PCOS
Comprehensive integrative medicine approach for lasting healing and complete recovery
Understanding PCOS
Polycystic Ovary Syndrome (PCOS) is a complex hormonal disorder characterized by chronic anovulation (failure to ovulate), hyperandrogenism (excess male hormones), and polycystic ovarian morphology. It affects approximately 1 in 10 women of reproductive age and is a leading cause of infertility, driven by insulin resistance and LH/FSH ratio imbalances.
Recognizing PCOS
Common symptoms and warning signs to look for
Irregular or absent menstrual periods (oligomenorrhea or amenorrhea)
Excessive hair growth on face, chest, or back (hirsutism)
Persistent acne vulgaris that does not respond to standard treatments
Unexplained weight gain, especially around the midsection
Difficulty conceiving despite regular attempts (infertility)
Multiple ovarian cysts visible on ultrasound (Rotterdam criteria)
What a Healthy System Looks Like
A healthy menstrual cycle typically ranges 21-35 days with regular ovulation occurring around day 14. The hypothalamic-pituitary-ovarian axis functions optimally: FSH stimulates follicle development, LH triggers ovulation, estrogen promotes endometrial proliferation, and progesterone maintains the luteal phase. In healthy women, androgen levels remain balanced with normal SHBG binding, insulin sensitivity is maintained (HOMA-IR < 1.5), and the ovaries contain a normal number of antral follicles (15-25 per ovary).
How the Condition Develops
Understanding the biological mechanisms
PCOS involves multiple interconnected pathophysiological mechanisms: (1) Insulin Resistance - Up to 70% of women with PCOS exhibit insulin resistance, leading to hyperinsulinemia which stimulates ovarian androgen production via the PI3K pathway and inhibits hepatic SHBG production, increasing free testosterone; (2) Hyperandrogenism - Excess testosterone and androstenedione from ovarian theca cells causes hirsutism, acne, and anovulation; (3) LH/FSH Imbalance - Elevated LH relative to FSH (LH/FSH ratio >2:1) stimulates ovarian stromal tissue and promotes cyst formation; (4) Ovarian Cyst Formation - Arrested antral follicles fail to mature, forming multiple peripheral cysts beneath the ovarian capsule; (5) Chronic Anovulation - Persistent estrogen exposure without progesterone leads to endometrial hyperplasia; (6) Chronic Inflammatory State - Elevated CRP, IL-6, and TNF-alpha contribute to metabolic dysfunction and cardiovascular risk.
Key Laboratory Markers
Important values for diagnosis and monitoring
| Test | Normal Range | Optimal | Significance |
|---|---|---|---|
| LH (Luteinizing Hormone) | 2.4-12.6 mIU/mL | 5-10 mIU/mL (mid-cycle peak) | Elevated LH with normal FSH suggests PCOS; LH/FSH ratio >2:1 is characteristic |
| FSH (Follicle Stimulating Hormone) | 3.5-12.5 mIU/mL | 5-8 mIU/mL | Normal or low FSH with elevated LH indicates pituitary-ovarian axis dysregulation |
| Free Testosterone | 0.1-6.0 pg/mL | 0.5-2.0 pg/mL | More sensitive marker than total testosterone; elevated in PCOS due to low SHBG |
| DHEA-S (Dehydroepiandrosterone Sulfate) | 18-391 mcg/dL | 100-200 mcg/dL | Adrenal androgen source; elevated suggests adrenal hyperandrogenism |
| Androstenedione | 0.7-3.7 ng/mL | 1.0-2.0 ng/mL | Elevated in PCOS; helps differentiate ovarian vs adrenal source of hyperandrogenism |
| SHBG (Sex Hormone Binding Globulin) | 18-144 nmol/L | 60-100 nmol/L | Low SHBG in PCOS increases free testosterone levels; insulin resistance suppresses SHBG |
Root Causes We Address
The underlying factors contributing to your condition
{"cause":"Insulin Resistance","contribution":"40%","assessment":"Fasting insulin, HOMA-IR calculation, 2-hour OGTT, body composition analysis"}
{"cause":"Genetic Predisposition","contribution":"30%","assessment":"Family history intake, genetic counseling if indicated"}
{"cause":"Chronic Low-Grade Inflammation","contribution":"25%","assessment":"CRP, IL-6, TNF-alpha, oxidative stress markers"}
{"cause":"Excess Androgen Exposure","contribution":"35%","assessment":"Complete androgen panel (testosterone, free T, DHEA-S, androstenedione, 17-OH progesterone)"}
{"cause":"LH Surge Abnormality","contribution":"20%","assessment":"Mid-luteal LH/FSH ratio, reproductive hormone panel"}
Risks of Inaction
What happens if left untreated
{"complication":"Infertility","timeline":"Ongoing if untreated","impact":"Chronic anovulation prevents egg release; 70-80% of PCOS-related infertility responds to treatment"}
{"complication":"Endometrial Hyperplasia and Cancer","timeline":"5-10+ years","impact":"3-4x increased risk of endometrial carcinoma due to unopposed estrogen"}
{"complication":"Type 2 Diabetes","timeline":"5-15 years","impact":"Up to 50% of PCOS women develop prediabetes or T2DM by age 40"}
{"complication":"Cardiovascular Disease","timeline":"10-20 years","impact":"Increased risk of hypertension, dyslipidemia, atherosclerosis, and coronary artery disease"}
{"complication":"Pregnancy Complications","timeline":"During pregnancy","impact":"Gestational diabetes (50% risk), preeclampsia, miscarriage risk 2x higher"}
How We Diagnose
Comprehensive assessment methods we use
{"test":"Rotterdam Criteria Diagnosis","purpose":"Confirm PCOS diagnosis using international criteria","whatItShows":"Requires 2 of 3: (1) Oligo/anovulation, (2) Clinical/biochemical hyperandrogenism, (3) Polycystic ovaries on ultrasound (>20 antral follicles per ovary)"}
{"test":"Comprehensive Androgen Panel","purpose":"Quantify hyperandrogenism","whatItShows":"Total testosterone, free testosterone, DHEA-S, androstenedione, SHBG"}
{"test":"Metabolic Panel","purpose":"Assess insulin resistance and diabetes risk","whatItShows":"Fasting glucose, fasting insulin, HOMA-IR, HbA1c, lipid panel"}
{"test":"Pelvic Ultrasound","purpose":"Visualize ovarian morphology","whatItShows":"Polycystic ovaries (>20 antral follicles per ovary, or ovarian volume >10 mL)"}
{"test":"Reproductive Hormone Panel","purpose":"Evaluate pituitary-ovarian axis","whatItShows":"LH, FSH, estradiol, prolactin, TSH, LH/FSH ratio"}
Our Treatment Approach
How we help you overcome PCOS
Phase 1: Diagnostic Clarity & Baseline
{"phase":"Phase 1: Diagnostic Clarity & Baseline","focus":"Comprehensive assessment, rule out differentials, establish baseline markers","interventions":["Complete medical and gynecological history","Advanced hormone panel and metabolic testing","Pelvic ultrasound assessment","Body composition analysis","Lifestyle and dietary intake assessment"]}
Phase 2: Metabolic Stabilization
{"phase":"Phase 2: Metabolic Stabilization","focus":"Restore insulin sensitivity, reduce androgens, establish regular cycles","interventions":["Low glycemic index diet implementation","Myo-inositol supplementation (2-4g/day)","Targeted nutritional intervention","Stress management and cortisol regulation","Sleep optimization protocol","Exercise prescription (resistance + moderate cardio)"]}
Phase 3: Hormonal Rebalancing
{"phase":"Phase 3: Hormonal Rebalancing","focus":"Restore ovulation, reduce androgenic symptoms, optimize fertility","interventions":["Continued metabolic support","Herbal and nutritional androgen modulation","Cycle tracking and ovulation induction support","Weight management optimization","Anti-inflammatory protocol","Acne and hirsutism management"]}
Phase 4: Maintenance & Optimization
{"phase":"Phase 4: Maintenance & Optimization","focus":"Sustain improvements, prevent relapse, optimize long-term health","interventions":["Personalized maintenance protocol","Continued metabolic monitoring","Fertility support if desired","Cardiovascular risk management","Endometrial health protection"]}
Diet & Lifestyle
Recommendations for optimal recovery
Lifestyle Modifications
Exercise 150 minutes weekly (combination of resistance + cardio), Strength training 2-3x weekly (builds muscle, improves insulin sensitivity), Stress management through meditation, yoga, or breathwork, Sleep hygiene - 7-9 hours consistent sleep schedule, Circadian rhythm optimization (morning light exposure), Weight management if overweight (5-10% loss can restore ovulation), Smoking cessation (smoking increases androgen levels), Environmental toxin reduction (BPA-free products, organic when possible)
Recovery Timeline
What to expect on your healing journey
Phase 1 (Weeks 1-2): Diagnostic clarity and baseline establishment. Phase 2 (Weeks 3-8): Metabolic stabilization with insulin sensitivity improvements. Phase 3 (Months 3-6): Hormonal rebalancing and ovulation restoration. Phase 4 (Months 7-12+): Maintenance and long-term optimization. Most patients see initial improvements in energy and sleep within 4-8 weeks, with significant cycle regularization and symptom improvement by 3-6 months.
How We Measure Success
Outcomes that matter
Regular menstrual cycles (every 28-35 days)
Restored ovulation (confirmed via BBT or progesterone testing)
Normalized androgen levels (testosterone, free testosterone within optimal range)
Improved insulin sensitivity (HOMA-IR < 1.5)
Reduction in hirsutism score (Ferriman-Gallwey score decrease)
Clearer skin (reduced acne lesions)
Frequently Asked Questions
Common questions from patients
Can PCOS be cured or reversed?
While PCOS cannot be 'cured' in the traditional sense, it can be effectively managed and symptoms can be significantly improved or resolved through lifestyle modifications, targeted supplementation (particularly myo-inositol), and functional medicine protocols. Many women achieve regular cycles, fertility, and symptom resolution through comprehensive treatment.
Will I need to take medication for PCOS forever?
Not necessarily. Many women can manage PCOS effectively through diet, lifestyle, and targeted supplements, reducing or eliminating the need for pharmaceutical interventions. The goal of functional medicine is to address root causes rather than suppress symptoms indefinitely.
Can I get pregnant with PCOS?
Yes, the majority of women with PCOS can conceive with appropriate treatment. Weight loss of just 5-10% can restore ovulation in many women. Myo-inositol and other supplements can improve insulin sensitivity and support ovulation. Advanced treatments like clomiphene, letrozole, or assisted reproductive technologies are available if needed.
What is the best diet for PCOS?
A low glycemic index, anti-inflammatory diet is most effective for PCOS. This emphasizes whole foods, lean proteins, healthy fats, and high-fiber carbohydrates while avoiding refined sugars and processed foods. The Mediterranean diet has strong evidence for improving PCOS outcomes through improved insulin sensitivity and reduced inflammation.
How do I know if my PCOS treatment is working?
Key indicators include: regular menstrual cycles (every 28-35 days), reduced hirsutism and acne, improved energy levels, stable weight, and normalized lab values (testosterone, LH/FSH ratio, insulin, cholesterol). Tracking symptoms over time helps measure progress.
What role does inositol play in PCOS treatment?
Inositol, particularly myo-inositol and d-chiro-inositol, improves insulin sensitivity by enhancing the PI3K pathway in cells. Studies show myo-inositol (2-4g daily) can restore ovulation, improve hormone ratios, and reduce testosterone levels. The 40:1 ratio of myo-inositol to d-chiro-inositol is considered optimal for PCOS management.
Medical References
- 1.Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reproduction. 2004;19(1):41-47. PMID: 14688157
- 2.Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction. 2018;33(9):1602-1618. doi:10.1093/humrep/dey256
- 3.Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler JE. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocrine Connections. 2017;6(8):647-658. doi:10.1530/EC-17-0243
Ready to Start Your Healing Journey?
Our integrative medicine experts are ready to help you overcome PCOS.