PCOS: More Than Ovarian Cysts — Understanding the Root Cause
Polycystic Ovarian Syndrome (PCOS) is one of the most commonly misunderstood and misdiagnosed conditions affecting women today. While its name suggests that it’s all about cysts on the ovaries, the reality is far more complex—and far more systemic.
In fact, not every woman with PCOS has ovarian cysts. And treating PCOS isn’t just about “fixing hormones” with birth control. To truly address PCOS, we need to zoom out and look at the whole body.
What PCOS Really Is
PCOS is a metabolic and hormonal imbalance that impacts multiple systems in the body—not just reproductive organs. Common symptoms include:
Irregular or absent periods
Difficulty losing weight
Acne or oily skin
Excess facial or body hair
Hair thinning on the scalp
Fatigue
Infertility or difficulty conceiving
Mood fluctuations or anxiety
What’s driving these symptoms, however, is often missed—insulin resistance.
Insulin Resistance: The Real Root of PCOS
Insulin is a hormone that helps shuttle glucose (sugar) from your blood into your cells, where it can be used for energy. When your cells stop responding effectively to insulin, your body compensates by making more of it.
This excess insulin doesn’t just affect blood sugar—it also signals the ovaries to produce more androgens (like testosterone), which contributes to the hallmark symptoms of PCOS.
Over time, this hormonal feedback loop worsens insulin resistance, creating a vicious cycle:
More insulin → more androgens → more symptoms → more resistance
Birth Control: Why It’s Not the Long-Term Fix
One of the most common treatments for PCOS is hormonal birth control. While it may improve symptoms like irregular periods or acne, it doesn’t address the root cause—and in some cases, it can actually worsen insulin resistance.
Additionally, hormonal birth control is known to deplete critical nutrients (like magnesium, B vitamins, and zinc), which are essential for blood sugar regulation, thyroid health, and detoxification.
Supporting PCOS from a Functional Medicine Perspective
A functional approach to PCOS looks beyond symptom suppression to investigate and correct the underlying dysfunctions. These are the core areas typically assessed:
1. Blood Sugar and Insulin Regulation
Fasting insulin (often skipped in conventional testing)
Glucose, A1C, and post-meal blood sugar responses
Triglyceride levels (can reveal diet-driven imbalances)
📌 Note: You can have normal glucose and A1C while still having high insulin.
2. Thyroid Function
Insulin resistance can impair thyroid function, often showing up as low free T3 (the active thyroid hormone). Since T3 is primarily converted in the gut and liver, both systems must be healthy for optimal thyroid performance.
3. Gut Health
The gut microbiome plays a critical role in hormone balance. Poor gut function can:
Worsen inflammation
Impair estrogen detoxification
Interfere with thyroid hormone conversion
Overgrowth of sugar-loving bacteria or yeast can also perpetuate insulin resistance.
4. Inflammation & Immune Activity
Many women with PCOS have underlying inflammation that isn’t always visible on standard labs. This may be due to food sensitivities, gut permeability (“leaky gut”), or chronic stress—all of which activate the immune system and worsen insulin sensitivity.
5. Stress and Cortisol
Chronic stress increases cortisol, which signals the liver to release glucose—even if you’re not eating sugar. This raises insulin levels unnecessarily and can derail progress.
Even one poor night of sleep can make you temporarily insulin resistant the next day. Managing stress and improving sleep are non-negotiable components of healing PCOS.
Nutrition for PCOS
The foundational dietary approach to PCOS involves lowering the carbohydrate load and reducing inflammatory foods. Key principles include:
Focus on whole foods over processed
Choose low-starch vegetables over high-carb ones
Incorporate healthy fats (avocado, olive oil, grass-fed ghee, tallow)
Include clean protein sources (pasture-raised meats, wild-caught fish)
Avoid seed oils, refined sugar, and ultra-processed snacks
This type of eating reduces the demand for insulin and helps reset your hormonal signaling.
Exercise: Less is Sometimes More
Many women with PCOS struggle with weight gain, and the go-to advice is often “exercise more.” But intense workouts can increase cortisol, which in turn worsens insulin resistance. Instead:
Focus on strength training, walking, and lower-impact movement
Avoid overtraining, especially during times of stress or poor sleep
Match your workouts to your energy levels and cycle phase
Testing: What to Ask For
Most conventional doctors only test fasting glucose and A1C—both of which can remain normal for years while insulin silently climbs. Consider asking for:
Fasting insulin
Comprehensive thyroid panel (TSH, Free T3, Free T4, reverse T3, antibodies)
DUTCH hormone testing (for insight into estrogen, progesterone, cortisol, testosterone)
GI-MAP or other stool testing (for gut health and pathogens)
Micronutrient panels
Final Thoughts: PCOS Is Manageable—and Reversible
With the right approach, PCOS doesn't have to mean years of frustration, hormonal chaos, or feeling stuck in your own body. By addressing the root cause—and supporting the whole body—women can begin to reclaim their energy, fertility, and health.
The more we understand PCOS as a metabolic condition with hormonal consequences, the better we can treat it—not just manage symptoms.
