PCOS: Understanding the Root Cause, Lifestyle Solutions, and How Bioidentical Hormones Can Help
If you’ve been told you have PCOS — Polycystic Ovary Syndrome — and left feeling overwhelmed or hopeless, you’re not alone.
The truth is, PCOS isn’t just about irregular periods or "having cysts." It's a metabolic and hormonal imbalance that needs to be treated at the root — not just masked with birth control pills or band-aid solutions.
Let’s talk about what’s really happening with PCOS, and how you can partner with your body to heal.
What Is PCOS, Really?
PCOS is not a simple ovarian disease. It’s a complex metabolic and endocrine disorder rooted in:
Insulin resistance (blood sugar dysfunction)
Androgen excess (elevated testosterone and DHEA)
Chronic low-grade inflammation
Ovulatory dysfunction
Imagine your body's hormone system as a symphony. With PCOS, the insulin, testosterone, and estrogen sections are all out of tune, throwing off the entire performance.
What Causes PCOS?
PCOS has multiple root drivers — often overlapping — including:
Genetic predisposition
Dietary factors (high sugar, processed foods)
Environmental endocrine disruptors (toxins that mess with hormones)
Chronic stress (raising cortisol and worsening insulin resistance)
It’s important to remember: PCOS is not your fault. But your daily choices can significantly influence how PCOS shows up in your life.
Lifestyle Changes: The Foundation of Healing
Nutrition That Honors Your Hormones
Low-glycemic, anti-inflammatory diet focused on whole foods.
Prioritize healthy fats (avocado, olive oil), high-quality proteins, and fiber-rich vegetables.
Limit sugar, refined carbs, and inflammatory oils.
Food is medicine. Consistent, balanced eating restores insulin sensitivity and calms androgen production.
Resistance Training and Movement
Strength training 2–4 times per week improves muscle mass and reverses insulin resistance.
Daily movement (walking, stretching, yoga) reduces cortisol and supports metabolic health.
You don’t need endless cardio. You need smart, regular movement.
Stress Management and Sleep Hygiene
Chronic stress raises insulin and cortisol, worsening PCOS symptoms.
Prioritize 7–9 hours of sleep, mindfulness practices, and scheduled downtime.
Healing your nervous system heals your hormones.
Supplements Backed by Science
I recommend targeted, evidence-based supplementation to correct deficiencies and support physiology:
Myo-Inositol and D-Chiro Inositol: Improve insulin sensitivity and ovulation.
Magnesium Glycinate: Reduces inflammation, supports glucose control.
Omega-3 Fatty Acids: Lower inflammation and balance hormones.
Vitamin D3 with K2: Critical for insulin function and hormone health.
N-Acetyl Cysteine (NAC): Improves insulin resistance and reduces oxidative stress.
Supplements should support your body's design, not override it.
Bioidentical Hormone Replacement Therapy (HRT) and PCOS
While lifestyle is foundational, bioidentical hormones can play an essential role for certain PCOS cases — especially when restoring normal ovulatory cycles and protecting long-term health.
In my practice, I use physiologic dosing of bioidentical hormones — matching the body’s natural rhythms — which can restore balance without the risks of synthetic medications.
For PCOS patients, HRT options might include:
Bioidentical Progesterone: Helps regulate cycles, lowers androgens, improves mood and sleep.
Insulin Sensitizers: Metformin can be used strategically if lifestyle and supplements aren’t enough.
GLP-1 Agonists (like semaglutide, tirzepatide): These newer medications mimic natural gut hormones that improve insulin sensitivity, lower appetite, and support healthy weight loss. In some women with PCOS, particularly those struggling with severe insulin resistance or obesity, GLP-1 therapies can be a valuable tool alongside lifestyle changes. They should be used strategically and temporarily, with the ultimate goal of teaching the body to maintain health naturally — not as a permanent crutch.
The goal is hormonal optimization, not suppression.
Birth control pills, often prescribed for PCOS, do not fix the root cause — they merely mask symptoms while allowing metabolic dysfunction to worsen underneath.
The philosophy is simple: support the body to function the way it was designed to function.
Hi, I’m Emily Koska, your women’s hormone expert based in Fargo, ND.
I’m passionate about helping women feel like themselves again.
As a nurse practitioner, mom, and fellow woman in the thick of midlife, I know what it feels like to be dismissed or told 'everything looks normal' when nothing feels normal. That’s why I created The Hormone Hangout Blog —to help women advocate for the care, answers, and support they deserve.
With love,
Emily
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