What is PCOS and why is it often undiagnosed?

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, affecting 8–13% of women globally. It is characterised by at least two of three features: irregular or absent ovulation (causing irregular periods), elevated androgens (excess male hormones causing acne, excess hair, or hair thinning), and polycystic-appearing ovaries on ultrasound. Despite its prevalence, PCOS is often undiagnosed for years because its symptoms are varied and can overlap with other conditions.

How does insulin resistance relate to PCOS?

Insulin resistance — where cells become less responsive to insulin's signals — is present in approximately 65–70% of women with PCOS, regardless of weight. Elevated insulin stimulates the ovaries to produce excess androgens and disrupts follicular development, contributing to irregular ovulation. This creates a reinforcing cycle: androgen excess worsens insulin resistance; insulin resistance worsens androgen excess. Addressing insulin resistance through diet, exercise, and (where appropriate) metformin is a central component of PCOS management.

Can diet significantly improve PCOS symptoms?

Yes — dietary intervention is one of the most impactful tools in PCOS management. Reducing the glycaemic load of the diet (limiting refined carbohydrates and sugar) directly reduces insulin and androgen levels. A Mediterranean-style dietary pattern has evidence for improving hormonal and metabolic markers in PCOS. Even modest weight loss (5–10%) in women with PCOS and overweight can restore ovulatory cycles, reduce androgen levels, and improve fertility. Inositol (particularly myo-inositol) supplementation has strong emerging evidence for improving insulin sensitivity and ovarian function in PCOS.

Does PCOS affect fertility and can it be managed?

PCOS is the most common cause of anovulatory infertility — infertility due to failure to ovulate regularly. However, most women with PCOS can conceive either naturally or with medical support. Lifestyle changes including weight management and dietary optimisation restore ovulation in many women. Letrozole (or clomiphene) induces ovulation medically. IVF is available for those who do not respond to ovulation induction. PCOS-related fertility challenges are generally more manageable than many other fertility conditions, and specialist support significantly improves outcomes.

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Reviewed by Dr. Ian Henderson · Microbiobial Health & Medicine26 March 2026Research-supported

Quick answer

PCOS (polycystic ovary syndrome) is a hormonal condition affecting the ovaries, commonly causing irregular periods, elevated androgens, and insulin resistance. Holistic approaches including nutritional therapy, inositol supplementation, stress management, and herbal medicine show good evidence for hormonal regulation and symptom management.

Do any of these feel familiar?

Irregular or absent periods
Excess hair growth on the face, chest, or abdomen
Thinning hair on the scalp
Persistent acne or oily skin, particularly on the jaw and chin
Difficulty losing weight, particularly around the abdomen
Fatigue and low energy
Low mood or anxiety with a hormonal pattern

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