PCOS is often treated like a fertility problem or an acne and irregular period problem. In reality, it is a complex metabolic and hormonal condition that can affect your energy, mood, weight, fertility, and long-term health.
If you have PCOS, you may have been told to lose weight, exercise more, and take birth control or metformin. That might help in the short term, but it ignores the deeper question:
What is driving your PCOS in the first place?
From a functional medicine perspective, PCOS is not just an ovary issue. It is a whole-person issue that involves blood sugar, inflammation, gut health, stress, sleep, and nutrient status. When we address those root causes, hormones often start to behave much more kindly.
In this article, I will walk you through how I think about PCOS in my practice, the patterns I look for, the labs that actually matter, and the core pillars of a functional medicine plan.
What Is PCOS, Really?
PCOS, or polycystic ovary syndrome, is one of the most common hormonal conditions in women of reproductive age. It is associated with:
- Irregular or absent ovulation
- Higher levels of androgens (testosterone and “male” type hormones)
- A tendency toward insulin resistance and blood sugar issues
You do not have to have visible “cysts” on your ovaries to be diagnosed with PCOS. Many women are surprised to learn that PCOS is diagnosed based on a pattern of symptoms and specific criteria, not just an ultrasound.
PCOS can show up as:
- Irregular or heavy cycles
- Acne and oily skin
- Hair growth on the face, chest, or abdomen
- Hair thinning on the scalp
- Weight gain that feels stubborn, especially around the middle
- Difficulty getting pregnant
- Fatigue and brain fog
- Anxiety, low mood, and feeling “off”
It is common to feel frustrated, confused, and even betrayed by your body when all of this shows up at once. You may also feel dismissed if your labs were called “normal” and you were told to be patient or try one more medication.
You deserve more than that.
Types Of PCOS Through A Functional Lens
There are a few common patterns in PCOS. Most women have a mix of these, not just one.
Insulin-Resistant PCOS
This is the most common pattern. Insulin is the hormone that helps move glucose from your bloodstream into your cells. When cells become less responsive to insulin, your body compensates by making more.
High insulin can:
- Push the ovaries to make more androgens
- Make it harder to ovulate regularly
- Drive weight gain, especially around the abdomen
- Increase cravings and energy crashes
If you feel like you gain weight just looking at carbohydrates, live on a blood sugar roller coaster, or feel exhausted after meals, insulin resistance may be a big driver.
Adrenal (Stress-Driven) PCOS
Your adrenal glands sit on top of your kidneys and help you respond to stress. They produce cortisol and can also produce androgens.
When stress is constant, sleep is poor, or your nervous system is always in “go mode,” the adrenals can contribute a larger share of androgens. Adrenal-driven PCOS often shows up as:
- Acne and hirsutism (unwanted hair growth)
- Irregular cycles
- Anxiety, feeling “tired and wired”
- A history of chronic stress, trauma, overtraining, or burnout
You might be told your labs “do not look that bad,” but your lived experience says otherwise.
Inflammatory PCOS
PCOS has a strong inflammatory component. Many women with PCOS have higher levels of inflammatory markers, blood sugar dysregulation, gut imbalance, or autoimmune tendencies.
Inflammation can:
- Disrupt ovulation
- Worsen insulin resistance
- Increase pain, fatigue, and mood symptoms
- Make weight loss much more challenging
Inflammatory PCOS often overlaps with gut issues, food sensitivities, joint pain, skin problems, or fatigue that feels disproportionate to your lifestyle.
How PCOS Shows Up In Your Body
You may already know the classic PCOS symptoms, but it helps to connect the dots.
Menstrual And Fertility Symptoms
- Irregular or absent periods
- Heavy bleeding when a cycle finally shows up
- Long cycles with no clear ovulation
- Trouble conceiving or early pregnancy loss
Skin And Hair Changes
- Acne along the jawline, chin, chest, or back
- Oily skin and clogged pores
- Darkened, velvety skin in body folds (neck, armpits, groin)
- Excess hair growth on the face, chest, abdomen, or thighs
- Thinning hair on the scalp
Metabolic And Energy Symptoms
- Weight gain, especially around the abdomen
- Intense carb or sugar cravings
- Energy crashes after meals
- Brain fog and trouble focusing
- Elevated cholesterol or triglycerides
Emotional And Mental Health
- Anxiety and irritability
- Low mood or depression
- Feeling “out of control” in your own body
These are not separate problems. They are different expressions of the same underlying imbalances.
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Labs I Use To Understand PCOS
Traditional labs are helpful, but I usually need a more complete picture. Here is what I look at.
Basic Hormone And Metabolic Labs
- Fasting glucose and insulin
- A1c (your three month average blood sugar)
- Lipid panel (cholesterol, triglycerides, HDL, LDL)
- Total and free testosterone
- DHEA-S
- Sex hormone binding globulin (SHBG)
- LH and FSH ratio
- Vitamin D and basic nutrient markers
These help me see how hard your pancreas is working, how your liver is handling hormones and lipids, and whether androgens are elevated.
Imaging And Conventional Tests
- Pelvic ultrasound with your doctor when appropriate
- Standard thyroid panel
- In some cases, an oral glucose tolerance test with insulin levels
You can have PCOS with a normal ultrasound, and you can have cysts on your ovaries without having PCOS. Context is everything.
Functional Testing
Depending on your history, I may also use:
- DUTCH testing to look at hormone metabolism and adrenal patterns
- Comprehensive stool testing to evaluate gut health, inflammation, and the microbiome
- Advanced lipid and metabolic markers if there is concern about cardiovascular risk
These tests are not required for every woman, but they can be powerful in complicated cases or when someone has already tried the basics without much progress.
The Functional Medicine Approach To PCOS
Now, let us talk about how we actually help you feel better. A functional approach focuses on root causes and personalized strategies rather than a one size fits all protocol.
1. Stabilize Blood Sugar And Improve Insulin Sensitivity
Even if your labwork is “within range,” small shifts in insulin and glucose can have big hormonal consequences. Core strategies include:
- Building meals around protein, healthy fats, and fiber
- Reducing highly processed carbohydrates and sugary drinks
- Prioritizing regular, consistent meals instead of grazing all day
- Using movement after meals to help your muscles pull glucose out of your bloodstream
For some women, medications play a role. For others, targeted nutrition and lifestyle changes are enough. The plan should match your body and your goals, not just a guideline.
2. Calm Inflammation And Support Gut Health
Because inflammation and gut health are tightly connected to PCOS, I often:
- Screen for gut symptoms like bloating, constipation, diarrhea, or reflux
- Look for hidden infections, dysbiosis, or leaky gut on stool testing when needed
- Emphasize anti-inflammatory foods such as colorful vegetables, fruit, herbs, spices, and omega 3 rich foods
- Support regular digestion and bowel movements
When the gut is happier, hormones are often easier to tame.
3. Support Hormones And Ovulation
The goal is not just a “bleed.” The goal is healthy, regular ovulation when appropriate for your life stage. Strategies can include:
- Normalizing insulin and inflammation so the ovaries can respond properly
- Using targeted nutrients that support ovulation and hormone metabolism
- Ensuring you are eating enough to support regular cycles, not undereating in a bid to lose weight
- Balancing thyroid function and addressing nutrient gaps such as vitamin D, magnesium, and B vitamins
Birth control pills suppress ovulation and can be helpful for symptom control in some situations, but they do not resolve root causes. You deserve to understand the pros and cons before deciding what is right for you.
4. Address Stress And Adrenal Health
If your nervous system is always on high alert, hormones will follow its lead. Adrenal support might include:
- Protecting sleep as a non-negotiable
- Setting boundaries around work, caregiving, and constant availability
- Gentle nervous system tools such as breathwork, yoga, walking, or time in nature
- Adjusting exercise so it supports your body rather than punishing it
High-intensity workouts every day, plus poor sleep, is a recipe for adrenal-driven PCOS symptoms in many women.
5. Consider Targeted Supplements
There is good research supporting certain supplements for PCOS, including myoinositol, NAC, omega 3 fatty acids, vitamin D, magnesium, and others. The right combination depends on:
- Your lab results
- Your main symptoms
- Other medications you take
- Whether you are trying to conceive
Supplements are powerful tools, not magic bullets. They work best when they are layered on top of solid foundations, not used as a shortcut. Here’s a protocol with my handpicked choices.
Always talk with a knowledgeable provider before starting new supplements, especially if you are pregnant, planning pregnancy, or taking prescription medications.
PCOS, Long-Term Health, And Longevity
PCOS does not switch off when you are “done” with fertility. It is connected to long term health risks such as:
- Type 2 diabetes
- Metabolic syndrome
- High blood pressure
- Cardiovascular disease
- Sleep apnea
This is not meant to scare you. It is meant to encourage you to take PCOS seriously as a whole body, whole life condition, not just an inconvenience in your twenties.
The choices you make now around sleep, stress, nutrition, movement, and hormone balance can change your health trajectory for decades.
Can PCOS Be Reversed?
Here is how I talk about this with my clients:
- PCOS is a pattern, not a personal failure.
- We may not “erase” the diagnosis, but we can often quiet the symptoms and normalize many of the lab markers.
- For some women, cycles become regular, symptoms calm down, and fertility improves significantly.
- For others, PCOS remains in the background, but it no longer runs the show.
The earlier we start addressing root causes, the more leverage we have, but it is never too late to support your body.
How I Work With Women Who Have PCOS
When I work with women who have PCOS, we start with a detailed history and the right labs, then create a plan that is realistic for your life.
That plan often includes:
- A blood sugar and nutrition strategy tailored to your preferences
- A movement and strength plan that supports insulin sensitivity and body composition
- Strategies for better sleep and nervous system regulation
- Targeted supplements based on your labs and symptoms
- Ongoing coaching so you do not have to figure this out alone
If you have been handed generic advice or bounced between providers who never connected the dots, it may be time for a functional medicine approach.
If you are ready to look at the whole picture and create a personalized plan, I would love to help.
👉 Learn more and schedule a consultation here: www.drannagarrett.com/lets-talk
References
(Numbered for your convenience; formatted in APA style.)
- Aboeldalyl, S., James, C., Seyam, E., Ibrahim, E. M., Shawki, H. E., & Amer, S. (2021). The role of chronic inflammation in polycystic ovarian syndrome: A systematic review and meta-analysis. International Journal of Reproductive Biomedicine, 19(2), 157–170. PubMed Central
- Cowan, S., Knight, C., & Teede, H. J. (2023). Lifestyle management in polycystic ovary syndrome. Climacteric, 26(2), 125–135. PubMed Central
- Forslund, M., Moran, L., & Teede, H. J. (2024). International evidence-based guideline on assessment and management of polycystic ovary syndrome. Acta Obstetricia et Gynecologica Scandinavica, 103(2), 124–136. PubMed+1
- Gautam, R., Chopra, A., & Sharma, D. (2025). The role of lifestyle interventions in PCOS management: A comprehensive review. Nutrients, 17(2), 310. MDPI
- Ghafari, A., & colleagues. (2025). The last update on polycystic ovary syndrome: Pathophysiology and management. Metabolism Open, 18, 100290. ScienceDirect
- Han, Y., Zhao, Y., & Li, X. (2024). Dietary supplements in polycystic ovary syndrome: Current evidence and practical applications. Frontiers in Endocrinology, 15, 1456571. Frontiers
- Marshall, J. C., & Dunaif, A. (2012). All women with PCOS should be treated for insulin resistance. Fertility and Sterility, 97(1), 18–22. PubMed Central
- Sacchinelli, A., Venturella, R., Lico, D., Di Cello, A., Zullo, F., & Gulletta, E. (2014). The efficacy of inositol and N-acetyl cysteine in PCOS: A prospective clinical trial. Obstetrics and Gynecology International, 2014, 141020. PubMed Central+1
- Teede, H. J., Misso, M., Costello, M., Dokras, A., Laven, J., Moran, L., & others. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction, 33(9), 1602–1618. OUP Academic+1
- Thakker, D., Raval, A., Patel, I., Walia, R., & Raval, A. (2015). N-acetylcysteine for polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled clinical trials. European Journal of Obstetrics & Gynecology and Reproductive Biology, 191, 1–9. PubMed Central
- Prosperi, S., & colleagues. (2025). Insulin resistance, metabolic syndrome, and polycystic ovary syndrome: Interlinked cardiometabolic risks. Frontiers in Endocrinology, 16, 1669716. Frontiers
- The Institute for Functional Medicine. (2025). Polycystic ovary syndrome and the benefits of a personalized lifestyle approach. IFM.org. IFM
Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Dr. Anna is the author of Perimenopause: The Savvy Sister’s Guide to Hormone Harmony. Order your copy at www.perimenopausebook.com.
Dr. Anna is available for 1-1 consultations. Find out more at www.drannagarrett.com/lets-
