What is PCOS?

PCOS stands for Polycystic Ovary Syndrome.

The term can be confusing because the condition does not simply mean “having ovarian cysts.” Many women with PCOS do not have visible cysts, and many women without PCOS can have polycystic ovaries.

Instead, PCOS is diagnosed based on a cluster of symptoms and hormonal features.

The most widely used diagnostic framework is the Rotterdam criteria, which requires at least two of the following:

• Irregular or absent ovulation

• Clinical or biochemical signs of hyperandrogenism (elevated male hormones)

• Polycystic ovarian morphology on ultrasound

These criteria highlight that PCOS is fundamentally a syndrome, meaning a collection of related features rather than a single disease.

The Core Hormonal Feature: Hyperandrogenism

One of the defining characteristics of PCOS is hyperandrogenism, meaning elevated levels of androgens such as testosterone.

While women naturally produce small amounts of these hormones, excessive levels can lead to symptoms such as:

• acne

• hirsutism (excess facial or body hair growth)

• thinning scalp hair

• irregular menstrual cycles

• fertility difficulties

These hormonal changes arise partly from abnormal ovarian hormone production and partly from metabolic factors such as insulin resistance.

The Metabolic Side of PCOS

Although PCOS is often discussed in reproductive terms, metabolic disturbances are extremely common.

Research suggests that up to 75% of individuals with PCOS may experience insulin resistance, even when body weight is within a normal range.

Insulin resistance occurs when the body’s cells respond poorly to insulin, causing the pancreas to produce higher levels of insulin to maintain normal blood glucose levels.

This has several consequences.

High insulin levels can:

• stimulate the ovaries to produce more androgens

• reduce levels of sex hormone binding globulin (SHBG)

• increase circulating free testosterone

• worsen metabolic health

This interaction between insulin and androgen production creates a self-reinforcing cycle that contributes to many PCOS symptoms.

PCOS and Body Weight

Women with PCOS have higher rates of overweight and obesity than the general population. However, it is important to understand that PCOS can occur at any body size.

Some women with PCOS maintain a normal BMI but still experience metabolic disturbances such as insulin resistance or increased visceral fat.

In these cases, body composition and fat distribution may be more relevant than body weight alone.

Does PCOS Slow Your Metabolism?

A common belief is that PCOS dramatically lowers metabolic rate, making weight loss nearly impossible.

However, the research does not strongly support this claim.

Several studies measuring basal metabolic rate (BMR) using indirect calorimetry show that metabolic rate in women with PCOS is generally similar to women without PCOS when body composition is matched.

Weight management challenges in PCOS are therefore more likely related to factors such as:

• insulin resistance

• appetite regulation

• psychological stress

• lifestyle patterns

• physical activity levels

rather than a fundamentally “broken metabolism.”

Nutrition and PCOS

There is currently no single ideal diet for PCOS. Instead, the most consistent recommendation across research is improving overall dietary quality.

Many studies highlight patterns consistent with the Mediterranean diet, which emphasises:

• vegetables and fruit

• legumes and whole grains

• olive oil (i' always recommend extra virgin olive oil, udos oil, pumpkin seed oil - all consumed RAW)

• nuts and seeds

• fish and seafood

• moderate dairy intake

This pattern appears beneficial because it:

• improves insulin sensitivity

• reduces inflammation

• improves lipid profiles

• supports cardiovascular health

Some research has also explored lower-carbohydrate or ketogenic diets, which may improve insulin resistance and hormonal markers in the short term.

However, long-term adherence to very restrictive diets can be difficult, and sustainability remains an important factor. I'd never recommend going keto (unless you suffer from epilepsy).

The Role of Dietary Fat

Healthy dietary fats may also play a role in PCOS management.

Two important types include:

Monounsaturated fats (MUFAs)

Found in olive oil, avocados, and nuts.

These fats are associated with improved insulin sensitivity and heart health.

Polyunsaturated fats (PUFAs)

Especially omega-3 fatty acids found in oily fish, flaxseeds, and walnuts.

Omega-3s may help reduce inflammation and improve metabolic markers.

Supplements and PCOS

Certain supplements have shown promise in clinical research.

One of the most studied is myo-inositol, which is a naturally occurring compound involved in insulin signalling. Supplementation may help improve insulin sensitivity and menstrual regularity in some individuals with PCOS.

Other supplements sometimes explored include things like:

• omega-3 fatty acids

• vitamin D (particularly if deficient)

• probiotics

• antioxidants

However, supplementation should not replace foundational lifestyle changes such as diet, physical activity, and sleep.

Exercise and Physical Activity

Regular physical activity is strongly recommended for individuals with PCOS.

Exercise can improve:

• insulin sensitivity

• body composition

• cardiovascular health

• mental wellbeing

Both resistance training and aerobic exercise appear beneficial, and the most important factor is long-term adherence rather than a specific exercise style.

Mental Health and PCOS

PCOS is associated with higher rates of:

• depression

• anxiety

• body image concerns

• eating disturbances

These psychological aspects are often overlooked but can significantly affect lifestyle behaviours and treatment outcomes.

Effective management therefore benefits from a holistic approach that addresses both physical and mental health.

Why PCOS Requires an Individualised Approach

One of the challenges in treating PCOS is that it presents differently from person to person.

Some individuals primarily experience reproductive symptoms, while others struggle more with metabolic complications.

Because of this variability, effective management often involves tailoring strategies based on:

• hormonal profile

• metabolic health

• body composition

• lifestyle factors

• personal goals

The Bottom Line

PCOS is a complex condition involving interactions between hormones, metabolism, and lifestyle factors.

Current research suggests that effective management should focus on:

• improving insulin sensitivity

• supporting metabolic health

• maintaining a nutrient-dense dietary pattern

• engaging in regular physical activity

• addressing psychological wellbeing

While PCOS can present real challenges, evidence-based lifestyle strategies remain powerful tools for improving health and quality of life.

Understanding the condition more clearly helps move the conversation away from myths and toward practical, sustainable solutions.

Remember, everyone is different - what works for someone else, might not work for you.

Much love,

Katie