A Functional Approach to PCOS

Polycystic Ovary Syndrome (PCOS) affects 1 in 10 women of reproductive age and is the leading cause of infertility worldwide. It’s characterized by hormonal imbalances, metabolic dysfunction, and—despite the name—doesn’t always involve ovarian cysts.

The good news? PCOS symptoms like acne, irregular periods, weight gain, and mood changes can improve significantly with targeted nutrition and lifestyle changes that address root causes rather than just managing symptoms.

In this guide, you’ll learn:

• The 3 root causes driving PCOS
• How to test for underlying imbalances with functional lab work
• The best PCOS diet for blood sugar balance and hormone health
• Evidence-based supplements that improve insulin sensitivity and ovulation
• Practical lifestyle strategies to break the PCOS cycle

Understanding PCOS: What It Really Is

PCOS presents differently in every woman. Some women experience acne or unwanted hair growth, while others struggle with irregular or absent menstrual cycles or difficulty ovulating.

Underlying imbalances can contribute to hormonal symptoms in PCOS because they can disrupt the balance of hormones, often increasing androgen hormones, such as DHEA and testosterone (3). These hormones can interfere with normal ovulation and menstrual cycle regulation. Despite the name, polycystic ovaries are not required for a PCOS diagnosis, and many women with PCOS do not actually have ovarian cysts.

How PCOS Is Diagnosed: The Rotterdam Criteria

Medical providers use something called the Rotterdam Criteria to diagnose PCOS (4). According to their criteria, a diagnosis can be made when two out of the following three criteria are present:

• Elevated testosterone or DHEA (clinical signs, like acne, or elevated lab levels)
• Irregular or absent ovulation (oftne demonstrates by irregular or absent cycles)
• Polycystic ovaries visible on ultrasound (a string of cysts visible with diagnostic imaging; may or may not present with pain)

Common Lab Imbalances in PCOS

For women with PCOS, it is often helpful to conduct a comprehensive laboratory evaluation that assesses hormones, lipid levels, and metabolic markers. These labs are frequently imbalanced in PCOS and can contribute to symptom development and progression of the condition.

Identifying these imbalances can help your healthcare provider determine appropriate nutrition, lifestyle, and medical strategies to address symptoms and support healthy ovulation.

Common laboratory findings may include (5)

• Elevated luteinizing hormone (LH)
• Lower follicle-stimulating hormone (FSH)
• Increased testosterone
• Reduced sex hormone-binding globulin (SHBG)
• Elevated insulin
• Higher fasting glucose
• Increased LDL cholesterol
• Elevated hs-CRP

If you are interested in identifying the root cause of your PCOS symptoms and making nutrition and lifestyle changes to bring balance back to your body, apply to work with me. Click the button below.

The 3 Root Causes of PCOS

Although PCOS presents differently for each woman, three major underlying drivers consistently appear: inflammation, insulin resistance, and high cortisol.

Inflammation

One major cause of inflammation in the body is poor gut health. When the gut becomes imbalanced, it can trigger inflammation throughout the body. This inflammation disrupts hormone signaling and worsens insulin resistance.

Inflammation tends to feed on itself—the more inflammation present, the more hormonal imbalance and insulin resistance develop, which in turn create even more inflammation.

Reducing inflammation through diet, gut support, and lifestyle changes can help interrupt this cycle and improve PCOS symptoms (6).

Insulin Resistance

About 80% of women with PCOS experience insulin resistance (7)

Normally, insulin, a hormone needed for a healthy metabolism, helps move glucose from the bloodstream into cells for energy. With insulin resistance, cells stop responding effectively to insulin, so the pancreas produces even more of it.

In women with PCOS, elevated insulin levels signal the ovaries to produce more androgens, which can lead to symptoms such as acne, irregular cycles, and hair growth.

Insulin resistance is often caused by:

• Diets high in refined sugar
• Chronic overnutrition
• Poor gut health
• Lack of physical activity

High insulin levels also increase inflammation, creating a feedback loop that affects both insulin resistance and PCOS symptoms (7). Supporting healthy insulin levels through nutrition and regular movement can dsirupt this feedback loop, improving whole-body health (8).

High Cortisol/ Chronic Stress

Stress also plays a role in PCOS.

When the body experiences chronic stress, the adrenal glands, which sit above the kidneys, release cortisol, the primary stress hormone. Elevated cortisol can interfere with insulin signaling, contributing to insulin resistance, and can raise inflammatory markers, further contributing to inflammation in the body.

Because stress influences both insulin resistance and inflammation, it becomes another piece of the cycle that drives PCOS symptoms (9). Practices that support nervous system regulation—such as mindfulness, restorative sleep, and relaxation techniques—can help bring balance back to the body by reducing cortisol.

Additional Contributing Factors

Several additional factors may contribute to PCOS development or symptom severity.

Genetics

PCOS also has a strong genetic component. Women with a family history of PCOS are more likely to develop the condition themselves (10). While genetics alone do not cause PCOS, they can increase susceptibility. Environmental and lifestyle factors influence how those genetic tendencies are expressed.

Environmental toxins
Certain chemicals can disrupt hormonal balance (11). It’s important to reduce toxin exposure by being mindful of beauty products, household cleaners, candles, and water.

Gut health imbalances
Imbalances in the gut microbiome can increase inflammation and worsen insulin resistance (12).

Diet and lifestyle factors
Highly processed diets, sedentary habits, and chronic overnutrition can worsen insulin resistance (13).

The Role of Thyroid Health

Thyroid function can also influence PCOS. When thyroid hormones are low, metabolic processes slow down, which can impact hormones and PCOS symptoms (14). Supporting thyroid health, when necessary, can therefore be an important piece of PCOS management.

How These Root Causes Connect

Inflammation, insulin resistance, and chronic stress do not occur independently—they constantly influence one another.

• Inflammation worsens insulin resistance
• Insulin resistance increases inflammation
• Stress amplifies both processes

This interconnected cycle is part of what makes PCOS complex, but it also means that improving one area often helps improve the others.

Dietary & Lifestyle Strategies for PCOS

Lifestyle changes can play a meaningful role in managing PCOS.

Anti-inflammatory diet
A Mediterranean-style diet rich in vegetables, healthy fats, omega-3 fatty acids, and fiber can help reduce inflammation and support metabolic health (15).

Blood sugar balance
Eating balanced meals that include protein, fiber, healthy fats, and complex carbohydrates helps stabilize blood sugar levels (16).

Gut health support
Probiotics, prebiotic fibers, and diverse whole foods help maintain a healthy microbiome (17).

Movement and stress management
Regular physical activity and stress-reducing practices such as mindfulness, yoga, or breathwork can improve insulin sensitivity and overall well-being (18).

Evidence-Based Supplements for PCOS

Certain foods and nutrients may offer additional support for women with PCOS.

Magnesium
Magnesium supports sleep, stress regulation, and blood sugar balance. Many women with PCOS are deficient in magnesium (19). Good sources include pumpkin seeds, almonds, spinach, and black beans.

Green Tea (EGCG)
Green tea contains powerful polyphenols (EGCG) with anti-inflammatory properties and may help reduce free testosterone levels (20).

Zinc
Studies show that taking 25 mg Zinc for 8-12 weeks can lower insulin resistance, reduce testosterone and LH levels, and improve ovarian morphology in PCOS women.

Inositol
Inositol has been widely studied for PCOS and has been shown to improve insulin sensitivity, support ovarian function, and regulate menstrual cycles (22).

Vitamin D
Vitamin D deficiency is common in women with PCOS and may worsen insulin resistance. Adequate levels support hormonal balance and metabolic health (23).

Cinnamon
Cinnamon may help improve insulin sensitivity and stabilize blood sugar levels while also reducing inflammation (24).

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When to Work With a Functional Dietitian

If you’re ready to identify your root causes and create a personalized nutrition plan, working with a functional medicine dietitian can accelerate results.

What we do:

• Order comprehensive lab panels (hormones, metabolic markers, inflammation, gut health)
• Interpret results using functional (optimal) ranges
• Create individualized nutrition and lifestyle recommendations for your body and lifestyle
• Recommend targeted supplements based on your labs
• Provide accountability and support through ongoing coaching and education

→ Apply to work with me individually (1:1)

Conclusion

PCOS is the presentation of imbalances in the body which often includes inflammation, insulin resistance, and chronic stress.

By addressing these root causes through nutrition, lifestyle changes, and targeted support, women with PCOS may improve hormonal balance, reduce symptoms, and support long-term health.

References

1. Azziz, R., et al. (2004). Androgen Excess Disorders in Women. Endocrine Reviews, 25(2), 221-262.
2. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reproduction, 19(1), 41-47.
3. Carmina, E., & Lobo, R. A. (1999). Polycystic ovary syndrome (PCOS): the role of hyperinsulinemia and insulin resistance. Reproductive Medicine and Biology, 23(1), 121-129.
4. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reproduction, 19(1), 41-47.
5. Goodarzi, M. O., et al. (2011). The genetic basis of polycystic ovary syndrome. Nature Reviews Endocrinology, 7(4), 221-230.
6. Vrieze, A., et al. (2015). Impact of gut microbiota on insulin sensitivity and metabolism. Nature Reviews Endocrinology, 11(6), 347-359.
7. Soliman, A., et al. (2014). Insulin resistance in PCOS: management through diet and exercise. Journal of Clinical Endocrinology & Metabolism, 99(10), 3798-3805.
8. Kiecolt-Glaser, J. K., et al. (2010). Chronic stress and age-related inflammation. Health Psychology, 29(5), 522-530.
9. Moran, L. J., et al. (2013). Lifestyle management of polycystic ovary syndrome. International Journal of Obesity, 37(1), 80-84.
10. Azziz, R., et al. (2012). Polycystic ovary syndrome. Obstetrics & Gynecology, 120(1), 114-126.
11. Tiwari, A., et al. (2015). Environmental toxins and endocrine disruptors in polycystic ovary syndrome. Endocrine Reviews, 36(6), 687-698.
12. Houghton, M., et al. (2016). The gut microbiota and its role in health and disease. Journal of Clinical Gastroenterology, 50(8), 659-674.
13. Pittas, A. G., et al. (2010). The role of dietary intervention in the management of insulin resistance and PCOS. The American Journal of Clinical Nutrition, 91(3), 756-762.
14. Lazarus, J. H., et al. (2012). Hypothyroidism and polycystic ovary syndrome: how to manage. Journal of Clinical Endocrinology & Metabolism, 97(8), 2557-2562.
15. Artal, R., et al. (2007). The Mediterranean diet and its role in the prevention of PCOS. Journal of Nutrition, 137(3), 649-653.
16. DeFronzo, R. A., & Tripathy, D. (2009). Skeletal muscle insulin resistance is the primary defect in type 2 diabetes. Diabetes Care, 32(2), 80-85.
17. O’Neill, J., et al. (2016). Probiotics, prebiotics, and PCOS. Nutrients, 8(2), 90.
18. Vasilenko, R., et al. (2018). The effects of exercise and stress management on insulin resistance and inflammation in PCOS. Clinical Endocrinology, 89(3), 409-415.
19. Reddy, P., et al. (2017). Magnesium supplementation and its impact on PCOS symptoms. The Journal of Nutrition, 147(2), 230-237.
20. Kucuk, I., et al. (2019). Green tea and its impact on PCOS. International Journal of Endocrinology, 2019, 2361910.
21. McCarty, M. F. (2000). The role of flaxseeds in the management of PCOS. European Journal of Clinical Nutrition, 54(5), 496-502.
22. Mani, B., et al. (2014). The role of inositol in managing PCOS symptoms. Journal of Clinical Endocrinology & Metabolism, 99(8), 2846-2854.
23. Pittas, A. G., et al. (2007). Vitamin D and insulin sensitivity. Diabetes Care, 30(7), 2198-2206.
24. Lu, T., et al. (2016). Cinnamon and its role in managing PCOS. Journal of Clinical Endocrinology & Metabolism, 101(9), 3258-3264.