Polycystic Ovary Syndrome (PCOS)

What is PCOS?

Affecting 8-13% of Australian women polycystic ovary syndrome (PCOS) is one of the most common and complex hormonal disorders among women of reproductive age. Yet, despite its prevalence, PCOS is notoriously hard to diagnose, with nearly 70% of cases remaining undiagnosed.

This condition causes a hormonal imbalance between male (testosterone) and female (oestrogen) hormones, leading to elevated levels of androgens—male hormones that are present in everyone.

This shift can throw off the ovaries’ usual rhythm, making it harder for eggs to mature and sometimes causing ovulation to be missed entirely. As a result, you might notice irregular periods, experience fertility challenges, weight gain, and a variety of other symptoms.

To add to the mix, the term "polycystic" can be a bit misleading. The "cysts" referred to are actually tiny, fluid-filled sacs, each holding an immature egg that hasn’t been released.‍

What are the symptoms of PCOS?

The symptoms of PCOS look different for everyone – making it difficult to definitively diagnose. While symptoms and their severity differ so greatly from person to person, some of the most common signs of polycystic ovary syndrome include:

• Irregular menstrual cycle
• Weight gain, especially around the midsection
• Excess hair growth and excess body hair
• Hair loss as a result of male pattern baldness
(androgenic alopecia)
• No periods (amenorrhoea)
• Difficulties losing weight
• Acne
• Polycystic ovaries
• Difficulties conceiving (infertility)
• Insulin resistance
• Pelvic pain
• Mood changes (including anxiety and depression)

What are the first signs of PCOS?

If you're wondering whether you might have PCOS, there are a few signs to watch out for. You may notice irregular periods or even missed ones, which is quite common. Changes in your skin, like more acne or excess hair growth on the face or body, can also be early signs.

Some people experience thinning hair or a receding hairline, while others might find it harder to manage weight, especially around the belly. If any of this sounds familiar, it’s a good idea to book an appointment with a PCOS specialist doctor. 

What are the complications of PCOS?

PCOS doesn’t just cause irregular periods, acne, and weight gain; it can also lead to more serious health complications.

Around 80% of women with PCOS have insulin resistance, which raises the risk of type 2 diabetes and cardiovascular disease. Additionally, PCOS can increase the risk of endometrial cancer due to thickening of the uterine lining from irregular periods. Women with PCOS are also more likely to experience high blood pressure and sleep apnea.

The condition also affects mental health, with many women experiencing higher levels of anxiety and depression due to hormonal imbalances and body image issues. Managing PCOS often requires addressing both physical and mental health to reduce these risks and improve overall well-being.

What causes PCOS?

While the exact cause of polycystic ovary syndrome (PCOS) remains unknown, several factors appear to play a role. Genetics, hormone imbalances, family history, lifestyle factors, and even environmental stressors are all believed to contribute to the risk of developing PCOS.

Studies suggest that genetics are a significant factor, with immediate relatives of women who have PCOS showing a 55-60% likelihood of developing the condition themselves. This indicates a strong hereditary link, suggesting that certain genetic variations might make some individuals more susceptible to hormonal imbalances associated with PCOS.

Hormones are another key player. Women with PCOS often have higher-than-normal levels of androgens, commonly known as "male hormones," which can lead to symptoms like acne, hair growth, and menstrual irregularities.

Insulin, a hormone that regulates blood sugar, also plays a critical role. When the body becomes resistant to insulin, it produces more of it, which may increase androgen production and disrupt the body’s hormonal balance.

Additionally, lifestyle factors such as diet, physical activity, and exposure to chronic stress can influence hormonal regulation and, in some cases, contribute to the onset or worsening of PCOS symptoms.

While more research is needed to fully understand the cause of PCOS, evidence suggests that a combination of genetic predisposition and lifestyle factors likely contribute to this complex condition.

When should I see a doctor about PCOS?

If you’re experiencing any PCOS symptoms, it’s important to seek support by speaking to a doctor – there’s a chance you could be dealing with PCOS. Early diagnosis and guidance can make a big difference in managing symptoms and reducing the risk of complications.

At Hazel, our doctors are here to provide expert care, helping you navigate symptoms, discuss PCOS disease treatment options, and explore lifestyle changes that can support your wellbeing. Connecting with a Hazel doctor can offer you personalised advice and help you manage PCOS in a way that fits your life.

How to diagnose PCOS?

To diagnose PCOS, doctors typically follow specific criteria, which means you need to meet at least two out of the three key signs:

1. Irregular ovulation (or anovulation) – This is often shown by an irregular or missed menstrual cycle.
2. Multiple small cysts on the ovaries, which can be seen on an ultrasound.
3. Higher levels of male hormones (androgens), which can lead to PCOS symptoms like excess hair growth, acne, or thinning hair.

It’s important to know that having cysts on your ovaries doesn’t automatically mean you have PCOS. You can have polycystic ovaries without the syndrome, and you can have PCOS without cysts. So, your doctor will consider all the factors—like your cycles and hormone levels—before making a diagnosis.

Will PCOS affect pregnancy?

PCOS can impact pregnancy primarily because it affects the way your ovaries function. The condition causes an imbalance in hormones, leading to irregular ovulation—or in some cases, no ovulation at all. Since ovulation is essential for conception (the release of an egg from the ovary), not ovulating regularly can make it more difficult to get pregnant.

In PCOS, elevated levels of male hormones (androgens) can interfere with the development of eggs in the ovaries, and small cysts can form on the ovaries, further complicating ovulation.

Additionally, insulin resistance is common in PCOS, which can lead to higher insulin levels. This can disrupt other hormones needed for ovulation, such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are essential for regulating the reproductive cycle.

Can you get pregnant with PCOS?

While PCOS can make conception more challenging, it's important to know that it doesn’t make pregnancy impossible. Many people with PCOS can conceive with the right treatment plan, which could include lifestyle changes (like diet and exercise), medications to regulate ovulation (such as Clomid), or assisted reproductive technologies like IVF.

It's always best to consult with a fertility specialist to tailor the right approach for your individual needs. With treatment, many individuals with PCOS go on to have healthy pregnancies.

Can PCOS be cured?

While there’s no cure for PCOS, the good news is that its symptoms can be managed well. With the right approach, many women with PCOS can feel like themselves again and lead healthy, happy lives. Treatments can help balance hormones, regulate your cycle, and support fertility when needed.

How to treat PCOS?

There are many types of PCOS treatment available to help manage PCOS symptoms. Whether you prefer conventional medicine, natural treatments, or a combination, your doctor can work with you to find an approach that fits your needs and lifestyle.

Conventional Medication for PCOS

• Metformin for PCOS: Metformin is a widely prescribed  PCOS medication to improve insulin sensitivity, which affects the majority of women with PCOS. Research supports its role in regulating menstrual cycles, managing blood sugar, and, in some cases, reducing androgen levels that contribute to PCOS symptoms like acne and excess hair growth.
  
  
• Myo-inositol and D-Chiro-Inositol: These naturally occurring compounds are commonly recommended to support insulin sensitivity and hormone balance. Studies show that they can improve ovarian function and help regulate menstrual cycles, particularly for those with insulin-resistant PCOS.
  
  
• Hormonal Birth Control: Birth control pills, patches, or rings containing oestrogen and progestin can help regulate menstrual cycles and reduce PCOS symptoms like acne and excessive hair growth. For women who cannot take oestrogen, progestin-only options may help control symptoms without impacting oestrogen levels.
  
  
• Anti-Androgen Medications: For those dealing with symptoms of high androgens (such as excess hair and acne), anti-androgen medications like spironolactone can reduce these effects. This PCOS treatment is often used in combination with hormonal birth control for best results.

Supplements for PCOS

• Vitamin D: Vitamin D deficiency is common in women with PCOS and is linked to insulin resistance and metabolic challenges. Supplementing can improve insulin sensitivity and potentially help regulate menstrual cycles.
  
  
• Omega-3 Fatty Acids: Omega-3s are known for their anti-inflammatory effects, which may be helpful for women with inflammatory PCOS. They can also support heart health by improving cholesterol levels and reducing triglycerides.
  
  
• Magnesium: Magnesium may assist with insulin resistance, reduce inflammation, and improve sleep, making it a beneficial supplement, particularly for those with adrenal PCOS.  However, while promising, current evidence is mixed, and more research is needed to fully understand its effectiveness and role in managing PCOS symptoms.

Self-care and lifestyle change PCOS

• Balanced Diet: A low glycemic index (GI) diet, emphasising whole foods like lean proteins, whole grains, fruits, and vegetables, is often recommended for people with PCOS.
  
  Reducing refined sugars and processed foods is especially beneficial for insulin-resistant PCOS, as these foods can cause blood sugar spikes. The Mediterranean diet, which is rich in healthy fats and fibre, is widely recommended for managing PCOS.
  
  
• Exercise: Regular physical activity is foundational in managing PCOS. Research supports a mix of strength training and moderate aerobic exercise (such as walking) for insulin sensitivity and hormonal balance. For women with adrenal PCOS, less intense activities like yoga may be especially beneficial.

Acupuncture for PCOS

Acupuncture may help regulate menstrual cycles, improve hormone balance, and reduce stress for some women with PCOS. Although more research is needed, some studies suggest it may be particularly beneficial when combined with lifestyle changes and dietary improvements.

Fertility Treatments for PCOS

For those trying to conceive, fertility PCOS treatments may be necessary:

• Clomiphene Citrate: Often a first-line treatment to stimulate ovulation.
• Letrozole: Another option for stimulating ovulation, with some studies showing it to be more effective than clomiphene for women with PCOS.
• Injectable Gonadotropins or IVF: For women who do not respond to oral PCOS medications, more advanced fertility treatments may be recommended. These options are typically used only when necessary and with close medical guidance.

Behavioral Therapy and Stress Management for PCOS

Stress and mental health are essential components of PCOS management, especially for adrenal PCOS or women experiencing depression or anxiety related to PCOS.

Our skilled Hazel psychologists offer personalised approaches to managing the emotional aspects of PCOS, however other behavioural interventions include: 

• Cognitive Behavioral Therapy (CBT): CBT can help manage stress and improve mental wellbeing, particularly for women with PCOS-related anxiety or depression.
• Mindfulness and Meditation: Regular mindfulness or meditation can help regulate stress, benefiting women with adrenal PCOS and supporting overall mental health.
  
  

Gastrointestinal (GI) Health Support for PCOS

Emerging research shows that gut health may influence hormone balance and insulin sensitivity, making GI health a new area of interest for managing PCOS.

Our Hazel naturopaths can help you with nutritional advice and provide guidance to help you incorporate dietary strategies that support gut health and overall wellbeing. Key approaches include:

• Probiotics and Prebiotics: These may support a healthy gut microbiome, positively affecting hormone balance and insulin resistance.
• Fibre-Rich Foods: A diet high in fibre can help regulate blood sugar, support digestion, and reduce inflammation, all of which may benefit women with PCOS.

Hazel’s Support for All Types of PCOS

Hazel’s doctors provide comprehensive, personalised care for each type of PCOS (polycystic ovary syndrome), helping patients find the most effective treatment combinations to manage symptoms.

• Post-Pill PCOS: This type often develops after discontinuing hormonal contraceptives. Hazel’s doctors can support you through lifestyle modifications and supplements aimed at promoting natural hormone rebalancing.
• Inflammatory PCOS: Characterised by chronic inflammation, which can typically be addressed with an anti-inflammatory diet, omega-3 fatty acids, and vitamin D supplementation.
• Insulin-Resistant PCOS: The most common form of PCOS, which responds well to insulin-sensitising medications, low-GI (glycemic index) diets, and supplements like myo-inositol.
• Adrenal PCOS: Linked to elevated levels of stress hormones, this type benefits from stress management techniques such as mindfulness, balanced physical activity, and optimised sleep.

How to lose weight with PCOS?

Losing weight with PCOS can feel like a challenge, however weight loss is achievable. The key is to focus on a healthy, sustainable approach that works with your body.

First, it's important to focus on managing insulin levels since insulin resistance is common in PCOS. Eating a balanced diet with plenty of whole foods, like vegetables, lean proteins, and healthy fats, can help regulate blood sugar and support weight loss.

Exercise is also important, but it's best to combine cardio with strength training to help improve insulin sensitivity and boost metabolism. Finding activities you enjoy will make it easier to stay consistent.

Additionally, managing stress and getting enough sleep can make a big difference, as both can affect hormones and weight. While losing weight may be slower with PCOS, making these changes and staying patient with the process can help you achieve your goals in the long term.

Doctors, like one of our Hazel doctors or our Hazel naturopath, are available to help guide you through the process and create a personalised plan that’s right for you.

PCOS in a nutshell

PCOS is a common hormonal disorder that affects many women, causing symptoms like irregular periods, weight gain, excess hair growth, and fertility issues. While its exact cause is unclear, it’s linked to genetics, hormone imbalances, and lifestyle factors. Although there's no cure, PCOS can be managed through medications, supplements, lifestyle changes, and stress management.

At Hazel, we offer personalised care for all types of PCOS, helping you find the best approach to manage your symptoms and improve your quality of life. If you think you may have PCOS, getting a proper diagnosis and support can make a big difference.

PCOS FAQS

How is PCOS different from other hormonal disorders?

PCOS is unique because it combines various symptoms related to hormone imbalances, such as irregular periods, elevated androgen levels, and sometimes small cysts on the ovaries. Unlike other hormonal conditions, PCOS often also affects how the body handles insulin, which can contribute to its symptoms. The good news? With the right approach, managing these symptoms and finding balance is absolutely possible.

Does PCOS always lead to weight gain?

While weight gain can be a common symptom of PCOS due to insulin resistance, not everyone with PCOS experiences it. Insulin resistance, which reduces the body’s ability to effectively use insulin, can lead to higher insulin levels, which may encourage weight gain and make it harder to lose weight.

However, adopting a healthy lifestyle with balanced nutrition and regular physical activity has been shown to improve insulin sensitivity, helping to manage weight and support overall health with PCOS.

How does PCOS affect your skin?

High androgen levels in PCOS can lead to acne, oily skin, and excess hair growth (hirsutism). Managing insulin resistance and using appropriate skincare can help improve these skin-related issues.

By managing insulin resistance—which can drive androgen production—and using skincare products designed for oily or acne-prone skin, you can often see improvements in these areas.

What’s the link between PCOS and thyroid problems?

PCOS and thyroid dysfunction often occur together. Women with PCOS may be more likely to experience thyroid imbalances, which can further affect metabolism, energy levels, and menstrual cycles. Women with PCOS are more likely to have thyroid problems, especially a condition called subclinical hypothyroidism (SCH).

SCH means you have an imbalance where thyroid hormone levels are normal, but the hormone that controls the thyroid (TSH) is higher than usual. Both PCOS and SCH share similar risk factors, like insulin resistance, which can make both conditions worse.

Although SCH mainly affects metabolism, it doesn’t interfere with hormone levels as much as PCOS. That’s why it’s important to monitor thyroid health if you have PCOS to help manage your overall health and metabolism​.

Is PCOS a lifelong condition?

Although PCOS  can’t be cured, its symptoms can be managed effectively. With appropriate treatment, women can manage PCOS at different stages of life, including during pregnancy and menopause.

Can PCOS be managed through lifestyle changes alone?

Every patient is unique, however making simple lifestyle changes, like regular exercise, a balanced diet, and managing stress, can make a big difference in managing PCOS symptoms for some patients. Exercise can help with insulin resistance and regulating periods, which are common concerns for women with PCOS​

Eating a healthy diet, especially one that helps with weight management, can also support hormone balance, although it works best alongside physical activity. Small adjustments can lead to big improvements.

Can PCOS cause miscarriage?

Women with PCOS are at a higher risk of miscarriage due to hormonal imbalances and irregular ovulation. However, with the right fertility treatments and care, many women with PCOS go on to have successful pregnancies. 

How does PCOS affect mental health?

PCOS can impact mental health, leading to feelings of anxiety and depression. Hormonal imbalances, struggles with fertility, and physical symptoms like weight gain or excess hair growth (hirsutism) can add to the emotional burden.

Studies show that women with PCOS are more likely to experience mental health challenges than those without the right support—like therapy, stress management, and a strong healthcare team—these emotional challenges can be managed. Taking care of your mental health is just as important as managing the physical symptoms of PCOS.