The nutritional guide to managing PCOS symptoms
Introduction
Polycystic ovary syndrome (PCOS) is a common whole-body hormone condition affecting around 10% of all reproductive-aged women. If you've been diagnosed with PCOS - or suspect you might have it - you're likely dealing with frustrating symptoms like irregular periods, stubborn weight gain, acne, or unwanted hair growth.
The good news is that nutritional therapy offers powerful, evidence-based ways to address the root causes of PCOS and help manage the symptoms. Understanding what's driving your androgen excess and determining your type of PCOS is key to finding the right approach for you.
In this guide, we'll explain how PCOS is diagnosed, what causes it, and the nutritional and lifestyle strategies that can help you manage your symptoms effectively.
In this article:
What is PCOS and how is it diagnosed?
Polycystic ovary syndrome is a condition of androgen excess and irregular cycles that affects the whole body, not just the ovaries. PCOS diagnosis can be challenging, and many women go years without answers.
The diagnostic criteria
The latest international guidelines* require two of the following three criteria for a PCOS diagnosis:
High androgens - either elevated levels on a blood test, or androgenic symptoms such as hirsutism (excess hair growth), jawline acne, or male-pattern hair loss
Irregular cycles - cycles shorter than 21 days, longer than 35 days, or fewer than 8 cycles per year in women of reproductive age
Polycystic ovaries - visible on ultrasound, or elevated Anti-Müllerian hormone (AMH) levels
Why diagnosis can be difficult
Arriving at a diagnosis isn't always straightforward. There are other reasons for androgen excess that need to be ruled out first, including certain hormonal birth control pills, chronic stress, and dysregulated brain-ovarian signalling.
A polycystic ultrasound finding isn't necessarily useful on its own either. The ‘cysts’ are in fact small follicles that may cluster one month and not be present the next. This can be particularly misleading when diagnosing adolescents within 8 years of starting their periods.
*International Evidence-based Guideline for the assessment and management of PCOS, 2023
Root causes and triggers
There can be many root causes of PCOS, and the exact triggers for the condition are not fully clear.
A genetic predisposition is usually present, but it may only surface through a combination of environmental triggers - for example diet and lifestyle, toxins, or an imbalance in the gut microbiome.
The key point is that it will be different for each person. Understanding what is driving your androgen excess and determining your type of PCOS is essential for getting the right support.
The four types of PCOS
Insulin-resistant PCOS - the most common type, driven by high insulin levels
Post-pill PCOS - a temporary surge in androgens after stopping certain types of birth control pill
Inflammatory PCOS - driven by chronic inflammation, often originating in the gut or from diet, lifestyle or toxin exposure
Adrenal PCOS - where the adrenal glands (rather than the ovaries) are the main source of excess androgens
Each type drives androgen excess in different ways and may present with different symptoms, which is why a one-size-fits-all approach rarely works.
How PCOS affects hormones, metabolism, and fertility
The effects of PCOS can be felt across all body systems:
Irregular cycles and PCOS ovulation issues
A key feature of PCOS is irregular and unpredictable periods due to disrupted ovulation and high androgens. Without regular ovulation, cycles become erratic and difficult to track.
Metabolic symptoms
Insulin resistance, the most common driver in PCOS, results in higher levels of insulin in the body. This can lead to metabolic symptoms including fatigue, increased hunger, and weight gain that can feel impossible to shift despite your best efforts.
Long-term health risks
Longer term, women with PCOS may have a higher risk of type 2 diabetes and heart disease. This is why addressing insulin resistance early is so important - not just for symptom relief, but for long-term health.
Polycystic ovaries and pregnancy
The disruption to ovulation in PCOS can make pregnancy more difficult for some women, as high androgens may prevent the body from maturing a dominant follicle. However, it's important to know that PCOS affects fertility differently for every woman - many women with PCOS conceive naturally or with support.
If you're trying to conceive with PCOS, working with a nutritional therapist can help to support ovulation and overall health with functional testing, nutrition and lifestyle interventions.
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The role of blood sugar balance and insulin resistance
Understanding the relationship between insulin and androgens is crucial for managing PCOS effectively.
The vicious cycle
Chronically elevated insulin in PCOS can stimulate the ovaries to produce more testosterone. In addition, androgen excess can worsen insulin resistance - creating a vicious cycle that exacerbates both metabolic and hormonal symptoms of PCOS.
Breaking this cycle is often the most impactful step in PCOS management, which is why blood sugar balance is central to our nutritional approach.
Signs of insulin resistance
You might have insulin resistance if you experience:
Energy crashes, especially after meals
Intense sugar or carbohydrate cravings
Difficulty losing weight, particularly around the middle
Skin tags or patches of darker skin (acanthosis nigricans)
Feeling hungry soon after eating
Evidence-based nutritional strategies
Nutritional therapy uses an evidence-based approach to support PCOS through reduction of androgen excess and balancing hormonal and metabolic processes in the body.
At Peach, we also use functional testing and symptom analysis to determine what is driving your androgen excess and look to address the root cause. The large majority of PCOS cases are driven by insulin resistance, but understanding other drivers allows more targeted, personalised support.
Core dietary principles for PCOS
For supporting insulin sensitivity:
Ensure good levels of protein at each meal
Include healthy fats (olive oil, avocado, nuts, oily fish)
Prioritise high-fibre foods
Eat a wide range of colourful plant foods
Reduce ultra-processed and sugary foods
Foods to emphasise
Protein-rich foods - eggs, fish, poultry, legumes, Greek yoghurt
Non-starchy vegetables - leafy greens, broccoli, peppers, courgettes
Healthy fats - extra virgin olive oil, avocado, nuts and seeds
Complex carbohydrates - sweet potato, quinoa, oats, legumes
Anti-inflammatory foods - oily fish, turmeric, ginger, berries
Helpful teas for reducing androgens
Certain teas can also support androgen reduction:
Spearmint tea
Nettle tea
Green tea
Supplements and lifestyle factors
Addressing the different underlying factors for each person's PCOS will require different approaches. A practitioner can recommend the appropriate supplement and dose depending on your individual PCOS presentation.
Supplements for insulin resistance
Key supplements to improve insulin sensitivity include:
Magnesium - supports glucose metabolism and stress response
Berberine - helps regulate blood sugar
Zinc - supports hormone balance and insulin signalling
Myo-inositol - one of the most researched supplements for PCOS, improves insulin sensitivity, lowers androgens and promotes healthy ovulation
Supplements for adrenal support
Where support for the nervous system is required to reduce androgen production by the adrenal glands, helpful supplements include:
Magnesium - calms the nervous system
Rhodiola - an adaptogen that supports stress resilience
Lavender - supports relaxation and sleep
Supplements for decreasing androgens
Key supplements for reducing androgens include zinc, inositol, reishi mushrooms, liquorice, and Chinese peony. A practitioner can recommend the appropriate supplement and dose depending on your individual PCOS presentation.
Lifestyle factors
Beyond nutrition, these lifestyle factors are essential for PCOS management:
Sleep - prioritise 7-9 hours of quality sleep
Regular exercise - both strength training and movement you enjoy
Stress management - crucial for adrenal PCOS especially. To calm the nervous system, consider walking in nature, mindfulness, breathwork, or yoga
Circadian rhythm support - regular wake and sleep times, morning light exposure
When to seek professional support
To determine a diagnosis and understand the underlying drivers for your PCOS, and to address symptoms effectively, it can be helpful to work with a nutritional therapist.
Testing options
Blood panel - to test for insulin resistance and markers of metabolic syndrome.
DUTCH hormone testing can help understand the way your body metabolises hormones - oestrogen, progesterone, androgens, and cortisol. This provides useful information to personalise support, for example by identifying whether the adrenals or the ovaries are contributing to high androgens.
Gut microbiome testing can be valuable where inflammation is a key driver for PCOS, as inflammation can stimulate the ovaries to produce excess testosterone. Studies have shown differences in the microbiome of women with PCOS. Stool testing helps understand the terrain of the gut and identify imbalances that can then be supported through diet and targeted supplements to improve microbiome diversity and gut wall integrity.
Curious about testing?
Our practitioners use comprehensive testing including DUTCH hormone testing to create personalised plans for managing PCOS.
Book a free call to discuss whether testing could be helpful for you
Frequently asked questions
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The exact causes of PCOS are not fully clear, but a genetic predisposition is usually present. This may surface through environmental triggers including diet and lifestyle factors, toxins, or gut microbiome imbalances. Understanding your individual root cause is key to effective treatment.
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There are four main types: insulin-resistant PCOS (the most common), post-pill PCOS, inflammatory PCOS, and adrenal PCOS. Each type drives androgen excess differently, which is why identifying your type helps guide the most effective treatment approach.
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Signs of insulin resistance include energy crashes after meals, intense sugar cravings, difficulty losing weight (especially around the middle), skin tags, and feeling hungry soon after eating. Blood tests can also measure fasting insulin and glucose levels.
Key takeaways
PCOS is a whole-body hormone condition of androgen excess and irregular cycles, affecting around 10% of reproductive-aged women
Diagnosis requires two of three criteria: high androgens, irregular cycles, or polycystic ovaries on ultrasound/elevated AMH
There are four types of PCOS - insulin-resistant, post-pill, inflammatory, and adrenal - each requiring a different approach
Insulin resistance drives most PCOS cases, creating a vicious cycle with androgen excess that can be broken through nutrition
Key nutritional strategies include balancing blood sugar with adequate protein, healthy fats, fibre, and colourful plant foods while reducing processed foods
Helpful supplements may include magnesium, myo-inositol, zinc, and berberine, depending on your individual drivers
PCOS and pregnancy - conception is often achievable once ovulation is restored through the right interventions
Testing such as DUTCH and gut microbiome analysis can help identify your root causes and personalise your treatment plan
Ready to get support?
If you're struggling with PCOS symptoms and want a personalised approach that addresses your root causes, our team at Peach Health can help. We use comprehensive testing to understand what's driving your androgen excess and create a tailored nutrition and lifestyle plan for your specific type of PCOS.
Book a free discovery call to learn how we can support you, or explore our hormone health services to find out more about our approach.
Written by
Caroline Atkinson
Reregistered nutritional therapist (mBANT, dipION), Women’s Health & Midlife Specialist at Peach Health