What is PCOS, and where does food fit in?

Just been told you have "polycystic ovaries"? You probably have a lot of questions. What does it mean? Is it dangerous? Does food have anything to do with it? Here's a clear picture, without scaring you and without promising miracles. It doesn't replace a visit to your doctor. It's here to help you walk into that appointment better prepared.

PCOS in plain language

Polycystic ovary syndrome (PCOS) is a hormonal condition, not just something that happens in the ovaries. The name is a bit misleading: many people with PCOS don't have "cysts" in the usual sense on an ultrasound, and seeing several follicles on a scan doesn't mean you have PCOS on its own.

Your doctor makes the diagnosis, usually by looking at a mix of signs like these:

• Irregular or infrequent periods
• Signs of higher levels of "male" hormones, such as extra hair growth, stubborn acne or hair thinning
• A typical appearance of the ovaries on an ultrasound

Your doctor will also rule out other things that can look similar, like thyroid problems. That's why diagnosing yourself from the internet, or from a friend's experience, isn't a good idea.

Why does food matter in PCOS?

In many people with PCOS, the body responds less well than usual to insulin. This is called insulin resistance. When cells don't respond well to insulin, the body makes more of it, and that extra insulin can affect the balance of other hormones too.

That's where food comes in. What you eat, how big your meals are and how regularly you eat all directly affect blood sugar and insulin. That's why clinical guidelines treat lifestyle (food, physical activity and sleep) as one of the foundations of PCOS care, whether or not you carry extra weight.

The important bit: a meal plan doesn't replace medical treatment. Sometimes medication is needed, and that's your doctor's decision. A good meal plan works alongside treatment and supports your body.

Does a PCOS meal plan mean going hungry?

No. A common mistake is hearing "PCOS" and jumping straight to very strict plans: cutting out bread and rice completely, long fasts, or the latest fad. They rarely last, and after a few weeks, exhaustion and overeating tend to take over.

What helps most is usually simpler:

• Regular meals instead of skipping meals and making up for it later
• Better-quality carbohydrates, like wholegrain bread and legumes, instead of cutting carbs out completely
• Protein and vegetables at every meal so you stay full for longer
• Fewer sugary drinks and less ultra-processed food

If you carry extra weight, even a small, gradual loss may help your symptoms. But it's not only about the number on the scale: your daily energy, how regular your periods are and how you feel overall matter too.

Why a ready-made plan doesn't work for everyone

PCOS looks different in every person. One person struggles with irregular periods, another with acne and extra hair, and a third mostly with tiredness and sugar cravings. Your age, your weight, the medication you take, your work and sleep hours, and even the foods you love all affect which plan is realistic for you.

That's why at Rejimist the doctor writes your meal plan from your own questionnaire, and asks for lab tests if they think you need them. Then the daily check-in shows where you're getting stuck, so the plan can fit your real life.

When should you definitely see a doctor?

• If you haven't had a period for several months, or your bleeding is very heavy or long
• If your symptoms suddenly get much worse
• If you're planning a pregnancy or you're pregnant
• If you take medication and want to change how you eat

In these situations, talk to your doctor before making any big change to your food.

The short version

PCOS is common, it's manageable, and it's less scary than you may have heard. Food is one of the important tools for managing it, as long as it's realistic, sustainable and fits you. In the next two pieces we'll look at insulin resistance and the "PCOS plate", and at walking and sleep. To learn why weight loss can feel harder with PCOS, read this article.

Sources

• Teede HJ, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Journal of Clinical Endocrinology & Metabolism, 2023.
• American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstetrics & Gynecology, 2018.
• Moran LJ, et al. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews, 2011.