The Ultimate Guide to PCOS

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Erratic periods, weight struggles, mood swings, infertility, acne, and hair loss along with unwanted hair growth. These are the symptoms of Polycystic Ovarian Syndrome and what this ultimate guide will dive into but first let me share who I am and why I am so passionate about PCOS.

“Let’s build wellness rather than treating disease.”

~ Dr. Bruce Daggy

After trying to get pregnant for over a year I was diagnosed with PCOS (Polycystic Ovarian Syndrome). I remember sitting there in a daze while my doctor went over my test results. I was trying to remember, from my Physician Assistant training, the details about PCOS. I was referred to an infertility specialist for further counseling and possible treatment. When I got home and started reading about PCOS and the low percentage chance of getting pregnant and the high chance I would end up with diabetes, heart disease and/or cancer I was a tearful and emotional wreck, to say the least.

This is how my quest for PCOS answers began and my passion for sharing what I’ve learned with other women so they never feel as lost, broken and hopeless about their health as I did.

This blog post is filled with information to help you understand and improve your PCOS but first I want to share some hope with you. I learned, took to heart and began implementing with very imperfect action and I finally got the positive pregnancy test I was looking for about four months later. Getting pregnant with my second child was easy and the third easier still. It is possible to take back control of your health and live free from the constraints of PCOS.

Polycystic Ovarian Syndrome

Modern medicine has a lot of tricks up its sleeves to assist the PCOS woman who needs it. However, the true management of PCOS requires a more holistic approach focusing on nutrition, fitness and emotional wellbeing. This is becoming more and more accepted and understood throughout the medical community although there is still focus on the interventions that they have to work with.

What is PCOS

Polycystic ovary syndrome, PCOS, is an endocrine and metabolic disorder characterized by insulin resistance, signs of too much androgens (male sex hormones such as testosterone that are normal for women but not at these levels), weight gain or difficulty losing weight, chronic inflammation, and is the most common cause of infertility in women. Women are generally diagnosed with PCOS between puberty and mid 30’s depending on which symptom or symptoms she is struggling with.

Cause of PCOS

The exact cause of PCOS is unknown but it appears to a vicious cycle. There appears to be some genetic component that is magnified by lifestyle factors leading to a snowball effect.  The imbalanced hormones along with elevated Body Mass Index (BMI) lead to one area of struggle after another. But the good news is that the reverse is also true. As we get one area back in balance the other pieces respond positively as well, until all areas begin to fall exponentially into place. (1)

The PCOS Insulin Factor

70% of women with PCOS are considered to be insulin resistant. After eating, insulin is released by the pancreases to allow the blood sugar (glucose) to go from our bloodstream into our body’s cells and be used as energy. When insulin resistance is present the body’s cells don’t allow the transfer of glucose into the muscles and organs with a normal amount of insulin resulting in more and more insulin being required to lower the sugar levels in the blood and be used as energy.

In turn, these high levels of insulin in our blood signal our ovaries to produce more androgens such as testosterone. This means that insulin resistance has a direct link to worsening symptoms of PCOS caused by androgens.

The good news is that insulin resistance can be greatly improved with lifestyle changes such as diet and exercise.

The Symptoms of PCOS

There is a long unpleasant list of PCOS symptoms with a wide variance between women depending on sensitivity to environmental factors. It  appears that a woman’s symptoms correlate to the magnitude of her hormone disturbances and that her symptoms lesson as her hormones are brought back into balance. (1)

Weight Management

Weight gain and inability to lose weight seems to be a trademark of PCOS. The underlying hormonal imbalance fights any efforts to lose or maintain weight. Increasing weight also leads to increased insulin resistance, which further throws off the hormones balance. This may sound like an impossible problem to conquer but with the proper adjustments to diet, exercise and self-care the underlying hormone issues can be brought into balance and allow for successful weight loss and maintenance.


Energy comes from many sources such as good and consistent sleep, well-balanced blood sugar so we avoid the energy crashes, and not relying on stimulants such as caffeine for our energy boost.

Hirsutism (unwanted hair growth)

Many women with PCOS often have excess thick hair in areas more common to men than women. Elevated testosterone levels are again to blame for thick darker hairs on the face, arms, back, chest, abdomen and even the thumbs and toes.

Alopecia or male pattern baldness

As women with PCOS may notice hair loss at the crown of the head and perhaps a receding hairline at the temples. This is again related to high testosterone levels, which can be kept in balance with lifestyle alteration. However, once hair loss is noted lifestyle changes at this point are not expected to replenish hair growth at best it can halt or slow the process.

Menstrual irregularities 

The irregularity of PCOS menstrual cycles stems from an imbalance of hormones. In order to have a normal cycle, there is a very delicate balance of estrogen and progesterone with just the right spike in LH (luteinizing hormone) and FSH (follicular stimulating hormone). When these are not in perfect balance your cycle length will be irregular and you will likely not ovulate.

 PCOS is the most common cause of infertility in women and the most common reason women seek fertility treatment. Since PCOS appears to be a spectrum of hormonal imbalance there definitely can’t be a cookie-cutter approach to infertility medical intervention. Some women have little to no trouble managing their symptoms whereas for others nothing seems to work.

Infertility and getting pregnant with PCOS 

As stated above PCOS messes with ovulation making the window to conceive difficult to track and the opportunities to conceive fewer or nonexistent altogether. This often leads to a prescription for Clomid or letrozole to hopefully induce ovulation.

Here are some pretty interesting statistics of the success rates of conception utilizing various combinations of intervention.

12.2% of patients conceived when treated with clomiphene (Clomid)

14.4% of patients conceived when treated with metformin

14.8% of patients conceived when treated with clomiphene + metformin

20% of patients conceived when following lifestyle modifications.

Also of note, the group of patients that made lifestyle modification achieved a significant reduction in waist circumference, reduced total androgen levels (more balanced hormones), and improved their lipid profile. (2)

Recurrent Miscarriages.

PCOS is associated with infertility and high rates of miscarriage. Research is limited and piecemeal but here are is what we know

Women with PCOS have a 30-50% chance of miscarriage in the first trimester compared with women without PCOS that have a first-trimester miscarriage rate of 10-15%.

Digging further into the research it is important to understand where these statistics come from. Many cases of PCOS are not diagnosed, the cases we are including in this research are usually receiving fertility treatment.

When able to conceive naturally it appears that the risk of miscarriage lowers significantly even approaching the range of a woman without PCOS.  Lifestyle factors are the best ways to conceive naturally as shown above, and it makes sense that forcing ovulation without fixing the hormone imbalance to support pregnancy that the miscarriage rate would be raised. (3), (4)

PCOS Skin Changes

The excess androgens of PCOS often lead to increased oil production as well as the increased inflammatory properties associated with PCOS. For many women, this leads to deep cystic acne breakout predominately along the jawline, cheeks, and chin but in severe cases can include the chest and back as well as other areas on the body.

PCOS skin changes not only lead to acne, but it can also lead to developing skin tags and the darkening of the skin around the neck, underarms, and groin called Acanthosis Nigerians. All of these changes can be managed by reducing insulin sensitivity through diet along with other lifestyle changes.

Mood Changes

Women with PCOS are known to struggle with more emotional ups and downs, anxiety and depression compared to women without PCOS. Research shows a link between depression and other mood disorders with insulin resistance. In addition experts feel the mere impact of the PCOS symptoms, such as weight, facial hair, acne and infertility leading to a lack of self, furthers the tendency towards depression. This circular nature of the PCOS symptoms and behaviors can lead to a severe downward spiral. I want to help more women break free of this downward cycle and begin an upward cycle towards better health, happiness and confidence.

Sleep Problems

That’s right! One more, lovely, side effect, adding to the lack of energy. Women with PCOS often report problems such as insomnia or poor sleep. Research has linked sleep apnea with PCOS, which makes sense do to the high risk of obesity. But I also think that the poor state of health leads to poor sleep and again by caring for your health and following intentional sleep habits better sleep is possible.

I feel like a broken record as I go through the numerous symptoms that we women with PCOS struggle with. You may only have a few to a lot of these symptoms but the way to reduce their impact is the same. Follow a PCOS friendly diet, increase your physical activity and care for your overall wellbeing more on this below.

How PCOS is Diagnosed

As the medical community has narrowed in on the key similarities of PCOS the Rotterdam criterion has been adopted to diagnose PCOS. The criteria state that a woman must have at least two out of three of the following in order to be diagnosed with PCOS.

  1. Irregular periods
  2. Hyperandrogenism, evidence of excess male sex hormones
    1. Clinically through observable symptoms such as hirsutism
    2. Lab tests of raised androgens such as testosterone
  3. Polycystic ovaries are seen on ultrasound

From a different standpoint knowing the functional type of PCOS that you have can be of great assistance in determining how best to alter your lifestyle to improve your PCOS  

Treating PCOS

First of all, there is no cure for PCOS. Prescriptions, such as hormonal birth control or Spironolactone written for PCOS are used to suppress symptoms. If a patient already has high insulin levels they may benefit from metformin to help prevent or slow the progression to type 2 Diabetes. This is definitely a conversation worth having with your healthcare provider as well as how lifestyle modifications can be adopted and monitored to work towards no longer needing the mediation or lowering your doses.

Weight Management and PCOS 

I know I am preaching to the choir when I say it can be very difficult to lose or even maintain weight when you have PCOS. The good news is that when you understand the hormones and underlying blood sugar issues that are trademarks of PCOS you can start to work with your body to manage your weight and even lose the stubborn weight.

It’s not just about losing weight. When looking to improve hormonal balance it’s fat loss that will improve ovarian function and reverse some of the associated hormonal abnormalities. (5)

The reason is that the more fat we have stored on our bodies the more we are prone to insulin resistance. This is actually true for the general population and not just women with PCOS, which is why obesity puts people at risk of type 2 diabetes. By simply reducing or body fat percentage we can reduce our insulin sensitivity and assist our androgens back into balance.

Scientific studies have made it clear that the excess weight, common in women with PCOS, decreases your chance of ovulation and reduces the likelihood of fertility treatment success.

In one study women that underwent a 6-month weight loss program were compared to women that did not complete a 6-month program. Here are some of the remarkable results. Women in the study lost an average of 10.2 kg/m2. 60 of the 67 anovulatory subjects resuming spontaneous ovulation

52 achieving a pregnancy – 18 spontaneously

45 live births with an 18% miscarriage rate compared to the 75% miscarriage rate of the same women prior to starting the 6-month program. (6)

These significant results are why your physician will likely recommend weight loss as your first and best option for managing your PCOS. Clearly there are hurdles to this approach, which is why your physician then moves on to other medical interventions in attempts to help you achieve a pregnancy or decrease the symptoms of your PCOS.

I was told that weight loss is helpful in PCOS when I was diagnosed. But I was not told how to lose the weight I had been trying to lose for the last 10 plus years. Nor was I told what type of diet and exercise and lifestyle changes would be helpful to manage my PCOS. And that is why I started Nourished to Healthy so that other women can take advantage of all I have learned about how to manage PCOS naturally.

Treatment Beyond Weight Loss

By now I’m sure you are ready to learn how to manage your PCOS through lifestyle modifications. Clearly that is the best first step as well as long term choice of treatments even if additional medical intervention along the way or needed.

Dietary Changes:

What you eat can change how your body functions. The key is to understand how your body works so that you can feed it correctly to get the results you want. The nutritional pillars of PCOS are as follows.


  • Eat a Low Glycemic Index Diet: Include protein and healthy fats with every meal or snack. Focus on whole foods, lean meats, vegetables, and some fruits while avoiding processed foods and drinks.
  • Remove gluten from your diet
  • Limit or eliminate dairy from your diet
  • Include protein and healthy fats with every meal or snack. Focus on whole foods, lean meats, vegetables, and some fruits while avoiding processed foods and drinks.

Supplements are a hot topic, some people swear by them and others swear they are a waste of time and money. So What’s the deal?  It’s important to remember that taking supplements is not meant to substitute for a healthy diet and the continued effort to improve your diet to be more and more PCOS friendly. They are not a quick fix nor a means of continuing your current lifestyle with different results. Supplements, when chosen wisely based on your specific health profile, can be incredibly helpful.

Why and when are supplements helpful? The western diet, lack of fresh air and exercise leave our bodies depleted. Making sure your body has adequate nutrients is vital for producing healthy hormones, feeling great and for your cycle function normally. Beyond vitamins, there are certain herbal remedies and supplements that can help regulate blood sugar and hormones. When you are getting the nutrients you need, you aren’t having spikes and crashes in blood sugar and your androgens and hunger hormones are improved it is easier to make progress with your health when you feel better and have fewer cravings.


Building some muscle and getting moving reduces insulin sensitivity, increases metabolism, and assists in better moods and decreased anxiety. The perfect workout is the one that you will actually do and enjoy so I’m not going to tell you to get your exercise a specific way.

Emotional Wellness:

This is a component that is easier said than done. But it a foundational step to success in all the other actions towards a healthier lifestyle and I would propose it is the missing piece to why so many people with or without PCOS “fail” when trying to make long term health changes. It is easy to get frustrated with our bodies when they are not working exactly how we want them to. But you only get one body and the symptoms you are experiencing with you PCOS is your body’s way of saying help me I need to be taken care of and nurtured. All human bodies need to be well cared for if they are expected to perform well. PCOS just accelerates and exaggerates that process a bit. Taking this opportunity to evaluate your health and make some changes can completely change your life and then like me you actually thank your PCOS for helping you live in a way that you feel amazing and good about.

Preventing the Risk Factors: Type Two Diabetes Cardiovascular disease and Cancer

Left unchecked the insulin resistance of PCOS will likely develop into type 2 diabetes, high cholesterol and other forms of heart disease. The imbalance of hormones increases your risk of endometrial cancer. The medical interventions typically given to PCOS patients are not intended to address these long-term risk factors of PCOS but lifestyle changes that you start today can make a huge impact on your chances of developing these diseases. (7)

Where to Start?

If lifestyle changes where easy everyone would be in great health. Getting to where we want, need, to be with our health is not about a quick fix or a simple substitution but encompasses our physical, emotional, mental, social and even spiritual selves.

“Wellness counselors help clients to strive for their highest level of functioning across all dimensions of life. Because PCOS negatively influences the moods of women with the diagnosis it is important [for coaches] to assist women with emotion regulation as a strategy for achieving a more balanced lifestyle. Improvements in one area of an individual’s life can positively affect other dimensions as well. Essentially, improvements in emotion regulation can lead to improvements in one’s physical state.”

It is highly recommend to find someone to work with. Someone that will keep you accountable and progressing towards living PCOS free! It’s not just me that recommends these two different studies relate that women do better with coaching and a community of support. (Kovacs 2007)

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