PCOS – Far More Than a Gynaecological Condition
Irregular periods, acne, excess hair growth, weight gain that defies your best efforts, thinning hair on your head, and difficulty conceiving. If you have been diagnosed with PCOS – or suspect you might have it – you are not alone. Polycystic Ovary Syndrome affects 8-13% of women of reproductive age, making it one of the most common hormonal conditions. Yet it remains poorly understood and often poorly managed.
At our practice in Zürich Seefeld, I approach PCOS as a metabolic and hormonal condition that extends far beyond the ovaries. Effective management requires addressing the root drivers, not just prescribing the contraceptive pill.
What Is PCOS?
PCOS is diagnosed when two of three criteria are met (Rotterdam criteria): irregular or absent ovulation, clinical or biochemical signs of excess androgens (acne, hirsutism, elevated testosterone), and polycystic ovarian morphology on ultrasound. Importantly, you do not need cysts on your ovaries to have PCOS, and having cysts does not automatically mean you have it.
The Four Types of PCOS
Insulin-resistant PCOS: The most common type (around 70% of cases). Elevated insulin drives the ovaries to produce excess androgens. Often accompanied by weight gain, acanthosis nigricans (dark skin patches), and sugar cravings.
Inflammatory PCOS: Chronic inflammation drives androgen production without significant insulin resistance. Often associated with gut dysfunction, food sensitivities, and environmental triggers.
Post-pill PCOS: Temporary androgen rebound and cycle irregularity after stopping hormonal contraception. Usually resolves within 6-12 months but can be distressing.
Adrenal PCOS: Elevated DHEA-S from the adrenal glands rather than ovarian androgens. Often stress-driven and responds to adrenal support strategies.
Why PCOS Matters Beyond Fertility
PCOS significantly increases the risk of type 2 diabetes, cardiovascular disease, endometrial hyperplasia, non-alcoholic fatty liver disease, and mental health conditions (anxiety, depression, eating disorders). It is fundamentally a metabolic condition, and long-term health management is essential regardless of whether fertility is a concern.
Our Diagnostic Approach
I perform comprehensive testing: testosterone (total and free), DHEA-S, SHBG, androstenedione, LH, FSH (and the LH:FSH ratio), fasting glucose and insulin (calculating HOMA-IR for insulin resistance), HbA1c, lipid panel, thyroid function, vitamin D, AMH, and pelvic ultrasound. This detailed assessment identifies which type of PCOS you have and guides targeted treatment.
What We Do: Root-Cause PCOS Management
Address insulin resistance: This is the cornerstone for most PCOS patients. Dietary changes (reducing refined carbohydrates, increasing protein and healthy fats), regular exercise (particularly resistance training), and supplements like inositol (myo-inositol and D-chiro-inositol in a 40:1 ratio), berberine, and chromium.
Reduce androgen excess: Spearmint tea, saw palmetto, zinc, and DIM can help lower androgens naturally. Spironolactone may be considered for persistent hirsutism or acne.
Support ovulation: Inositol, vitamin D, NAC, and vitex can support regular ovulation. When fertility is the goal, I coordinate with reproductive specialists when needed.
Manage inflammation: Omega-3 fatty acids, curcumin, gut health optimisation, and identifying food triggers for inflammatory PCOS.
Address adrenal PCOS: Stress management, adaptogens, and lifestyle modifications for adrenal-driven androgen excess.
Mental health support: Acknowledging the emotional burden of PCOS and providing or referring for appropriate psychological support.
Conclusion
PCOS is a complex condition that requires more than a pill prescription. By identifying your specific type and addressing the root drivers – whether insulin resistance, inflammation, or adrenal dysfunction – significant improvement is achievable. If you have PCOS or suspect you might, I welcome you to our practice in Zürich Seefeld for a comprehensive, personalised evaluation.
