Polycystic Ovary Syndrome (PCOS) and Lifestyle - Mini Prevention Guide

Polycystic Ovary Syndrome, known as PCOS, is one of the most common endocrine disorders in women of reproductive age. Although it is often associated with menstrual irregularities and infertility, in everyday clinical practice, we observe that this syndrome presents much more broadly, with many diverse symptoms. Unexplained fatigue, increased cravings for carbohydrates, difficulty regulating weight, acne, hair loss, excessive hair growth, sleep disturbances, even digestive discomfort or mood fluctuations, may all be part of the same functional picture.

Modern lifestyle appears to significantly aggravate the expression of polycystic ovary syndrome. Sedentary behavior, high consumption of processed foods, chronic exposure to stress, disruption of the circadian rhythm, and continuous exposure to environmental endocrine disruptors create a background that favors the development of insulin resistance and hormonal dysregulation. In Functional Medicine, we do not focus solely on diagnosing the syndrome, but primarily on understanding why the body is led into this state.

It is particularly important to emphasize that polycystic ovary syndrome is not merely a gynecological issue. It is a metabolic and hormonal phenomenon that affects multiple systems and axes: the endocrine, metabolic, gastrointestinal, and even the immune system. Prevention and early intervention can reduce the risk of future complications such as type 2 diabetes mellitus, dyslipidemia, non-alcoholic fatty liver disease, and cardiovascular disease.

The positive message is that small, targeted lifestyle changes can substantially influence the body’s function. Improving insulin sensitivity, supporting the gut microbiome, regulating sleep, and reducing inflammatory burden are not theoretical concepts. They are practical prevention pillars that are applied daily.

What Happens in the Body in Polycystic Ovary Syndrome (PCOS)

To understand how lifestyle affects polycystic ovary syndrome, we must first examine its key pathophysiological mechanisms.

At the core of the syndrome, in most cases, lies insulin resistance. This means that cells do not respond effectively to insulin, prompting the pancreas to produce more insulin to maintain normal blood glucose levels. Hyperinsulinemia not only affects glucose metabolism. It stimulates the ovaries to produce more androgens, such as testosterone, leading to menstrual irregularities, anovulation, acne, and hirsutism. At the same time, the production of sex hormone-binding globulin (SHBG) decreases, resulting in increased circulating free androgens.

In recent years, particular interest has focused on the gut–metabolism–ovary axis. Contemporary reviews show that women with polycystic ovary syndrome exhibit altered gut microbiome composition, reduced microbial diversity, and increased markers of low-grade inflammation. At the same time, dysbiosis appears to worsen insulin resistance and enhance systemic inflammation, creating a vicious cycle.

Moreover, chronic activation of the HPA axis (hypothalamic-pituitary-adrenal) due to stress may increase cortisol levels, further impairing glycemic control and promoting visceral fat accumulation. The liver, a key organ for hormone metabolism and detoxification, is often burdened, particularly when non-alcoholic fatty liver disease coexists.

Therefore, PCOS is not simply an ovarian disorder. It results from the interaction of metabolic, hormonal, inflammatory, and microbial factors. This multifactorial nature of the syndrome explains why lifestyle interventions and a functional approach can play such a substantial role.

Mini Prevention Guide - Practical Steps You Can Apply Immediately

In Functional Medicine, we approach polycystic ovary syndrome as a multisystem condition. Prevention and symptom improvement are not based on a single intervention, but on a combination of small, consistent changes that enhance insulin sensitivity, reduce inflammation, and support the gastrointestinal system and liver function. Below are key pillars you can incorporate into your daily routine:

1. Low-glycemic-load nutrition with emphasis on quality. Glucose regulation is a central goal in PCOS. Choose complex carbohydrates, legumes, vegetables, high-quality protein, and healthy fats such as olive oil and nuts. Limit processed sugars and frequent high-glycemic meals. Recent reviews confirm that dietary interventions are the foundation of PCOS management. Stable blood sugar levels reduce insulin levels and, consequently, hyperandrogenism.
2. Support of the gut microbiome. Gut health is closely linked to metabolic regulation. Include foods rich in fiber, fermented products, and polyphenols. Increased fiber intake enhances the production of short-chain fatty acids, which in turn improve insulin sensitivity. Contemporary studies support that modifying the microbiome through diet, probiotics, or combined interventions can significantly improve metabolic and hormonal markers.
3. Regular physical activity with emphasis on muscle strengthening. Exercise increases muscular glucose uptake independently of insulin and reduces visceral fat mass. The combination of aerobic activity and resistance training has been shown to be particularly effective in improving the HOMA-IR index (a marker of insulin resistance) and ovulatory function. Excessive intensity is not required; consistency is more important than workout intensity.
4. Sleep and circadian rhythm regulation. Inadequate or disrupted sleep disrupts the secretion of insulin, cortisol, and appetite hormones. The goal is 7 to 8 hours of quality sleep, with a consistent schedule. Ideally, avoid intense screen exposure before bedtime and enhance exposure to natural light in the morning.
5. Stress management and support of the adrenal axis. Chronic stress activation worsens insulin resistance. Techniques such as breathing exercises, gentle yoga, meditation, or simple daily contact with nature have measurable benefits in cortisol regulation.
6. Reduction of exposure to endocrine disruptors. Plastic food containers, thermal receipts, and cosmetics containing certain chemicals may act as endocrine disruptors - substances that can mimic or block the body’s natural hormones. Prefer glass containers and natural cosmetics to limit unnecessary exposure.
7. Monitoring key metabolic markers. Prevention in PCOS is not solely behavioral. Regular assessment of the insulin and glucose curve, lipid profile, liver enzymes, and vitamin D helps identify dysfunction early. Within a functional approach, additional markers such as inflammatory parameters or hormonal profiles may also be evaluated.

These interventions do not replace pharmacological treatment when necessary, but they often significantly enhance its effectiveness and, in several cases, reduce the need for more aggressive interventions.

When Further Investigation Is Needed

Although many women with polycystic ovary syndrome can significantly improve their condition through lifestyle changes, there are cases where a more systematic and individualized investigation is required. Prevention does not mean postponing evaluation, especially when symptoms persist or worsen. You should seek a more detailed assessment when you notice:

• Persistent menstrual irregularity, amenorrhea, or highly irregular cycles lasting more than 3 to 6 months. Prolonged anovulation may increase the risk of endometrial hyperplasia and requires medical evaluation.
• Difficulty regulating weight despite proper nutrition and exercise. In such cases, significant insulin resistance or thyroid dysfunction may be underlying and require laboratory investigation.
• Marked fatigue, hypoglycemic episodes, increased sugar cravings, or a family history of diabetes mellitus. Evaluation of the glycemic profile may reveal early metabolic disturbances not evident in a simple fasting glucose test.
• Significant acne, hair loss, or worsening hirsutism. Assessment of sex hormones and thyroid hormones is required.

In clinical practice, we often observe that “standard” laboratory tests may fall within reference ranges, while the body exhibits functional deviations. The functional approach emphasizes not only reference limits, but also the optimal value for the individual organism. In certain cases, evaluation of the gut microbiome, low-grade inflammatory markers, or parameters related to oxidative stress may be considered when clinically justified.

Early investigation in PCOS is not aimed at “confirming a problem,” but at preventing long-term metabolic burden. The earlier imbalances are identified, the more effectively they can be corrected.

Recommended Tests for a Detailed Assessment

As mentioned, when PCOS symptoms persist or the clinical picture is complex, a more comprehensive laboratory evaluation may reveal underlying imbalances that are not apparent in a basic preventive check-up. The goal is not overdiagnosis, but targeted mapping of the metabolic and hormonal profile.

The Polycystic Ovary Syndrome Evaluation (Check Up F12) is a comprehensive diagnostic package designed to confirm and map PCOS at both hormonal and basic metabolic levels. It is not limited to a single test but examines the main endocrine and metabolic domains involved in the pathophysiology of the syndrome. Specifically, it includes:

• Complete androgen hormonal profile. Markers such as total testosterone, DHEA-S, Δ4-androstenedione, and SHBG are assessed. The combination of these markers allows evaluation of hyperandrogenemia, a core feature of PCOS. SHBG is particularly important, as it influences the proportion of free bioactive testosterone.
• Gonadotropins and ovarian axis. LH and FSH, as well as the LH-to-FSH ratio, help assess the function of the hypothalamic–pituitary–ovarian axis.
• AMH, Anti-Müllerian Hormone. AMH is often elevated in PCOS and reflects an increased number of small follicles. It is useful both diagnostically and for evaluating ovarian reserve.
• 17-OH-progesterone. Contributes to excluding congenital adrenal hyperplasia, supporting the differential diagnosis of adrenal-origin disorders.
• Thyroid function assessment. TSH is included to rule out subclinical thyroid dysfunction that may mimic or worsen menstrual irregularities.
• Metabolic assessment. Insulin and glycated hemoglobin (HbA1c) provide an initial picture of glycemic regulation and possible insulin resistance.
• Lipid profile. Total cholesterol, LDL, HDL, VLDL, and triglycerides assess cardiometabolic risk, which is increased in PCOS.
   

Therefore, this evaluation adequately covers the diagnosis and basic metabolic assessment of PCOS. However, within a more preventive and functional approach, and in certain cases, it is advisable to enrich the assessment with additional markers that highlight early dysfunction:

• Insulin Resistance, HOMA-IR Index: Early assessment of insulin resistance through fasting glucose and insulin testing, along with calculation of the HOMA-IR (Homeostasis Model Assessment – Insulin Resistance) index. HOMA-IR is one of the most sensitive tools for detecting insulin resistance, particularly in cases with normal HbA1c.
• hs-CRP: High-sensitivity C-reactive protein evaluates low-grade inflammation, which has been associated with PCOS and increased cardiovascular risk.
• Vitamin D: Vitamin D deficiency is common in PCOS and is associated with increased insulin resistance, ovulatory dysfunction, and inflammatory burden.
• ALT and γGT (Liver enzymes): PCOS is frequently associated with non-alcoholic fatty liver disease. Evaluation of liver function is essential in women with increased body weight or metabolic disturbances.
• Ferritin: In cases of significant fatigue or irregular bleeding, assessment of iron stores helps in the differential evaluation of symptoms.
• Gut Microbiome Analysis EnteroScan®: In selected cases, gut microbiome assessment may serve as a useful complementary investigation in PCOS, particularly when significant digestive symptoms coexist, markers of low-grade inflammation are elevated, or insulin resistance remains resistant despite proper nutrition and regular exercise. Evaluation of microbial balance contributes to understanding the gut–metabolism–ovary axis and allows for more targeted interventions in nutrition and inflammatory load regulation. It is not a routine test, but a personalization tool in complex or persistent PCOS cases.
   

PCOS is not exclusively a gynecological syndrome. It is a metabolic and endocrine disorder with systemic implications. While the Polycystic Ovary Syndrome Profile (Check Up F12) provides a strong foundation for diagnosis and monitoring, when the goal is prevention of long-term complications such as type 2 diabetes, dyslipidemia, or fatty liver disease, expanding the evaluation with the above markers allows for:

• Early detection of insulin resistance
• Assessment of inflammatory burden
• Evaluation of hepatic strain
• Personalized guidance for targeted dietary and lifestyle interventions
   

The essence is not to perform more tests, but to perform the right tests, at the right time, based on the clinical picture. In PCOS, personalization of laboratory evaluation is a central prevention tool, not merely a means of confirming diagnosis.

In Conclusion

Polycystic Ovary Syndrome (PCOS) is not a static diagnosis. It is a dynamic condition influenced by how you live, sleep, eat, and manage stress. Prevention does not require perfection, but consistency. Small daily interventions can substantially change your biochemistry.

Information, regular evaluation, and a personalized approach form the foundation for meaningful improvement. In multifactorial conditions such as PCOS, lifestyle and prevention are not merely supportive factors, but important therapeutic pillars.

References

1. Gautam, R., Bhateja, A., Malhotra, N., & Arora, T. (2025). Mapping the research landscape of lifestyle modification in PCOS management: A 10 year bibliometric analysis. Clinical Epidemiology and Global Health.
2. Liu N, Wang X, Wang M. (2025). The effect of pre/pro/synbiotics on cardiometabolic health in patients with polycystic ovary syndrome: A systematic review, meta-analysis and meta-evidence. Journal of Functional Foods, 133, 106996.
3. Chen X, Wan Y, Xie L. Insulin resistance in polycystic ovary syndrome: pathophysiological mechanisms of menstrual dysfunction and evidence-based treatment strategies. Biol Reprod. 2025;113(6):1340-1354. doi:10.1093/biolre/ioaf197
4. Mohammed, S., Cockburn, B. N., & Sundaram, V. (2024). Exploring the novel alternative and modern treatment options for polycystic ovary syndrome: A review. Integrative Medicine Reports, 3(1). doi:10.1089/imr.2023.0045
5. Jin YX, Hu HQ, Zhang JC, et al. Research status of polycystic ovary syndrome treatment: a mini review and a bibliometric analysis from 2010 to 2023. Gynecol Endocrinol. 2024;40(1):2405098. doi:10.1080/09513590.2024.2405098
6. Zhu S, Chen H, He B, Zhang Y, Li P and Kuang J (2025) Gut microbiota dysbiosis in polycystic ovary syndrome: focus on diet, probiotics, and traditional Chinese medicine. Front. Microbiol. 16:1659783. doi: 10.3389/fmicb.2025.1659783
7. Mei Y, Li W, Wang B, Chen Z, Wu X, Lin Y and Wang M (2025) Gut microbiota: an emerging target connecting polycystic ovarian syndrome and insulin resistance. Front. Cell. Infect. Microbiol. 15:1508893. doi: 10.3389/fcimb.2025.1508893

At Diagnostiki Athinon, we treat prevention with the seriousness it deserves. This is where science meets personalized care.