Modern Metabolic Health with Dr. Lindsay Ogle, MD

A Doctor’s Guide To PCOS: Symptoms, Diagnosis & Treatment Options

• Lindsay Ogle, MD

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PCOS isn’t just a “hormone problem.” It’s a metabolic condition with real-world effects on cycles, skin, hair, weight, and fertility—yet it shows up differently for every woman. We dig into how genetics, lifestyle, and environmental triggers intersect, then explain the exact diagnostic criteria without the confusion that birth control can add. From there, we map practical pathways that meet you where you are, whether your top goal is clear skin, regular periods, weight stability, or getting pregnant.

We break down the two-of-three rule for confirming PCOS and translate androgen signs like jawline acne, chin hairs, and hair thinning into plain language. Treatment gets specific: combined hormonal contraceptives for hormone balance when pregnancy isn’t the goal, spironolactone for acne and hirsutism with safety guardrails, and topical minoxidil 5% for hair loss with simple, effective application tips. On the metabolic front, we compare metformin and inositol, highlighting how each supports insulin sensitivity, weight management, and more predictable cycles, and where fertility-focused therapy may need to layer in ovulation agents, IUI, or IVF.

You’ll also get a realistic lifestyle framework that actually fits a busy life: fewer added sugars, high fiber and protein at meals, cutting habitual snacking in favor of three satisfying meals, and adding consistent movement to improve insulin resistance. I share my own PCOS journey to show how small changes compound over time and how medical tools can complement those habits to calm symptoms and restore confidence. Subscribe, share this episode with someone who needs a straight guide to PCOS, and leave a review so more people can find trustworthy metabolic health advice.

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Dr. Lindsay Ogle:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board certified family medicine and obesity medicine physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. Hello and welcome back. We are going to be talking about a common metabolic condition for women of reproductive age. PCOS, polycystic ovarian syndrome. This is super common in women of reproductive age. It actually occurs in approximately 5 to 10% of women. This is a multifactorial condition that has variable presentation from person to person. So what that means is it can look different in everybody. And it has a lot of different underlying causes. So it's not just one thing that triggers PCOS, it's multifactorial. And the treatment options are just as variable as the condition itself. So of course, with everything here, this is general general medical knowledge, not direct medical advice. Please talk to your doctor about your specific concerns and to get the most precise and individualized treatment plan that is best for you. So we'll start with what is the underlying cause of PCOS. There's a genetic component, there is a lifestyle component, and there is environmental triggers that we do not fully understand. So most people they have some sort of genetic predisposition to this condition, and then there may have been something that they encountered through in their life, whether that's a certain virus or a chemical in the environment, an environmental factor like a pollen that triggers their genes to kind of wake up and turn on this condition. Lifestyle factors that can contribute are inactivity, a poor diet, so a lot of processed foods, a lot of refined carbohydrates, and inactivity. Stress can also be a factor here as well. Symptoms that somebody with PCOS will have would be irregular menstrual cycles. There are often hormonal acne, so acne that occurs along the jawline or the chin, thick, dark hairs in this area as well, and then thinning of the hair on either side of like the temporal region. Weight gain or difficulty losing weight, and then difficulty conceiving or having infertility or fertility issues. And then if someone gets an ultrasound, then there's often several cysts around each ovary. And that kind of takes us to the diagnostic criteria. So you need two out of three criteria to make the diagnosis of PCOS polycystic ovarian syndrome. One is the irregular menstrual cycles. Now, this can be difficult to identify if somebody is on birth control. So if you're on birth control, then we can't really make this diagnostic criteria because oftentimes the birth control can mask irregular menstrual cycles. The second is either getting a blood test that shows elevated testosterone levels, or you have evidence of elevated testosterone, which are which is that hormonal acne, the chin hairs, and then the thinning of the hair on the top of the head. And then last is that ultrasound, a transvaginal ultrasound that looks at the ovaries and sees those cysts around the ovaries. So you need two out of three to make that diagnosis of PCOS. And like I said earlier, I really want to highlight that every woman presents differently with PCOS. So some may have all of these criteria, all these symptoms, some may just have two of the criteria and a few of the symptoms, and they may not be very symptomatic. It is highly variable. Now the treatment options can vary as well, and it depends on patient preference. So classically, it's recommended to treat whatever symptoms are bothersome to that person or that patient. So if you're having acne, we have plenty of acne treatments that are very effective in PCOS, and the typical acne treatments can be helpful in women who have PCOS. We can also use hormonal birth control, which can help regulate the hormones and can help with the acne. It can also help regulate those irregular periods if those are bothersome to the patient. But of course, if someone is trying to conceive, trying to get pregnant, then they should not be on birth control because that will go against their desires there. Sometimes we use a medication called sporonolactone, and this helps to indirectly even out the masculine hormones with the feminine hormones. And this can indirectly help with that hormonal acne in the chin hairs and the thinning on the scalp. It's really important that this, since this does indirectly affect hormones, this is something that women should not be taking if they are if they have a chance to become pregnant. So you want to be on birth control to be taking this medication because it could affect the fetus. This is also a mild diuretic, and so some people get a little bit dehydrated on it to where they feel like lightheaded, especially from sit it when from seating to standing. You should also have your electrolytes checked at least once after starting this medication because some people have an elevated potassium after starting it. Other treatments for the hair loss, we can use topical monoxidil or generic rogain. This you can get over the counter. I always recommend my female patients to get the version that is branded for men because it's a higher strength, it's 5%, and there's no reason that women can't take this, and so you're getting more for your money because the women's version is usually more expensive and has a lower percentage at 3%. So you want to get the generic monoxidil, the generic rogain, 5%, the one that is for men. You can use this, and you can use it one to two times a day in the area of thinning of the hair. Just make sure that it doesn't drip down the side of your face because you will have hair growth in that area wherever the medicine touches. Metformin is often used because, as I mentioned in the beginning, this is a metabolic condition. This is related to insulin resistance. So metformin can help that insulin resistance. The metformin can help with weight management and it can indirectly help with the other symptoms of PCOS. We have seen that it can for some women help with fertility, but it is not a specific fertility treatment. We do have other treatments for fertility that can be used. There are oral options, and then of course there is IUI, IVF, all of those fertility-specific treatments that you can talk with your doctor about if it is appropriate for you and your goals. There is a supplement called inocitol that can be used as well, and it has been shown to be similarly effective as metformin. So if you are wanting to avoid prescription medications but want to try a supplement, inocitol is what I would recommend. And then lifestyle optimization, something I'm always a proponent of. Recommendations for PCOS are to reduce added sugars, specifically in any sugar and sweetened beverages that you may be consuming, limiting your processed carbohydrates, your white breads and pastries and chips and those sorts of things, and focusing on a high protein, high fiber diet with lots of vegetables will be really beneficial for your PCOS. Some women respond well to intermittent fasting. It's not a requirement. I do tend to recommend at least sticking to three meals per day rather than snacking throughout the day. Usually women do better with a little bit of breaks in between their meals, and you don't necessarily have to do like a full-day fast or anything like that. You can get really great benefits just by cutting out snacking. Again, PCOS is a metabolic condition and it's very common. I myself have PCOS. I was diagnosed several years ago, and even before that, I had suspicions that it was a condition that I have. I've tried lots of different treatments, including oral birth control pills, a spironolactone. I have not tried metformin, although I'm pretty interested in trying it at some point, and I have not tried inocitol, another thing that I am pretty interested in trying. Tried a lot of acne treatments and have had good success with those. And for me, cutting out snacking was huge. I responded very well to that. I did a lot of snacking in college, and once I cut that out, I lost several pounds, and my symptoms definitely improved. I exercise on a very regular basis. And so a lot of these symptoms can be controlled with lifestyle optimization, those things that I mentioned before, but we have medications to use in addition to help with any lingering symptoms that you have. So if you have PCOS, please know that you're not alone. And we have options for you. We can tailor the treatment to you. If you live in Missouri, I would love to help you. If you don't live in Missouri, then definitely follow my channel. I will continue to provide additional videos every Monday with education on how to improve your metabolic health. And I look forward to seeing you next week. Take care. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.