PCOS: Symptoms and Management

• Polycystic ovary syndrome (PCOS) is a common hormonal condition where a diagnosis is based on meeting two out of three of the following criteria: ovulation dysfunction, signs of hyperandrogenism and polycystic ovaries. 
• Insulin resistance and hyperinsulinemia are common characteristics of PCOS, and potential drivers of the symptoms associated with the condition including acne, hair thinning, hirsutism, irregular periods and infertility. 
• Consuming foods with a low glycaemic index alongside an anti-inflammatory diet can be supportive in managing common PCOS symptoms.
• Key nutrients including Myo inositol, vitamin D, chromium and saw palmetto have been shown to be effective in PCOS.
• Stress and poor sleep are common with PCOS but addressing these through lifestyle interventions are necessary to manage the condition.  

Polycystic ovary syndrome (PCOS) is a common hormonal condition characterised by polycystic ovaries, hyperandrogenism, irregular periods and metabolic abnormalities, including insulin resistance, obesity, dyslipidemia and an increased risk of cardiovascular disease. ​¹​ 

The imbalance in sex hormones can lead to a range of symptoms both physical and mental, which may help explain why so many women are undiagnosed as many of the symptoms could fall under a different diagnosis including fibroids, polyps or pelvic inflammatory disease.

  There is also no specific test to diagnose PCOS, rather three sets of criteria have been developed for diagnosis which include:

• Ovulation dysfunction which is indicated by irregular periods
• Signs of hyperandrogenism which include hirsutism, acne or elevated free testosterone.
• An ultrasound scan showing polycystic ovaries.^3​

Insulin resistance and hyperinsulinemia, (where there is an abnormal amount of insulin in the blood) are common characteristics of PCOS. When there is too much insulin in the blood, this can inhibit the release of sex hormone – binding globulin (SHBG) from the liver. SHBG acts as a binding protein for testosterone transport but as insulin reduces SHBG, this increases the bioavailability of free testosterone, which can then lead to an increase in androgenic activity which contributes to those symptoms of excess androgens in women, including hormonal acne, hair loss and hirsutism; the term to describe excessive facial hair. ​⁴​

Whilst obesity is a risk factor for insulin resistance, it is estimated that 30-75% of people who aren’t overweight also have insulin resistance, also known as ‘lean PCOS’, ​⁵​ suggesting there are other factors driving the metabolic abnormalities. One study looked at the gene status of 24 insulin -resistant PCOS patients and 24 cases of individuals without PCOS. They discovered methylation changes in the LMNA gene were found in half of the cases with PCOS suggesting genetics may also be involved in the regulation of PCOS associated insulin resistance. ^​6​    

Supporting PCOS with diet 

Insulin resistance is a common symptom of PCOS, but it may also be a key driver into the other symptoms experienced as high levels of insulin may cause the ovaries to produce too much testosterone as well as stimulating the pituitary to make more LH ​10​ which affects both ovulation and lowers SHBG resulting in hyperandrogenism. ^​4​ Excess androgens may also encourage weight gain and excess fat to accumulate around the abdomen, making cells become more resistant to insulin.​¹¹​ This can create a bit of a vicious cycle where insulin is contributing to excess androgens and vice versa. So how do we break the cycle?  

Blood sugar regulation

Supporting insulin sensitivity may be a good place to start. If your diet is high in saturated fat, refined carbohydrates and low in fibre, this can lead to huge fluctuations in blood sugar levels and over time, insulin receptors become weakened, contributing to insulin resistance and inflammation.​¹²​  

Low GI, high fibre foods

Consuming foods that are low in glycaemic index (GI) and high in fibre such as beans, grains and vegetables can help stabilise blood sugars and support insulin sensitivity. Prioritising protein found in meats, fish, quinoa, lentils and eggs as well as foods rich in omega 3 fatty acids such as oily fish, nuts and seeds can also be effective in balancing blood sugars.  

Anti-inflammatory diet

Chronic low-grade inflammation has also been shown to be involved in the pathogenesis of PCOS. ​13​  Studies have shown that women with PCOS saw improvements in their inflammatory markers, blood pressure and body composition when consuming an anti-inflammatory diet. Within 12 weeks, 63% of women experienced regular cycles again and there was also improved fertility outcomes where 12% saw spontaneous pregnancy. ​¹⁴​  An anti-inflammatory diet involves eating wholefoods including: 

• Oily fish including salmon, anchovies, mackerel and sardines that are rich in omega 3 and have been shown to support inflammation. ​¹⁵​ 
• A range of vegetables including leafy greens such as kale, spinach and collards. 
• Fruit rich in antioxidants including blueberries, blackberries and cherries 
• Extra virgin olive oil, rich in monounsaturated fatty acids and antioxidants including oleocanthal which can help fight inflammation. ​^16​ 
• Anti-inflammatory herbs and spices including turmeric, ginger and rosemary. ​¹⁷​ 

For more recommendations on supporting inflammation, check out our blog “How to reduce inflammation naturally” 

Women with PCOS are more likely to develop depression or anxiety than those without. ^​24,25​ The reason for this is not clear, but it is likely down to a combination of hormonal imbalances and the psychological impact the physical symptoms including acne, hair loss and hirsutism can have on a person’s wellbeing. Sleep disturbances are also common in those with PCOS, possibly due to an imbalance of cortisol and melatonin,​²⁶​ the hormones which are responsible for the sleep-wake cycle, further driving stress, anxiety and wellbeing.  

Studies have also shown that high levels of stress are associated with the root cause of anxiety and depression and the physiological reaction to stress is greater in those with PCOS than without.​^27,28​ Stress can also be a driver of other PCOS related symptoms so finding ways to activate the parasympathetic nervous system can be supportive. This could include gentle movement such as yoga, tai chi and walking, or mindfulness which allows you to be focussed on the present moment. This could involve meditation, deep breathing, journalling or any hobby that you enjoy gets you fully engaged such as painting or reading.  For more advice on reducing stress read our article “Top Lifestyle and Diet Tips to De-Stress”. 

Although sleep disturbances are common in PCOS, good quality sleep is essential as poor sleep can contribute to insulin resistance​^29​ and poor mental health.​³⁰​ Creating habits to support the sleep -wake cycle such as early morning daylight exposure, avoiding screens at least 4 hours before bed and calming nutrients such as magnesium, lemon balm and L. Theanine can be helpful. For more tips on improving sleep read our article “Your Guide To a Better Night’s Sleep”. 

Given the complexity of PCOS and the many symptoms it encompasses, both a holistic and tailored approach is required when managing the condition. Whilst most symptoms are being driven by a hormonal imbalance, the cause of that hormonal imbalance will be unique to the individual. What’s empowering is that both dietary and lifestyle interventions can support the genetic, environmental and hormonal drivers to improve the symptoms associated with PCOS.  

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​2.  Polycystic ovary syndrome. Accessed October 10, 2024. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome 
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