Lifestyle Modification a Top Treatment for Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) is a hormone problem that happens during a woman’s reproductive years. The hallmark features of PCOS are linked to elevated male hormone levels, known as hyperandrogenism. This may appear as excess hair on the face, chest, or abdomen (known as hirsutism), acne, or thinning or loss of scalp hair (known as alopecia).
Many women with PCOS also have irregular menstrual cycles, often caused by infrequent or absent ovulation.
The condition is more common among those with a family history of PCOS and those with a history of insulin resistance—a state in which the body’s cells respond poorly to insulin.
It’s also more common among those with a family history of metabolic syndrome, which refers to a cluster of conditions including high blood pressure, elevated blood sugar, excess abdominal fat, and abnormal cholesterol levels, said Dr. John C. Parker of Wilmington Health.
“The foundation of treatment for PCOS is lifestyle modification, including healthier eating, increased physical activity, and weight loss—particularly in women who are overweight or obese,” Parker said. “Even modest weight loss can help restore ovulation, regulate menstrual cycles, and improve insulin sensitivity.”
PCOS appears to have a genetic component, with signs of heritability observed in women and men. Male relatives may show related traits such as early-onset baldness or other metabolic abnormalities, including type 2 diabetes or central obesity.
The syndrome is more frequently diagnosed in populations with higher rates of insulin resistance, including Hispanic, South Asian, and African American women.
Many women with PCOS also have irregular menstrual cycles, often caused by infrequent or absent ovulation.
An ultrasound may reveal polycystic ovarian morphology, in which the ovaries appear enlarged and contain many small follicles arranged around the edge, often described as resembling a “string of pearls.”
Diagnosis is typically based on the Rotterdam criteria, which require any two of the following three: clinical or laboratory signs of excess androgens, irregular or absent ovulation, or polycystic-appearing ovaries on ultrasound. PCOS is a diagnosis of exclusion—other causes of elevated androgens, such as adrenal disorders, thyroid dysfunction, or rare tumors must be ruled out before the diagnosis is confirmed.
Treatment: Linked to symptoms, long-term health goals
The main objectives are to manage menstrual irregularity, hirsutism, infertility, and metabolic complications such as insulin resistance, type 2 diabetes, elevated cholesterol, and obesity.
For women looking to become pregnant, treatment focuses on ovulation induction using medications that stimulate egg release. In such cases, spironolactoneca commonly used anti-androgen—must be discontinued in advance, as it is teratogenic, meaning it can harm fetal development if taken during pregnancy.
GLP-1 receptor agonists, such as semaglutide, are showing promise for women with PCOS who are also obese. These medications support weight loss and improve insulin sensitivity, and both of those could help restore ovulatory cycles and reduce the metabolic risks associated with the condition.
PCOS treatment
In addition to lifestyle modification mentioned earlier—such as healthier eating, increased physical activity, and weight loss—the first-line medication for menstrual irregularity and hirsutism is usually combined oral contraceptives, also known as birth control pills. Those help regulate the menstrual cycle and reduce the production of male hormones by the ovaries, and that can lessen acne and excess hair growth.
Metformin, a medication that improves the body’s response to insulin, is often used to support more regular ovulation and cycles. It is particularly helpful in women with glucose intolerance or in those trying to become pregnant but who are not yet ready for more advanced fertility treatments.
Reducing the risk of comorbidities in PCOS
Addressing obesity and restoring regular ovulation can lower the risk of developing type 2 diabetes, cardiovascular disease, endometrial cancer, and sleep apnea. Even a modest weight loss of 5–10% can improve the body’s response to insulin, help regulate menstrual cycles and increase the chances of natural ovulation and conception.
Women with PCOS should also be routinely assessed for depression and anxiety, which are more common in this population and should be treated promptly.
Although PCOS does not change how conditions like heart disease are treated, improving the underlying metabolic disturbances associated with PCOS can strengthen treatment responses and help slow disease progression.
How to raise awareness and increase PCOS research funding
Despite being one of the most common endocrine disorders among women of reproductive age, PCOS remains underfunded relative to how widespread it is and how severely it can affect women’s health and quality of life.
Raising awareness will require grassroots advocacy, better patient education, and inclusion of PCOS in broader women’s health campaigns. Building partnerships with public health organizations, medical societies, and elected officials can help position PCOS as a national research priority.
To make progress, increased NIH funding and incentives for private-sector investment will be essential—particularly as funding for women’s health research faces growing pressure. Strategic engagement at both policy and community levels will be key to closing the gap between the burden of PCOS and the resources allocated to understanding and treating it.
John Parker, M.D., FACE, ECNU, graduated medical school from the University of North Carolina in Chapel Hill. He completed his internal medicine internship and residency at the University of Kentucky in Lexington. His endocrinology, metabolism, and nutrition fellowship was performed at Duke University in Durham. He is certified in Internal Medicine, Endocrinology, and Diabetes and Metabolism. In addition, he received his Endocrine Certification in Neck Ultrasound (ENCU) from the American College of Endocrinology.