changes in waist circumference and cholesterol. Ultimately this study concluded that obesity and cardiovascular risk factors improved in vitamin D deficient women with PCOS over a 20-week lifestyle intervention during which vitamin D status improved with seasonal change.

Vitamin D3 is generally well tolerated when taken in the appropriate doses (2000 IU/day or 50,000IU weekly), but as with all supplements extremely high doses aren’t harmless (side effects include: elevated calcium levels, azotemia, and anemia).

Bottom line… Based on the above findings, data would certainly support D3 supplementation when you’re deficient, so make sure to get your levels checked!

Infographic of 3 PCOS Supplements That Deserve a Closer Look

How to Choose Quality Supplements for PCOS, and Why the Source Matters

Now that you have a better understanding of 3 key supplements for PCOS! But…

How do you choose a quality product among the sea of supplements online?

From misleading claims… to unnecessary additives… to fancy packaging…

There’s a lot to consider.

At a high level, here are a few considerations when you shop for your next supplement:

No bold claims…Technically, the FDA does not allow supplement manufacturers to make specific health claims about supplements or vitamins. So if you see a bold claim on the bottle, then beware of the product.
High-quality ingredients… Micronutrients and botanicals come in many different forms, and some are much easier to absorb and more active than others. It’s important to do your homework about the active ingredient before making a purchase.
Minimal additives…Manufacturers should test for contaminants such as mold and heavy metals. However, that doesn’t stop them from including unneeded fillers such as gluten, artificial flavoring, or preservatives. Good products will use hypoallergenic fillers if absolutely necessary.
Appropriate dosage…We’ve said it before, but more is not always better when it comes to supplements or vitamins. Make sure you know the appropriate dose for the condition or symptom you are trying to manage.
3rd party testing…A quality supplement manufacturer will typically have their products verified by 3rd party testing groups. Look for stamps on the bottle from ConsumerLab, NSF International, or US Pharmacopeia.

Of course, there are certainly other considerations when it comes to choosing the best supplement for managing your PCOS symptoms… But these pointers, along with personalized recommendations from your physician will help you avoid a poor quality supplement.

When to Consider Metformin for PCOS

We know what you might be thinking…

“I thought we were talking about supplements, not prescription medications?”

Well sometimes, supplements aren’t enough to manage your PCOS symptoms 🙁

And because we see Metformin get such a bad wrap on social media, we thought it best to let you know that this medication does have its place when used appropriately…

… oh, and here’s a fact that most experts on social media also forget to mention…

Metformin was originally developed from natural compounds found in the plant Galega officinalis, also known as French lilac (19).

Similar to many of the supplements recommended for PCOS, one of Metformin’s primary mechanisms of action is to improve insulin and glucose regulation as we briefly discussed in our post on diet and PCOS. And not only does Metformin make your body more sensitive to insulin, but it also acts to decrease the liver’s production of glucose.

Due to the central role of insulin resistance in the pathophysiology of PCOS researchers initially tried to use metformin to boost ovulation which ultimately did not pan out when compared to other ovulation induction medications like clomiphene citrate and letrozole (20).

Ultimately, letrozole alone has demonstrated higher live birth rates compared to metformin, or metformin + clomiphene citrate (21). Moral of the study… Metformin alone likely won’t boost your chances of getting pregnant.

Based on expert recommendations, lifestyle modifications in addition to metformin may be considered for the treatment of the weight gain as well as the metabolic outcomes related to PCOS (22). However, empiric treatment of PCOS with Metformin alone is NO longer broadly recommended.

The most common side effects of metformin include things like gastrointestinal (GI) upset (nausea, vomiting, and diarrhea) and abdominal discomfort. More often than not, these symptoms can be avoided by starting at a low dose in the evening and gradually working up from there.

Unfortunately, we often see women without impaired glucose tolerance or insulin resistance being given this drug, only to experience miserable nausea and diarrhea, which often suppresses their appetite further. Although not everyone will experience those side effects, it certainly would seem more pleasant to make some simple dietary swaps and add in a supplement or two to reduce the risk of insulin resistance and elevated glucose levels.

It’s important to note that long-term use of metformin has also been associated with vitamin B12 deficiency. So, it’s important to keep that in mind, especially if your goal is to get pregnant.

Final Thoughts

There you have it! Our thoughts on 1 commonly misrepresented supplement (inositol) and 2 lesser talked about supplements (cinnamon & vitamin D).

For those of you already taking inositol, we certainly aren’t suggesting that you stop using it. We simply want you to be informed about the current evidence. Please don’t get fooled into thinking it has magical powers that will counteract a half-gallon of ice cream (it’s sad, but we’ve seen this supplement represented that way).

As for cinnamon and vitamin D, these can be great additions to your PCOS treatment plan, especially if you struggle with insulin resistance. Cinnamon is great to use in its whole food form so you can avoid another pill, and vitamin D should definitely be repleted if you’re deficient.

No matter what you choose, always make sure to select quality supplements when you shop and speak with your healthcare provider or fertility specialist about YOUR unique circumstances to see what’s right for you!

References:

Riley JK, Jungheim ES. Is there a role for diet in ameliorating the reproductive sequelae associated with chronic low-grade inflammation in polycystic ovary syndrome and obesity? Fertil Steril. 2016;106(3):520-7.
Qin B PK, Anderson RA. Cinnamon: Potential Role in the Prevention of Insulin Resistance, Metabolic Syndrome and Type 2 Diabetes. Journal of Diabetes Science and Technology. 2010;4(3):685-93.
Khan A SM, Ali Khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003;26:3215-8.
Wang JG, Anderson RA, Graham GM, 3rd, Chu MC, Sauer MV, Guarnaccia MM, et al. The effect of cinnamon extract on insulin resistance parameters in polycystic ovary syndrome: a pilot study. Fertil Steril. 2007;88(1):240-3.
Kort DH, Lobo RA. Preliminary evidence that cinnamon improves menstrual cyclicity in women with polycystic ovary syndrome: a randomized controlled trial. Am J Obstet Gynecol. 2014;211(5):487 e1-6.
Borzoei A, Rafraf M, Niromanesh S, Farzadi L, Narimani F, Doostan F. Effects of cinnamon supplementation on antioxidant status and serum lipids in women with polycystic ovary syndrome. J Tradit Complement Med. 2018;8(1):128-33.
Nestler JE JD, Reamer P, Gunn, Allan G. Ovulatory and Metabolic Effects of d-Chiro-Inositol in the Polycystic Ovary Syndrome. NEJM. 1999;340:1314-20.
Unfer V. Myo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. Eur Rev Med Pharmacol Sci. 2011;15(4):452-7.
Artini PG, Di Berardino OM, Papini F, Genazzani AD, Simi G, Ruggiero M, et al. Endocrine and clinical effects of myo-inositol administration in polycystic ovary syndrome. A randomized study. Gynecol Endocrinol. 2013;29(4):375-9.
Jamilian M. et al. Comparison of myo-inositol and metformin on clinical, metabolic and genetic parameters in polycystic ovary syndrome: A randomized controlled clinical trial. Clin Endocrinol (Oxf). 2017;87:194-200.
Jamilian M. et al. Comparison of myo-inositol and metformin on mental health parameters and biomarkers of oxidative stress in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. J Psychosom Obstet Gynaecol. 2018;39:307-314.
Benelli E, Del Ghianda S, Di Cosmo C, Tonacchera M. A Combined Therapy with Myo-Inositol and D-Chiro-Inositol Improves Endocrine Parameters and Insulin Resistance in PCOS Young Overweight Women. Int J Endocrinol. 2016;2016:3204083.
Unfer V, Facchinetti F, Orru B, Giordani B, Nestler J. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocr Connect. 2017;6(8):647-58.
Park SK, et al. Plasa 25-hydroxyvitamin D concentration and risk of type 2 diabetes and pre-diabetes: 12 year cohort study. PLOS One.https://doi.org/10.1371/journal.pone.0193070
Butts SF SD, Koelper N, Senapati S, Sammel MD, Hoofnagle AN, Kelly A, Krawetz SA, Santoro N, Zhang H, Diamond MP, Legro Rs. Vitamin D Deficiency is Associated with Poor Ovarian Stimulation Outcome in PCOS but not Unexplained Infertility. J Clin Endocrinol Metab. 2018.
Raja-Khan N, Shah J, Stetter CM, Lott ME, Kunselman AR, Dodson WC, et al. High-dose vitamin D supplementation and measures of insulin sensitivity in polycystic ovary syndrome: a randomized, controlled pilot trial. Fertil Steril. 2014;101(6):1740-6.
Maktabi M, Chamani M, Asemi Z. The Effects of Vitamin D Supplementation on Metabolic Status of Patients with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. Horm Metab Res. 2017;49(7):493-8.
Thomson RL, Spedding S, Brinkworth GD, Noakes M, Buckley JD. Seasonal effects on vitamin D status influence outcomes of lifestyle intervention in overweight and obese women with polycystic ovary syndrome. Fertil Steril. 2013;99(6):1779-85.
Shen M. A second look at the ancient drug: new insights into metformin. Ann Transl Med. 2014;2(6):51.
Legro RS. et al. Clomiphene, metformin or both for infertility in the polycystic ovary syndrome. N Engl J Med 2007;356:551-566.
Legro RS. et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med 2014;371:119-29.
Teede et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018;110:364-379.

How is Polycystic Ovarian Syndrome (PCOS) Diagnosed? And Your Next Steps…

June 19, 2025 by William Haas 1 Comment

After weeks of wondering what has been going on with your body, you leave your doctor’s office with a useless piece of paper entitled, “What You Need to Know About Your PCOS Diagnosis”.

A million questions begin running through your head, none of which can be found on that paper.

You are NOT alone!

And if you haven’t been diagnosed with Polycystic Ovarian Syndrome (PCOS), then chances are you know someone affected by it. In fact, PCOS is one of the most common endocrine disorders affecting approximately 1 in 10 reproductive-age women.

PCOS is a complex condition that impacts your fertility, metabolism, and mental health – all of which often go undiagnosed or unaddressed until women have difficulties trying to conceive.

And given that it’s so complex, there’s a lot of misinformation out there. Unfortunately, this misinformation is partially due to gaps in knowledge among both patients and doctors when it comes to understanding the diagnostic criteria.

Of course, any confusion surrounding PCOS is certainly not helped by the inaccurate and misguided information found on social media and the internet.

So here we are… Hoping to clarify, dispel, and set the record straight over the course of this 4-part blog series in recognition of PCOS awareness month (and every month thereafter).

Part 1: How to diagnose PCOS (and no, “cysts on ovaries” are actually not required).

Part 2: First-line treatment for PCOS – lifestyle modifications (we’ll cover the dietary changes that are actually backed by evidence).

Part 3: What’s the best type of exercise for PCOS?

Part 4: Supplements for PCOS – do they really work?

Let’s jump into Part 1 – How To Diagnose PCOS!

Here’s a quick overview of what you’ll discover:

How to accurately diagnose PCOS
What causes PCOS to happen
Comorbidities associated with PCOS
Taking the first steps to beat PCOS

How To Accurately Diagnose PCOS

PCOS is all about understanding what’s required and what’s NOT required to make the proper diagnosis.

The most common diagnostic criteria for PCOS is the Rotterdam Criteria, which requires 2 out of the 3 following clinical criteria to be met:

Woman looking at PCOS diagnostic criteria

Hyperandrogenism

The term hyperandrogenism is just a fancy way of describing when high levels of androgens (hormones that play a role in male reproductive traits and activity) are present in females.

Androgens may be referred to as “male hormones,” but don’t let this fool you. Both men and women produce androgens, just in differing amounts.

The principal androgens in our bodies are testosterone and androstenedione. Other androgens include dihydrotestosterone (DHT) and dehydroepiandrosterone (DHEA). In women, one of the primary purposes of androgens is to be converted into estrogens.

Okay, enough basic science…

Clinical signs of hyperandrogenism can include:

Hirsutism – excessive course terminal hair growth in a male-like pattern (upper lip, chin, abdomen, chest, inner thighs, and back). Of note, this does not include the lighter, softer fine (vellus) hair growth that many women experience in these areas.
Alopecia– central loss of hair on the head (a symptom that is incredibly bothersome but not as many people know about).
Cystic/inflammatory acne – a severe form of acne with painful and infected nodules that are often resistant to medication.
Acanthosis nigricans – rough, darkly pigmented areas of skin.

Biochemical signs of hyperandrogenism include elevated blood levels of:

Bioavailable testosterone
DHEA-S
Androstenedione

Note that it’s not recommended that all of these be assessed when making the diagnosis of PCOS (expert recommendation is to assess bioavailable or calculated free testosterone), but are worth noting when discussing biochemical hyperandrogenism.

Polycystic ovaries

It’s important to note that just having polycystic appearing ovaries on ultrasound does NOT mean you have PCOS in the absence of other symptoms.

Yes, you read that correctly – your ovaries can be polycystic appearing but you don’t necessarily have PCOS. On the flip side, your ovaries can look totally normal and you can actually still have PCOS. Remember, it all comes down to having 2 out of the 3 diagnostic criteria.

Before moving on, let’s address what it means to have polycystic appearing ovaries…

The “cysts” that are described in PCOS refer to the unique distribution (around the periphery of the ovary like a string of pearls) and higher number of follicles (measuring 2-9 mm) seen on ultrasound which is often associated with a larger ovarian volume as well.

As you can see, this is not the same thing as a persistent or recurring ovarian “cyst” which typically describes a single, larger fluid-filled follicle. No wonder why this is such a common misnomer!

Ovulatory dysfunction

When it comes to ovulatory dysfunction (either irregular ovulation or absence of ovulation altogether) this often results in irregular cycles occurring < 21 days or > 35 days apart or having < 8 menstrual cycles per year. Please note that regular cycles at irregular intervals are not normal. For example, having “regular” cycles every 45 or 60 days… not normal.

Bottom line:

The clinical presentation of PCOS varies widely and can look like many different things, making the diagnosis difficult to establish in some cases for both providers and patients.

Additional laboratory evaluation for diagnosis often involves ruling out other clinical diagnoses that can mimic PCOS like symptoms, but would be treated completely differently!

What Causes PCOS To Happen

Diagnosing a condition is only the first step towards healing the body. It’s equally important to understand the root cause of PCOS in the first place.

Why?

Because it’s not just about regulating your menstrual cycle or achieving pregnancy… It’s also about minimizing the long term health risks associated with this syndrome.

As you just learned, one of the major problems with PCOS is hyperandrogenism. Although there is still much we don’t know for sure, it’s believed that the increase in androgens is kicked off by chronically elevated levels of luteinizing hormone (LH) and insulin via multiple mechanisms.

Both elevated LH and insulin levels in the body stimulate androgen production by your ovaries.
Elevated levels of insulin also increase androgen production by your adrenal glands.
To make matters worse, excess insulin also suppresses the production of sex hormone-binding globulin in the liver, which in directly results in increased levels of free testosterone… which is what causes the more bothersome symptoms of acne, excessive hair growth and the like.

Another issue with excess insulin within the body is its ability to increase adiposity (i.e., body fat). And the more body fat we carry, the more insulin resistant we become. Although not all women with PCOS will have overweight or obesity, you can see how this turns into a troublesome cycle that feeds into itself.

Of course, all of the above also contributes to the irregular menstrual cycles and ovulatory dysfunction resulting from impaired hormonal signaling from the brain. Unfortunately, for many women, it’s the impact on fertility that first brings PCOS to their or their doctor’s attention.

Comorbidities Associated With PCOS

Beyond making the correct diagnosis of PCOS, and achieving pregnancy it’s important that both women and their health providers recognize that there are many comorbidities associated with PCOS that need to be recognized and addressed.

Beyond an increased risk of ovulatory infertility, women with PCOS have been shown to have a significantly higher likelihood of:

Impaired glucose tolerance and/or type 2 diabetes – 3-5x higher prevalence
Increased body mass index (BMI) – 50-80% of women with PCOS struggle with obesity
Cardiovascular disease
Endometrial hyperplasia or endometrial cancer – 2-6 fold increased risk
Depression (moderate or severe forms) – 3-4x higher odds
Eating disorder – 4-5x higher odds

A survey of OB/GYN providers published in Fertility and Sterility in 2017, showed that while the majority of providers (> 85%) recognized the cardiometabolic comorbidities associated with PCOS, only around half were aware of the psychological comorbidities including anxiety, depression, and reduced quality of life.

This means that as healthcare providers continue to broaden their awareness, you must advocate for yourself and seek out support because the emotional struggles you feel are real.

If you are struggling with anxiety or depression around PCOS, please know that you are not alone and there are many resources available to support you as you learn to triumph over PCOS which we’ll be covering in the coming posts.

Taking The First Steps To Beat PCOS

As you’ve probably gathered by now, PCOS is a complex disorder that can be challenging to diagnose… but successfully managing PCOS is possible if you follow proven steps.

Unfortunately, all too often, women struggling with PCOS only receive band aid treatments that fail to address the root cause.

But that’s not going to be you!

When setting out to beat PCOS, you must first be ready to make some changes to your lifestyle. And before you sigh, we know you can do this because Metformin is NOT the only answer!

More importantly, lifestyle changes that address the root cause of PCOS have additive benefits that far exceed any medication you can take (and without all those unpleasant side effects).

For the science nerds among us, there are numerous high-quality research studies that tell us which lifestyle strategies are best. And if you decide to search for the answers on the internet, maintain a healthy degree of skepticism – because there are countless claims out there with little to no scientific evidence to back them up (you know the ones we’re talking about – juice cleanses, grapefruit diets, and carbohydrate restricting).

Either way, there’s no need to fret, we cover all the lifestyle changes that truly matter in our PCOS mini-series. For now, here are the 3 most important considerations we always ask ourselves when evaluating recommendations for PCOS:

Consideration #1: Does it improve clinical outcomes? (Reduced hyperandrogenic symptoms, improved menstrual cyclicity, improved ovulation or pregnancy rates, etc.)
Consideration #2: Does it result in improved quality of life? (Reduced anxiety/depression scores, etc.)
Consideration #3: Is it sustainable? (Are women able to maintain it? Or are they so miserable doing it, once they stop their symptoms are worse than before or they gain even more weight than they lost?)

If all these three boxes aren’t checked, then in our book, it’s simply not good enough.

So no matter what you’re considering – diet, exercise, or supplements – stop and review these 3 considerations for yourself. We promise to break it all down for you, but our ultimate goal is to empower you to take informed action for yourself (even if we’re not around).

Final Thoughts

Understanding your diagnosis of PCOS is extremely important if you want to take control of this condition.

Remember PCOS looks different for every woman, and you don’t actually need to have cysts on your ovaries to meet the criteria for diagnosis.

After you’ve reached the correct diagnosis, make sure that you and your healthcare provider take a holistic approach when treating PCOS as there are many potential health risks associated with this condition.

And above all, be your own advocate and carefully consider which lifestyle changes will work best for you.

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