How to PCOS: What exactly is it? Symptoms, Diagnosis & Treatment Explained
- Dr Natalie Hutchins
- Mar 3
- 3 min read
Episode Introduction
Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions affecting women of reproductive age, and one of the most misunderstood.
It is often reduced to irregular periods and “cysts on the ovaries.” In reality, PCOS is a complex, lifelong metabolic and hormonal syndrome that can affect ovulation, skin, weight regulation, insulin sensitivity, mood, fertility, cardiovascular risk and long-term health.
It does not look the same in every woman.It is not just a reproductive diagnosis. And it cannot be managed with a one-size-fits-all approach.
In this episode of The Woman’s Handbook: How to Be a Woman, I’m joined by Dr Bassel Wattar, Associate Professor in Reproductive Medicine and PCOS researcher, to unpack what PCOS actually is, how it is diagnosed, what drives it biologically, and how treatment should evolve across the life course.
If you have PCOS, or suspect you might, this episode will help you understand your body more clearly and advocate for more personalised care.
Guest Bio
Dr Basile Watter is an Associate Professor in Reproductive Medicine and an expert in polycystic ovary syndrome (PCOS).
His clinical and research work focuses on reproductive endocrinology, metabolic health, fertility optimisation, and long-term health outcomes in women with PCOS.
He is actively involved in shaping research priorities and advancing a more holistic model of care that recognises PCOS as a whole-body endocrine condition rather than simply a reproductive diagnosis.
What We Will Cover
00:00 – PCOS: common, complex and frequently misunderstood
• Why PCOS affects up to 1 in 10 women • Why care is often fragmented • The need for holistic management
03:00 – How PCOS is diagnosed
• The Rotterdam “2 out of 3” criteria • Irregular ovulation explained • Hyperandrogenism (acne, hirsutism, raised testosterone) • Why the “cysts” are not true cysts
06:30 – PCOS is not one disease: understanding phenotypes
• Lean vs overweight presentations • Why symptoms vary dramatically • Emerging research into epigenetics
11:00 – PCOS in teenagers
• The immature brain–ovary axis
• Why diagnosis is difficult in adolescence
• Avoiding both over- and under-diagnosis
15:45 – Insulin resistance & metabolic inflexibility
• Why weight gain can feel disproportionate
• How insulin and androgens interact
• The vicious metabolic cycle in PCOS
19:30 – PCOS beyond fertility
• Type 2 diabetes risk
• Endometrial hyperplasia and cancer risk
• Sleep apnoea (independent of weight)
• Depression, anxiety and disordered eating
26:00 – Lifestyle treatment for PCOS
• Low glycaemic approaches
• Intermittent fasting and ketogenic strategies
• Weight loss vs metabolic maintenance
32:00 – Metformin & GLP-1 agonists
• Insulin sensitisation and ovulation
• GLP-1s as short-term catalysts
• Muscle mass considerations
• Pregnancy safety and washout periods
41:00 – Supplements in PCOS
• Inositol: what the evidence shows
• Vitamin D deficiency
• Cost, regulation and realistic expectations
45:00 – The pill and PCOS
• Endometrial protection
• Anti-androgenic formulations
• Mental health considerations
• Why PCOS cannot be diagnosed while on the pill
53:00 – Social media myths
• “Post-pill syndrome”
• Does birth control cause PCOS?
• Masking vs treating symptoms
01:04:00 – Renaming PCOS & the future of research
• Why the name is misleading
• Recognising PCOS as a polymetabolic endocrine syndrome
• Listening to women to shape research priorities
What You Will Learn
What actually causes PCOS?
How is PCOS diagnosed?
Can you have PCOS if you are slim?
What does insulin resistance really mean?
Does PCOS increase the risk of diabetes or heart disease?
Is the pill a treatment or just a temporary fix?
Can birth control cause PCOS?
Do GLP-1 injections help PCOS?
Is inositol evidence-based?
Does PCOS go away after menopause?
Key Takeaways
PCOS is not just about your ovaries. It is a lifelong endocrine and metabolic condition that affects multiple systems in the body.
Treatment must be individualised. The pill, metformin, lifestyle medicine, GLP-1s and anti-androgens all have roles but not for every woman.
Insulin resistance sits at the centre of many PCOS symptoms. Addressing metabolic health changes outcomes far beyond fertility.
Your PCOS will evolve across your life stages. Your treatment plan should evolve with it.
Further Resources
World Health Organization – Women’s health and non-communicable disease guidance
Endocrine Society – Clinical practice guidelines
International PCOS Network – Evidence-based PCOS guidelines
American College of Obstetricians and Gynecologists – Patient education materials
Verity – Patient support community
