If you have been diagnosed with PCOS, or suspect you have it, this is how I explain it to a newly diagnosed patient and how I approach treatment.
What is happening in the body
PCOS, or polycystic ovary syndrome, is most often recognized and diagnosed by irregular periods and cysts on the ovaries. But the issue is not the ovaries. PCOS is an endocrine disorder. Think of it as a condition where the body's hormones are out of balance. Many women with PCOS produce higher levels of androgens and have trouble using insulin efficiently.
This is part of why most women are misdiagnosed and never get the proper treatment. The textbook clinical picture is cysts on the ovaries, irregular periods, acne, facial hair growth and being overweight. However, many women have PCOS without having all of these symptoms.
So where does the insulin resistance start? The problem starts in the gut. Many women experience inflammation, and that inflammation triggers a gut imbalance that makes insulin work less effectively. Insulin resistance comes before PCOS. The increase in insulin then signals the body to produce more hormones, specifically androgens. The increase in testosterone then interferes with ovulation. The cascade continues, making weight harder to lose and creating the symptoms many women experience without knowing why or how to fix them.
Why "just lose weight" is not enough
Many clinicians do not recognize PCOS as an endocrine or metabolic disorder, and they do not know how to properly treat the metabolic side together with the hormone imbalance.
The reasoning behind weight loss is that more body fat means more inflammation, more dysregulated hormones and more insulin resistance. Weight loss can improve many PCOS symptoms. But many women are frustrated by the answer "just lose weight," and that frustration comes from doctors not helping to treat the underlying metabolic problem.
Women with PCOS have a harder time losing weight because they do not respond to the regular weight loss strategies that work for other women. Diet and exercise alone are not enough. Many women with PCOS find it hard to follow a doctor's order to diet and exercise because they barely see the scale budge.
The reason is the underlying reduced insulin sensitivity. That means increased hunger, sugar cravings and feeling hungry again shortly after eating. The way energy is used and how calories are stored both affect PCOS patients differently. If we do not treat the underlying insulin sensitivity while balancing hormones, the body is fighting against them.
How PCOS is diagnosed, and what gets missed
The first place most women seek help is the gynecologist, usually because of missed periods. Treatment often begins with oral birth control pills and a pelvic ultrasound to check for cysts. That standard workup does not consider bloodwork or the full set of symptoms.
PCOS does not always present with hair growth, cysts and acne. Many women have fatigue, weight gain or hair changes instead. The best way to diagnose PCOS is through a thorough conversation about your background, bloodwork and symptoms.
The bloodwork I check includes:
- LH/FSH ratio
- A hormone panel including total and free testosterone and progesterone
- A thyroid panel
- Insulin resistance markers
The things I most commonly see on these panels are progesterone deficiency, thyroid deficiency, insulin resistance and androgen excess.
What treatment involves beyond birth control
Treatment is built on the whole clinical picture, so what it looks like depends on each individual patient. Simply blocking the androgen excess does not correct PCOS. Depending on the patient, treatment can include:
- Lifestyle changes, such as intermittent fasting or a low-glycemic diet
- Addressing the inflammation that starts in the gut
- Optimizing hormones with progesterone and thyroid therapy
- In some cases, a GLP-1 medication or metformin to help improve insulin resistance
Fixing the root causes, meaning the inflammation, high insulin and elevated androgens, is what helps treat PCOS. You can read more about how I care for women with this condition on my PCOS treatment page, and about thyroid testing and treatment on my thyroid optimization page.
When a GLP-1 medication makes sense, and when it does not
I consider GLP-1 therapy for each patient individually. I review your background, including any history of thyroid cancer or multiple endocrine neoplasia (MEN). Your preference plays a role in the decision too.
Some patients want to optimize their hormone levels first while following a more natural approach: a low-glycemic diet and intermittent fasting with exercise. Others want to start a GLP-1 right away, because they have already tried many different diets and exercise programs and have more inflammation to control. For them, it can help jump-start insulin control and weight loss.
The right patient for a GLP-1 is one who is willing to change and adjust their lifestyle. The biggest risk with GLP-1 medications is muscle loss. If a patient wants to rely solely on the medication to do the work, they are at significant risk of rebound after stopping it, along with other problems caused by muscle loss. And in general, the less metabolic dysfunction is present, the less likely a GLP-1 is the primary solution. My medical weight loss page explains more about how I use these medications.
If you are worried about fertility
A common misconception is that having PCOS means you will not be able to have children. Without proper treatment, PCOS can make ovulation less predictable. Proper treatment, by fixing the gut, insulin resistance and elevated testosterone, can support fertility and reproductive health.
The long-term risks of untreated PCOS
Untreated PCOS can lead to cardiovascular disease, type 2 diabetes, infertility and mental health effects. Insulin resistance that continues without proper treatment can lead to abnormal cholesterol, high blood pressure and weight gain, all of which increase the risk of cardiovascular disease. Untreated ovulation problems can make conception more difficult.
Mental health becomes a factor when a woman starts to struggle with body image, anxiety, depression and a lower quality of life from the hormonal and psychosocial effects of the condition.
PCOS or PMOS? What the new name means
In 2026, PCOS was renamed PMOS (polyendocrine metabolic ovarian syndrome). The change comes from the misconception the old name creates about ovarian cysts. The new name points to the underlying cause: an endocrine disorder involving metabolic dysfunction.
The important thing to know is that the name changed, but the condition did not. Understanding PMOS as a whole-body hormonal and metabolic condition will lead to better diagnosis, better patient education and better long-term management.
Start with a conversation
If you are in Lake Mary or anywhere in Central Florida and you have been told to just lose weight or start birth control, I would like to hear your story. Request a consultation and we will look at the whole picture together.
Sources
- Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2017;102(2):604-612. doi:10.1210/jc.2016-2963
- Legro RS, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014;371(2):119-129. doi:10.1056/NEJMoa1313517
- Teede HJ, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469. doi:10.1210/clinem/dgad463
- American Society for Reproductive Medicine. PCOS is now PMOS: understanding the name change. May 27, 2026. asrm.org
This article is general education, not individual medical advice. See our medical disclaimer.