Are you confused about what’s actually causing your PCOS symptoms? You’re not alone. Polycystic Ovary Syndrome (PCOS) is a complex condition — and despite how common it is, researchers still don’t know exactly what causes it. Some evidence points to genetics or environmental exposures before birth, while other studies suggest nutrient deficiencies and lifestyle factors may play a role.

But here’s what we do know: while the root cause of PCOS might differ from person to person, the symptoms you experience every day — from irregular cycles to fatigue — are driven by a few key underlying imbalances.

And let’s be clear: PCOS isn’t your fault. It’s also not your fault if you feel confused or frustrated trying to figure it all out. With so many influencers telling you to cut gluten, ditch dairy, or fear seed oils, it’s easy to get lost in the noise. The truth is, PCOS symptoms aren’t caused by fads or food fear — they’re caused by real, measurable shifts in hormones, inflammation, and metabolism.

When you understand what’s driving your symptoms, you can finally stop guessing — and start making changes that actually help you feel better.

Here’s a quick PCOS Symptoms Checklist to help you identify what your body might be trying to tell you:

PCOS Symptoms Checklist 

While everyone’s experience looks a little different, here’s a science-backed checklist of the most common PCOS symptoms — you don’t need to have all of them to qualify for a diagnosis.

✅ Menstrual & Ovulation Changes

• Irregular periods (less than 8 per year)
• Missed or absent periods (amenorrhea)
• Heavy or prolonged bleeding
• Difficulty predicting ovulation or tracking fertile windows
  

✅ Hormonal Symptoms

• Acne (especially jawline/chin)
• Oily skin
• Hair loss or thinning on the scalp (androgenic alopecia)
• Unwanted hair growth on the face, chest, or abdomen (hirsutism)
  

✅ Metabolic Signs

• Unexplained weight gain or difficulty losing weight
• Fatigue, especially after meals
• Sugar or carb cravings
• Skin darkening (acanthosis nigricans) on the neck, armpits, or groin
  

✅ Reproductive Health

• Infertility or trouble conceiving
• Irregular or absent ovulation
• Polycystic ovaries on ultrasound (12+ immature follicles)
  

✅ Gut & Inflammatory Symptoms

• Bloating, constipation, or IBS-like symptoms
• Brain fog
• Chronic low energy
• Increased inflammation markers on labs (CRP, IL-6)
  

Note: PCOS is diagnosed using the Rotterdam Criteria (2) — you need at least two of three:
1️⃣ Irregular or absent periods or menstrual cycle
2️⃣ Elevated androgens – usually testosterone or androgens (on labs or physical symptoms)
3️⃣ Polycystic ovaries on ultrasound

If you’re checking several boxes here, it’s worth connecting with a provider who specializes in PCOS to confirm your diagnosis and create a personalized plan.

Let’s break down what the research says about the real drivers of PCOS symptoms and what you can do about each one.

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1. High Androgens (Testosterone and DHEA-S)

Elevated androgens which are usually mostly testosterone are one of the hallmark features of PCOS — and they’re a key reason why you might experience acne, hair thinning, excess hair growth (hirsutism), and irregular menstrual cycle.

Androgens like testosterone interfere with ovulation, which is why many people with PCOS have cycles that are long, irregular, or even absent. When ovulation doesn’t occur, egg follicles remain immature, forming the “cysts” that give PCOS its name.

Research has consistently shown that women with PCOS have higher serum testosterone or DHEA-S levels, which are strongly linked to menstrual irregularity and acne (1, 2).

It’s important to note that some people like to talk about “adrenal PCOS,” which isn’t an actual clinical term. However, PCOS that’s driven more by DHEAs is more associated with your adrenal system, because DHEA is an adrenal hormone. This means this type of PCOS is more driven by anxiety and stress than other types, and you’ll need to focus more on stress management.

How to lower testosterone with PCOS 

This could be its own blog post but in short, this is how my clients lower testosterone to literally balance hormones with PCOS: 

• Drink spearmint tea 2x/day or consider a supplement (3) 
• Eat soy and/or flax every day (4)
• Get at least 150 minutes of vigorous physical activity and 30-45 mins of strength training weekly (6)
• Get enough vitamin D (5) and zinc (7)
• Eat balanced meals with protein, fat and fiber to balance blood sugar 
• Follow a Mediterranean Style Diet (8)

🧠 Reducing androgen levels can help restore ovulation and improve period regularity, skin, and hair health. It can also make it easier to lose weight with PCOS.

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2. Chronic Inflammation

Chronic low-grade inflammation is another core driver of PCOS symptoms. It’s linked to insulin resistance, increased androgen production, fatigue, brain fog, and difficulty losing weight.

Inflammation triggers oxidative stress and can disrupt normal hormone signaling. One study found higher levels of inflammatory markers (like C-reactive protein and interleukin-6) in women with PCOS compared to controls (9).

What drives inflammation:

• Diets high in refined carbohydrates and added sugars
• Processed meats and trans fats
• Chronic stress and poor sleep
• Environmental toxins and endocrine disruptors
  

What helps lower inflammation:

• Eat anti-inflammatory foods like fatty fish, berries, turmeric, olive oil, flaxseed, walnuts, leafy greens, and beans daily. 
• Stress management (yoga, walking, journaling, breathing exercises)
• Consistent sleep schedule
  

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3. Insulin Resistance & Blood Sugar Imbalances

Up to 70% of women with PCOS have insulin resistance (10). When your cells don’t respond properly to insulin, your body produces more of it — and excess insulin stimulates the ovaries to make more testosterone.

Insulin resistance drives these PCOS symptoms:

• Weight gain (especially around the midsection)
  Fatigue and energy crashes
  Cravings for carbs and sweets
  Difficulty losing weight
  

How to improve insulin sensitivity:

• Eat balanced meals with protein + fiber + healthy fat
• Include plant-based proteins like beans, tofu, and lentils
• Engage in resistance training and daily movement
• Avoid skipping meals to prevent blood sugar dips
  

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4. Gut Health Imbalances

Your gut plays a major role in hormone regulation, inflammation, and metabolism — and emerging research shows people with PCOS have different gut microbiota than those without (11).

An imbalanced gut can worsen insulin resistance, inflammation, and androgen excess. Common signs include bloating, constipation, and fatigue.

What supports gut health:

• Fiber-rich foods (beans, oats, chia, flax, fruits, vegetables)
• Probiotics (yogurt, kefir, sauerkraut, kimchi)
• Prebiotics (garlic, onions, asparagus, bananas)
  

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5. Endocrine Disrupting Chemicals (EDCs)

EDCs are chemicals found in plastics, cosmetics, cleaning products, and even receipts — and they can mimic or block hormones in your body. Studies have linked EDC exposure (like BPA and phthalates) to insulin resistance, inflammation, and higher androgen levels in women with PCOS (11, 12).

How to reduce exposure:

• Use glass or stainless steel instead of plastic
• Avoid heating food in plastic containers
• Choose clean beauty and fragrance-free products
• Wash hands after handling receipts

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6. Lean PCOS (When You Have PCOS but Aren’t Overweight)

Many people assume PCOS only affects those who are overweight — but up to 20–30% of people with PCOS fall into the “lean PCOS” category (13). These individuals have a normal BMI but still experience hallmark PCOS symptoms like irregular periods, acne, or infertility.

Lean PCOS is often misunderstood because insulin resistance can still occur without visible weight gain. Research shows that even lean women with PCOS can have insulin resistance, inflammation, and elevated androgen levels (14, 15). The difference is that their bodies may store fat differently, often more viscerally (around the organs), which doesn’t always show up as a high BMI.

Other common features of Lean PCOS include:

• Irregular or absent ovulation
• Hormonal acne or hirsutism
• Low energy or fatigue despite “normal” labs
• Difficulty gaining muscle
  

💡 What helps:
Even if you’re not trying to lose weight, addressing insulin sensitivity and inflammation is key.

• Prioritize balanced blood sugar meals (protein, fat, fiber)
• Get strength training at least 2–3x/week to improve metabolic health
• Include omega-3s and antioxidant-rich foods daily
• Don’t restrict calories unnecessarily — nourishment > dieting
  

Lean PCOS often requires a more gentle, supportive approach that focuses on hormone balance rather than fat loss.

7. “Silent” or Mild PCOS (When You Have Few or No Symptoms)

Some people meet diagnostic criteria for PCOS but don’t experience many outward symptoms — often referred to as “silent PCOS.” They might only discover it after an ultrasound or fertility testing reveals polycystic ovaries or slightly elevated androgens.

This form of PCOS can be confusing and sometimes leads to under-treatment. Even if symptoms seem mild, underlying imbalances (like subtle inflammation, mild insulin resistance, or hormonal fluctuations) can still impact fertility, metabolic health, and long-term risks (16).

Why it matters:
Even without obvious acne or weight gain, unaddressed hormonal imbalances can raise your risk for irregular cycles, blood sugar issues, and cardiovascular changes later in life.

What to focus on:

• Maintain a balanced, anti-inflammatory diet
• Support gut health and stress management
• Monitor labs annually (androgens, insulin, A1c, lipid panel)
• Work with a practitioner to prevent progression of symptoms
  

You don’t need to wait for symptoms to worsen — early support can help you stay in balance long-term.

The Bottom Line

Your PCOS symptoms aren’t random — they’re signals from your body about deeper imbalances. By addressing root causes like high androgens, inflammation, insulin resistance, gut health, and endocrine disruptors, you can finally start to heal naturally.

Instead of cutting random foods or following restrictive influencer advice, focus on science-backed strategies that target your unique needs.

Next Steps:

If you’re ready to take the next step, get a free copy of my PCOS Fat Loss Kickstarter or book a free nutrition chat to make a plan to treat your PCOS naturally.