I work with women with PCOS all the time

and I can safely say that:

• Some women come to me and were actually misdiagnosed with PCOS
• So many come to work with me, and we realize their doctor never flagged PCOS despite fitting the criteria
• Many were told by their doctor that oral birth control or metformin were their only options to manage symptoms
• Some are told that they just need to “eat better” or “cut out the sugar” which, understandably, gets internalized as blame and guilt

Now, there is a lot behind the ins and outs of getting a PCOS diagnosis and I’m not here to play the blame game – but the hard truth of the matter is that a lot of women with PCOS don’t get the care and compassion they deserve.

Which is why we’re giving you your PCOS 101 Starter Guide 👇

And let me start off by saying that Polycystic Ovary Syndrome (aka PCOS) is so. incredibly. common

in fact, 1 in 10 women will have PCOS

• and yet, nearly 70% of women remained undiagnosed

as women, we deserve more spotlight, more care, and more compassion around the PCOS picture.

N currently, the standard of care = go on hormonal birth control

—> despite the fact that hormonal bc has been linked to poorer blood sugar control, a primary concern in PCOS.

Now, if you have PCOS and hormonal b.c. is what works for you – amazing! Happy you found a path that feels aligned.

But I think it is important to note that this isn’t getting to the root.

It is a bandaid to help manage symptoms, and once discontinued, all the same concerns will still be there (and in some cases, even worsened due to depletion)

pppsstt. that’s why I created my Coming Off of Hormonal Birth Control MasterClass

Either way, on BC or off, you can think of the below as your PCOS start guide 👇

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a multifaceted hormonal and metabolic condition that affects women of reproductive age.

While often framed as a gynecological issue, PCOS is much more than that—it’s a complex interplay between hormones, metabolic dysfunction, and inflammation.

PCOS is seen as a syndrome, meaning it’s a collection of symptoms and root causes rather than a one-size-fits-all diagnosis.

The exact drivers can vary from person to person, but the most common threads include insulin resistance, chronic low-grade inflammation, and hormonal imbalances such as elevated androgens (male hormones like testosterone).

The primary way it is diagnosed is using the Rotterdam criteria which states you must have 2 out of the 3 for a PCOS diagnosis (please note that only a doctor can diagnosis you with PCOS):

1. Hyperandrogenism (think: high androgens, like testosterone)
2. Polycystic ovaries
3. Anovulation (meaning cycles where you do not ovulate and have irregular cycles)

Meaning, there are women without cysts present that still have PCOS.

+ with all this in mind, PCOS doesn’t just impact your reproductive health. It can affect your energy, mood, skin, weight, and even long-term health risks, like diabetes and cardiovascular disease.

The biggest takeaway?

It’s not your fault.

This is complex.

There are dynamic pieces involved, from genetics to metabolism, diet and environment.

And you deserve to give yourself love and care through every step of the way.

What Are the Symptoms of PCOS?

PCOS symptoms can vary widely, and not everyone with PCOS experiences the same ones. Common symptoms include:

• Irregular or Absent Menstrual Cycles: Cycles may be wildly irregular—short one month (e.g., 21 days) and long the next (e.g., 43 days)—or you may have fewer than eight periods per year. This often reflects a lack of consistent ovulation.
• Lack of Ovulation (Anovulation): Many women with PCOS don’t ovulate regularly, which contributes to irregular cycles and fertility challenges.
• Acne and Oily Skin: Hormonal imbalances, particularly elevated androgens, can lead to acne, especially around the jawline and chin.
• Hair Loss on the Scalp (Androgenic Alopecia): Thinning hair can be due to the sensitivity of hair follicles to androgens.
• Excess Hair Growth (Hirsutism): Unwanted hair growth on the chin, upper lip, or chest is another sign of elevated androgens.
• Insulin Resistance and Weight Gain: Many women with PCOS experience difficulty managing weight, especially around the abdomen, due to impaired blood sugar regulation.
• Fatigue and Mood Swings: Chronic fatigue and emotional ups and downs are common, often linked to blood sugar instability and inflammation.
• Ovarian Cysts: While not required for diagnosis, multiple small, fluid-filled sacs on the ovaries may appear on an ultrasound.
• Voice Changes: A deepening voice is a less common but notable symptom, often linked to more severe androgen elevation.

If any of this resonates, and know this: it’s not your fault.

But rather than dismissing these signs, we can see them as clues pointing to what’s happening under the surface.

Understanding the Blood Sugar and Androgen Connection

At the heart of PCOS lies a critical connection between blood sugar dysregulation and androgen production.

Let’s unpack how this works:

Starting with insulin

Insulin is a hormone that helps regulate blood sugar by signaling your cells to absorb glucose from your bloodstream.

In many women with PCOS, cells become less responsive to insulin, a condition called insulin resistance.

This leads to higher insulin levels (hyperinsulinemia) as your body works harder to stabilize blood sugar.

High insulin levels are problematic because:

• It stimulates the ovaries to produce excess androgens, like testosterone.
• It impairs ovulation by disrupting the delicate balance of hormones needed for a healthy menstrual cycle.
• It contributes to weight gain and make it harder to lose weight

now here’s the catch

high insulin = high androgens, but high androgens = more insulin….creating a tough cycle

When androgens are elevated, they can disrupt how your body processes glucose, making your cells less responsive to insulin.

This means your body has to pump out even more insulin to keep blood sugar stable.

On top of that, androgens can also affect how the liver handles glucose and insulin, further contributing to the imbalance.

Now, I get it – breaking this cycle might sound overwhelming, but it’s totally possible.

So where to start?

The conventional route often involves birth control, metformin, or even anti-androgens.

While these can be helpful for some, there’s also so much you can do to support PCOS through diet and lifestyle.

Ready for more? Read the rest here on Substack