Female hormonal imbalances are the root cause of numerous gynecological and endocrine pathologies whose prevalence is constantly rising in France and worldwide. But among all the diseases associated with female imbalances, one stands out as the most common and under-diagnosed. Polycystic Ovary Syndrome, or PCOS, affects between 8 and 13% of women of childbearing age according to World Health Organization estimates, with over 70% of cases estimated to be undiagnosed.
PCOS is a complex pathology whose clinical manifestations vary extremely from one woman to another, which partly explains the often long and painful diagnostic delays that many patients experience. Irregular or absent cycles, persistent hormonal acne, excessive hair growth, unexplained weight gain, chronic fatigue, and difficulty conceiving are all symptoms that can be associated with PCOS but are regularly attributed to other causes by healthcare professionals who do not immediately consider this pathology.
What makes PCOS particularly complex is that it is not solely a gynecological disease. It is a comprehensive metabolic and endocrine syndrome whose consequences go far beyond the reproductive sphere to impact cardiovascular health, glucose metabolism, and the long-term risk of type 2 diabetes.
What is Polycystic Ovary Syndrome or PCOS?
Polycystic Ovary Syndrome is the most common endocrine pathology in women of childbearing age. Despite its significant prevalence, affecting between 8 and 13% of women of childbearing age, PCOS remains one of the most misunderstood and under-diagnosed gynecological pathologies in modern medicine, with diagnostic delays that can reach several years after the appearance of the first symptoms.
Contrary to what its name suggests, PCOS is not only a disease of the ovaries. It is a complex metabolic and endocrine syndrome whose central mechanism is a disruption of the hypothalamic-pituitary-ovarian axis, which leads to excessive androgen production by the ovaries. This hyperandrogenism is the common thread connecting all the clinical manifestations of PCOS and explains the diversity of symptoms that patients present.
The diagnosis of PCOS is based on the Rotterdam criteria, established in 2003 and still used in 2026. These criteria define PCOS by the presence of at least two of the following three elements: Oligo-anovulation, characterized by irregular or absent menstrual cycles; clinical hyperandrogenism, such as acne or hirsutism, or biological hyperandrogenism documented by a blood test; and polycystic ovarian morphology visible on ultrasound, with the presence of at least 20 follicles per ovary or an ovarian volume greater than 10 ml.
The pathophysiological mechanisms of PCOS are multiple and interconnected. Insulin resistance is present in 50 to 70% of women with PCOS, regardless of their body mass index. This insulin resistance stimulates androgen production by the theca cells of the ovaries and reduces SHBG production by the liver, which increases the availability of free androgens in the tissues. Low-grade chronic inflammation is a second documented mechanism that worsens insulin resistance and disrupts normal folliculogenesis. Finally, the imbalance of the LH/FSH axis, with an elevated LH/FSH ratio, disrupts follicular maturation and prevents normal ovulation.
The long-term consequences of unmanaged PCOS extend beyond the gynecological and reproductive sphere. An increased risk of type 2 diabetes, higher cardiovascular risk, an increased risk of metabolic syndrome, and an association with mood disorders like anxiety and depression are all documented comorbidities that make PCOS a systemic pathology requiring comprehensive management.
What are the symptoms of PCOS?
The symptoms of PCOS vary extremely from one woman to another, which explains the often long diagnostic delays and the difficulty many patients face in identifying their condition. Here are the most common clinical manifestations.
Menstrual cycle irregularities
The first and most common symptom is menstrual cycle irregularities. Women with PCOS generally present with long cycles of over 35 days, oligomenorrhea with fewer than eight cycles per year, or amenorrhea with a total absence of periods for several months. These irregularities are directly linked to the chronic anovulation that characterizes PCOS. Without regular ovulation, the menstrual cycle cannot progress normally, and periods become unpredictable, rare, or absent.
Clinical hyperandrogenism
The second symptom is clinical hyperandrogenism, which encompasses all physical manifestations linked to an excess of androgens. Persistent hormonal acne on the chin, cheeks, and neck is often one of the first visible signs of PCOS. Hirsutism, or excessive hair growth on the face, chest, abdomen, and thighs in typically male-pattern areas, is another frequent clinical sign. Androgenetic alopecia, characterized by a progressive thinning of the hair on the crown of the head, can also be associated with marked hyperandrogenism.
Insulin resistance and weight gain
The third symptom is insulin resistance and its metabolic manifestations. Unexplained weight gain, particularly in the abdominal area, difficulty losing weight despite an appropriate diet and regular physical activity, and the presence of acanthosis nigricans—those darker, thickened patches of skin on the neck and in the armpits—are all signs indicating underlying insulin resistance.
Polycystic ovarian morphology
The fourth symptom is only visible on pelvic ultrasound. The presence of numerous small follicles in the periphery of the ovaries, giving a characteristic "string of pearls" appearance, and increased ovarian volume are the ultrasound signs that point to a PCOS diagnosis according to the Rotterdam criteria.
Emotional disorders and chronic fatigue
The fifth symptom involves emotional disorders and chronic fatigue, frequently associated with PCOS but rarely identified as symptoms of the pathology. Anxiety, depression, mood swings, and persistent fatigue that does not resolve with rest are documented manifestations of the hormonal and metabolic imbalance characteristic of PCOS.
How to manage PCOS naturally?
Natural management of PCOS relies on a comprehensive approach that simultaneously addresses insulin resistance, chronic inflammation, and hormonal imbalance, which are the three central mechanisms of this pathology. Here are the best-documented approaches.
The first approach is an anti-inflammatory diet with a low glycemic index. Significantly reducing refined sugars and ultra-processed foods that worsen insulin resistance is the most impactful dietary change for women with PCOS. Prioritizing vegetables, lean proteins, healthy fats, and slow-absorbing complex carbohydrates stabilizes blood sugar and gradually reduces the androgen production stimulated by hyperinsulinemia.
The second approach is regular physical activity. Moderate and regular physical exercise significantly improves insulin sensitivity and reduces circulating androgen levels. Brisk walking, hormonal yoga, swimming, and light strength training are the best-tolerated and most documented activities for improving the metabolic markers of PCOS.
The third approach is targeted supplementation with inositol, whose effectiveness on insulin sensitivity and menstrual cycle regularity is documented in several clinical studies on PCOS. Vitamin D3, magnesium, and zinc complete this basic supplementation.
The fourth approach is probiotic supplementation with Nemi gummies, available at mynemi.com, which directly support the balance of the vaginal flora, often disrupted by the hormonal imbalances of PCOS.
