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PCOS treatment options by stefani

PCOS Treatment Options

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PCOS is a complex condition. It can be caused by many things… which means that it can also be overcome via many different strategies. What are the best PCOS treatment options? What are the worst PCOS treatment options?

PCOS treatment options: choosing which is right for you

There are many different causes of PCOS. I describe them in great depth in my program for overcoming PCOS (you can download it here). Briefly, here is a quick list of potential causes of PCOS: diabetes, insulin resistance, being overweight, stress, birth control pill use, hypothyroidism, MTHFR, undereating, and dramatic weight loss.

The best way to decide which PCOS treatment options are right for you are to consider your goals. Ask first: do I wish to eliminate symptoms, or is it crucial for me to become pregnant right away? If fertility is a pressing concern, then you may wish to accelerate your healing protocol and even consider combining diet and exercise with fertility treatments with an OBGYN.

Ask then: do I wish to use solely diet and lifestyle changes (which are the most effective way to overcome PCOS),  or am I in a special case in which I might want to also implement some pharmaceutical options such as thyroid or blood sugar medications…. and do I want to take supplements?

Finally, the most important thing that needs to be done to overcome PCOS in almost every case is to figure out what has caused your PCOS. PCOS always arises as a result of some underlying health problem. If you work with a doctor, get bloodwork done, and/or educate yourself about the causes and cures for PCOS, then you can overcome PCOS relatively quickly by going right for the heart of your underlying problem.

Here I discuss all the different PCOS treatment options, so you can learn about them and help calibrate which ones are going to be the most appropriate for you.

PCOS treatment options: Diet

Studies have shown that diet and lifestyle changes are approximately twice as effective in the long-term for PCOS treatment than drugs.

The best thing every woman with PCOS can do is eliminate processed foods from her diet. Focusing on whole foods consisting of fresh fruits and vegetables, healthy fats, and pasture-raised animal products greatly boosts nutrient status and reduces the number of toxic, problematic compounds in the body. This helps streamline metabolism, reduce inflammation, heal the gut, and balance hormones in the right way to overcome PCOS.

Overweight and/or insulin resistant PCOS patients (which I call “type 1 PCOS”), may benefit from a lower carbohydrate diet that helps manage insulin levels. I typically recommend starting at about 100 grams of carbohydrate a day. Elevated insulin levels is one of the most common causes of PCOS, because it increases testosterone levels. Fixing the insulin problems that may be the causative root of your PCOS is a bit more complicated than this, and may involve some serious gut healing, but people seem to have success with this method reducing insulin and testosterone levels.

Underweight and under-fed PCOS patients (“type 2 PCOS”) may benefit from a diet higher in carbohydrates. I recommend several servings of dense carbohydrates like fruits or starches in these case. The body needs carbohydrates in order to feel fed. The female body simply needs to feel fed in order to manufacture adequate amounts of sex hormones.

These PCOS patients also need to eat as much as possible, and be careful not to be restrictive with calories or exercise too much.

Hypothyroidism is another common cause of PCOS. There are many different ways this can be helped with diet, depending on which kind of hypothyroidism it is. Hashimoto’s Thyroiditis is an autoimmune disease that requires an autoimmune-healing diet. My favorite book for this is Sarah Ballantyne’s The Paleo Approach. Hypothyroidism without autoimmunity requires a higher carbohydrate diet, as well as being sure to eat when hungry and stop when full… and perhaps also iodine and selenium supplementation.  Seaweed (a few servings a week) and Brazil nuts (2 a day) are great, natural ways to get your iodine and selenium respectively without resorting to supplements.

Sometimes PCOS patients are in hormonal deficit instead of excess. In this case, be sure to eat plenty of fat! At minimum, every woman should eat 1 tbsp of fat with each meal. Fat is crucial for the production of hormones. Good fats to focus on are the monosaturated fats–olive oil, avocado, and macadamia oil–and saturated fat in the form of coconut oil or organic, pasture-raised animal products (if possible) such as eggs and grass-fed beef.

Steer clear of Omega 6 PUFAs. Omega 6 fats are associated with increased testosterone levels in both women and men, in addition to causing excessive inflammation. This means seriously limiting soy, canola, rapeseed, vegetable, and corn oils. Nuts in their natural form are not awesome and should be treats instead of daily staples.

Eat organic meat or wild game, not factory farmed meat, as often as possible.  The hormone levels are guaranteed to be natural and to disrupt your system as little as possible.

Eat foods good for the liver, which helps clear excess hormones out of the bloodstream. The best are high in choline, such as eggs and organs.

Women with excess testosterone may wish to consider drinking spearmint tea. Spearmint tea is fairly highly regarded as a testosterone blocker. Here is my favorite spearmint.

PCOS treatment options: supplementation

While supplementation can be a great way to supplement a good diet, it should by no means replace a good diet. Supplements are excellent ways to help correct nutrient deficiencies. Nevertheless they are less good at doing so than the vitamins and minerals in their natural forms present in natural foods.

For all mineral supplements, it is incredibly important to use the organic (that is, carbon-based), or chelated forms of any mineral supplements you take.  Magnesium oxide, for example, is magnesium in its metal form. Taking it is basically eating crunched up metals. Instead, take a form of magnesium that is “bio-available,” or “chelated,” which means that it is a part of a molecule your body can actually use. These forms will often end in the letters “-ate.” Glyinate, carbonate, and taurate are just a few examples.

Iodine for PCOS

Iodine can be helpful for PCOS for the sake of boosting thyroid function. However – iodine should always be taken in conjunction with selenium. The thyroid gland needs both iodine and selenium to function optimally. Additionally, if you have Hashimoto’s Thyroiditis, you may wish to keep your iodine supplementation limited relative to selenium, since over-doing iodine supplementation with Hashimoto’s can actually damage the thyroid gland and cause a “thyroid storm” which is basically a brief period of extreme symptoms of hyperthyroidism.

Iodine can be taken in kelp form, though I prefer to get my own through consuming seaweed a few times a week or by regular consumption of iodized salt.

Selenium for PCOS

Selenium is crucial for thyroid functioning. Try eating one or two brazil nuts each day– they are an excellent way to meet this need. This is the supplement I recommend if you choose to go the supplement route.

Chromium for PCOS

Chromium helps to encourage the formation of glucose tolerance factor which is a substance released by the liver and which is required to make insulin more efficient. A deficiency of chromium can lead to insulin resistance.  Because of this, it is the most widely researched mineral used in the treatment of insulin resistance and weight loss. This is a great supplement for women with insulin resistant PCOS.

B vitamins for PCOS

Vitamins B2, B3, B5 and B6 are particularly useful for controlling weight, and here’s why: Vitamin B2 helps to turn fat, sugar and protein into energy. B3 is a component of the glucose tolerance factor (GTF), which is released every time blood sugar rises, and vitamin B3 helps to keep the levels in balance. Vitamin B5 has been shown to help with weight loss because it helps to control fat metabolism. B6 is also important for maintaining hormone balance and, together with B2 and B3, is necessary for normal thyroid hormone production. Any deficiencies in these vitamins can affect thyroid function and consequently affect the metabolism.

The B vitamins are also essential for the liver to convert your ‘old’ hormones into harmless substances which can then be excreted from the body.

Here is an excellent B complex to supplement with. This is important if you have been a vegetarian for an extended period of time, are anemic, or eat a diet low in red meat.

Zinc for PCOS

The world’s soil has been depleted by overfarming, so there is very little natural zinc found in fruits and vegetables. No matter how good your diet, you may not be getting anywhere near the levels of zinc that you need. There are two approaches to this: you can eat whole organic food, which has much more rigorous controls on farming methods, or you can add a good chelated zinc supplement (about 20mg a day, perhaps) to your diet. But why is it so important?

Zinc is an important mineral for appetite control and a deficiency can cause a loss of taste and smell, creating a need for stronger-tasting foods.  Zinc is necessary for the correct action of many hormones, including insulin, so it is extremely important in balancing blood sugar. It also functions together with vitamins A and E in the manufacture of thyroid hormone.

Magnesium for PCOS

Magnesium levels have been found to be low in people with diabetes and there is a strong link between magnesium deficiency and insulin resistance. Magnesium is also awesome all around and can be read for reducing inflammation, enhancing sleep and promoting calm.

Here is my favorite magnesium supplement (it’s a flavored beverage powder!) – I do it almost every night before bed.

Co-Enzyme Q10 for PCOS

This is a vitamin-like substance that is contained in nearly every cell of your body. It is important for energy production and normal carbohydrate metabolism. Co-Q10 has also been proved useful in controlling blood sugar levels.

Herbs for PCOS 

I’m not generally a very big fan of herbs. Their effects are not well studied – pretty much all of the recommendations people make are based off of tradition and anecdotes. You never know what effect an herb will have on you specifically, so if you choose to use herbal supplementation steps cautiously and start with low doses.

Agnus castus (Vitex/chastetree berry)
Chasteberry anecdotally helps to stimulate and normalise the function of the pituitary gland, which controls the release of LH and FSH, which signal the menstrual cycle. Here is a good brand.

Saw Palmetto (Serenoa repens) 
Saw palmetto is an herb that is traditionally considered in light of its success in treating prostate problems caused by an imbalance of hormones (including excess testosterone). It is a small palm tree found in North America and the berries of the tree are used in tinctures or capsule form.  Some sparse research has shown that saw palmetto works as an anti-androgen, which can be very helpful for women who have elevated testosterone. Here is a good brand.

Milk Thistle (Silybum marianum)
This is one of the key herbs for the liver. It helps to protect your liver cells against damage and to promote the healing of damaged cells, so improving the general functioning of the liver and all its detoxifying properties.

Spearmint tea also counts.  The mechanism is unknown, but spearmint tea has been shown to significantly reduce circulating free testosterone levels in women with hyperandrogenism. This is my favorite spearmint tea.

Exercise for PCOS

Exercise is an excellent way to increase insulin sensitivity and promote metabolic fitness! I talk about this at great length in my book on women’s health and fitness. If you are a “type 1” PCOS, then incorporating some more sprint and weight-bearing exercises in your life could go a long way. The kind of PCOS I describe as “type 2” then you may wish to consider exercising less.

Sleep for PCOS

A great deal of healing and hormone production takes place during the night. This is when cortisol levels are low and the body is recharging. This enables the hypothalamus and pituitary glands to send their signals to reproductive tissues uninterrupted. I also talk about sleep at great length in the book on women’s health and fitness. Basically, I recommend a dark, cool room, waking without an alarm, and other tricks for a long, deep, restful sleep.

PCOS treatment option: Optimize thyroid function for PCOS

If you have hypothyroid, or even subclinical hypothyroid, try addressing this issue before getting on different PCOS medications.  Hypo- or subclinical hypo- thyroidism os often the underlying cause of reproductive failure.  To understand more about hypothyroid and PCOS, see my recent post on PCOS pathology.   

PCOS treatment option: Metformin medication

Metformin is a blood sugar lowering drug that several dozen million of Americans take in order to reduce their risk of diabetes. Women with PCOS take it in order to reduce their testosterone levels. It is usually fairly effective at doing so, and at reducing the severity of PCOS symptoms such as acne and facial hair.

Nevertheless, metformin has it’s own complications and problems, which I discuss at great length in the blog post Metformin and PCOS: Everything You Need to Know.

PCOS treatment option: Birth Control Pills

Birth control is effective in “treating” PCOS by increasing either estrogen or progesterone levels, though usually both. It helps regulate hormone fluctuations throughout the month.

However, birth control doesn’t solve the underlying issue. In fact, many women experience even greater dysfunction in their cycles once they go off the pill. As one popular example, some women began taking birth control as teenagers.  They continued taking it until they want to have babies, yet once they got off the pill, they found themselves breaking out for the first time in decades and unable to conceive.  Birth control pills are great for mitigating PCOS symptoms, but they will never make you more fertile, and they rarely restore hormonal balance.

For more on birth control, it’s varieties and how you can manage your experience with it, see my quick e-guide to birth control, Birth Control Unlocked.

PCOS treatment options: Progestin

Women who don’t menstruate are sometimes proscribed synthetic progesterone (progestin) medications by their doctors in order to induce menstruation. How it works is that these women take progesterone pills for ten day. A week later, as the progesterone levels fall, estrogen levels rise, and the pituitary and ovaries read this as a signal to shed the corpus luteum.

Because amenorrhea (the failure to menstruate) increases the risk for endometrial cancer, amenorrheic women are advised to induce menstruation every few months. Some go years without ill effects, and this depends on each individual’s PCOS pathology and hormone levels.  Progesterone also might help jumpstart your system back into more normal health, such that you can take it for a while and then afterwards have achieved enough of a cycle to continue functioning without progesterone. This is a decent option if you are trying to balance your  hormones via diet, but are hoping to speed along your progress or conceive quickly.

PCOS treatment options: Anti-androgen medication

 Anti-androgens act to block or inhibit testosterone activity in the body.  For this reason, they are often proscribed for acne or hirsutism, helping women cope with these nasty issues while they try to sort out the rest of their endocrine health.

Spirionolactone is the most popular anti-androgen proscribed for PCOS. It is normally proscribed for high blood pressure, but it is proscribed off label to help women reduce their androgen levels. It has been shown to be quite successful with mitigating symptoms of PCOS such as acne and facial hair, and has even helped women with PCOS ovulate. In this study, 11 out of 13 women began ovulating after a few months of treatment.

Nevertheless, spironolactone has it’s own problems. In fact, I personally had to check myself into the ER because of spiro. Spiro spares potassium in the kidneys, which can upset elctrolyte balance in the bloodstream. This can cause serious cardiovascular symptoms, and even sudden death. This harmful effect on electrolytes can also cause neurotransmitter problems, insomnia, and anxiety. This is a rare side effect, so simply be on the lookout for any problems if you decide to experiment with spiro. You can read about how spironolactone almost killed me – if you’re interested! – here.

PCOS treatment options: Ovarian Drilling

This is the only surgical intervention for PCOS. Ovarian drilling is exactly what it sounds like—in this course of treatment, a woman lays on a table and a doctor inserts a microdrill through her abdomen and into the ovaries, creating tiny holes. These holes puncture the thick endometrium of amenorrheic women and reduce testosterone production. Ovarian drilling to me seems like a great option, but the complications if something goes wrong include permanent infertility. For this reason, many people leave this option as a last resort.

Ovarian Drilling also fails to address the underlying health problem, which leaves you just as ‘unhealthy’ as you were before. This makes it inferior to diet and lifestyle changes in my opinion.

In sum

PCOS is complex! There are many things that can cause PCOS, and many different PCOS treatment options. Some of these options are great for everybody – some may only work for a select few.

I describe the different kinds of PCOS and how to overcome them in even greater depth in my program for PCOS: PCOS Unlocked the Manual. If you are interested, that’s a great program that’s helped literally thousands of women figure out their PCOS and overcome it all on their own with simple dietary changes.

PCOS is complex! But it is not impossible. :)

What are your thoughts? What have you done for your PCOS treatment options? Which have worked best for you?



So, just as a heads up - some links above may be my affiliate links, which means I get a small commission if you click on it and make a purchase. Doing so is no additional cost to you, but helps me tremendously. Your support is SO greatly appreciated, so thank you in advance if you choose to do so. Check out my entire disclosure to know exactly how things work.

Managing director of Paleo for Women and author of Sexy by Nature.


  1. So glad I found your site – wealth of information here that I’m looking forward to reading! This article in particular is very useful to me. I appreciate how comprehensive your treatment options are. Thanks!

    • Hah, yes, I should go back and edit them. Today I am feeling much less charitable about medical treatment options as I was when I wrote that article. :)

  2. I love all of your suggestions above, and have been eating a paleo type diet for about a year and have seen some positive changes. I am kinda confused about whether I fall into a “thin” or “overweight” model of PCOS… I am 5’6″ and 135 lbs… which I figure is pretty “normal.” What does someone with an “average” weight do for PCOS – practice fasting/low carb to control insulin or eat carbs and not fast? Perhaps I need to keep experimenting with myself.. at this point I follow a pretty moderate approach, no fasting and pretty moderate carbs for a paleo diet (which is probably still pretty low carb compared to a standard american diet).

    • Hi Kristin,
      I would recommend first and foremost getting your blood tested and such to see where you lie. Perhaps– I will definitely write a post on this soon. but when I say “thin” or “overweight” PCOS it has as much to do with hormone levels in the blood as it does with weight status. Your diet sounds good. If you test for insulin resistance, and if you have the typical PCOS LH/FSH ratio inversion, this is an indicator that you produce too much testosterone via insulin effects, so you would definitely want to pursue fixing that problem, whatever that would entail for you. Low carb in that case may be something you want to play with, though I recommend listening both to your body and to your doctor far and above me in that regard.
      My recommendation in moving forward is to stick with paleo meals–absent dairy– two – four meals each day, whichever you feel comfortable with, without any grazing in between. That should help sharpen insulin sensitivity if you are not already doing that. Exercise, too, sprint exercise, a few times each week will also help with insulin sensitivity.
      Stress reduction and the elimination of phytoestrogens–soy, nuts, seeds–and the improvement of sleep quality are also powerful usual suspects to try and get into line.

  3. There’s lots of great information here. When you say not to eat dairy, are you mainly talking about pasteurized, factory farmed dairy, or is all dairy androgenic? Would you recommend sufferers of PCOS stay away from all dairy, even grass fed, raw, fermented, etc? Thanks

  4. This is so helpful! I can’t believe i missed this when I first came to your site yesterday. It should have been the first thing I read! Anyway it is very clear and super helpful. I would say from personal experience that taking iodine is about the worst thing you can do for an auto-immune thyroid problem. I have Hashimoto’s and taking iodine will definitely make your symptoms worse. I’m glad to have clear, definite answers for diet though. I eat a grain and sugar-free diet, but now I am going to cut out fructose. I guess I’ll have to cut back on the raw cabbage salads, though. Either way it will be worth it to get better! Thanks again for all your info and good work.

  5. What do you mean by fructose? Do you include fruit in this category or do you mean added sugar?
    Also I’m not entirely sure what legumes include ;D (beans and peas, I guess, anything else?)

    I’m pretty sure I have PCOS. My doctor mentioned early on that I was at risk when I was a lot younger, and now I have all the symptoms. I’m 5’2, 145 :( and menstruate very rarely (maybe once or twice a year). I can’t really afford many of the supplements and my diet depends on what my parents buy (it took me so long to convince them to supply me with enough meat to do a Primal diet), so organic, grass fed is not even a possibility, despite my pleading (nor is it widely available where I live).
    What would you recommend?

    I’ve been Primal and VLC and even zero carb at one point, on and off, and I keep losing and gaining the same 20-15lbs. But it seems each time I need a loooooooong recovery period for my body to start losing weight (the first time I went Primal it took me 6 month to lose 10lbs).
    It seems like diets only work when they’re new. If I try the same one again, it just doesn’t work. It’s so frustrating! :(

    I really love your blog, by the way! So I’m reading all of it from the beginning. I was apprehensive at first, because right now loving my body, my face, my self doesn’t seem feasible :(. But your story really sounds like mine, the PCOS, the acne, the overweight. So I really consider you as a role model!

  6. What kind of low-carb vegetables do you recommend? When I think of low-carb meals, I think of meat/seafood, fat, and green leafy (cruciferous) vegetables. What do you suggest, instead, for those in the overweight PCOS camp?


    • all of them. :) literally. they’re all fair game. When I recommend people go on an insulin-sensitizing diet, I do not mean that they go to zero carbohydrate. I mean that they eat lowish/reasonable carbohydrate. Some potatoes certainly will not be bad for you, and ALL varieties of vegetables are fair, healthy game.

      • Thanks! Should make for fun trips to the farmers market!

        So I take it that grapefruit is low enough in carbs and fructose for those who are overweight?

        Also, I notice that you don’t mention fish oil supplements. What’s your opinion of them?

        I recently discovered your blog and it’s fantastic! Thank you for what you are doing!

  7. Do you have any specific research on the dairy/androgen issue? I was discussing your recommendations with my husband and he does not understand how androgens being present in the milk would transfer to being in the human bloodstream. All his research and schooling in nutrition indicates that since a hormone is only a cholesterol your body will process it as a saturated fat (same concept as eating dietary cholesterol does NOT correlate with blood cholesterol). Your blog posts have generated several conversations about PCOS and diet but this is one of the big points he cannot understand based on his knowledge of the topic.

    • Thank you, Rachel. I agree with you that this is one of the weaker points of my arguments, but I still stand by it, based on anecdote, theory, and some evidence. It is based, first, on anecdotes, finding that even small amounts of dairy for women who have PCOS and/or high testosterone or DHEA-S levels leads to acne. In addition to the anecdotes, which of course wouldn’t support a “hormone in dairy theory,” theories/speculation based on the presence of natural hormone levels in dairy as well as on growth hormone injections float widely in homeopathic dermatological circles. To back that up in a totally “I’m busy and doing my best” sort of way I just googled “hormones dairy” and came up with an article from Harvard Gazette with a milk researcher, http://news.harvard.edu/gazette/2006/12.07/11-dairy.html. A more scientific approach is found in this article, which is old but refers to the potential for IGF, estrogen, progesterone, etc, to interact with the human body in such a way as to promote cancer. http://www.sciencedirect.com/science/article/pii/S0306987797901109 I would argue that if these hormones can promote cancer, they can do other things as well.

      Secondarily, I am not sure I agree with your assertion that hormones are processed as a saturated fat. What of the case of xenoestrogens? Those are ingested hormones and they seem to play a significant role in both rodent and human fertility models, in a wide variety of studies.

  8. Are you taking clients? Can you point me to someone who is? I need more help with this.

  9. Hi Stefani,

    I have a question. You said that an overweight PCOS patient should eat a low car diet but a hypothyroid PCOS patient should eat a high carb diet. What if I am an overweight hypothyroid PCOS patient? What do I do?

    • Is fasting still safe for me?

    • low-ish carb should be just fine for you :) 50-150 g / day is a healthy range I think

  10. My issue is a little different. I have PCOS, but I have high estrogen, high DHEAS, low 17-OH progesterone, and low cortisol. Testosterone (free and total) is normal, as is regular progesterone. I’m not overweight (anymore. Was on the chubby side most my life. Lost weight several years ago. Have kept it off since, and have been following a paleo-ish diet for several months). My fasting glucose and insulin are both normal. It’s rather hard to decipher what my diet and supplementation might ideally look like, especially on the carb front! Any thoughts?

  11. Hello thankyou for this great site ,I was wondering wether or not HGH ingection will help with pcos .I have it but I am on the lean side I am 5’7 and 52 kg I have a hard time keeping weight on and I also have excess hair this started really possing a problem after I was ingected with depo provera my symptoms got worse they seem to drop off when I am pregnate and both pregnacies have been boy’s .I was able to grow my nails my skin cleared up and my hormones feelt great and then about three mths after bebies were born I developed post natel and post pardom depression.I was wodering if it would help this rolercoaster is getting a bit ridiculas .thanks again for your time

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  13. A low-carb diet is generally used to lose weight. Some low-carb diets say that they have health benefits beyond weight loss, such as reducing risk factors associated with heart disease, certain cancers, diabetes and metabolic syndrome. .*.,

    Best regards

  14. Stefani, I can’t thank you enough for your thoughts re complex carbohydrates and no fasting for thin-pcos, non-insulin resistant women. ***Please*** try to get this point out to as many women as possible! My body seemed to think it was starving, even though my calorie intake was very high. Adding back carbs, something very few seem to advocate, is so simple, yet effective.

    • I am doing what I can, Lynne! I know — I am super passionate about this as well. I am glad its working for you, thank you so much for sharing.

  15. Hi Stefani, my niece is thin, very depressed now since she ahas all the symptoms, so what kind of diet do you recommend? How about the paleo or primal? I read you said for thin, high carbs, but these diets say no carbs, and they claim to cure pcos with their diets, so very conflicting! please explain!

    • Depending on the type of PCOS your niece has, I would recommend a different take on carbohydrates. If she struggles with being overweight and/or insulin resistance, I recommend a paleo diet with reasonably limited carbohydrate intake. If, on the other hand, she is quite thin and exercises a lot, I recommend keeping carbohydrates in the moderate range. This is because limiting carbohydrates can help improve insulin signalling and reduce testosterone levels, so its great for women who have excess hormones, but women who have historically starved themselves or been too stressed need more of that “I’m fed” signal from carbohydrate intake.

      • Thanks Stefani, but why do people who have done the primal and paleo claim the diet helped them so much and no carbs? I guess they were all overweight. Yes my niece is now below weight, very stressed out and sad, so I am trying to help. So I suggest her doing the paleo, with addition of which carbs do you suggest?

  16. Hi Stefani,
    I bought your manual this summer and was ready to tackle my PCOS but now I am slightly confused! I’m 5’4″, 135 lbs with 19% BF, chronically low blood pressure, and no insulin resistance at all. I have been doing Paleo for about a year with vast improvements in acne and bodyfat%. My extreme facial hirsutism, which causes lots of ingrowns and hyperpigmentation, is slowly being tackled with this new lifestyle and electrolysis treatments. Moreover, my cysts are all gone! However, my testosterone is high. And that is the only abnormality I have. No problems with estrogen, LH, FSH, progesterone, T3, T4, or TSH. I take NAC and spearmint tea and iodine to hopefully help my ingrown facial hair and testosterone but it is very slow going. I was diagnosed, interestingly, with PCOS after losing about 50 lbs. That’s when the facial hair issue first began and what made me get an ovarian ultrasound for PCOS diagnosis. My question is: I am a “normal weight” PCOS patient with no metabolic/hormonal issues besides high testosterone. I don’t fit neatly into any of the PCOS subcategories outlined in your manual. What is the ideal macronutrient ratio and exercise plan for me? (I currently eat 50% fat, 30% protein, 20% carb with at least 25 g of fiber, and workout 5-6 times a week: usually 5-6x a week body-part specific lifting with 4x a week steady state cardio, or 3-5x a week HIIT if I can’t make it to the gym). i’m currently a 2nd year medical student, hoping to go into primary care, so I would definitely love to be as educated on PCOS not only for myself, but for my future patients.

    • Hi Janelle, please feel free to respond to this comment @ stefaniruper@paleoforwomen.com. I have one question: has your DHEA-S been tested? I would guess – but of course this is a big guess – that your DHEA-S may also be elevated. In women who exhibit PCOS after weight loss, this is often the case. That’s because the male hormones have leapt up in response to stress, and particularly DHEA-S, as it is a stress hormone in and of itself.

      With how much you work out, I am not sure that even making sure you eat 20 percent carb is enough. It seems to me as though your body is in a bit of panic — much like mine was — as it is adjusting to your new body fat levels, but more importantly as you experience perhaps a fair amount of stress as a result of your high amount of exercise. Being a med student, I am inclined to think you live under a fair amount of psychological stress and sleep deprivation as well, which exacerbates that problem, and I’d drop you square in the category of type II PCOS, from this incredible distance and with so little information, of course, being the important caveats.

      Anyway – Please let me know what you think via email. I am super happy to keep talking about this and working through it with you.

  17. love this its def helpful…was diagnosed with pcos when was 13 am 25 now and me and my husband want kids ive lost 70lbs in the past 6 months all my blood work is normal except my testosterone is to high so i dont mestrate my endo dr put me on 750 mg metformin 2x daily havent really been noticing diff i excersise daily bout an hr so my question is what kind of diet shld i be doing…oh and i take a prenatal too any info wld be great

  18. I am doing what I can, Lynne! I know — I am super passionate about this as well. I am glad its working for you, thank you so much for sharing. friv 2

  19. A lot of the Do’s & Don’ts you mentioned are accurate, but what you said about legumes and and cruciferous vegetables is the exact opposite of what is true.

    Other than soy–which is terrible for you, like you said–beans are actually very beneficial to managing estrogen levels and so are cruciferous vegetables. Broccoli for example is well known for being one of the most beneficial vegetables for managing pcos symptoms.

    I’m not sure where you’re getting your info, but there is a book called “The Anti-Estrogenic Diet” by Ori Hofmekler that you should read. It’s incredibly informative and he references many scientific studies for proof of this.

  20. I am a thin pcos woman who was following a very low carb high fat diet due to insulin resistance/type 2. I lost about 20 pounds in a year and now weigh in at 117 and am 5’5″. I also haven’t had a period in a year and am losing hair. And my cholesterol is very out of whack. I’m on metformin as well. You say if you are thin to eat high carb but avoid fructose (as found in fruit)? Problem is I don’t know how to eat high carb without having my blood sugar increase. The nutritionist at my Endo’s office I go to is having me add in some grains and fruits again to my diet as she thinks I’m severely nutrient and mineral deficient based on some lab work I had done. She is working to find more of a balance in my body and nutrient deficiency. Also is having me take some supplements for a few months to see if that helps anything. I haven’t eaten grains, starches or much fruit in a year because I don’t want my sugar to go up. Now I’m nervous to add it back in. I just don’t understand how to find a balance between eating high carb so my body doesn’t think its starving and also at the same time maintaining good glucose control (which I was doing when eating low carb – only about 50-70 total carbs (about 25-40 net probably) a day. More on the lower end though). Interested to hear your thoughts?

    • Hi Anna! Does fruit work for you? I should go back and re-write that post – I think fruit is totally fine and awesome, especially for helping with blood sugar control.

  21. Hi
    I love the directions about what food to eat however by the time I got to the medication part I remembered my own experience with Metformin and Yasmine and I had a hard time agreeing. I am not denying that for some people it might have positive results but for me it created so much more problems that I never want to hear of them or any birth control pill ever again.

    At the beginning my weight gain stopped, but I did not lose anything no mater what I did (is true, I was following conventional diet at that time). But after a while I was dehydrated no mater how much water I would drink, and I would have horrendous diarrhea when I needed to go to the bathroom that I was terrified of leaving the house and daily massive headaches. After 2 years of being on this combo I went to the doctor to say i want to stop them. We did a full battery of test and discovered I needed to get of both of them as my liver was so stressed that if I would keep up I would get medication induced hepatitis.
    To make matter worst, during this time as my liver was working at a low capacity, my system started gathering heavy metals from my dental fillings resulting in problems with my hair, skin and lungs. By the time the doctors realized what I had (the allergic reactions were not on the skin, but manifested in sneezing, headaches and stuffed nose) I had 30 times more mercury in my system than accepted. I lost a lot of my hair and was a torture for me to leave the house as any type of perfume or chemical would shut down my lungs.

    It is true, in my case there was some issues that are not that commonly found (like the old type of dental fillings that were so common when I was a child). However the reason why I wanted to tell you all this is to be careful with Metformin especially in combination with birth control pills as it can have serious side effects.

    I am fine now. I have been trying to eat primal for the last 3 years. I am completely off the grains as the stressed liver resulted in a gigantic list of allergies. But I am still working on fixing the hair damage and vitamin deficiencies created in those times.

    Thank you for all the info you are sharing with us, it is of fantastic help.

  22. Hi Stefani,
    My OB/GYN suspects that I may have PCOS as I have had secondary amenorrhea for about three years and is sending me for some blood tests. Depending on the results she also mentioned that she may send me to a reproductive endocrinologist for further testing. Given that there are so many different causes for secondary amenorrhea, which tests do you recommend for determining the root cause?

    • testosterone DHEA-S estrogen progesterone lH FSH prolactin and then the thyroid hormones if you like TSH T3 T4 TPO :)

  23. Hi,
    Would you clarify for me…
    Above you said, “Nuts in their natural form are not awesome and should be treats instead of daily staples.” Are you saying nuts are not healthy for women with pcos? It’s opposite what I’ve read anywhere else so I’m a little confused. Thanks.

    • yeah, I am actually. there’s a post somewhere kicking around on here called ‘why i don’t eat nuts” and, again, while I think they are FINE, I also don’t find them IDEAL, as they are full of omega 6 fats (unless they are macadamias) which can be inflammatory if eaten in high doses. They also have a reasonably hefty dose of phytoestrogens in them which can mess with hormone balance. On the other hand, if your experience is that they work for you, that’s wonderful!

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