What is PCOS?

Polycystic ovary syndrome (PCOS) is defined by the accumulation of numerous cysts on the ovaries associated with hyperandrogenism, oligo-ovulation/anovulation, and polycystic ovaries. Polycystic ovaries are characterised by ultrasound detection of 12 or more follicles <9 mm in diameter, increased ovarian volume >10mL, and absence of a dominant follicle. (‘Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)’, 2004)

Pathophysiology of PCOS

The pathophysiology, or underlying mechanisms, of PCOS involve multiple factors that contribute to the development and progression of the condition. While the exact pathophysiology is not completely understood, there are several key aspects that are believed to play a role.

Hormonal Imbalance:

PCOS is characterized by an imbalance in hormone levels, particularly androgens (such as testosterone) and oestrogen. Women with PCOS often have higher levels of androgens, which can disrupt the normal hormonal balance and affect the development and release of eggs from the ovaries.

Insulin Resistance:

Insulin resistance is a condition in which the body's cells become less responsive to the effects of insulin, leading to higher insulin levels in the blood. Insulin resistance is common in women with PCOS and is believed to be a contributing factor to the hormonal imbalances seen in the condition. Elevated insulin levels can stimulate the ovaries to produce excess androgens, further exacerbating the hormonal imbalance.

Ovarian Dysfunction:

In PCOS, the ovaries may have difficulty in producing and releasing mature eggs during ovulation. This can result in the formation of small cysts, known as follicles, on the ovaries. These follicles may fail to mature and become trapped, leading to the characteristic appearance of multiple cysts on the ovaries. The disrupted ovulation process can contribute to irregular menstrual cycles and infertility.


Chronic low-grade inflammation has been observed in women with PCOS. Inflammatory markers, such as C-reactive protein (CRP) and pro-inflammatory cytokines, may be elevated. Inflammation can further disrupt normal ovarian function, insulin sensitivity, and hormone production.

Clinical Symptoms

  • Irregular menstrual cycle
  • Too much hair on the face, chin, or body parts.
  • Acne on the face, chest, and upper back
  • Thinning hair or hair loss on the scalp; male pattern baldness
  • Weight gain or difficulty losing weight
  • Darkening of skin, particularly along neck creases, in the groin, and underarm, underneath breast area

Hormonal changes:

Hormone & Lipid IncreasedHormone & Lipid Decreased
LH (Luteinising Hormone)FSH (Follicle Stimulating Hormone)
InsulinSHBG (Sex hormone binding globulin)
Prolactin (in some cases)Adiponectin (Toulis et al., 2009)
LDL and TriglyceridesHDL

Natural Remedies to Manage PCOS

PCOS and Diet – Weight loss improves ovulation, testosterone levels and insulin resistance in women with PCOS, but the optimal diet composition is disputed. A diet low in carbohydrates may be superior to a standard diet in terms of improving fertility, endocrine/metabolic parameters, weight loss and satiety in women with PCOS. (Barrea et al., 2018; Shahid et al., 2022; García-Gómez et al., 2023)

Reduce Stress – When we put ourselves under a lot of stress, the brain stimulates the adrenal glands to produce stress hormones (cortisol). The following could indicate that stress hormones contribute to PCOS: feeling tired all the time, waking up tired even after 7-8 hours of sleep, feeling exhausted after exercise, and feeling tired but wired at night.

Address Inflammation - Inflammation has been shown to increase androgens and exacerbate PCOS even without insulin resistance. If you get recurrent infections, this could be an indicator that you have chronic inflammation.

Exercise - Exercise reduces insulin loads in the blood by moving it into the muscles, lowering the need for insulin and improving the body's sensitivity to insulin. If you can manage insulin, you are better able to manage testosterone, the cause of a lot of our PCOS symptoms. Ideally, it would be best if you were doing a combination of strength and cardio training as both types of exercises give us different benefits. Cardio training causes your heart rate to rise and uses energy, increasing your total calories, which will help with weight loss. On the other hand, strength training builds muscle, which is important in raising your basal metabolic rate so that you burn more calories while at rest and while exercising. (Harrison et al., 2011)

What can we do to help PCOS patients?

It's important to remember that PCOS is a complex and heterogeneous condition, meaning that the exact pathophysiology can vary among individuals. While these factors provide an overview of the underlying mechanisms, each person's experience with PCOS may be unique.

At Timeless Skincare Clinic, we provide PCOS functional testing and dietary and lifestyle advice. PCOS management is unique to each individual; personalised nutritional therapy understands the uniqueness of each individual's condition and guides appropriate treatment options.


Barrea, L. et al. (2018) ‘Source and amount of carbohydrate in the diet and inflammation in women with polycystic ovary syndrome’, Nutrition Research Reviews, 31(2), pp. 291–301. doi: 10.1017/S0954422418000136.

Escobar-Morreale, H. F. (2018) ‘Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment’, Nature Reviews Endocrinology, 14(5), pp. 270–284. doi: 10.1038/nrendo.2018.24.

García-Gómez, E. et al. (2023) ‘The Effect of Metformin and Carbohydrate-Controlled Diet on DNA Methylation and Gene Expression in the Endometrium of Women with Polycystic Ovary Syndrome’, International Journal of Molecular Sciences, 24(7), p. 6857. doi: 10.3390/ijms24076857.

Harrison, C. L. et al. (2011) ‘Exercise therapy in polycystic ovary syndrome: a systematic review’, Human Reproduction Update, 17(2), pp. 171–183. doi: 10.1093/humupd/dmq045.

‘Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)’ (2004) Human Reproduction, 19(1), pp. 41–47. doi: 10.1093/humrep/deh098.

Shahid, R. et al. (2022) ‘Diet and lifestyle modifications for effective management of polycystic ovarian syndrome (PCOS)’, Journal of Food Biochemistry, 46(7). doi: 10.1111/jfbc.14117.

Toulis, K. A. et al. (2009) ‘Adiponectin levels in women with polycystic ovary syndrome: a systematic review and a meta-analysis’, Human Reproduction Update, 15(3), pp. 297–307. doi: 10.1093/humupd/dmp006.

Wu, D. et al. (2013) ‘Intake of Vinegar Beverage Is Associated with Restoration of Ovulatory Function in Women with Polycystic Ovary Syndrome’, The Tohoku