PCOS is a common female hormonal condition that affects how the ovaries work. It has three main features.

Irregular periods due to less frequent ovulation. This can make it more difficult to get pregnant for some women.

High levels of androgens. These are the male sex hormones, so high levels in a woman can cause signs such as excess facial or body hair, male pattern hair loss and acne.

Polycystic ovaries, where the ovaries become enlarged and contain many fluid-filled sacs. These form from the follicles that surround the unovulated eggs.
Despite the name, not all women with PCOS will have cysts on their ovaries. To meet the diagnostic criteria women must present with at least two of the above features.

Symptoms often appear during adolescence or a woman’s early twenties. Common signs and symptoms of PCOS include:

• A longer than normal gap between menstrual cycles of no cycle at all.
• Infertility problems, both getting pregnant and miscarriages.
• Male patterns of hair growth such as long sideburns, hair on the upper lip or just below the belly button
• Acne and oily skin
• Male pattern hair loss
• Weight gain and difficulty losing weight
• Anxiety and depression

The exact cause of PCOS is unknown, but it often runs in families. However, it’s also related to abnormally high levels of insulin in the body.

Insulin is the hormone that controls blood sugar levels. It allows cells to take up glucose from the bloodstream. Many women with PCOS are insulin resistant. This means their cells don’t respond very well to the insulin message so more needs to be produced in order to keep blood sugar levels stable.

The problem is excess insulin can cause the ovaries to produce more androgens than normal. The excess androgens then interfere with the production of the hormones that develop and ovulate an egg each month, as well as causing many of the PCOS symptoms.

Insulin resistance is related to obesity, poor dietary choices and lack of exercise. Women with PCOS also often have higher than normal levels of inflammation in their body. This excess inflammation can also interfere with insulin sensitivity as well as increasing the levels of androgens.

Left untreated PCOS can increase a woman’s risk of developing type 2 diabetes, heart disease and endometrial cancer.

Medical treatment for PCOS depends on a woman’s fertility plans.

For those not planning a pregnancy, first-line therapy is an oral contraceptive pill that also contains an anti-androgen drug. This can help to restore a regular, artificial monthly bleed and reduce some of the PCOS symptoms

For those that are overweight, the insulin sensitising medication Metformin may be recommended. This helps to reduce insulin levels and can, therefore, have positive effects on androgen levels too.

If fertility is the main goal there are medications available that can stimulate ovulation.

From a functional medicine perspective there’s a lot that can be done to support balanced hormone and insulin levels:

• The cornerstone of a PCOS regimen is a nutrition and exercise plan aimed at balancing insulin levels. There are also a number of specific nutrients and herbs that can be included that help to balance blood sugar levels. ^{1 2 3 4 5}
• For those who are overweight, reducing body weight to within the healthy range can help to improve insulin and hormonal balance. A personalised diet plan specifically designed for PCOS can assist you in losing weight and may be more effective than the non-specific diets you’ve tried in the past. ^{4 5 6}
• There are also herbs, nutrients and therapeutic foods that can be included to help balance hormone levels and assist in managing PCOS signs and symptoms. Your practitioner will be able to determine which of these are best suited to you and how they will work alongside any conventional treatment you’re receiving. ^{7 8}