Episode #149:Inherited Battles: Understanding the Genetic Roots of PCOS

Hello, my friend, and welcome back to the PCOS Repair Podcast. Today, we’re going to dive into some questions I’ve been getting around what causes PCOS and whether it runs in families. Is it genetic? How come some people say you can “cure” it, while others say you can never get rid of it? And what does it really mean to reverse symptoms? So, lots of questions about—where is this coming from?

Why do I have this? How can I figure out what’s going on? And does that play into what my root cause is? So with that, let’s dive in.

If you’ve ever wondered, “Is it just me?” or “How did I get this?”—you’re not alone. Maybe the rest of your family seems fine, or you’re struggling with fertility, and everyone else had no trouble getting pregnant. Or maybe you do notice a pattern through generations, and you’re wondering if your daughter might have it. Is it genetic?

And what influences PCOS to show up in the symptoms we experience?

First of all, yes, PCOS does have a genetic component. But it’s not the same as the kind of genetics we think of when we talk about hair color, skin tone, eye color, height, or body type—traits that are very visually clear in families. Maybe there’s a “family nose” or a particular leg shape that everyone seems to have. That kind of inheritance is different from what we’re talking about with PCOS.

Instead, we’re talking about certain genes that influence how specific systems in our body function—our metabolic system, reproductive system, and endocrine system. These genes may have variants, and not everyone will have them turned on or expressed in the same way. So even if multiple people in a family carry these genetic tendencies, it won’t always show up the same way, or at all.

There are genes related to insulin sensitivity, hormone regulation, ovarian function, and chronic inflammation. For example, someone may have no insulin issues until later in life when they develop type 2 diabetes. That might not look like PCOS, but the tendency is there. Likewise, certain genes can affect how sensitive your body is to hormonal fluctuations, how your ovaries respond, or how easily your body becomes inflamed.

Now, awareness of PCOS has grown significantly in recent years. Many of us in our 30s didn’t have mothers who were diagnosed with PCOS, simply because it wasn’t something that was being tested for or treated much back then. Those of us in our 40s may now have daughters being diagnosed with PCOS, so we’re starting to see more evidence of a genetic link. But it’s not that our moms didn’t have any symptoms—it’s just that it may not have been identified as PCOS.

That brings us to lifestyle. Even if you inherit a genetic predisposition, whether or not PCOS shows up—and how severe it is—can depend a lot on your environment. Previous generations had different diets, lower levels of processed foods, and often more physical activity built into daily life. So even if the genes were there, the symptoms may have been milder or hidden.

If your mom wasn’t diagnosed with PCOS, ask yourself—did she have irregular cycles? Gestational diabetes? Thyroid issues? Fertility struggles? Did she gain weight easily or develop type 2 diabetes as she got older? These could have been signs, even if they weren’t labeled as PCOS.

And lifestyle habits tend to be passed down, too. Think about how you learned to cook, what kinds of meals were typical in your house, whether your family was active, if sports or recreation were part of your life, and whether exercise was prioritized. These patterns become part of your own habits as an adult. Maybe your family was active and you weren’t, or vice versa. And sometimes, as life gets busier—college, work, adult responsibilities—we move away from those healthy patterns.

For some people, that’s when their PCOS becomes more noticeable. That was the case for me. I had signs of PCOS after puberty—hair growth on my neck and sideburns, a unibrow, and hair on my toes. My periods were regular but extremely heavy, and I struggled with my weight despite eating a healthy diet and being active. Thankfully, my mom was really supportive with nutrition, and we were a fairly active family. We didn’t do formal workouts, but we moved our bodies, got outside, and stayed busy. Back then, formal fitness wasn’t pushed the way it is today, so while I was healthy, I probably wasn’t exercising enough to suppress all my PCOS symptoms.

Still, that healthy environment helped keep things in check until I tried to get pregnant in my late 20s. That’s when birth control threw things off, and my PCOS became much more apparent. So sometimes, your environment can hold your symptoms at bay—until it doesn’t.

And here’s the cool part about genetics. The kind involved in PCOS are what we call epigenetic, meaning they’re strongly influenced by your environment. So yes, PCOS has a genetic predisposition, but whether it’s turned on—and how severely—depends on your lifestyle.

Even if your genetics have been triggered already, by changing your environment and how you care for your body—how you nourish it, move it, manage stress, and support emotional health—you can reverse the expression of those genes. You can turn down the symptoms and, in many cases, eliminate them altogether.

That doesn’t mean you’ve erased your genetic predisposition—it’s still there. But the symptoms go away. So someone who was once struggling with irregular periods, infertility, cravings, acne, low energy, and weight gain can discover their root causes, adjust their lifestyle, and reverse those symptoms.

Your labs—low progesterone, elevated insulin, and inflammatory markers—can return to normal. You could walk into a doctor’s office, and if they didn’t know your history, they might say, “No, you don’t have PCOS.”

Now, if you go back to your old lifestyle, those symptoms can come back. Your genes haven’t changed. But your body—this living, dynamic system—responds to its environment. And while we can’t change our eye color or height much (outside of a small window during growth years), PCOS-related genes are much more flexible.

With consistency, you can quiet them down so much that they don’t show up at all. The degree to which this is possible varies from person to person, and a lot depends on how much you prioritize your health and your goals.

For example, if your goal is a certain fitness level, you’ll need to put in effort to reach that. Some people start out just wanting to lose ten pounds, then surprise themselves by falling in love with fitness and going much further. But most of us will get where we intend to go—no more, no less—based on how much effort we’re willing to put in.

That said, most women with PCOS, barring other underlying conditions, can reverse their symptoms and create a life where their body feels great. Some things, like excess facial hair or hair loss, may take longer to resolve. You may need support like laser hair removal or other interventions. But the point is, once your hormones are balanced again, that hair isn’t going to grow back unless your hormones become imbalanced again.

So I hope this helps clear up some of the confusion around PCOS, genetics, and reversing versus curing. If you have more questions about your PCOS, I’d love to hear from you over on Instagram—that’s where I get so many great questions and ideas for episodes like this one.

If today’s episode helped you understand what’s going on beneath the surface—even beneath your root causes—please hit that subscribe button so you don’t miss future episodes. I release new ones every week.

Until next time, bye for now.