PCOS Management: A Practical, Science-Backed Guide

Polycystic ovary syndrome (PCOS) affects a lot more than periods — it can influence fertility, weight, mood, skin, and long-term metabolic health. The good news: many symptoms are highly manageable with targeted lifestyle changes, sensible medical treatments when needed, and ongoing support. This post explains what PCOS is, what the evidence says about the most effective strategies, and how to put a practical plan into action.

What is PCOS — in plain language?

PCOS is a hormonal condition that commonly includes a combination of:

• irregular or absent menstrual cycles,
• higher levels of androgens (male hormones) causing acne or excess hair,
• and ovaries with multiple small follicles on ultrasound (though ultrasound isn’t always required for diagnosis).

It’s a syndrome — meaning people can present differently — and underlying features commonly include insulin resistance and a tendency to gain or hold on to weight. Management is individualized: the priorities differ if someone’s primary concern is irregular cycles, fertility, acne/hirsutism, or long-term metabolic risk. OUP Academic+1

The big picture: three pillars of PCOS care

1. Lifestyle first — diet, exercise, sleep, and stress; this is the foundation for nearly everyone with PCOS. OUP Academic
2. Targeted medications — for cycle regulation, symptom control (acne/hirsutism), insulin resistance or fertility, when needed. ACOG+1
3. Supplements & adjuncts — some (e.g., inositols) have emerging evidence for metabolic and reproductive endpoints; discuss with a clinician. OUP Academic

1) Lifestyle: what to prioritize and why

Why it matters. Weight loss of even 5–10% improves menstrual regularity, ovulation, and metabolic markers for many people with PCOS. Because insulin resistance commonly contributes to symptoms, lowering body fat and improving fitness often has outsized benefit. OUP Academic+1

Diet — practical principles

• Focus on whole foods: vegetables, lean protein, healthy fats, whole grains, and legumes.
• Reduce intake of refined carbs and sugary drinks (these spike insulin).
• Consider a lower-glycemic or Mediterranean-style pattern; there isn’t a single “PCOS diet” that fits everyone, so tailor to tolerance and preference.
• If weight loss is a goal: aim for a modest, sustainable caloric deficit (e.g., 250–500 kcal/day) rather than extreme dieting. OUP Academic

Exercise — what the evidence supports

• Combine aerobic and resistance training. Aerobic activity improves insulin sensitivity; resistance training builds muscle, which helps glucose handling.
• Aim for 150–300 minutes of moderate aerobic activity (or 75–150 minutes vigorous) per week, plus 2 strength sessions weekly — this is a practical target shown to improve metabolic health in PCOS. Even 120 minutes of higher-intensity activity weekly shows benefit in some studies. ScienceDirect+1

Sleep, stress, and mental health

• Prioritize consistent sleep (7–9 hours), and address symptoms of anxiety or depression — psychological health affects adherence and metabolic outcomes. Cognitive behavioral approaches and structured lifestyle coaching can help. PMC

2) Medical options (brief, clinician-led)

These are commonly used treatments — they’re effective, but need to be prescribed and monitored by a clinician.

Combined oral contraceptives (COCs)

• What they do: regulate menstrual cycles and reduce androgen-driven symptoms (acne, hirsutism).
• When used: first-line for cycle control in those not seeking pregnancy. They don’t treat insulin resistance directly, but are useful for symptom control. ACOG+1

Metformin

• What it does: improves insulin sensitivity and can help with metabolic risk and cycle irregularity in some people. It is especially considered when insulin resistance or glucose abnormalities are present, or when weight loss plus COCs aren’t sufficient. Evidence supports benefits for certain reproductive outcomes and for reducing risk of ovarian hyperstimulation during fertility treatments. Common side effects are gastrointestinal and often temporary. Cochrane+1

Anti-androgens (e.g., spironolactone)

• Used for moderate–severe hirsutism/acne when COCs alone are insufficient. Requires monitoring and contraception (if fertile), because of potential risks. Discuss risks/benefits with a provider.

Fertility treatments

• If pregnancy is desired and lifestyle/first-line meds are inadequate, ovulation-inducing meds (letrozole is now commonly used), assisted reproductive approaches, or specialist referral may be recommended. Follow a fertility specialist’s guidance.

3) Supplements & complementary options — what the evidence says

• Myo-inositol and d-chiro-inositol: growing evidence shows these can improve insulin sensitivity, some metabolic markers, and may help ovulation in some people with PCOS. Evidence is promising but heterogeneous; formulations and dosing vary between studies. Discuss with your clinician before starting. OUP Academic+1
• Vitamin D: deficiency is common and repletion is reasonable when deficient; some studies suggest metabolic or reproductive benefits but evidence is mixed.
• Other supplements (e.g., omega-3s, N-acetylcysteine) have variable evidence — treat them as adjuncts and consult a clinician.

What a realistic 12-week plan looks like (actionable)

Goal: improve metabolic health, regularize cycles, and reduce acne/hirsutism where present. Adjust per priorities (fertility, skin, long-term health).

Weeks 1–4: baseline + small wins

• Book a primary care or endocrine/gynecology visit for baseline labs: fasting glucose/HbA1c, lipids, pregnancy test if applicable, testosterone if clinically indicated.
• Start a food pattern focused on whole foods; pick one habit (e.g., replace sugary drinks with water/unsweetened tea).
• Begin exercise: 20–30 minutes brisk walking 4–5×/week + 2 short bodyweight strength sessions.

Weeks 5–8: build consistency

• Aim for 150 minutes/week of moderate aerobic activity or 75 minutes vigorous; increase strength sessions to progressively overload (squats, lunges, push patterns — 2×/week).
• Track sleep and add one stress-management habit (10 minutes breathing/meditation daily).
• Reassess symptoms: cycles, acne, energy. If cycles remain irregular and pregnancy is not desired, discuss COC options with your clinician.

Weeks 9–12: refine & medical follow-up

• If weight loss target (5–10%) is not on track, intensify nutrition adjustments with a dietitian.
• If insulin resistance or prediabetes confirmed, discuss metformin with clinician (possible benefits for cycles and metabolic risk).
• Consider a trial of myo-inositol if discussed with clinician and appropriate.
• Set long-term follow-up plan for monitoring metabolic health and mental wellbeing.

When to see a clinician sooner

• You want to become pregnant and have irregular cycles.
• You have very heavy bleeding, severe acne/hair growth, or rapid weight gain.
• You have symptoms of diabetes (excessive thirst, urination) or your screening labs are abnormal.

Quick FAQs

Q: Will losing 5% body weight help?
Yes — many people see improved menstrual function and metabolic markers with modest weight loss (~5–10%). PMC+1

Q: Is metformin a cure?
No — it treats insulin resistance and can help with some symptoms, but it’s typically part of a broader plan (lifestyle + other treatments when needed). Cochrane

Q: Should I take inositol?
Evidence is promising for certain benefits (metabolic markers, ovulation), but effects vary. Discuss dosing/formulation with your clinician. OUP Academic

Bottom line (the Stone Wellness approach)

PCOS is best managed with a personalized, realistic plan that starts with lifestyle (diet, exercise, sleep, mental health) and adds medications or supplements only when needed. Small, consistent changes — supported by clinicians, dietitians, and coaches — often yield the biggest wins for symptoms and long-term health. If you’re ready, we can create a personalized 12-week plan that fits your goals (cycle regulation, skin, fertility, or metabolic health).

Key sources

• 2023 International Guideline for the Assessment and Management of PCOS. OUP Academic
• ACOG Practice Bulletin: Polycystic Ovary Syndrome (2018; reaffirmed). ACOG
• Cochrane review: Metformin for women with PCOS (fertility outcomes and metabolic effects). Cochrane
• Systematic reviews & recent studies on exercise recommendations in PCOS. ScienceDirect+1
• Recent systematic reviews/meta-analyses on inositol in PCOS.