PCOS Made Simple: Your Go-To Guide for Understanding and Managing It

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders affecting women of reproductive age, yet many remain unaware of the full impact it can have on their physical and psychological health. From irregular periods and weight gain to skin issues and fertility problems, PCOS can turn life into a constant challenge. In this guide, we’ll break down what PCOS is, its causes, symptoms, and available treatment options, helping you better understand and manage this complex condition.

What Is PCOS & Why Is it Called Like That?

Polycystic Ovary Syndrome (PCOS) is a complex hormonal condition that affects millions of women worldwide (around 8-13% of women in their reproductive age) (1). Despite its name, PCOS is not only defined by the presence of ovarian cysts, but it’s a combination of symptoms, including irregular menstrual cycles, elevated levels of androgens (male hormones), and metabolic disturbances. This variability in presentation has led to significant debate in the medical community about whether the term "PCOS" accurately reflects the condition's true nature.

The term "polycystic" suggests that the presence of ovarian cysts is the defining feature of the syndrome, but this is misleading. Not all women with PCOS have cysts, while having ovarian cysts does not necessarily mean one has PCOS.

The small fluid-filled sacs observed in ultrasounds are actually follicles—structures that contain developing eggs, which can appear larger or more numerous in people with PCOS due to hormonal imbalances. However, the presence of these follicles alone is not enough for a diagnosis, and some people with PCOS may have completely normal-looking ovaries.

Because of these misconceptions, many scientists argue that PCOS should be renamed to better reflect its underlying hormonal and metabolic nature (2). Some proposed alternatives focus on the syndrome’s core characteristics, such as androgen excess and ovulatory dysfunction, rather than the misleading emphasis on ovarian cysts, though until today, nothing has been decided or changed. 

Risk Factors for PCOS

While the exact cause of PCOS remains unclear, several factors are believed to increase the likelihood of developing the condition: 

• Genetics plays a significant role, as PCOS often runs in families, suggesting a hereditary component (3). 

• Insulin resistance is another major risk factor—many individuals with PCOS have difficulty processing insulin, leading to higher insulin levels that can contribute to hormonal imbalances and increased androgen production (4). 

• Lifestyle factors, such as poor diet, sedentary behavior, and obesity, can further exacerbate insulin resistance and metabolic dysfunction, though PCOS can also occur in individuals with a healthy weight. 

• Additionally, prenatal exposure to excess androgens and environmental influences, including endocrine-disrupting chemicals, are being explored as potential contributors. 

Symptoms of PCOS

Polycystic ovary syndrome (PCOS) manifests through a variety of symptoms that can differ significantly among women. Common indicators include irregular or absent periods, difficulty conceiving, excessive hair growth, weight gain, thinning hair, and acne. These symptoms often become noticeable in a woman's late teens or early twenties. Let’s take a look at them in detail: 

1- Irregular Periods or Absence of Periods

One of the hallmark symptoms of PCOS is menstrual irregularity (5), which can present as infrequent periods, prolonged cycles, or the complete absence of menstruation. Such irregularities are typically due to hormonal imbalances that disrupt the normal ovulation process, leading to unpredictable or missed periods.

2- Weight Gain

Weight gain is one of the most common and frustrating symptoms of PCOS, affecting up to 40% of diagnosed women (6). If you’ve been struggling to manage your weight despite maintaining a balanced diet and regular exercise, insulin resistance may be to blame.  This occurs when the body’s cells don’t respond properly to insulin, leading to elevated blood sugar levels and increased fat storage, particularly around the abdomen (4). Over time, insulin resistance not only makes weight management more difficult but also raises the risk of developing type 2 diabetes and other metabolic complications.  

3- Low Sex Drive

Hormonal imbalances in PCOS, particularly elevated androgens and insulin resistance, can contribute to a decreased sex drive (7). Additionally, symptoms like weight fluctuations, acne, and mood changes can impact confidence and overall well-being, further affecting libido. 

4- Infertility

PCOS is one of the most common causes of infertility due to irregular or absent ovulation. When ovulation doesn’t occur regularly, it reduces the chances of conception, making it more challenging to get pregnant (8). However, with the right medical interventions—such as ovulation-inducing medications, lifestyle modifications, and fertility treatments—many women with PCOS are able to conceive and have healthy pregnancies.

5- Acne 

Persistent acne, especially along the jawline, chin, and back, is a common symptom of PCOS due to high testosterone levels. Excess androgens increase oil production in the skin, leading to clogged pores and recurring breakouts.

6- Facial Hair

Excess facial hair, known as hirsutism, is another frustrating symptom of PCOS caused by elevated androgen levels (8), leading to dark, coarse hair growth on the chin, upper lip, and jawline, impacting self-esteem and confidence.

7- Insomnia

Many women with PCOS experience disruptions in their sleep cycle due to hormonal imbalances, insulin resistance, or increased cortisol levels. Additionally, sleep disorders like sleep apnea are more common in those with PCOS, making restful sleep even more difficult. Poor sleep can further exacerbate symptoms such as fatigue, weight gain, and mood swings, creating a frustrating cycle. 

8- High Blood Pressure

PCOS doesn’t just affect reproductive health—it also increases the risk of cardiovascular issues like high blood pressure (9). Insulin resistance, chronic inflammation, and excess androgens can contribute to higher blood pressure levels, putting additional strain on the heart and blood vessels. Over time, this can raise the risk of heart disease and stroke. 

9- Mood Swings, Anxiety & Depression

PCOS can take a toll on emotional well-being, leading to mood swings, anxiety, and depression. The hormonal imbalances associated with PCOS, particularly fluctuations in estrogen and progesterone, can impact brain chemistry and neurotransmitter function. Additionally, dealing with physical symptoms like weight changes, acne, or fertility struggles can add to feelings of frustration, self-doubt, and stress.

10- Chronic Inflammation

Chronic low-grade inflammation is a common but often overlooked aspect of PCOS. Many women with PCOS have elevated levels of inflammatory markers (10), which can contribute to insulin resistance, weight gain, and increased risks of cardiovascular disease. This type of persistent inflammation can also make fatigue and other symptoms worse, leaving you feeling drained and unwell. 

What Are the Four types of PCOS?

PCOS is not a one-size-fits-all condition. While the symptoms can vary widely from woman to woman, conventional medicine categorizes PCOS into four main types (10) based on a combination of hormonal imbalances and physical manifestations. Understanding which type you have can help you and your doctor create a more personalized treatment plan.

Type A: The Classic PCOS

This is the most common and severe form of PCOS. Women with Type A PCOS experience all three key diagnostic criteria: 

• high androgen levels (excess male hormones), 

• irregular or absent periods, 

• and polycystic ovaries visible on an ultrasound. 

If you have persistent acne, hair thinning, or excessive hair growth along with cycle irregularities, this may be your type. 

Type B: Androgen-Dominant PCOS

In Type B PCOS, high androgen levels and irregular periods are present, but polycystic ovaries are not. You may experience symptoms like:

• acne, 

• hair loss, 

• excessive facial and body hair growth, 

• unpredictable or absent menstrual cycles. 

If an ultrasound shows normal ovaries but your blood tests indicate elevated androgens and cycle irregularities, this type may apply to you. 

Type C: Ovary-Linked PCOS

This type includes women who have high androgen levels and polycystic ovaries but maintain relatively regular menstrual cycles. If you struggle with acne, excessive hair growth, or other androgen-related symptoms, but your periods arrive on time, Type C PCOS may be the best fit. A doctor can confirm this with hormone testing and an ultrasound. 

Type D: Ovulation-Disrupted PCOS

Women with Type D PCOS have irregular or absent periods and polycystic ovaries but do not show high androgen levels. This type may be more commonly linked to metabolic imbalances rather than androgen excess. If your bloodwork shows normal androgen levels but you experience cycle irregularities and polycystic ovaries on an ultrasound, Type D might describe your case. 

How Is PCOS Diagnosed?

Diagnosing PCOS can be challenging because there is no single test that confirms the condition. Instead, doctors rely on a combination of:  

• symptoms, 

• medical history, 

• physical exams, 

• ultrasounds, 

• and blood tests to make an accurate diagnosis. 

Since PCOS presents differently in each woman, it’s important to work with a knowledgeable healthcare provider who understands the condition’s complexities. Getting the right diagnosis is the first step toward managing symptoms and improving long-term health.

What Lab Work Will Be Done to Diagnose PCOS?

Getting a diagnosis for PCOS isn’t always straightforward, and for many women, it can take years of frustration before finally getting answers. If you're feeling unheard or dismissed, you’re not alone. PCOS is still widely misunderstood, even within the medical community, which means many women go through unnecessary delays or misdiagnoses before receiving the right care. That’s why it’s important to advocate for yourself and find a knowledgeable doctor—ideally an endocrinologist—who understands the complexities of PCOS and can guide you through the right tests.

Ultrasounds

If your doctor suggests an ultrasound, it’s important to know that this test alone can’t confirm or rule out PCOS. While many women with PCOS have multiple small follicles (often mistaken for "cysts") on their ovaries, not everyone does. And on the flip side, having these follicles doesn’t necessarily mean you have PCOS. An ultrasound can be helpful, but it should always be considered alongside your symptoms and hormone levels. Many women struggle to get an accurate diagnosis because of outdated or oversimplified diagnostic criteria, so if you feel like your concerns aren’t being taken seriously, don’t hesitate to seek a second opinion.

Blood Tests 

Blood work is one of the most important steps in diagnosing PCOS, but many women aren’t told how crucial timing is. Hormone levels fluctuate throughout the menstrual cycle, so for the most accurate results, tests should be done on day 3 of your cycle (CD3). This helps doctors assess key hormones like estrogen, FSH, and LH in a standardized way (12).  

If you’ve recently been on hormonal birth control or other medications that affect your hormones, it’s usually best to wait at least one to two months after stopping them before getting tested. Unfortunately, many women aren’t given this information, leading to inaccurate results and further delays in diagnosis. 

Long-term Health Risks and Complications of PCOS

Polycystic Ovary Syndrome (PCOS) doesn’t just affect your menstrual cycle and hormones—it also comes with long-term health risks that can impact your overall well-being: 

• Type 2 Diabetes and Insulin Resistance: Up to 70% of women with PCOS develop insulin resistance, which increases the risk of type 2 diabetes (13).
• Cardiovascular Disease: Women with PCOS are more likely to have high blood pressure, elevated cholesterol, and other risk factors for heart disease. 
• Endometrial Cancer: Irregular or absent periods can lead to a buildup of the uterine lining (endometrial hyperplasia), which may increase the risk of endometrial cancer over time (14). 
• Obesity and Metabolic Syndrome: Many women with PCOS struggle with weight gain, which can contribute to metabolic syndrome—a cluster of conditions that raise the risk of heart disease, stroke, and diabetes. 
• Mental Health Challenges: PCOS is linked to higher rates of anxiety, depression, and mood disorders due to hormonal imbalances, body image struggles, and long-term health concerns that can take a toll on mental well-being.
• Infertility and Pregnancy Complications: PCOS is one of the leading causes of infertility due to irregular ovulation. Even when conception occurs, women with PCOS have a higher risk of gestational diabetes, preeclampsia, and preterm birth (15). 

While these risks can feel overwhelming, the good news is that early intervention and lifestyle adjustments can significantly reduce complications. 

What Is the Treatment for PCOS?

While medications like Metformin and birth control pills are commonly prescribed, they are not always the most effective standalone solutions. Metformin is primarily used for insulin-resistant PCOS but should be paired with diet and lifestyle changes for long-term success (16). Similarly, birth control pills can help regulate cycles and manage androgen-related symptoms like acne and hair growth (17), but they do not address the root causes of PCOS.

Diet, Exercise, & Lifestyle Interventions

Lifestyle modifications are the first-line treatment for PCOS and have been shown to be as effective—if not more so—than medication in managing symptoms. Regular exercise, a balanced diet, and stress management can improve insulin sensitivity, regulate periods, and reduce inflammation. 

• For women without insulin resistance, birth control pills may be prescribed to regulate cycles, sometimes alongside anti-androgens like Spironolactone to manage excess hair growth and acne. 

• However, for those with insulin-resistant PCOS, Metformin may be recommended instead of birth control, as it specifically targets insulin dysfunction. 

• Since all medications come with side effects, it’s important to work with your doctor to determine the best treatment plan for your needs.

Can PCOS Be Cured?

Currently, there is no cure for PCOS, but symptoms can be effectively managed with the right combination of lifestyle changes, medical treatments, and supportive care, such as a community of women who understand what you’re going through. Also, natural supplements like Myo-inositol have shown promising results in managing PCOS symptoms, particularly in regulating menstrual cycles and supporting metabolic health. 

We're excited to announce an upcoming supplement that combines a therapeutic 4-gram dose of Myo-inositol with essential nutrients like B12, D3, Folic Acid, and Chromium – specifically formulated to address multiple aspects of PCOS management. Stay tuned to learn how this comprehensive formula could help you on your PCOS journey!

FAQs

What’s the Difference Between Congenital Adrenal Hyperplasia vs PCOS?

Congenital adrenal hyperplasia (CAH) and polycystic ovary syndrome (PCOS) share similar symptoms, such as irregular menstrual cycles and elevated androgen levels. However, CAH is a genetic disorder affecting adrenal hormone production, while PCOS is a multifaceted endocrine condition. A comprehensive hormonal panel can help distinguish between the two, as PCOS is often diagnosed through the exclusion of other conditions.

Why Does PCOS Cause Infertility?

PCOS can lead to infertility primarily due to hormonal imbalances that disrupt ovulation, resulting in irregular or absent menstrual cycles (8). This anovulation prevents the release of mature eggs necessary for conception.

Why Does PCOS Cause Diabetes?

The link between PCOS and diabetes stems from insulin resistance: Elevated insulin levels can lead to increased androgen production, exacerbating PCOS symptoms and increasing the risk of developing type 2 diabetes (13)

Can PCOS Cause Pain? 

While PCOS is primarily a hormonal disorder, some women may experience pelvic discomfort or pain, often associated with ovarian cysts or ovulation. However, significant or persistent pelvic pain is uncommon in PCOS and may indicate other conditions, such as endometriosis. 

What’s the Difference Between PCOS vs Fibroids?

PCOS and uterine fibroids are distinct conditions affecting different parts of the reproductive system. PCOS involves hormonal imbalances leading to ovarian cysts and menstrual irregularities, while fibroids are noncancerous growths in the uterus that can cause heavy bleeding and pelvic pain. Although both can impact fertility, their causes and treatments differ.

What’s the Difference Between PCOS vs Endometriosis?

PCOS and endometriosis are separate conditions that can cause menstrual irregularities and fertility issues. PCOS is characterized by hormonal imbalances leading to ovarian cysts, whereas endometriosis involves the growth of uterine-like tissue outside the uterus, causing pain and potential complications.