What is PCOS?

Polycystic ovary syndrome (PCOS) affects up to 10% of women of reproductive age, making it one of the most common hormonal disorders. Yet an estimated 70% of cases remain undiagnosed.

What is PCOS?

PCOS is a hormonal condition characterized by:

• Irregular periods or ovulation - Infrequent, irregular, or prolonged menstrual cycles or lack od ovulation
• Excess androgens - Elevated levels of male hormones causing irregular cycles, acne, hair growth (hirsutism), or hair loss
• Polycystic ovaries - Ovaries may be enlarged with many small follicles

It is important to note that clinical manifestations of elevated androgens-evaluated by a clinician-are sufficient for diagnosis, as blood androgen levels may still fall within the normal reference range. Another key point is that a polycystic ovarian appearance on ultrasound, by itself, is insufficient to diagnose PCOS. The diagnosis requires clinical and/or biochemical criteria beyond ultrasound findings

You don’t need all three features to be diagnosed with PCOS - two out of three is typically sufficient.

Some guidelines also highlight elevated AMH levels as a characteristic finding in patients with PCOS.

Common Symptoms

• Irregular or absent periods
• Heavy bleeding when periods do occur
• Excess facial and body hair (hirsutism)
• Acne, especially on the face, chest, and back
• Weight gain, particularly around the midsection
• Thinning hair or male-pattern baldness
• Darkening of skin in certain areas
• Skin tags
• Difficulty getting pregnant (lack of ovulation)

The Four Types of PCOS

1. Insulin-Resistant PCOS

The most common type (it affects around 70% of women with PCOS). High insulin levels cause the ovaries to produce excess testosterone.

2. Post-Pill PCOS

Occurs after stopping hormonal birth control. Usually temporary (but it still requires treatment)

3. Inflammatory PCOS

Chronic inflammation - which in women with PCOS may stem from Hashimoto’s disease, other autoimmune conditions, or gastrointestinal dysfunction such as increased intestinal permeability - can stimulate the ovaries to produce excess testosterone.

4. Adrenal PCOS

Elevated DHEA-S from the adrenal glands, rather than ovarian androgens.

Causes and Risk Factors

• Genetics - PCOS runs in families
• Insulin resistance - Present in up to 70% of women with PCOS
• Inflammation - Low-grade chronic inflammation
• Hormonal imbalances - Elevated LH, androgens

Management Strategies

Lifestyle Changes ()

• Anti-inflammatory, nutrient-dense, low–glycemic index diet
• Regular exercise
• Stress management
• Adequate sleep

Medical Treatments

• Metformin for insulin resistance
• Hormonal birth control (it is not a root-cause treatment - after stopping hormonal contraception, the underlying PCOS symptoms typically reappear; this does not address the underlying cause.)
• Anti-androgen medications (this is not a root-cause treatment)
• Fertility treatments if trying to conceive

Supplements (depends on PCOS type)

• Insulin-resistant PCOS: inositol, NAC, berberine, alpha-lipoic acid, chromium, selenium, resveratrol, curcumin.

• Post-pill PCOS: zinc + anti-androgenic support such as saw palmetto, peony & licorice; plus replenishing common post-pill deficiencies (B12, folate, selenium).

• Adrenal PCOS : melatonin, B-vitamins, licorice, Rhodiola, ashwagandha.

• Inflammatory PCOS: more individualized, but often: probiotics, zinc, NAC (glutathione precursor), melatonin, curcumin.

Understanding your specific type of PCOS is crucial for effective management. Ona can help you track symptoms and identify patterns that may indicate which type you have.