Rethinking PCOS
Polycystic Ovary Syndrome (PCOS) affects up to 1 in 5 women of reproductive age in India, yet it is vastly underdiagnosed and often treated only for its gynecological symptoms. The missed insight is that PCOS is, at its core, a metabolic condition — driven by insulin resistance — and its reproductive manifestations are downstream consequences.
The Insulin Connection
In PCOS, insulin resistance triggers the ovaries to produce excess androgens (testosterone). This disrupts ovulation, causes irregular cycles, and drives symptoms like acne and hair thinning. The insulin-androgen axis is the central mechanism. Treating PCOS without addressing insulin resistance — for example, with oral contraceptives alone — manages symptoms without resolving the underlying metabolic dysfunction.
PCOS is not a reproductive disorder that happens to involve metabolism. It is a metabolic disorder that manifests in the reproductive system.
Diagnostic Criteria
The Rotterdam criteria require at least two of the following three features:
Oligo-ovulation or anovulation — irregular or absent menstrual cycles (fewer than 8 per year)
Clinical or biochemical hyperandrogenism — elevated testosterone, acne, or male-pattern hair thinning
Polycystic ovaries on ultrasound — 12 or more follicles per ovary
A Metabolic Treatment Approach
The evidence is clear: insulin sensitisation is the single most effective intervention for PCOS. Weight loss of just 5–10% can restore ovulation in the majority of women with PCOS. Combined with targeted nutrition, structured exercise, and stress reduction, improvements in cycle regularity, androgen levels, and metabolic markers are achievable within three to six months.
CGM-guided nutrition — identifies personal glucose triggers and flattens the insulin curve
Inositol supplementation — myo-inositol and D-chiro-inositol improve insulin sensitivity and ovulation rates
Time-restricted eating — lowers basal insulin levels, reducing ovarian androgen production
Resistance training — builds muscle, improves insulin sensitivity, and does not spike cortisol the way excessive steady-state cardio can