Polycystic Ovary Syndrome, or PCOS, is a common hormonal and metabolic disorder that affects about 6% to 12% of women of reproductive age. It impacts the ovaries and ovulation and often leads to symptoms like:

Irregular periods
Acne and oily skin
Hair growth on the face, chest, or back (hirsutism)
Weight gain or difficulty losing weight
Fertility problems
Enlarged ovaries with many small cysts

Despite the name, not everyone with PCOS has ovarian cysts. The term “polycystic” refers to the appearance of the ovaries on ultrasound.

What Causes Polycystic Ovary Syndrome?

PCOS is believed to have a genetic component and is often influenced by lifestyle and environmental factors. A key feature is a hormonal imbalance—many women with PCOS produce higher levels of androgens (male hormones like testosterone) and lower levels of estrogen and progesterone.

This imbalance disrupts ovulation and can lead to the formation of multiple small cysts in the ovaries. Over time, these changes can impair fertility and increase the risk of other health issues.

PCOS and Insulin Resistance

One of the most significant findings in recent years is the strong link between PCOS and insulin resistance. Insulin resistance means the body’s cells don’t respond well to insulin, causing the pancreas to produce more of it.

High levels of insulin can:

Trigger the ovaries to produce more androgens
Disrupt normal menstrual cycles
Increase the risk of developing type 2 diabetes, gestational diabetes, and metabolic syndrome.

Even women who are not overweight can have insulin resistance with PCOS. This makes it essential to screen regularly for blood sugar issues.

PCOS and Type 2 Diabetes

Women with PCOS are 2 to 5 times more likely to develop type 2 diabetes compared to those without the condition. Other related risks include:

High blood pressure
High LDL cholesterol and triglycerides
Cardiovascular disease

The American Diabetes Association recommends regular screening with an oral glucose tolerance test (OGTT) for all women with PCOS, especially those who are overweight or have a family history of diabetes.

Treatments for PCOS

1. Lifestyle Changes

Small changes in diet and exercise can have significant effects:

Lose 5–10% of body weight
Eat a lower-glycemic diet (low sugar and refined carbs)
Exercise regularly (e.g., walking, strength training, yoga)

These steps improve insulin sensitivity and may restore regular menstrual cycles and ovulation.

2. Medications

Metformin: Improves insulin sensitivity, lowers blood glucose, and may help restore regular cycles
Inositol supplements (myo-inositol and D-chiro-inositol): Support insulin function and hormonal balance
GLP-1 receptor agonists (like semaglutide): Promote weight loss and improve insulin resistance (still under study for PCOS use)
Oral contraceptives: Regulate periods and reduce acne and hair growth
Anti-androgens (like spironolactone): Help treat hirsutism

3. Fertility Treatments

If restoring fertility is the goal:

Hormone-based drugs like clomiphene or letrozole can induce ovulation
Caution is needed with insulin-sensitizing medications during pregnancy, as safety data are limited

What to Expect from Treatment

Some symptoms improve faster than others:

Acne may clear up within weeks
Hair growth may take 6–12 months to decrease
Ovulation and fertility may return with lifestyle or medical support

A tailored treatment plan is best, depending on symptoms, fertility goals, and how well a person tolerates medication.

New and Emerging Research

Recent studies are exploring new approaches:

Structured exercise programs specifically for PCOS
GLP-1 medications for weight loss and metabolic improvement
Inositol supplements for pregnancy support and lowering the risk of gestational diabetes

To learn more, check out current PCOS clinical trials at UCSF and updates from the American Diabetes Association.

Final Thoughts

PCOS is more than a reproductive disorder—it affects long-term metabolic health. By addressing insulin resistance through lifestyle changes, medication, and support, many women can reduce symptoms and lower the risk of diabetes.

If you suspect you have PCOS, talk with your healthcare provider about screening and treatment options tailored to your needs.