PCOS: How to reclaim your rhythm

Getting to the root causes of polycystic ovary syndrome is key to restoring hormonal balance and easing symptoms, says Dr Leigh Erin Connealy

Polycystic ovary syndrome, or PCOS, is one of the most common hormonal conditions in women today. It’s a leading cause of infertility, affecting about one in 10 women of reproductive age—and rates appear to be on the rise.

PCOS involves irregular or absent ovulation, elevated androgens (“male” sex hormones including testosterone), and the appearance of multiple small follicles on the ovaries—often described as a “string of pearls” on ultrasound. Despite the name, these are not true cysts but immature follicles that failed to ovulate.

The condition is usually a sign that a woman has been under significant stress for a long time, whether emotional, metabolic, inflammatory or environmental. Her body adapts by shifting into survival mode, and ovulation becomes inconsistent because reproduction is energetically demanding. Over time, this adaptive pattern becomes the hormonal picture we call PCOS.

But PCOS is often reversible. It does take some effort—meaningful dietary shifts, stress reduction, metabolic repair and hormonal support. But when the underlying drivers are addressed, cycles can regulate and ovulation can return.

What’s happening hormonally?

Many people characterize PCOS as a condition of “too much testosterone.” Elevated androgens are certainly a hallmark—they contribute to symptoms like acne, hair thinning, unwanted facial or body hair, and irregular cycles. But focusing only on androgens means missing the bigger hormonal picture.

In many women with PCOS, estrogen and insulin imbalances may also play an important role, disrupting the normal signals that regulate ovulation and hormone production. When these hormones are out of balance, they can create a cascade of effects that contribute to the symptoms commonly seen in PCOS.

PCOS was initially defined by the growth of multiple fluid-filled sacs, or cysts, on the ovaries. There are two key words here: fluid and growth.

One of estrogen’s functions is fluid regulation within cells. And estrogen is responsible for cell division or “growth” (including the growth of cysts). When estrogen levels are out of balance, it may contribute to an environment in which ovarian cysts develop.

Estrogen imbalance may also affect other hormone pathways. For instance, elevated estrogen can increase free fatty acids in the blood, which can contribute to insulin resistance. When the body stops responding properly to insulin, it becomes harder for sugar to move from the blood into the cells and be used for energy.

It can also stimulate the adrenal glands to produce androgens and stress hormones, which can lead to symptoms like acne, blood sugar imbalances, excess hair growth and skin darkening.

In one study, researchers measured estrogen levels not only in the peripheral bloodstream but directly from the ovarian vein of a woman with PCOS.¹ Her serum estradiol, the primary form of estrogen produced by the ovaries, was about 1,000 pg/mL.

However, the estradiol concentration draining directly from the ovary was much higher—around 5,000 pg/mL. This meant the ovary itself was producing very high levels of estrogen locally even though the systemic blood level appeared lower.

These findings show that standard bloodwork may not always reflect what is happening inside the ovary. In many cases of PCOS, estrogen production in the ovary remains elevated and persistent, particularly because ovulation is not occurring. When ovulation fails, too little progesterone is produced to balance estrogen’s proliferative effects.

Because women with PCOS often don’t ovulate, they don’t make enough progesterone, which normally counterbalances estrogen. The adrenal glands likely increase androgen production to oppose the effects of elevated estrogen.

The conventional approach

Doctors are often trained to manage PCOS symptomatically, and hormonal birth control is usually the first-line treatment. Combined oral contraceptives suppress ovulation and regulate bleeding patterns, which can improve acne and irregular cycles. But symptom suppression is not correction.

Hormonal contraceptives override the body’s natural cycle by shutting down communication between the brain and ovaries. Ovulation stops, progesterone is not produced naturally and synthetic hormones replace the body’s own rhythms.

While this can reduce visible symptoms, it doesn’t directly improve estrogen dominance (high estrogen levels relative to progesterone), insulin resistance, metabolic dysfunction or stress—the underlying drivers in many cases of PCOS.

It’s also common for women to be diagnosed shortly after stopping birth control. In many cases, the pill was masking an underlying metabolic imbalance or directly contributed by supplying exogenous estrogen and depleting key nutrients. When the synthetic hormones are withdrawn, the original irregular cycle reappears—sometimes more noticeably because ovulation has been suppressed for years.

Natural ways to treat PCOS

Fortunately, there are several effective natural strategies for PCOS. Lifelong medication is not always necessary because the ovaries are responsive organs. When the environment changes, hormones can change.

Here are six ways to address PCOS using a root-cause approach.

1. Improve glucose metabolism

Insulin resistance is a key feature of PCOS, meaning the body struggles to use insulin properly. For many women, chronic stress, both psychological and physiological, is a major underlying driver. Stress hormones increase, which increases free fatty acids (in turn increasing androgen production), changes the way the body processes glucose, and leads to insulin resistance.

The goal is not just to lower blood sugar levels but to ensure the body is using glucose efficiently to make energy. Here are a few ways to improve glucose metabolism:

• Prioritize consistent meals with adequate protein and carbohydrates.
• Eat every three to four hours to keep blood sugar stable.
• Walk for 10 minutes after meals.
• Lower your intake of industrial seed oils, such as canola (rapeseed) and sunflower oils.
• Ensure you’re getting enough nutrients for carbohydrate metabolism: B vitamins (especially thiamine), magnesium, potassium, sodium and vitamin K.
• Avoid chronic undereating or extreme dieting, which can worsen cortisol and insulin resistance.

2. Address estrogen dominance

Because women with PCOS don’t regularly ovulate, they aren’t naturally producing sufficient progesterone—the natural balancer of estrogen. Without ovulation, the corpus luteum does not form properly, and progesterone never rises in the second half of the cycle. This leaves estrogen relatively unopposed and allows its effects on the ovaries, thyroid and metabolism to accumulate.

In PCOS, we want to address why the body is overproducing estrogen in the first place. Part of addressing estrogen dominance is removing excess exposure. This means minimizing xenoestrogens (estrogen-mimicking compounds) from plastics, synthetic fragrances, pesticides and personal care products. It also means being mindful of hormonal medications when possible and reducing exposure to unnecessary endocrine disruptors in daily life.

Here are some simple steps that can help:

• Reduce your exposure to plastics, pesticides and synthetic fragrances, personal care products and cleaning products.
• Ensure regular bowel movements to prevent estrogen reabsorption. Eat plenty of fiber and try Dr Ray Peat’s carrot salad (see below), a simple recipe created by the late biologist and nutritionist to support gut health and hormonal balance.
• Support liver conjugation pathways—your body’s natural detoxification processes—with adequate protein, glycine and taurine.
• Ensure you’re getting enough vitamin A in your diet. Egg yolks, dairy and liver are good sources.

3. Supplement with inositol

Inositol—found in citrus fruits, beans, grains and nuts—is one of the most well-studied natural compounds for PCOS.² It acts as a secondary messenger in insulin signaling, helping to restore proper communication between insulin receptors and the enzymes that move glucose into the cell. This helps restore glucose metabolism, address insulin resistance and lower unnecessary stress.

Improvements in fasting insulin and ovulatory function are typically seen after consistent use over several weeks.

Suggested dosage: 2 g twice daily

4. Support thyroid function

Many women with PCOS also have low thyroid function. Excess estrogen increases thyroid-binding globulin (TBG), which binds thyroid hormone and reduces the free, active amount available to tissues.

Elevated cortisol suppresses thyroid-stimulating hormone and impairs the conversion of the hormone T4 into active T3. Low progesterone removes an important stabilizing influence, as progesterone normally supports metabolic rate and counterbalances estrogen’s inhibitory effects.

The result can be functional hypothyroidism: hormonal imbalance, impaired ovulation and a shift toward stress-driven, less efficient metabolism. When the thyroid slows, the body relies more heavily on cortisol and adrenaline to maintain blood sugar, further reinforcing the PCOS pattern.

Here are some natural ways to support thyroid function:

• Optimize nutrition. Especially make sure you’re getting enough carbohydrates, selenium and zinc.
• Supplement with a combination of T4 and T3 (natural desiccated thyroid).
• Avoid calorie restriction.
• Get enough sunlight exposure, especially on your neck, where the thyroid gland is.
• Support gut and liver function by getting enough glycine and taurine and eating plenty of fiber and easily digestible foods. Also consider castor oil packs.
• Avoid industrial seed oils.
• Ensure adequate vitamin A intake (see above).

5. Support zinc levels

Multiple studies show that women with PCOS tend to have low levels of zinc.³ This mineral modulates insulin receptors, supports antioxidant defenses and regulates androgen production, so suboptimal levels can contribute to insulin resistance, inflammation and elevated testosterone.

Zinc also supports proper follicular development and ovulation. In clinical trials, supplementation has been associated with improvements in insulin sensitivity, reductions in inflammatory markers, and modest decreases in total testosterone and excess hair growth.

Good food sources of zinc include oysters, shellfish, red meat, pumpkin seeds and cashews. But it’s a good idea to take a supplement. Bear in mind that long-term high-dose zinc supplementation can lower copper levels, so monitoring and balance are important.

Improvements in metabolic markers and skin symptoms are generally seen after several weeks of consistent use.

Suggested dosage: 25–50 mg daily

6. Address emotional health

Women with PCOS have usually endured some form of severe, prolonged stress or trauma. The body adapts to this by shifting into a survival state. When the system is in survival mode from environmental or emotional stressors, it is no longer prioritizing fertility or ovulation because this would be too demanding on the body.

Ovulation requires energy, stability and safety. If those signals are not present, the brain downregulates reproductive signaling to conserve resources. This results in low progesterone, unopposed estrogen, irregular cycles and the hormonal picture commonly seen in PCOS. The body is responding to stress.

Healing from PCOS often requires emotional healing as well. Creating stability can signal to the brain that it is safe to resume normal reproductive rhythm. When safety is restored, ovulation often becomes more consistent.

Here are some tips to help ease stress and overcome past trauma:

Get outdoors. Spend time in nature, especially in green spaces.

Take time offline. Limit news and social media.

Make peace. Spend time reflecting on and healing important relationships in your life.

Write it down. Try journaling and expressive writing or “free writing,” when you set aside time to write to release pent-up thoughts or emotions.

Get creative. Creative activities like drawing, doodling, knitting or crocheting can help to relieve stress.

Try EVOX therapy. It reduces stress and anxiety and heals emotional trauma through perception reframing. Search online for “EVOX perception reframing” along with the name of your city or state to find a practitioner offering the therapy near you.

Speak to yourself with love. Practice self-compassion and use kind, supportive inner language.

Back in balance

I’ve seen what happens when hormones are misunderstood and oversimplified. Women are often given narrow explanations and band-aid solutions for complex symptoms.

Many of the strategies here target the actual drivers of PCOS—things like insulin resistance, blood sugar instability, chronic inflammation and disrupted ovulation. When you improve the way the body is processing glucose, reduce inflammatory load and support consistent ovulation, hormone levels often begin to shift in a more balanced direction.

When underlying systems are supported in a consistent, targeted way, it’s common to see improvements in cycle regularity, symptoms and overall hormonal health.

For more insights from Dr Leigh Erin Connealy, subscribe to her bi-weekly newsletter here: drconnealy-newsletter.beehiiv.com

Dr Ray Peat’s Carrot Salad

Ingredients

1 large carrot
1 tsp coconut oil or olive oil
1 tsp apple cider vinegar (without additives)
Pinch of sea salt or Celtic salt (optional)

Method

1. Shred the carrot lengthwise to create long strips and set aside.
2. Mix the remaining ingredients to make the dressing.
3. Toss together the dressing and the carrots in a bowl. Eat within an hour for best results.

Recipe adapted from biochemnordic.com

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