At Capital Women’s Care, we believe patients deserve to understand what’s happening in their bodies—not just to treat symptoms, but to feel empowered and informed. Polycystic Ovary Syndrome, or PCOS, can be a confusing and frustrating diagnosis. It affects hormones, metabolism, and menstrual cycles—and it can look different in each person. Some patients come in because they’re not having regular periods. Others are concerned about skin changes, unwanted hair growth, or difficulty becoming pregnant. Some are diagnosed after years of wondering why they’ve always struggled with weight or irregular cycles. Whatever path brings you here, our goal is to help you make sense of the condition and find a plan that fits your life.
PCOS Starts with a Hormonal Imbalance—But It Doesn’t End There
While we often think of PCOS as a “hormone problem,” it’s more accurate to think of it as a whole-body condition—one that affects how your body processes energy, regulates your hormones, and responds to signals between the brain, ovaries, and other organs.
At the center of PCOS is something called insulin resistance. Insulin is a hormone that helps your body move sugar out of the blood and into your cells for energy. When your cells don’t respond to insulin the way they should, your body compensates by making more of it. That excess insulin has ripple effects throughout your system.
High insulin levels can tell the ovaries to produce more androgens (male-pattern hormones like testosterone). They can also reduce a protein called SHBG (sex hormone-binding globulin), which normally keeps androgens in check. As a result, you may have more free testosterone, which can cause acne, unwanted hair growth on the face or body, and sometimes scalp hair thinning.
At the same time, insulin resistance tends to promote weight gain around the midsection, which itself makes insulin resistance worse. This becomes a cycle that feeds on itself—more insulin, more androgen, more weight gain, more hormonal disruption.
How Does This Affect the Menstrual Cycle?
Your menstrual cycle depends on a delicate balance of signals between your brain (specifically, the hypothalamus and pituitary gland) and your ovaries. Every month, the brain sends hormones that tell the ovary to grow a follicle and release an egg—this is ovulation. After ovulation, another hormone called progesterone is produced. If no pregnancy occurs, progesterone drops, and your period begins.
In PCOS, the hormonal feedback loops get disrupted. The extra androgens and estrogen (from both the ovaries and fat tissue) send confusing signals back to the brain, which can interfere with ovulation. Without ovulation, there’s no progesterone. Without progesterone, the endometrium (lining of the uterus) continues to build up under the influence of estrogen, often for weeks or months at a time. This can lead to infrequent or very heavy periods—and over time, can increase the risk of endometrial hyperplasia, or thickening of the uterine lining, which we take seriously.
For this reason, even if you’re not trying to become pregnant, it’s important that you have some way of protecting the uterus, either by triggering regular bleeding (with hormonal medication) or by using treatments that keep the lining thin and healthy.
What Else Does PCOS Affect?
Because insulin resistance is at the core, PCOS can increase your risk over time for medical conditions like:
- Type 2 diabetes or prediabetes
- High cholesterol or triglycerides
- High blood pressure
- Sleep apnea, especially in those with central weight gain
- Non-alcoholic fatty liver disease
- Possibly long-term cardiovascular disease
This doesn’t mean these problems are inevitable, but it does mean we want to monitor for them and work on prevention. Depending on your situation, we may recommend screening labs or coordinate with your primary care provider for long-term follow-up.
Diagnosing PCOS: No Single Test, No One-Size-Fits-All
There is no single blood test or ultrasound that diagnoses PCOS. We make the diagnosis based on patterns—irregular ovulation, signs of excess androgen, and sometimes a particular appearance of the ovaries on ultrasound. At the same time, we rule out other conditions that can mimic PCOS, like thyroid disorders or elevated prolactin.
We may order lab tests to look at hormone levels (like testosterone or DHEAS), and we often check markers of metabolic health, like blood sugar (glucose, A1c), cholesterol, and sometimes insulin levels. Imaging studies like pelvic ultrasounds can be helpful, but they are not always necessary. And importantly, in adolescents or very young adults, we often choose not to give the PCOS label—even if some signs are present—because their reproductive systems are still maturing, and we want to avoid premature or unnecessary labeling.
How is PCOS Treated?
The best treatment for PCOS depends on your goals. Are you mostly concerned about irregular bleeding? Acne or unwanted hair? Hoping to become pregnant? Looking to reduce long-term health risks? Often, we’re working on several of these at once.
For those not trying to conceive, we often use hormonal contraception (such as the pill, patch, ring, or hormonal IUD) to regulate periods, lower androgen levels, and protect the uterine lining. These options are safe for most patients and offer multiple benefits beyond contraception.
For those hoping to become pregnant, restoring ovulation becomes the goal. That may involve weight loss, improved exercise and nutrition, and sometimes medications like metformin, which improves insulin sensitivity and may help regulate cycles. When it’s time to actively pursue pregnancy, medications like letrozole (used to stimulate ovulation) can be very effective, and we can help guide you or refer you to fertility specialists if needed.
For skin-related symptoms like acne or hirsutism, hormonal treatments may take several months to show results. In some cases, we also prescribe spironolactone, which blocks androgen effects, though it requires appropriate monitoring and cannot be used during pregnancy.
Many patients benefit from metformin even outside of pregnancy planning. It can improve cycle regularity, reduce insulin levels, and support weight management. We often prescribe it as a first step when there’s clear evidence of insulin resistance.
Finally, lifestyle changes—such as regular physical activity, more balanced nutrition, better sleep, and stress reduction—are foundational. That said, we recognize that these aren’t always easy, and we try to approach these conversations with compassion, not judgment. Even small improvements can make a big difference, and we’ll support you in finding what’s realistic for you.
What’s the Outlook?
PCOS is a lifelong condition, but it’s also highly manageable. You are not broken. This is not your fault. And you are not alone. With the right care and support, most patients with PCOS are able to manage their symptoms, achieve healthy pregnancies if desired, and reduce their long-term risks. Our role is to help you understand your body, make informed decisions, and feel confident in your care.
📞 If you have questions or want to talk about your treatment options, please call us: (301) 681-9101
