“I think something is wrong with my hormones, I can’t lose weight no matter what I do!…”

In the case of the estimated 5-26% of all reproductive-aged females suffering from polycystic ovary syndrome (PCOS), clients are 100% correct (Gu et al., 2022; Shukla, Rasquin, & Anastasopoulou, 2025).

PCOS is characterized by excessive visceral fat (regardless of BMI) leading to errors in hormonal signaling and causing the following hormonal abnormalities:

• Ovarian dysfunction 
• Excessive “male” hormones (testosterone, free testosterone, DHEA)
• Excessive antimullerian hormone and luteinizing hormone which promotes increased androgen release and compromises fertility with diminished egg quality
• Insulin resistance and excess insulin secretion  (Gu et al., 2022; Shukla et al., 2025).

Symptoms of PCOS include: 

• Acne 
• Abnormal hair growth such as darker, coarser male pattern hair distribution: upper lip, chin, and face, chest, and back 
• Irregular periods
• Presence of multiple follicles or cysts on ovaries as seen on imaging studies (Gu et al., 2022)

Women with PCOS are at increased risk of developing the following conditions:

• Infertility 
• Acne
• Metabolic syndrome (elevations in LDL cholesterol, low HDL cholesterol, elevated blood sugar, excess waist size, elevated triglycerides, elevated blood pressure) 
• Obesity 
• Type 2 diabetes 
• Cardiovascular disease risk elevation 
• Depression and anxiety
• Sleep apnea 
• Endometrial cancer
• Fatty liver disease (Shukla et al., 2025; NIH, 2022; Thomas & Kudesia, 2025). 

Why do certain women get PCOS?   

PCOS has strong underlying genetic components, which are responsible for an estimated 70% of the risk of developing PCOS based on identical twin studies (Shukla et al., 2025).

Multiple genetic factors are involved in the development of PCOS, including significant epigenetic factors.  The good news is that epigenetic factors are influenced by lifestyle and thus, are modifiable  (Alegría-Torres, Baccarelli, & Bollati, 2011). 

Research suggests that genetic factors predispose at-risk women to development of PCOS, with additional lifestyle risk factors such as development of excessive visceral fat, overweight and obesity worsening symptoms and outcomes of PCOS in susceptible women (Shukla et al., 2025).  

Interestingly, many women with PCOS experience insulin resistance regardless of body fat levels or BMI (Shukla et al., 2025).  

Further, C-reactive protein–a marker of inflammation–is elevated in women with PCOS even when they are normal weight (Shukla et al., 2025).  Inflammation, insulin resistance, and metabolic syndrome go hand-in-hand.  

Pharmacologic treatment for women with PCOS

Hormonal contraceptive combination therapy with estradiol and progesterone is considered first line therapy for women struggling with abnormal hair growth, irregular menses, and acne (Shukla et al.,2025). 

Progesterone can prevent the conversion of testosterone into the more potent form of dihydroepiandosterone.  Estrogen supports improvements in cholesterol profiles.

Spironolactone also has anti-androgenic effects and can be used if contraceptive therapy alone is insufficient in managing abnormal hair growth (Shukla et al., 2025).  

Metformin is used to improve insulin sensitivity, and can support improvements in weight, waist circumference, BMI, and can improve menstrual cycles as well (Shukla et al.,2025). .  

DPP-4 inhibitors are medications such as sitagliptin, alogliptin, and linagliptin. These medications prevent the pancreas from releasing glucagon, leading to decreased blood sugar production from the liver while also improving pancreatic insulin secretion.  Use of these medications in PCOS is associated with lower visceral fat and improved insulin sensitivity (Shukla et al.,2025). . 

SGLT2 inhibitors such as empaglifllozen prevent glucose reabsorption in the kidneys leading to its excretion in the urine.  This medication has been shown to be superior to metformin in reducing BMI, weight, fat mass, and also lowers insulin and androgen levels (Shukla et al.,2025). .  

GLP-1 therapy and PCOS   

GLP-1 therapy such as semaglutide or tirzepatide is not currently FDA approved to treat PCOS.  However, GLP-1 has been shown to reduce excess testosterone, improve BMI, and boost insulin sensitivity superior to metformin (Shukla et al., 2025).  GLP-1 therapy also improves cholesterol profiles and blood pressure levels, as well as lowers visceral fat levels (Szczesnowicz et al., 2023).  

Perhaps surprising is GLP-1 therapy’s ability to lower inflammation in persons with PCOS–leading to reductions of vascular inflammation, improved blood vessel health (endothelium function), and lower risks for clotting (Szczesnowicz et al., 2023). 

GLP-1 therapy also reduces risk of fatty liver disease and has been shown to lower peptides associated with liver cirrhosis–particularly in women with PCOS (Szczesnowicz et al., 2023).  

Therapy with GLP-1 medications has been shown to improve fertility by normalizing menstrual cycles and ovulation rates in overweight and obese women with PCOS (Szczesnowicz et al., 2023). 

During a six-month treatment using liraglutide to treat overweight women with PCOS, ovarian volume was significantly reduced as demonstrated using ultrasound monitoring throughout the six months to track changes (Szczesnowicz et al., 2023).

Finally, a small case study report found 19 obese women with PCOS reported improved social health and improved physical and psychological health over a six month period using the GLP-1 medication liraglutide (Szczesnowicz et al., 2023).

Natural options for women struggling with PCOS

Research has affirmed that lifestyle modifications can substantially improve outcomes for women with PCOS (Gu et al., 2022).  

In fact, it is estimated that in at least half of women suffering from PCOS, lifestyle modifications alone could normalize periods and fertility (Gu et al., 2022).  

In one fascinating randomized-controlled study, the three intervention arms included lifestyle interventions alone for PCOS, versus oral contraceptive therapy alone, versus lifestyle + oral contraceptive therapy (Thomas & Kudesia, 2025; Legro et al., 2015).

For the 16-week  lifestyle intervention arms of the study:

• 7% bodyweight reduction was promoted with use of:
  • Calorie-controlled meals provided to participants to create a calorie deficit 
  • Use of orlistat or sibutramine to support weight loss,
  • A progressive walking program that increased brisk walking to 150 minutes per week (Legro et al., 2015).

For both intervention arms using the lifestyle interventions, women with PCOS:

• Lost approximately 10-15 lbs bodyweight 
• Lost visceral fat as analyzed by DEXA scan 
• Lowered abnormal hair growth 
• Lowered skin oil production 
• Increased cycles of ovulation 
• Lowered follicles/ cysts on their ovaries 
• Lowered excessive testosterone levels 
• Lowered excessive antimullerian hormone levels (Legro et al., 2015)

The oral contraceptive group alone however experienced worsening of their triglycerides, and worsening of their glucose tolerance tests.  Development of metabolic syndrome was higher as well in the oral contraceptive treatment group when such was provided without the lifestyle interventions.

The “Physical Activity Guidelines for Americans” (U.S. Department of Health and Human Services, 2018) recommends higher levels of activity for persons struggling with weight management.  

The guidelines recommend 250 minutes to 300 minutes of moderate activity per week (4.5 to 5 hours of exercise per week) or its equivalent for persons who struggle with weight management.  Brisk walking, gardening, swimming, physical housework such as cleaning all count as moderate exercise activity.  

The guidelines also recommend total body strength training 2 to 3 times per week.

Vigorous activity includes jogging at any level of intensity (even light jogging), hiking, biking, and martial arts, among other activities. 

One minute of vigorous activity counts as two minutes of moderate activity according to the guidelines.  Some researchers suggest that 90 minutes of vigorous activity per week may be more appropriate for women with PCOS who are able to safely exercise at this level of intensity compared to moderate activity (Szczesnowicz et al., 2023).  

This is because strength training along with vigorous exercise have been shown to lower testosterone levels in and improve insulin sensitivity in women with PCOS (Szczesnowicz et al., 2023).

Dietary patterns that improve PCOS

Nutrition strategies for PCOS have involved a wide range of interventions, including high protein/ low carbohydrate diets, high fat/ low carbohydrate diets, bean-based low glycemic index diet, and diets with a wide range in protein, fat, and carbohydrate percentages (Thomas & Kudesia, 2025).

Results tend to show improvements from a variety of dietary patterns, with no single dietary pattern demonstrating superior outcomes to date specifically for treating PCOS symptoms (Thomas & Kudesia, 2025).

Accordingly, factoring in elevated risk factors for diabetes, heart disease, weight gain, it is important to choose dietary patterns that demonstrate strong evidence for decreasing risks of these diseases such as (Dernini et al., 2017; Kahleova, Levin & Barnard, 2017; Thomas & Kudesia, 2025; Szczesnowicz et al., 2023):

• Whole-food plant-based diets (protect against inflammation, lowers overall cancer rates, prevents weight gain, lower risks of diabetes, and heart disease)
• Mediterranean diet (protects against inflammation, heart disease, diabetes, stroke, and various forms of cancer)
• Generalized healthy diet patterns that promote intake of fruits, vegetables, whole grains, nuts/ seeds, beans and lentils, and lean protein sources, monounsaturated and polyunsaturated oil sources and omega-3 fatty acids are sufficient for persons with PCOS per current international guidelines.
• Reducing animal protein intake/ replacing animal protein with increased plant-based proteins such as beans/ lentils, whole grains, nuts, and seeds–research shows that animal proteins promote the growth of harmful bacteria while lowering health-promoting species in the gut microbiome whereas whole food plant-based proteins have the opposite effect.  

It is interesting to note that women with PCOS tend to run lower levels of vitamins such as vitamin E, vitamin A, may benefit from higher vitamin K levels, and benefit from higher levels of specific vitamins such as folate, B1, B6, and B12 that will be reviewed below (Alesi et al., 2022).

Natural sources of these vitamins are as follows:

• Vitamin A is found as beta-carotene in kale, carrots, sweet potatoes, spinach, and other dark leafy greens or orange pigmented vegetables.  
• Vitamin E is found in nuts, seeds, whole grains, and olive oil.  
• Vitamin K is found in dark green leafy vegetables., 
• B1 and B6 are both found in soy based foods such as soy milk and tofu, B6 is also found in beans and meat/ fish.  
• B12 is found in fortified soy milk as well as most animal based foods (Harvard Health Publishing, 2025). 

Alpha lipoic acid appears to be helpful in reducing PCOS symptoms, with one randomized prospective trial showing that ALA supplementation reduced ovarian cysts, improved menstruation, improved HDL cholesterol, and reduced body weight and BMI  (Alesi et al., 2022).  ALA is found in many plant-based foods, nuts and seeds, and is particularly rich in flaxseed (Rajaram, 2014).

A healthy plant-dominant diet with seafood, potentially with lean dairy and lean cuts of poultry minimizes inflammatory compounds such as saturated fat, and provides the vitamins listed and ALA as listed above.  

Pro-fertility dietary patterns 

Dietary patterns linked in research to greater success in terms of conceiving and having a viable birth include the following patterns per interventional trials:

• Replace meat with seafood
• Choose low pesticide fruits and vegetables
• Consume whole grains
• Consume dairy
• Consume soy based foods 
• Include supplemental folic acid, vitamin D, and vitamin B12 (Gaskins et al., 2019)

It is interesting as these same foods have confirmed anti-inflammatory components according to the “Dietary inflammatory index”–in particular the seafood, fruits, vegetables, whole grains, soy, vitamin D, and folic acid (Shivapa et al., 2014).  

Supplements that may help with PCOS according to research

Disclaimer:  always discuss supplements with your health care provider before deciding if they are right for you, especially if you have any underlying health condition, or are pregnant or nursing.  Medication interactions are possible with supplements.  Supplements are not FDA approved to treat any disease or health condition.  

The following supplements may help support women with PCOS according to a review published in the journal Advances in nutrition (Alesi et al., 2022; Li et al., 2018):

• Berberine improves cholesterol and insulin sensitivity: nine randomized controlled trials demonstrated that berberine produced effects that were essentially indistinguishable from metformin in treatment for PCOS for improving insulin sensitivity and cholesterol/ lipid profiles.  Combining the two treatments does not seem to lead to additional benefits compared to solo-therapy with metformin or berberine.  

• Vitamin D improves insulin sensitivity:  research notes that supplemental vitamin D, particularly lower dose daily supplementation as opposed to high dose periodic supplementation may help women with PCOS improve insulin sensitivity.  This has been validated with multiple randomized controlled trials. The effects are more pronounced when correcting vitamin D deficiency. 

• Myo-Inositol improves insulin sensitivity, improves regulation of ovulation and menstrual cycles:  several meta-analyses of multiple randomized controlled trials have found myo-inositol either by itself or in combination with d-chiro-inositol is effective at improving insulin sensitivity, and myo-inositol alone has been shown to improve menstrual and ovulation regularity.  It increases sex-hormone binding globulin which can help with excess androgens.  Myo-inositol is a molecule naturally found in plants and animals, and serves as a molecular messenger in the ovaries .  Research shows women with PCOS have abnormal inositol metabolism.  Supplementation may take 24 weeks to show improvement in symptoms.   

• Folic acid improves insulin sensitivity, lowers inflammation, and improves cholesterol profiles: folic acid supplementation has been shown to lower inflammation as measured by C-reactive protein and homocysteine levels,, improve insulin sensitivity, lower a carcinogenic compound called malondialdehyde, improve cholesterol levels, and increase production of natural antioxidants within the body such as glutathione.

• B vitamins (B12, B1, B6) lowers homocysteine levels :  B12 is commonly deficient in women with PCOS related to absorbance impaired by metformin therapy.  This can lead to increases in pro-inflammatory homocysteine levels.  Supplementation with B12(1000 mcg), B1 (250 mg), and B6 (250 mg) lowered homocysteine levels by 21% in a single randomized-controlled trial.

• Calcium:  calcium deficiency is common in women with PCOS. A systematic review of six randomized controlled trials found calcium supplementation plus vitamin D may be beneficial in women with PCOS for lowering inflammation as measured by C-reactive protein, improving immune cell function, insulin sensitivity, antioxidant levels, and menstrual regularity, reducing abnormal hair growth, and improving androgen levels.   However, calcium supplementation can also lead to harmful outcomes such as potentially increased cardiovascular risk due calcification of the arteries (Li et al., 2018). 

• Selenium improves insulin sensitivity, reduces inflammation:  a systematic review of five randomized controlled trials noted that 200 mcg selenium daily over an 8-12 week period improved insulin sensitivity, and reduced inflammation and oxidative stress.  

• Melatonin lowers androgen levels and inflammation:  melatonin naturally acts as an antioxidant in the body, and also is involved in ovulation, folliculogenesis, ovarian function, and has an androgen lowering effect.  Two prospective studies using 2-3 mg melatonin daily over a 2-6 month period found melatonin supplementation lowered anti-mullerien hormone, BMI, and androgen levels.  A randomized controlled trial of 56 women with PCOS demonstrated that 5 mg melatonin supplement twice daily lowered abnormal hair growth, testosterone, inflammation (C-reactive protein), and the carcinogenic compound malondialdehyde.  

• Other natural compounds that need more study:  there are other compounds that have research support for improving insulin sensitivity, reducing inflammation, and potentially improving symptoms of PCOS such as probiotic supplements featuring lactobacilli and Bifidobacterium species, and L-carnitine supplementation as well.  L-carnitine appears to also improve hormone profiles for testosterone, luteinizing hormone, and follicle stimulating hormone in women with PCOS.  For a list of herbs and spices that have strong research support for treating insulin resistance in general see our article on insulin resistance and weight gain.  

Summary

PCOS is a syndrome characterized by inflammation, insulin resistance, and imbalances of hormones leading to symptoms that can be distressing for women.  These symptoms such as male-pattern hair growth, irregular menses, infertility, and weight gain pair with increases in risk factors for a variety of cardiometabolic diseases and complications.  

Fortunately, there are a host of medication options as well as lifestyle modalities that can support women with PCOS in managing their weight, lower their risk of complications, boost fertility and improve their wellbeing.  

How we can help

At Lancaster Wellness, we assist clients in optimizing their metabolic health.  We do this through our weight loss program which entails a 360-degree program that includes health coaching, movement programs, medication therapies, and tailored nutrition guidance.  

These combined approaches frequently result in clients feeling less inflammation, improved cholesterol levels, improved blood sugar levels, 20-40 lbs weight loss in the first 3 months, and more.

Schedule a free consultation or call us at 717-297-7900.

References

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Alesi, S., Ee, C., Moran, L. J., Rao, V., & Mousa, A. (2022). Nutritional Supplements and Complementary Therapies in Polycystic Ovary Syndrome. Advances in nutrition (Bethesda, Md.), 13(4), 1243–1266. https://doi.org/10.1093/advances/nmab141 

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Szczesnowicz, A., Szeliga, A., Niwczyk, O., Bala, G., & Meczekalski, B. (2023). Do GLP-1 Analogs Have a Place in the Treatment of PCOS? New Insights and Promising Therapies. Journal of clinical medicine, 12(18), 5915. https://doi.org/10.3390/jcm12185915 

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