PCOS: Managing Your Symptoms Effectively

Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions affecting women of reproductive age, with estimates suggesting it affects 1 in 10 women in the UK. Despite its prevalence, PCOS remains poorly understood by many women — and sometimes by the healthcare professionals treating them. In my clinic, I see women who have spent years being told their symptoms are ‘just stress’ or that they simply need to lose weight. That reductive advice misses the complexity of this condition entirely.

What is PCOS?

PCOS is a condition characterised by a combination of hormonal imbalance, metabolic dysfunction, and ovarian changes. To receive a diagnosis, you typically need at least two of the following three criteria (known as the Rotterdam criteria):

1. Irregular or absent periods
2. Clinical or biochemical signs of excess androgens (e.g., acne, excess hair growth, hair thinning)
3. Polycystic ovaries on ultrasound

Having polycystic ovaries on a scan alone does not mean you have PCOS. The condition is a syndrome — a collection of features — not defined by a single finding. I often see women who were told at 18 they had polycystic ovaries and were given a diagnosis that wasn’t actually correct. Equally, some women have significant PCOS with completely normal-looking ovaries.

Understanding insulin resistance — the hidden driver

PCOS is increasingly understood as a metabolic condition, not simply a reproductive one. Roughly 70% of women with PCOS have some degree of insulin resistance, regardless of their weight. This is the piece that so many women — and their doctors — miss.

Here’s what happens: when your cells become resistant to insulin, your pancreas produces more of it to compensate. High circulating insulin directly stimulates the ovaries to produce excess androgens (testosterone and related hormones). Those androgens are responsible for many of the symptoms women find most distressing — acne along the jawline, dark coarse hair on the face, chest, and abdomen, and thinning hair on the scalp. They also disrupt normal ovulation, leading to irregular or absent periods.

This insulin–androgen connection is why women with PCOS have a higher lifetime risk of type 2 diabetes (up to 5–10 times the general population), cardiovascular disease, non-alcoholic fatty liver disease, and endometrial problems. Long-term management matters, even if your immediate concern is irregular periods or skin changes.

Dietary guidance that actually works

What I tell my patients is this: the goal is not a restrictive diet. Crash diets and severe calorie restriction actually worsen insulin resistance and hormonal imbalance. What works is a consistent, anti-inflammatory dietary pattern that keeps blood sugar stable throughout the day.

A Mediterranean-style eating pattern has the strongest evidence base for PCOS. In practice, this means:

• Protein at every meal: Eggs, fish, chicken, Greek yoghurt, lentils, tofu — protein slows the glucose spike from carbohydrates and keeps you fuller for longer. I suggest aiming for at least 20–30g of protein per meal.
• Low-GI carbohydrates: Swap white bread, white rice, and sugary cereals for wholegrains, sweet potatoes, oats, and legumes. These release glucose more gradually, reducing the insulin surge.
• Healthy fats: Olive oil, avocado, nuts, seeds, and oily fish (salmon, mackerel, sardines). These fats reduce inflammation and support hormone balance.
• Plenty of vegetables: Particularly leafy greens, cruciferous vegetables (broccoli, cauliflower, kale), and colourful produce rich in antioxidants.
• Limit ultra-processed foods and added sugars: These are the biggest drivers of insulin spikes. That doesn’t mean perfection — it means building a pattern you can sustain.

I also encourage my patients not to skip meals. Irregular eating and long gaps between meals can destabilise blood sugar and increase cortisol, both of which worsen PCOS symptoms.

Exercise: what type and how much

Regular physical activity improves insulin sensitivity independent of weight loss — and that distinction matters. I see too many women exercising purely to lose weight, becoming demoralised when the scales don’t shift, and giving up. The metabolic benefits of exercise happen whether or not you lose a single kilogram.

The evidence supports a combination of:

• Resistance training: Weight lifting, bodyweight exercises, resistance bands — two to three sessions per week. Building muscle mass improves your body’s ability to use insulin effectively. This is arguably the single most beneficial type of exercise for PCOS.
• Moderate cardiovascular exercise: Brisk walking, cycling, swimming — aim for at least 150 minutes per week. Both steady-state cardio and HIIT (high-intensity interval training) have shown benefits, though I generally recommend whatever you’ll actually do consistently.
• Daily movement: Walking after meals, even for 10–15 minutes, has a measurable effect on post-meal glucose levels.

What I discourage is excessive, punishing exercise — marathon training or two-hour daily sessions — which can raise cortisol and paradoxically worsen hormonal imbalance.

The mental health impact

This is something I always raise with my patients, because it’s too often overlooked. Women with PCOS have significantly higher rates of anxiety and depression compared to the general population — studies suggest up to 40% experience clinically significant anxiety and around 30% experience depression. The reasons are multifactorial: the hormonal imbalance itself affects mood, the visible symptoms (acne, hair growth, hair loss, weight gain) erode body image and confidence, and the experience of feeling dismissed by healthcare professionals takes its own toll.

I often see women who have been struggling silently, assuming their low mood is a personal failing rather than a recognised feature of their condition. If this resonates with you, please know that psychological support — whether through CBT, counselling, or in some cases medication — is a legitimate and important part of PCOS management, not an afterthought.

Supplements with evidence

The supplement market for PCOS is overwhelming, and much of it is not backed by good evidence. However, a few supplements do have meaningful research behind them:

• Inositol: Specifically myo-inositol (typically 4g per day), often combined with D-chiro-inositol in a 40:1 ratio. This has good evidence for improving insulin sensitivity, reducing androgen levels, and supporting ovulation. I recommend it frequently in my practice.
• Vitamin D: Deficiency is extremely common in women with PCOS (and in the UK population generally). If your levels are low, supplementing with 1,000–4,000 IU daily can improve insulin resistance and ovulatory function.
• Omega-3 fatty acids: Fish oil at 2–3g daily has anti-inflammatory effects and may help reduce androgen levels and improve lipid profiles.

I always check vitamin D levels and fasting insulin in my PCOS patients, because these results directly inform my supplement and treatment recommendations.

Managing hair and skin symptoms

The androgen-driven symptoms of PCOS — hirsutism (excess hair), acne, and androgenic alopecia (hair thinning) — are often what bring women to my clinic in the first place. They deserve specific attention.

For hirsutism, options include topical eflornithine cream (which slows facial hair growth), laser hair removal or electrolysis (most effective for dark hair on lighter skin), and anti-androgen medications. For acne, topical retinoids, azelaic acid, and in more severe cases, combined oral contraceptives or spironolactone can be very effective. Hair thinning on the scalp responds more slowly, but anti-androgen treatment combined with topical minoxidil can help over 6–12 months.

What I tell my patients is that these treatments take time. You won’t see results in two weeks. But with persistence and the right combination, most women see meaningful improvement.

When medication is the right step

Lifestyle changes are the foundation of PCOS management, but they are not always enough on their own. I am a great believer in combining lifestyle with targeted medication when the clinical picture warrants it:

• Metformin: Originally a diabetes medication, metformin improves insulin sensitivity at the cellular level. I prescribe it for women with clear insulin resistance, typically starting at 500mg and building to 1,500–2,000mg daily. It can improve menstrual regularity, reduce androgen levels, and support ovulation.
• Spironolactone: An anti-androgen that is particularly effective for acne and hirsutism. Doses of 50–200mg daily are typical. It must be used with reliable contraception as it can affect foetal development.
• Combined oral contraceptive pill: Certain pills (those containing anti-androgenic progestogens like drospirenone or cyproterone acetate) can regulate periods, reduce androgens, and protect the endometrium. They’re a good option for women who are not trying to conceive.
• Ovulation induction: For women trying to conceive, medications such as letrozole (now considered first-line) or clomifene can stimulate ovulation effectively.

The right approach depends entirely on your priorities — whether that’s managing skin symptoms, regulating your cycle, protecting your long-term metabolic health, or achieving a pregnancy. There is no one-size-fits-all treatment for PCOS, and anyone who tells you otherwise is oversimplifying.