The PCOS Puzzle: Why 1 in 4 Women May Have This Condition Without Knowing It
Emma thought she was just unlucky with her skin. At 28, she was still battling acne that had plagued her since her teens, whilst her periods arrived whenever they felt like it. Weight seemed to stick to her middle no matter how carefully she ate or how often she exercised. It wasn't until a routine blood test revealed elevated androgen levels that Emma discovered she had polycystic ovary syndrome (PCOS).
She's far from alone. Recent research suggests that PCOS affects between 4-20% of women of reproductive age, with some ethnic groups seeing rates as high as 1 in 4 women. Yet many cases go undiagnosed for years, leaving women struggling with symptoms they can't explain.
Understanding PCOS: More Than Just Ovarian Cysts
Despite its name, PCOS isn't primarily about cysts on your ovaries. In fact, you can have PCOS without having any ovarian cysts at all. The condition is fundamentally a hormonal imbalance that occurs when your ovaries produce unusually high levels of hormones called androgens.
This hormonal chaos creates a cascade of symptoms that can affect virtually every system in your body. When androgens are elevated, they suppress ovulation and interfere with your menstrual cycle, but the effects extend far beyond reproductive health.
The key features of PCOS include:
Irregular or absent menstrual periods
Elevated androgen levels (causing acne, excess hair growth, or male-pattern hair loss)
Polycystic ovary appearance on ultrasound
Insulin resistance (affecting up to 70% of women with PCOS)
Weight gain, particularly around the abdomen
Difficulty losing weight
The Hidden Connection: Why PCOS Is Really About Insulin
One of the most significant developments in PCOS research is the recognition that insulin resistance isn't just a side effect of the condition, it's often a driving force. An elevated insulin level, even when blood glucose remains normal, can indicate insulin resistance and directly contributes to the hormonal imbalance characteristic of PCOS.
When your body becomes resistant to insulin, your pancreas responds by producing more insulin. These elevated insulin levels cause your ovaries to produce more androgens, creating a vicious cycle that perpetuates PCOS symptoms.
This explains why women with PCOS often struggle with:
Persistent weight gain despite healthy eating
Intense sugar cravings
Energy crashes, particularly after meals
Difficulty building muscle
Dark patches of skin (acanthosis nigricans)
Research shows that addressing insulin resistance can dramatically improve PCOS symptoms, often leading to more regular periods, clearer skin, and easier weight management.
The Inflammatory Factor You're Not Hearing About
Recent studies have identified another crucial piece of the PCOS puzzle: chronic low-grade inflammation. People with PCOS tend to have elevated levels of inflammatory markers like C-reactive protein and white blood cells, which can worsen insulin resistance and androgen production.
This inflammatory state may be triggered by factors including:
Ultra-processed foods and excess sugar
Chronic stress
Poor sleep quality
Lack of physical activity
Environmental toxins
The good news is that inflammation is highly modifiable through lifestyle interventions, offering another avenue for symptom improvement.
Breaking Down the Diagnostic Criteria
Healthcare providers diagnose PCOS when at least two of these three criteria are present:
Irregular ovulation or periods: This might mean cycles longer than 35 days, fewer than 8 periods per year, or completely absent periods.
Signs of excess androgens: This can be clinical (acne, excess hair growth, male-pattern hair loss) or biochemical (elevated testosterone levels in blood tests).
Polycystic ovary appearance on ultrasound: Multiple small follicles visible on the ovaries, though this isn't required for diagnosis.
The diagnostic process should also rule out other conditions that can mimic PCOS, such as thyroid disorders, prolactin abnormalities, or adrenal problems.
The Metabolic Consequences You Need to Know About
PCOS isn't just about irregular periods and unwanted hair growth. The condition significantly increases your risk of developing serious health conditions later in life:
Diabetes Risk: Women with PCOS have a 4-7 times higher risk of developing type 2 diabetes, often at a younger age than women without the condition.
Cardiovascular Disease: PCOS is associated with increased risks of high blood pressure, abnormal cholesterol levels, and heart disease.
Endometrial Cancer: Irregular periods mean the lining of the uterus isn't shed regularly, increasing the risk of endometrial cancer.
Mental Health: Depression and anxiety are significantly more common in women with PCOS, partly due to hormonal imbalances and partly due to the stress of dealing with symptoms.
Sleep Disorders: Sleep apnoea occurs more frequently in women with PCOS, even in those who aren't overweight.
Treatment Approaches That Actually Work
The most effective PCOS treatment combines lifestyle interventions with targeted medical therapy, personalised to your specific symptoms and health goals.
Lifestyle Interventions: The Foundation
Research consistently shows that lifestyle modifications are the most effective first-line treatment for PCOS. Even a modest weight loss of 5% can lead to significant improvements in symptoms, including more regular ovulation and reduced androgen levels.
The most effective dietary approaches include:
Mediterranean-style eating: Emphasising olive oil, fish, vegetables, and whole grains
Low-glycaemic index foods: Choosing carbohydrates that don't spike blood sugar
Adequate protein: Supporting muscle mass and blood sugar stability
Anti-inflammatory foods: Including omega-3 rich fish, leafy greens, and berries
Exercise That Helps
Both resistance training and moderate aerobic exercise improve insulin sensitivity and can help with weight management. High-intensity exercise may actually worsen PCOS symptoms in some women by increasing cortisol levels, so finding the right balance is crucial.
Medical Treatments
For metabolic symptoms: Metformin remains a cornerstone treatment, helping improve insulin sensitivity and often leading to more regular periods and reduced androgen levels.
For menstrual irregularities: Combined oral contraceptives can help regulate periods and reduce androgen-related symptoms like acne and excess hair growth.
For fertility: Clomiphene citrate is often the first-line treatment for women trying to conceive, whilst letrozole is increasingly being used as an alternative.
The Gut Health Connection
Emerging research suggests that gut health may play a significant role in PCOS development and management. Women with PCOS often have altered gut bacteria populations, which can affect hormone production and inflammation levels.
Probiotics and prebiotics may help improve insulin sensitivity and reduce inflammation, though research is still in early stages. Supporting gut health through fermented foods, fibre-rich vegetables, and stress management appears beneficial for overall PCOS management.
Natural Approaches: What Has Evidence
Several natural supplements have shown promise in PCOS management:
Inositol: This vitamin-like substance can improve insulin sensitivity and may help with ovulation. Studies suggest doses of 2-4 grams daily may be beneficial.
Spearmint tea: Research indicates that drinking spearmint tea twice daily may help reduce androgen levels.
Cinnamon: Some studies suggest cinnamon supplements may improve insulin sensitivity, though more research is needed.
Omega-3 fatty acids: These may help reduce inflammation and improve metabolic markers.
However, supplements should complement, not replace, lifestyle interventions and medical treatment when needed.
The Fertility Question
PCOS is a leading cause of female infertility, but it doesn't mean you can't get pregnant. Many women with PCOS conceive naturally, particularly after implementing lifestyle changes that improve insulin sensitivity.
For those needing assistance, fertility treatments are highly effective. The key is working with healthcare providers who understand the complexities of PCOS and can optimise your metabolic health before and during fertility treatment.
Mental Health Matters
The psychological impact of PCOS is often underestimated. Dealing with unpredictable periods, unwanted physical changes, weight struggles, and fertility concerns can take a significant emotional toll.
Depression and anxiety occur at much higher rates in women with PCOS, and these mental health concerns can make physical symptoms harder to manage. A comprehensive treatment approach should address both the physical and emotional aspects of the condition.
When to Seek Help
If you're experiencing several PCOS symptoms, don't wait for them to worsen. Early diagnosis and treatment can prevent many of the long-term complications associated with the condition.
Seek medical evaluation if you have:
Irregular periods (cycles shorter than 21 days or longer than 35 days)
Signs of excess androgens (persistent acne, excess hair growth, hair loss)
Difficulty maintaining a healthy weight
Insulin resistance symptoms (intense cravings, energy crashes, dark skin patches)
Trouble conceiving after 6-12 months of trying
The Road Ahead
PCOS is a complex condition, but it's also highly manageable with the right approach. The key is understanding that it's not just a reproductive disorder, it's a metabolic condition that affects your entire body.
Recent advances in understanding the insulin resistance and inflammatory components of PCOS have led to more effective treatments. Rather than just managing symptoms, we can now address many of the underlying causes.
With proper diagnosis, evidence-based treatment, and ongoing support, most women with PCOS can achieve significant symptom improvement and reduce their risk of long-term complications.
Your PCOS journey is unique, and your treatment plan should be too. If you're struggling with symptoms that might be PCOS-related, or if you've been diagnosed but aren't seeing the improvements you'd hoped for, book a consultation with us via WhatsApp. We can help you develop a comprehensive, personalised approach to managing your condition and optimising your health.