In this factsheet, we’ll go over what PCOS actually is, how to recognise, test and treat it.

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PCOS Introduction

The second biggest cause of all hormone problems is the woefully under-diagnosed but really common PCOS*. PCOS (polycystic ovarian syndrome) is the most common menstrual disorder in women, in fact, and lies behind a whole myriad conditions.

It can be genetic in origin – thanks Mum or Dad – and appears in between 5-18% of women according to research (1 in 8 women in the UK, which is over 4 million), but I’m willing to bet it is much higher! It’s classed as a ‘lifelong’ metabolic, reproductive and psychiatric disorder. I’ve put ‘lifelong’ in inverted commas because I don’t think it is always for life – if it is treated correctly.

Here’s a quote from Verity, the leading PCOS charity in the UK. I’m not sure I agree with all of this but it certainly brings home how much more needs to be done to help PCOS women! 70% remain undiagnosed, no licensed med, no NICE treatment guidelines. I mean: come on! Continue reading below for my take on PCOS – it’s a lot more hopeful, I promise!

4.25 million in the UK live with #PCOS, and yet:

we don’t know the cause

there is no treatment for PCOS as a condition, but treatment for individual symptoms

no licensed medication

only one dedicated PCOS clinic in the whole country

70% remain undiagnosed

patients rate the support for PCOS 2 out of 10

people are still confused about ovarian cysts vs PCOS

radically underfunded

no NICE Guidelines

no funding for laser hair removal

no recognition and support for the impact on mental health

it takes too long to be diagnosed

we are still being told to go away and lose weight and come back when we want a baby

told they should be grateful to have infrequent / no periods

⁠labelled a gynaecological condition

⁠inadequate time in the curriculum on PCOS, educating the next generation of healthcare professionals

and perhaps most importantly of all:

⁠zero proactive management and support to reduce the risks of co-morbidities and improve health outcomes and quality of life

Verity PCOS Awareness Month Sep 24

PCOS Symptoms

Symptoms include weight gain (in many but certainly not all), periods all over the place, irregular ovulation, acne and loss of insulin/sugar control, making you starving all the time. Skin tags, male pattern hair loss, but also male pattern hair growth/hirsutism (just not on the head, annoyingly!), darker-coloured skin in folds and armpits because insulin causes pigmentation change. Lovely, huh?

But it is really far-reaching, in fact. It can impair fertility and give you a higher risk of cardiovascular disease, diabetes and depression (not surprisingly with all that going on!). It’s actually pretty severe and is underestimated far too much. It is a complex disease and is quite tough to turn around, but you can improve things in most cases, mainly by controlling insulin spikes, inflammation, the gut, liver and balancing weight.

Tip: If you have hair loss, the most common cause is actually PCOS, not hypothyroid or stress, as everyone always thinks! Check my Hair Loss factsheet here for more on that.

I wish someone had taught me all this as I have had PCOS since my teens!!

PCOS Diagnosis

Generally, start with a good hormone test with your health professionals or use the Hormone Tests here – either of the two main hormone tests, plus DHT would be good. It’s the strongest androgen metabolite and, if high, can be the main cause of things like weight gain, hair growth, hair loss, acne etc.

Here’s the NHS advice on diagnosing PCOS, in case it helps.

In essence, if I see LH or testosterone high, I think: PCOS and check further.

LabTestsOnline have a useful list below of what to look for on your test results:

• FSH (Follicle Stimulating Hormone), may be normal or low with PCOS
• LH (Lutenizing Hormone), may be elevated
• LH/FSH ratio. This ratio is normally about 1:1 in premenopausal women, but a ratio of greater than 2:1 or 3:1 may provide supporting evidence for a diagnosis of PCOS
• Prolactin may be normal or mildly elevated
• Testosterone, usually elevated
• DHEAS (may be measured to rule out a virilising adrenal tumour in women with rapidly advancing hirsutism), frequently mildly elevated with PCOS
• Oestrogens, may be normal or elevated
• Sex hormone binding globulin, may be reduced
• Androstenedione, may be elevated
• Anti-Müllerian Hormone is a relatively new test used by some centres and has been found to be increased 2-3 times in PCOS. At present, this test is not routinely used in the investigation of PCOS in the UK, although this could change as a result of ongoing research.
• hCG (Human chorionic gonadotropin), used to check for pregnancy, negative
• Lipid profile, (collected after a fast), (low HDL, high LDL, and cholesterol, elevated triglycerides)
• Glucose, fasting and/or a glucose tolerance test, may be elevated
• HbA1c may be elevated
• Insulin, (collected after a fast), often elevated
• TSH (Thyroid stimulating hormone) some women who have PCOS are also hypothyroid
• Cortisol to rule out Cushing’s syndrome
• 17-hydroxyprogesterone to exclude adrenal hyperplasia
• Insulin-like growth factor (IGF-1) to exclude acromegaly

In terms of diagnostics, note that you don‘t have to have ovarian cysts on an ultrasound; that’s a common myth. And they can come and go – I have PCOS and mine disappeared, but the syndrome remained, sadly! Ditto with weight gain. I have come across plenty of PCOS women who are slim; it’s a metabolic syndrome, not everyone gains weight.

If the serum testosterone on tests is peaking higher than it should anywhere in your cycle, that’s your main clue. Test random times in both the luteal and follicular phases of the cycle to find it effectively. A snapshot of one time on one day of the cycle may not be enough.

It might be that you see other male hormones/androgens are high such as DHEA. Or metabolic syndrome clues can suggest PCOS. Look for: insulin resistance (fatigue after meals), poor glucose control (need sugar after meals), high glucose, high HBA1c, high triglycerides and cholesterol. If you struggle to manage your blood sugar, then assume there could be an issue and do the Belly Fat Plan for a couple of months to see if balancing your insulin and glucose makes a difference to your hormones.

PCOS Treatment

Mainstream approaches might include anti-androgen meds, such as spironolactone (aldactone), flutamide (Drogenil) and cyproterone (Androcur, Cyproterone acetate), combined with oral contraceptives. For help with getting pregnant, clomiphene citrate (Clomifene, Clomid) is usually used to help induce ovulation. Rarely surgical options are used to try and increase ovulation.

The key aim with most PCOSs, from a functional medicine perspective, is to control the insulin properly, not necessarily the hormones themselves. 

PCOS Diet

First: simple fibre like psyllium, but especially guar gum, flaxseed and pectins in your diet will help. Taking something like Fibromin with a meal can help slow down the glucose absorption so you are less likely to get a spike after eating or crash later.

In between meals, phytosterols and certain branched-chain amino acids can really help stabilize things and prevent blood sugar crashes. Glycemovite will help here. Take between meals either once or twice a day. If you start to feel your blood sugar dropping and you can’t get to something to eat, taking this can really help. Glycemovite can be hard to get in the UK. If you have trouble, use Amino Quick-Sorb instead. 10-15 drops under the tongue between meals, especially if you can’t eat and blood sugar is dropping. ​  

Don’t forget to also sort out and support your adrenals, which control our blood sugar levels too.

For insulin resistance, the trick mainly is to cut down sugar, slow carbohydrate absorption and get some exercise. Diet-wise, use the Belly Fat Plan, which is actually low allergenic and insulin-balancing.

Body Fat and PCOS

Not every PCOS woman gains body fat, but many do. If fat does go up, it causes a vicious cycle in that insulin increases because of the metabolic problems caused by the PCOS itself and insulin helps you to store more fat. Ugh. Body fat cells are metabolically-active and can be triggered to start releasing inflammatory chemicals that then cause systemic inflammation. That might show as bone loss, migraine, arthritis, chronic pain, depression, asthma, diabetes, heart disease etc.

Excess body fat also increases a mechanism called ‘aromatisation,’ where we can make more of our oestrogen into testosterone – causing the male symptoms like hair growth and acne etc. That’s why, if fat goes up in a PCOS case, it really needs to be brought down if at all possible.

The problem is: that is a tough ask because the odds are stacked against us metabolically-speaking because of the way PCOS works.

Tip: if your BMI is 25 or more, you are more likely to be increasing testosterone production and inflammation.

The way to do it is to lower the insulin spikes using eg. the Belly Fat Plan, fibre etc as described above and the exercise and supplements below. Some women with really entrenched insulin and blood sugar dysregulation might even need meds like semaglutide/GLP-1 modulators to help break the cycle. They have a place in your armoury if needed. The risk of a med like that has to be weighed (literally) against the risks of the metabolically-active fat. If I had to, I know which I’d choose, and it will probably be a temporary measure so try not to worry about taking it if you need it.

PCOS Exercise

Being sedentary really affects hormone balance and exercise is especially important in PCOS. To have the best effect, you need to aim for 120 minutes per week of intense exercise – not a casual walk. High intensity exercise is max heart rate (220 minus your age), where you are too out of puff to hold a conversation.

You do need to be careful not to overdo it, though, as it will have the opposite effect. Some people can have hormone imbalances purely because of overtraining. Balance is key. So, manage your exercise well.

You don’t have to do the high intensity exercise all in one go – break it up between lower level exercise ie. do some free weights and maybe some running or star jumps, then more stretching and some more higher intensity stuff, or one day HIIT, a day off, next day yoga or tai chi, next day HIIT. You get the gist.

The message is: move. Preferably using HIIT. But don’t overdo it.

PCOS and Sleep

A lack of sleep can really play havoc with hormones – the pituitary and hypothalamus are going to have a hard time regulating hormone output if your sleep and circadian pattern is out. Poor sleep is linked to obesity, insulin balance, diabetes, depression and appetite problems, quite apart from making us feel crap and affecting our ability to function day to day. Sleep is particularly crucial in PCOS. Check my Insomnia Factsheet out for more help with this.

PCOS and Toxins

There is such a strong link between Endocrine Disrupting Chemicals (EDCs), toxins, especially pesticides and plastics like BPA, and PCOS. In some patients, avoiding those, making sure the detox pathways are working properly and boosting antioxidant levels can make all the difference. Check my Detox Factsheet out for more on this. In most hormone cases, especially PCOS, I will start with a gut and liver detox and MOT to sort of ‘clear the foundations’.

PCOS Supplements

The aim is is to control insulin properly. Follow the supplement guidelines given above too, but here is a kind of ‘core’ PCOS supplement regime for you.

Overall, the most effective supplement for insulin control seems to be berberine. 

Studies have even shown it works better then metformin, the drug most often used to stabilize insulin in PCOS women – so you definitely wouldn’t want to take both, note! Dosage varies for individuals, but often 500mg per meal works well. If you have one particular meal of the day where you feel really tired after it, definitely take it then. 

Another supplement that can really help specifically with PCOS is called Myo-Inositol. I’ve written about it for years and always give it. It is an insulin-sensitising amino acid, but also seems to improve FSH and TSH levels.

I would combine myo-inositol, berberine and alpha lipoic acid specifically for PCOS. You can get ALA and Myo-inositol in one capsule here. Plus the berberine above. Remember the caution that you won’t need both these and metformin; it would be too much. 

*The biggest cause of hormone problems is hypothyroid! If you really look, the symptoms of low thyroid and PCOS are really similar. They can also occur together, of course.

PCOS Resources

Verity is the main PCOS charity for awareness and education in the UK. They’ve done a good video intro you might find useful here: