Treatment for 4 Types of PCOS. Treat the Cause.

4 types of PCOS

I invite you to think differently about polycystic ovary syndrome (PCOS) and the types of PCOS.

PCOS is not one thing. It is not one disease. Instead, PCOS is a set of symptoms, with the key symptom being impaired ovulation which leads to androgen excess or a high level of male hormones. Androgen excess then causes the common PCOS symptoms of hair loss, hirsutism, and acne.

To treat PCOS you must first ask: “Why, in your particular case, do you not ovulate?”

I say “in your particular case” because your reason may be different than someone else’s reason. That’s why there are so many different natural treatments, and that’s why only some will work for you.

👉 Tip: Don’t be too quick to accept a PCOS diagnosis. Read PCOS cannot be diagnosed by ultrasound.

4 Different Types of PCOS

Insulin-resistant PCOS

This is the classic type of PCOS and by far the most common. High insulin and leptin impede ovulation and stimulate the ovaries to make testosterone. Insulin resistance is caused by sugar, smoking, trans fat, and environmental toxins.

Is this you? You have been told that you are borderline diabetic, or you had an abnormal glucose tolerance test. You probably have elevated insulin, and you may also have elevated LH (luteinizing hormone). You are probably overweight, although you may be a normal weight. Normal-weight insulin resistance can occur in the years following dieting or eating disorder.

Treatment ideas: The first step is to quit sugar because high-dose fructose is a major contributor to insulin resistance. Please also consider gentle intermittent fasting, which works well to improve insulin sensitivity. The best supplements for insulin resistance are magnesium, lipoic acid, inositol, and berberine. The pill is not a treatment for this type (or any type) of PCOS because it impairs insulin sensitivity. Improvement for Type 1 PCOS  is slow and gradual over six to nine months. Read How to reverse insulin resistance.

Post-pill PCOS

Hormonal birth control suppresses ovulation. For most women, it’s a temporary effect, and ovulation will usually resume fairly soon after the Pill is stopped. But for some women, ovulation-suppression can persist for months or even years. During that time, it is not unusual to be given the diagnosis of PCOS. Some experts deny the existence of Pill-induced PCOS, but it is very real. It is the second most common type of PCOS that I see. I have spoken to many other clinicians who are seeing the same thing. We desperately need more research into it.

Is this you? You had regular periods before starting the Pill, although you may have had acne. You probably now have elevated LH on a blood test, although you may have normal LH and high-normal prolactin.

Treatment ideas: If your LH is elevated, the best herbal treatment is peony & licorice combination (see my book for more information). If your prolactin is high-normal, then the best herbal treatment is Vitex (also called chaste tree or chaste berry). Do not use Vitex if your LH is elevated. Vitex stimulates LH so it will make things worse. Indeed, many of my PCOS patients report feeling worse on Vitex. See my Vitex post.

Both peony and Vitex work on your pituitary-ovarian axis, and they are powerful herbs. I recommend you do not use them too soon or for too long. Do not take them if you are a teenager, or if you have just come off the Pill. Give yourself at least 3-4 months off the Pill. Do not use Peony or Vitex for more than 10 months in a row. They should not need to be used that way. If they are the right herbs, they will work fairly quickly (within 3-4 months). And then, your periods should stay regular after you stop the herbs. Do not take licorice if you have high blood pressure. Please seek professional advice.

Inflammatory PCOS

Inflammation—or chronic immune activation—results from stress, environmental toxins, intestinal permeability and inflammatory foods like gluten or A1 casein. Inflammation is a problem for PCOS because it impedes ovulation, disrupts hormone receptors, and stimulates adrenal androgens such as DHEA and androstenedione.

Is this you? You have other symptoms of immune dysfunction such as recurring infections, headaches, joint pain or skin conditions. Your blood test shows inflammatory biomarkers such as vitamin D deficiency, abnormal blood count, elevated C-RP, thyroid antibodies, or gluten antibodies. You may have elevated DHEA or androstenedione, and a positive urine test for intestinal permeability.

Treatment ideas. Reduce stress and exposure to environmental toxins like pesticides and plastics. Eliminate inflammatory foods such as wheat, dairy, and sugar. Treat intestinal permeability with zinc, berberine, and probiotics. Supplement magnesium because it is anti-inflammatory and normalizes adrenal hormones (HPA axis). Improvement is slow and gradual over 6-9 months.

Adrenal PCOS

Adrenal PCOS means that you have elevated adrenal androgens such as DHEAS (dehydroepiandrosterone sulfate). You have normal levels of testosterone and you may ovulate regularly. Adrenal PCOS accounts for about 10 percent of PCOS diagnoses.

Is this you? You do not exactly fit the criteria for the first three types of PCOS. You have tried a number of natural PCOS treatments and nothing seems to work. Look deeper.

pcos diagnosis

Know when it’s time to let go of your PCOS Diagnosis.  In most cases, PCOS is not a permanent condition. With the right diagnosis and the right treatment, PCOS can become a thing of the past.

There is some overlap between these four types. For example, inflammation is a major driver in both the insulin-resistant and inflammatory type of PCOS. 

**See the updated 2019 version of this blog post: 4 types of PCOS (a flowchart) **

656 thoughts on “Treatment for 4 Types of PCOS. Treat the Cause.”

  1. Hi Lara, I have just finished reading your book and have already learnt a lot! I am 27 and went off the pill 4 months ago after around 12 years. I am wondering whether I have post-pill PCOS? My LH is 11 and FSH is 8, however I have no other symptoms (very little acne, no facial hair etc). My periods were normal when I went on the pill. My BMI is around 19 so quite small but not quite underweight (I eat a fairly healthy and normal diet). I’d like to try licorice and peony (and maybe magnesium too) but don’t want to be taking something that isn’t right for me. Would love your opinion! Thank you.

  2. Hi Dr Lara,

    What if ones seems to fit into the Adrenal type of PCOS because they have high DHEAS, low cortisol with normal testosterone and free androgens ? What may be the deep investigations they can look at ?

  3. Hi Lara,

    Thank you for all your work, I just read your book last night and have been doing so much research to figure out what my issue is. My naturopath doesn’t think i have PCOS but my gyno says I do based on no periods for 10 months, polycystic ovaries, and acne. I stopped taking birth control in January after 17 years (I started when I was 14, and am now 32). I do not have insulin resistance and have BMI of 21. Can you please advise if you think I have PCOS or possibly functional hypothalamic amenorrhea? is acne a symptom of FHA?

    Tests done 9/14/2020
    fasting insulin: 3.5
    glucose: 86
    estrogen: 64 pg/ml
    LH: 11.9
    FSH 7.7
    TSH: 3.8 ( i started 30 mg armour thyroid 10/5/2020)
    progesterone 2.5 ng/ml

    Any advice would be greatly appreciated.

  4. Know when it’s time to let go of your PCOS Diagnosis. In most cases, PCOS is not a permanent condition. With the right diagnosis and the right treatment, PCOS can become a thing of the past.

    So by stating the above, are you saying that for most women, PCOS can be cured?

  5. Hi, Lara! What does it mean if you have hirsutism (as do other females in my family), but you DO ovulate and have regular healthy cycles? I confirm ovulation by using symptothermal FAM. No fertility issues. Is it still PCOS? That is the label my doctor wants to give it.

  6. This is a wonderful site. I would love to be a guinea pig for trials and to tell you my story as I think that picture would really benefit your research, especially in light of my mother having miscarriages and her hypothyroidism and hirsutism. It’s a complex picture. With myself as well. With high testosterone during adolescence and high libido, hirsutism and irregular periods. After childbirth reduced ability to metabolize glucose and the first symptoms of insulin resistance inflammation, weight gain coupled with adrenal fatigue. Even my teeth looked as if I had reflux problem and my hair was thinning.
    I have had success with Vitex before falling pregnant in terms of regulating period and minimising bloating and PMS. Now I’m perimenopausal I find the licorice peony blends with mag zinc keep my insulin resistance in check along with dietary measures but there are times it gets really bad and I would love to lose weight and have less inflammation. I think dairy exacerbated things and in my DNA test it shows a sensitivity to organophosphates, so I eat biodynamic food. I also have low HCl stomach acid, so need to take enzymes before each meal. Is there a way to make an appointment with you?

  7. Thank you, Lara. But is the marker at all helpful in differentiating between different types of PCOS (so excluding non-PCOS aetiologies)? So can high AMH occur in other types of PCOS, besides the classic type? Thank you.

  8. Hi Lara, if someone diagnosed with PCOS has high AMH would this suggest that they are likely to have classic PCOS, as opposed to say post-pill PCOS? Thank you

    • high AMH doesn’t really help with the diagnostic process. It’s also possible to have hypothalamic amenorrhea (undereating) and have high AMH.

  9. Is 100 percent grapefruit juice with no added sugar good for pcos? I’ve read it’s extremely high in inositol for a small amount. Maybe that’s why people say grapefruit makes them lose weight?? I would rather get inositol from food than take a supplement. Inositol pills made me nauseous.

  10. Hi Lara!
    I feel as though I’m stuck between post-pill PCOS and inflammatory.

    I received a recent PCOS diagnosis due to irregular periods (although I have found most people talk about missing periods, I have been getting more than one per month).

    Over the past 2 years, I have been on and off oral birth control, specifically Lo Loestrin. I also received the Depo shot a 3 years ago, which seemed to be the start of my hormonal issues. I got severe acne, so my dermatologist prescribed spironolactone, which I’ve been on ever since.

    My current blood work on day 4 of my period shows:

    FSH 11.4 (reference range 3.5-12.5 mIU/mL)
    LH 15.4 (reference range 2.4-12.6 mIU/mL)
    Prolactin 11 (reference range 3.3-26.7 ng/mL)
    Progesterone 0.37 (reference range 0.06-0.89 ng/dL)
    Estradiol 73 (reference range 41-398 pg/mL)
    Pregnenolone 50 (reference range 22-237 pg/mL)
    Deoxycortisol (reference range <46 ng/dL)
    Cortisol post Dexamethasone 0.9 (I was advised this is good)
    Progestserone 52 (reference range 23-102 ng/dL)
    Androstenedione 127 (reference range 51-213 ng/dL)
    Glucose 75 (reference range 65-99)
    Insulin, fasting 7 (reference range 2-25)* not true fasting, I had candy in the office because I was extremely hungry – about 24g sugar – an hour prior, but we went with the lab anyway because I had not eaten otherwise for the day
    DHEA Sulfate 76 (reference range 45-295 ug/dL)

    At this point, I was on spironolactone 100mg 1x per day, so I imagine my blood work doesn't show my "true" numbers. I'm trying to reduce to 50mg a day without much luck.

    Prior to birth control my periods were very normal. I have experienced periods of extreme stress this year and it seems like my periods go nuts the next month. In August I had 3 distinct periods and I've had 2 in September.

    Can you let me know what you think? Please and thank you!

  11. Hi Lara, have you used Bitter Melon or Prickly Pear extracts vs Berberine to treat PCOS with any level of success ? I’ve been reading about their insulin modulating and anti inflammatory effects lately. Would appreciate your insight. Thanks.

  12. Hello Lara,
    Your book is excellent and provided a lot of education, positive energy and inspiration for my way forward. One topic that is unclear for me though is the Peony & Licorice combination. Whilst for nearly all other medications a specific dosis is mentioned there is none here. The book mentions a mixture out of a bottle so I guess it is a liquid? What is the mixture ratio and/ or are pills or teas an alternative?
    Thank you!!

    • Hi Laura,

      The exact dose of peony and licorice very much depends on the preparation and formulation. It’s possible to use a liquid extract of the two herbs in a 1:1 ratio. A herbalist could help you with that.

      With my Australian patients, I usually prescribe either Metagenics T-Clear which has:
      1 tablet:
      Glycyrrhiza glabra (root) ext. equiv. dry (Licorice) 1.5 g
      Inositol 1 g
      Paeonia lactiflora (root) ext. equiv. dry (Peony) 1.5 g

      Or Mediherb PCO support tablets which has:
      1 tablet:
      Cinnamomum verum (stem bark) ext. equiv. dry (Ceylon Cinnamon) 750 mg
      Glycyrrhiza glabra (root) ext. equiv. dry (Licorice) 750 mg
      Hypericum perforatum (herb top flowering) ext. equiv. dry (St John’s Wort) 750 mg
      Paeonia lactiflora (root) ext. equiv. dry (Peony) 750 mg

      The PCO support tablets have undergone a clinical trial: Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial.

      I realise that these two Australian products are not yet widely available in other countries. When I wrote my book, I had hoped that they would become more available. (Which is why I included them)

  13. Thank you so much, I have never gone through such detailed knowledge about PCOS.
    I am doctor with newly diagnosed PCOS. Very much confused regarding the right & wrong things to follow. This article was better explainatory. I have reduced my intake of gluten, sugary, dairy products , but I still get acne on beard line & back, so what will you suggest?

  14. Yes I agree. Still waiting to get the book.
    My daughter has been irregular since her teenage years and menstruated around 16.
    She also was just diagnosed with Hashimoto.
    Took many antibiotics as a young child too 🙁

  15. Hello Laura, I would like to say thank you for all your work. I was diagnosed with PCOS last August and then put on the birth control pill. I reacted badly to it in the first month, and decided to not continue with it. I then looked for alternatives to the pill, and that’s how I came across your work. I’ve been taking zinc & magnesium per your recommendation since the beginning of February this year, and am happy to report regular ovulatory cycles ever since the beginning of March! I was having very long and irregular cycles before, so it really was the magnesium & zinc that did it. Thank you! 🙂

  16. Sorry but the message I sent you showed that my daughter had low testosterone which is incorrect. That is in the normal range.
    Thank you,
    Ellen W

  17. I’m looking forward to reading this book. My daughter is looking to get pregnant, had one miscarriage and does not have timely periods.
    She had Saliva testing done a while back and it showed Low Estradiol, low Progesterone(ratio to PG/E2 low) Low Testosterone and high Cortisol. This was randomly tested during her cycle since she is not regular. SHe was also diagnosed with Hashimoto but all other thyroid is in range.
    I was wondering if you had any thoughts and looking for the best doctor versed on this in NYC.
    Thank you,

  18. Hi,

    Your articles and book have been an amazing hepl, thank you!
    I am from Israel and I really want to get pregnant.

    I would love to hear your advice:

    I have been recently diagnosed with pcos after being on the pill for nearly two years (I am 24, skinny, I don’t have excessive hair or acne/ I do have IBS and I’m not sure I eat enough).
    I have always had irregular periods, heavy periods, blood clots, periods over 7 days, spotting for many days instead of a period, or spotting and then getting my period…..

    After I stopped the pill(yasmin) in september 2018, i had withdrawal bleeding right away, and then a period a month later and then no period for four months. I went to a doctor who gave me ‘primulot nor’ to get my period and check for pcos. She also gave me a referral for an ultrasound but the blood test I didn’t do because my second and third day of my period where friday and saturday and the clinics are closed in Israel then.

    The diagnosis was made after my altrasound results which showed “many small folicles” and I know that it can’t be made by altrasound alone but I haven’t gotten a period yet in the past few months(I had a spotting period a few weeks ago) and my doctor said in order to do the blood test to test for pcos, I have to be on the second or third day of my period.
    I haven’t found a good gynecologist who understands in pcos and will give me good advice and not just fertility drugs.

    My doctor said I don’t need to go off sugar or change my diet because I’m skinny.

    What would you recommend?How can I check if I ovulate if my period is never regular?
    Also in specifically regarding how to check for pcos. What to check in a blood test? What type of PCOS would I have? If any?
    By any chance, do you know of a good gynaecologist/neturopath in Israel?

    I really appreciate your input and time!!!


  19. Hi, I am 20 year girl. I was diagnosed with pcod when I was 13 yrs old . Initially I got my periods but suddenly after 4 cycles they stopped. I did an ultrasound and found cysts. And my testosterone levels were high but my other hormones were in range. I waited for about 2 months and no periods. They my doctor put me on pills like dronis, krimson 35…when advancing treatment my cysts got clear and I stopped taking any medication but no periods. Then I was again put on medication. But I went to other doctor who initially gave me myoshine which caused my periods, then on multivitamin and I got my periods again and then on metformin even I had never high sugar level, and I still got my period. But when I stop taking any kind of medication my periods does not come. I continued taking medication but then in august 2018 I stopped medicines. I ate flax seeds for a month in morning and dark choclate and got my periods, but in next month no period and continued till February 2019. I ate dark choclate, walnuts, almonds, black beans and got my periods in March 2019. And now again no periods but im not taking any of this…im confused what is going on with me…i did tests and everything is in range, testosterone were 46..but cysts in ovaries.
    Please help me with this, im tired of this now. And getting depressed day by day..please please and please
    Thank you

  20. I didn’t! 16 months later and no period. I recently stopped eating sugar and limited gluten and had a period for the first time in around 16 months. I’m thinking more inflammatory PCOS….do you agree?!

  21. Hello Lara,

    I’ve been reading soooo many of your articles regarding PCOS, and have decided to give Saw Palmetto a try. It’s been a little over 4 weeks now (450mg/daily) and I’ve noticed some accentuated hair shedding :(. I was wondering if this could be normal and due to a drop in my estrogen level… or if you would recommend to cease taking it altogether? I’ve also been taking a very small dose of natural green tea capsules daily. I’ve also noticed some elevated face flushing and sweating (or is it high blood pressure while boxing… I must say they are very high intensity trainings though)…

    I’m pretty worried as it seems like my male pattern baldness is getting worse !

    Thanks so much in advance !

  22. Hi there. I’m a little confused about my diagnosis. When I saw my endocrinologist, They found cysts on my ovaries, some hirsutism and very irregular cycles (no period for over a year) however I am not overweight and do not suffer from acne. My BMI was 19.5. On my last bloods, my LH was 25.6 and my FSH was 5.6.

    My doctor told me I have hypothalamic amenorrhea, and recommended to gain weight. I did so, and my BMI increased a little (around 20.5). Still no period, it has now been around 18 months.

    Do you think this is actually PCOS?
    Thank you so much

      • I didn’t! 16 months later and no period. I recently stopped eating sugar and limited gluten and had a period for the first time in around 16 months. I’m thinking more inflammatory PCOS….do you agree?!

  23. Hello,
    I am currently reading (audible version) the Period Repair Manual book. I am a woman in my early 40’s and have been off of birth control pills for about a year. I started at 21 years old for pregnancy protection and did a clinical trial so it would be free. I had always had a light version of “period acne” before this pill (Loestrin FE 1/20) but after about a year on it my acne turned into horrible cystic acne that plagued my skin and body for a few years. After using antibiotic treatment to help it and get me through my wedding I decided it was enough and I stopped both the pill and antibiotic (At that time in my mid 20’s) and went back to vegetarian and exercised. Allot of exercise…I even trained for a marathon. For that 1 year I felt great and did fairly well with little acne. Then after my marathon I took a break and got off my very strict diet and the acne came back even worse. Having dealing with this for a second time my parents brought me to a dermatologist they used for my sister and she prescribed spironolactone to me. Spironolactone had been mentioned before to me along with Accutane but I always shut those ideas down due to what it may do to my body. But in complete desperation I went on Spironolactone (the lesser evil in my mind) along with a steroid to help with the initial heavy cysts. The steroid was stopped quickly due to bad side effects and I just waited to see what spironolactone would do. And it was the magic pill that finally cured me of my cystic acne. I was amazed at how my skin looked and felt and how spironolactone along with birth control was finally my answer for life for this issue. But I was young and desperate to just be normal and take the easy route. I then continued with that duo of spirono and BC for a few years then we decided to have children. I basically went off that combo twice to have 2 children one delivered in 2008 and one in 2013. I went off a few months before conceiving very quickly with both and then stayed off until 1 year post delivery due to breastfeeding. Breastfeeding to me was my natural acne cure. With both pregnancies I had the most debilitating cystic acne I have ever had. Face, Back, chest and arms….it was very bad the 1st pregnancy and just a little better the 2nd time. Each time the breastfeeding helped to naturally cure the acne I had but it came back as soon as I stopped breastfeeding. I would pray it would not come back and as soon as it did I would go right back on my magic pill combination. I always pressed the doctors for help on how to naturally mimic my breastfeeding hormones and they would just laugh. Of course no period during my breast feeding year was great but that always came back right on cue after I was done as it always has. Which is why PCOS is always confusing to me since I have always had a period since I started at age 11. I have rarely been irregular just a handful of times in over 30 years. I have never smoked cigarettes and have tried to eat healthy and be active if not exercise for most of my life.

    Now I have a 5 and 11 year old and I am 42 and I am ready to take control of my life and hormones which I have always known from the beginning of my adult life story that they needed better balancing. I just happened to ignore that and never was able to find the right doctor to help me and I feel like I messed up beyond repair. I am now currently only on Spironolactone at 50 mg per day and it is keeping my cystic acne away. I am trying to slowly wean myself off and hope to be off in another week or so. I am very scared to get off of it and see what lies ahead of me in trying to naturally reverse my years of damage. But I am ready to try and stick with a natural plan and get off this last piece of the puzzle that has made my hormones unhappy for so long. I have been told that I am just sensitive to the normal level of androgens in my body. Which may be true. I have seen PCOS written in my Dr reports before but the type that I have is still unclear to me. I have never shown high levels of androgen or testosterone in blood work. But I am hairy (genetics) not certain if excessive is correct for me but I feel like its excessive….since I pluck coarse hairs daily from my chin. The acne has always been there since puberty but became cystic and chronic in my 20’s after BC started. I don’t fall into many other categories in regards to major issues but the mood swings I have and the overall feeling of daily tiredness, bloat, fatigue and just plain unhappiness makes me realize its the accumulation of many years of neglecting my hormones. The only major steps I have taken since having my children is now currently I am finally starting to get out and run again for exercise. I am not overweight at all. I have not weighed myself in months but I am around 100 -103 pounds and just under 5ft tall so I am very petite minus my constant bloated belly.

    So my hope is that now that I have begun to read more on how to get natural help that I can have someone guide me along. I am ready to feel to take back control of my life. I don’t know where I am now in regards to perimenopause since I am almost 43 but I want to get my hormones more balanced so I can go through that stage a little more sanely. The ups and downs have become too much to bear. I feel like right now I have put my hormones through a constant roller coaster ride and I am impressed I haven’t gone on anti depressants. I do believe birth control pills are just as toxic as tabacco and I pray both my girls will learn from my mistake and never go on it.
    Thank you for your time and I do hope to hear from you as to how I can get help.

  24. Hi Lara! It would be so great if you can give me an opinion about my case! I was diagnosed with pcos and endometriosis 7 years ago. I’ve been put on BCP and everything was ok for 4 years, when one day I started to feel really bad. I had very bad stomach acid reflux, my IBS activated really bad and I had a lot of panic atacks, even at night. When I’ve done several blood tests, it came up that my thiroid anticorpes were positive, crp positive (12 at a limit of 5 – and it was around 12 all year long), ca-125 was almost 60 and a very low value of vitamin D. My gyn told me that my endometriosis got worse and that’s why ca 125 got high (I have to mention that I do not have any ovarian chyst,only bad pains during menstruation). At that moment I decided to quit pills and get pregnant. I tried to get pregnant for 8 months. During these months I took metformin for ovulating and a lot of antibiotics because I had 3 urinary infections. Because of them I had really bad skin problems, like dermographism(which I never had before in my life). It was horible. In the end I got pregnant, and after giving birth I felt much much better. My skin issues gone and my IBS and stomach issues were much better. But when I’ve done some blood tests I had the following: more thyroid antibodyies but the thyroid hormones are fine. Crp is 6 before period and 5 after period. But ca-125 is around 80 now. I do not have cancer as there is nothing suspect at ultrasounds. My gyn says that this is not only from endo but from somthing autoimmune too. But then why crp is not elevated anymore after so much time? I gess that if something autoimmune was elevating ca-125 value, than it should elevate crp also…Gyn says that one year after pregnancy ca-125 should be lower, but mine is bigger than it was before pregnancy and is not tipically for endometriosis…don’t know what to believe anymore, I am really confused. Do you have any opinion about this? Thanks in advance!

  25. What an awesome article! I don’t suffer with pcos myself but having struggled with a huge hormonal imbalance in the past I find all things hormone related very interesting. This is the first article that made me understand pcos!

  26. Sr or mam I have regular periods and facial hairs and my dr did a internal scan and she said that you have pcos bt I have regular periods …she recommend me spironolactone and chrominac a tablet …plz tll me weather I have pcos or not …bcz m married and m confused so plz suggest me and help me

  27. When is the best time to test hormones to rule out PCOS? Went off birth control May 2018 and cycles are very irregular. Wanting to test hormones but want to make sure it’s the right time. Have done LH urine testing for ovulation and never shows positive.

  28. I have yet to find a cause to my PCOS. I have insulin resistant PCOS and inflammatory PCOS. My 2 hour insulin(not glucose) was 176, when the max it should be is 25. I take metformin for that. And whenever I eat dairy or any food at all I bloat up and feel like I’m going to die. I would typically get my period at least once a year and found my estrogen and progesterone to be at 10% of what it should be, so I take hormones. I’m currently 25. Getting off birth control was the best choice I ever made, but getting my hormones balanced so I don’t have poop brain is almost impossible. I’m looking for a solution to ending my insatiable cravings, my dr said it’s from Leptin Resistance from the PCOS but I can’t find A solution. Please don’t tell me to eat better, I eat stricter than anyone I know.

  29. I had hyperthyroidism caused by an autoimmune disease. I had my thyroid removed over a year ago and came off the pill about 6 months ago. My hormonal acne is at an all time high and my doctor recently tested me for testosterone which showed I was pretty high. His solution: put me back on birth control. Which I do NOT want to do. I have not been diagnosed with PCOS but am unsure if that’s needed to start treating myself. I do not want to spend money on unnecessary tests so what tests are the most helpful in determining a treatment option that would be best for me?

  30. Is it possible to have insulin resistance due to eating habits or weight….but actually have the adrenal (inflammation) type of PCOS? I found out from my doctor yesterday that my A1C has gone from 6.2 to now 5.7 (just by making sure I’m eating three balanced meals a day when before I’d eat one large meal a day!)

  31. My daughter has taken metformin for pcos and it has helped alot. She recently read where DIM helps balance hormones. Is it ok to take both together. She has a tendency to get ovarian cyst of not taking anything. thanks in advance

  32. Hi I’m trying to get pregnant and my cycle is unpredictable so I started taking vitex with Mayo inositol and I’m less than a week my feet and ankles are painfully swollen I don’t know what to do

  33. Dear Lara,

    after reading this section in your blog I suspect my amenorrhea might be caused by excessive consumption of soy.

    I have been vegetarian for 7 years and have always suffered from irregular period (more infrequent rather than too frequent). I started taking the pill very early (when i was 15, am now 33) to help with this but when i stopped it 2.5 years ago my period went for over a year.

    It slowly came back 1.5y ago and took a good few months to resemble a fairly normal period, which for me means between every 30 and 40 days.

    This year i went vegan around June and increased my protein and fat intake by adding quite a bit of soy, nuts and seeds to my diet. I’d say that these are the main food I eat on a daily basis now, plus obviously lots of veggies (especially crucifers which i understand may interfere with iodine effect), fruit and B12 supplements.

    As a result I lost a couple of kilos but haven’t had a period since August now.

    I will definitely try and reduce soy consumption and add seaweed to my diet after reading this, but any other useful advice from you would be very welcome!

    Thanks for this useful blog.


      • Very interesting, thanks Laura!

        In terms of deficiencies in my case I’d probably exclude protein, iron (i give blood quarterly and it’s ok), B12/B6 (taking supplements), omega 3 (eating flax/linseed almost daily), vitamin A (again have almonds daily), K2 (i think it’s in alfalfa which again i try and eat often)…. I might be wrong, but if I had to guess I’d suspect iodine, zinc and vitamin D deficiency (i like in London, so sunshine is a vague memory of my Italian times, alas!).

        I’ll give it a go at reducing soy and carb consumption 🙂

        Do you have any good zinc and iodine supplement to recommend?

        Thanks again

  34. Hi Lara,
    Is it possible to only have elevated androstenedione and still be considered as having “androgen excess”? I do not have any signs of androgen excess such as acne, facial hair, or hair loss. However, I do have irregular cycles (40+days) and polycystic ovaries. My only high marker on my bloodwork is androstenedione. Thanks!

  35. Hello!

    I am 19 years old and have never had a menstrual cycle naturally. Upon receiving a “possible” diagnosis of PCOS roughly 1.5 years ago, I was given the choice of either Provara or birth control to induce a period. I tried both options and both were successful for a few trials, and then failed to work at all over the last few attempts.
    While I am not completely sure how my body reacted when the pill or provara gave me a period, i didn’t notice a change when the pill was no longer working. I had severe stomach issues: gas, constipation, and bloating which often lasted for hours on end. It took me months to change my diet and exercise in an attempt to counteract my uncomfortable state. First, i ate cleaner and exercised routinely. I felt somewhat better, but still bloated and had little appetite due to the bloating. Then, I chose to cut out gluten recently. Huge difference/much improved. Still no period, however. Given this history, do you have any idea which PCOS type I may fall under? Do you theorize that if I continue to cut out gluten, I may see a natural period over several months? Should i cut out sugars as well? I primiarily eat unrefined sugars, but now I realize many of the products I eat are still high in sugar (even know it’s unrefined) and that may be a problem.

    • I forgot to mention some pertinent details about me:

      I am by no means overweight. I have been extremely lean all my life (more a genetic thing.. i eat well balanced meals and i eat a lot!)

      I have been extremely active for the majority of my life as well. I played 3 sports all through middle school and high school.

      • Do you think you’re eating enough to be able to ovulate and have a period? A few things that you’ve said make me think that under-eating (and not PCOS) could be the main problem. (extremely lean, extremely active, and eating clean)

        I know you say you eat a lot but do you regularly consume animal protein, starch such as rice, and fat? Because that’s usually what it takes to be able to get a period.

        If under-eating is the main problem, then the diagnosis is hypothalamic amenorrhea and not PCOS. It’s very common for doctors to make that mistake.

        Are you eating enough to get a period?
        Maybe it’s not PCOS

      • Also, the fact that you feel better off gluten could be a clue. If you are truly eating enough but not able to gain weight, then yes, gluten could be the issue. In that case, it should take about 4 months strictly gluten-free to start to ovulate. (assuming you’re also eating enough including enough rice or potato.)

        • Thank you for your help!

          And to answer your questions, I would say that I do eat enough animal protein, starches, & fats. A typical day for me includes fruit with either eggs or oatmeal (with collagen) for breakfast, a combination of snacks throughout the day (it’s what works best with my schedule and meal options): usually gluten free bread (rice-based) & nut butter, fruit, avocado, hummus, seed crackers, or salad; and then for dinner, I generally make sure I have animal protein, potatoes & veggies. As a college student, this isn’t always achievable so I may be lacking in protein and starches somewhat overall, but I generally do hit the 2,000 calorie plus marker daily for someone who actively exercises.

          In high school, my eating was much less balanced and I ate lots of gluten-filled breads and pastas, but I definitely ate adequate amounts of protein and starch.

          But I do have a question with regards to cutting out gluten: when you say strictly gluten-free, if i eat it on occasion (in small amounts), would that throw the hopes of ovulation off?
          Just wondering because I’ve been mostly gluten-free for a few months now (with no period), but not entirely.

          • that does sound like enough food (or close to enough). although Nicola Rinaldi (author of No Period, Now What?) recommends 2500 calories per day to recover from hypothalamic amenorrhea.

            As for gluten, IF you have gluten sensitivity, then yes, you would need to avoid it 100%. There’s no such thing as partially or mostly gluten-free.

  36. Hello Lara. I was diagnosed with PCOS after coming off the pill. I have a high LH from blood tests. After 7 months without a period I was prescribed a 10 day dose of Provera. I had just started taking a peony/licorice supplement. Is it ok to continue that with the 10 days of Provera. Or is there a specific length of time to take the 2 pills 3 times a day? Should it be taken cyclically? Appreciate your help!
    ( I am continuing to take inositol)

  37. I’ve had an eating disorder since I was 16- I am 19 now – and was in the middle of a mild relapse when I noticed that I had painful constipation and my periods were either absent or a little too spontaneous. Went to the doctor, got a blood test done (slightly higher insulin levels, but still within the normal range, as well as slightly low – I think it was T3? – levels as well). I also had an ultrasound, and they discovered about 24 cysts total on my ovaries. So I was told I had PCOS, and made to go on birth control pills. I’ve just started my first pack and am midway through the pack already. After reading your post, it has gotten me extremely worried – have I inevitably screwed myself up and made my condition worse by taking these pills? DO I have PCOS? I am of a normal weight as of now, I can’t really trust myself to judge if I’ve gained weight, though I am extremely bloated at the moment as I am still on my period.

    I guess I need some reassurance and advice on how to proceed from here.

  38. I am getting conflicting diagnoses for PCOS. I have ring shape polycystic ovaries in ultrsound but AMH is normal. Fasting Insulin is low (no sign of insulin resistance). Periods are irregular. Progesterone low. Androgens normal. Have 40+ pound weight gain unexplained in past 2 yrs after coming off BC 1.5 yrs ago. Eat carb mix of veggies fruits sweet potatoes (so rules out HA?) Exercise daily. Been on magnesium for 6 months and vitex for 2 months. Any suggestions??

  39. Hi Lara, not sure if this will reach you but I’m writing as a 30 y/o with regular periods, healthy weight, healthy diet, and advancing hirsutism, head hairloss, acne, and other symptoms for the past 8+ years.

    I have an adrenal tumor, deemed nonfunctioning. I was placed on norgestimate to curb my symptoms. I experienced some very positive side effects (hair regrowth, clear skin, slowed hirsutism), but some very weird “off” feelings and nonexistent libido. I had to go off the pill for more blood tests related to the tumor.

    Going off the pill was one of the most difficult experiences of my life. I had headaches, abdominal pain, depression, major acne, hairloss, the works. Despite slightly elevated DHEA everything is within ‘normal’ limits according to my endocrinologist. But I see my hair falling out, my beard/nipple beard growing in and know my body is telling me something.

    I am now committing to trying dietary changes and herbs before calling uncle and going back on the pill. I ordered the peony liquorice formula and want to know what part of my cycle to take it on?

    I am taking zinc, rhodiola, vit D, and magnesium. Thanks

  40. Hi Dr. Briden,

    I know you shouldn’t take Berberine if you’re pregnant or breastfeeding, but is it safe to take after ovulation, during the “2-week wait” or up until I get a positive pregnancy test?

    I have the 1st edition of your book, have read various posts, and listened to an interview you did over at PCOS Diva, but still can’t find the answer. I think I would benefit greatly from Berberine for my Insulin Resistant PCOS and I think it could help me conceive.

    If its not safe, can I take it up until ovulation?

    Thank you!!

  41. I have had PCOS for 21 years. My first period was when I was 16, I had to take Provera to get it. I never got my period on my own. My fiance and I started trying to get pregnant, so I tried clomid and metformin, I didn’t get pregnant.I started taking Fertilemd supplement and I actually got my period. I have only been taking it for two months but I have high hopes! I recommend fertilemd , it’s a natural way to regulate your cycles.

  42. Hi, I have PCOS that I am almost certain is related to taking an anti-psycnotic psychiatric medication called Epival. It can cause PCOS. I have not had periods in 4 years since taking it. I used to be regular. I have started to develop hirsutism and thinning hair at the hair line. What type of PCOS would I have and what would be the best treatment?

    I cannot go off or down on my medication at this time because it is stabilizing a Bipolar diagnosis.

    • Yes, certain medications cause androgen excess that essentially looks like PCOS. It’s medication-induced so it’s not any of the PCOS types listed here. And there is no easy natural fix, I’m afraid.

  43. Hi, I don’t have any other symptoms than excessive body hair(male pattern) and hair loss in the scalp. My periods are very regular. Lately, I’ve been having back acne(two months before and spreading more now). My total testosterone level is quite normal and i have no ovarian cysts. I don’t have any idea what to do! I’ve researched so much and have applied so many methods. But i guess, I don’t even know the core of my problem at last! Any idea what i need to do, Lara?

  44. I was diagnosed with PCOS in 2004. I am insulin resistant and over the last five years have also started to experience the chronic immune activation piece, with lots of new and severe allergies. My lymph nodes are constantly swollen and the fatigue is unbareable. I feel so trapped by this diagnosis and although having been aware of it for nearly 15 years, can’t manage to control it. Thank you for posting this as its the first time I’ve seen it explained out this way.

  45. Hi dr Lara
    My daughter 15 y old with irregular periods absent for 6 months hormones blood test done normal high limit prolactin in ultrasound polycystic ovary more then 12 no obesity acné face the dr diagnosis as pocs and prescribe pills still she didn’t receive we are looking for better solutions can you help as

  46. I’m 34, and I’ve had PCOS ever since I was a teen. I get acne, chin hairs, 100 day plus cycles, painful periods, and I have the classic pcos chain of cysts in ultrasounds. I have never been overweight (BMI 22-23), I don’t have insulin resistance, I eat paleo (sometimes Keto), and yet I have never been able to shake the pcos. I have high prolactin and androgens. I’ve tried Vitex, Maca, zinc, and Ashwagandha and seen some improvement, enough to get pregnant. However, the only thing that really seems to get rid of the acne, boost my mood, and regulate my cycles is natural progesterone cream on days 14-28. I’ve only been using it for a couple months, but its been amazing. I read your post, and I don’t feel like I fit any of those catagories. Maybe the 4th? I do have autoimmune issues, EOE and lots of food/environmental allergies. I don’t want to use the progesterone cream forever, and I would love to find a permenant solution. Any ideas?

  47. I have read your explanation but what bothers me is it’s not that simple I’ve had pcos all my life diet after diet didn’t do anything but just made everything worse like hair growth in places it shouldn’t and going bald no periods and now I can’t even ovulate

    • Julie: the issues you mentioned are literally the very definition of PCOS. Diets didn’t cause those symptoms, the hormonal imbalances caused those symptoms.

    • Doctors also say it’s due tome secreting more of the male hormones and now take proverb every 3 months to starts periods as I have only had 1period after having my child 10yr ago

  48. I’ve just found your blog after listening to a the Fertility Friday podcast you were on a few years ago…. and I wish I had of found you sooner. But at the same time, I am now feeling far more lost and overwhelmed! I have been diagnosed with PCOS but am not sure what type or even if it’s an accurate diagnoses. What would be your suggestion for finding out please?

    • Please start with the new (pink) edition of my book Period Repair Manual. I provide a flow-chart for PCOS assessment.

  49. Good morning,
    Thank you very much for your helpful posts!
    i have read the androgen excess post and i am a little confused .
    PCOS is a hormonal imbalance caused by excess androgens that ‘s impact the ovaries but is adrenal angdrogen excess umpair ovulation? is it considered as PCOS or not?


    • is there a difference between androgen excess and PCOS?

      I am a woman of 32 year old i have regular periods ( cycles of 30 days , some times 2 days of delay, never on the pill) with PMS .04 years ago i started to have acne on the wright jaw line and chin.
      I have high normal prolactine and FSH.
      High level of DHEA – S but normal testotérone , Tsh, androstenedione, 17 oH Hydroxy progesterone.

      Am PCOS or i have excess angrogen caused by high prolactine?
      Should i take VITEX and DIM ? what is the dosage of Vitex per day ( i have seen in another post 200 mg per day).

      Thank you for your help!


    • High adrenal androgens may or may not impair ovulation, depending on the situation. Once other causes of adrenal androgen excess (such as congenital hyperplasia) have been ruled out, it is typically diagnosed as PCOS. Although it’s quite a different condition than the classic type of ovarian androgen PCOS.

  50. Hi Dr Lara,
    I have always had normal periods and went on nuvaring at 27, I’m 33 now. I stopped it in June and noticed my period was late in January and i haven’t had a period since January 28. Had ultrasound and told i have PCOS. Should i take this as the truth? I don’t have other symptoms and took pride in the fact my periods were always on time. I have a follow up appt on Monday and wondering what i should ask. Also on a low carb diet since october and under some stress. I ordered Peony and licorice should i take? Looking to get pregnant in the next year.

    • jenny; she says in one of her posts that an ultrasound cannot diagnose pcos, it has to be through bloodwork and symptoms. have your hormones checked, your insulin, maybe a glucose tolerance test too. but women have cysts on their ovaries at any given time and they don’t have pcos.

  51. Hi Lara,

    I got really impressed reading your blog on types of PCOS.

    I am suffering from irregular periods from the age 28. Up to age 28 my periods were very regular although I was always overweight by 20 lbs. During age 28 , my skin specialist gave me BC pills for acne and ever since my system has become irregular. My periods never got regular. In my early late 20s’ and early 30s’, I used to get periods 2-3 times in a year but since age 35 my periods completely stopped and I have no natural cycles from past 2 years and have gained lot of weight and got pre-diabetes.

    I am not sure whether I have post pill PCOS or Insulin resistance PCOS. From past 6 weeks I am taking 3 gms of inositol plus DHA and 800 mg folic acid. I am not too sure what kind of herbs should I be taking. Can you please advise as I am TTC this year? Please recommend me right course of treatment.


    • km; hi, check your bloodwork, including your hormones, fasting insulin, a glucose tolerance test, crp, etc. if you have only 2-3 periods a year, and you are overweight, and are now pre-diabetic, you prob have insulin resistance like she discusses in the post above. if you haven’t had a period for 2 years, you will probably have a hard time both conceiving and carrying a child to term unless you correct your diet, so no sugar, gluten, dairy, and I would say animal products in general, but she is such a hardcore pro-meat person, ill be surprised if she doesn’t block this comment. but too many hormones found in meats, just sayin. and you can prevent vitamin “deficiencies” she talks about by taking a multi vitamin or just eating fruits and veg that have that particular vit or mineral. the dha is good for you, but wont cure inflammation or any other issue you might have. take a methylated folate, not folic acid, too. if you have pcos as listed above, and you change your diet and lifestyle (sleep at night, reduce your stress, light exercise), you should be able to start having regular cycles, and hopefully ovulate with each cycle. these changes will be more effective than any supplement like vitex or peony. diet is 80% of the solution, so you cant skip it and think the other things will work instead. no ice cream or fried chicken (or whatever your fave food is) is as sweet as starting a family. you can do it!

  52. Hello Dr. Lara ,

    This is a very valuable post for PCOS sufferers. I was normal but just taking 15 days of BC last year launched me into a never ending acne saga. Based on acne I was asked to have an ultrasound and got diagnosed with PCOS. So I have a pill induced PCOS. All my hormones are normal except for LH:FSH ratio. My progesterone is fine too. My acne has now become cystic. I went to a naturnaturopath and tried many supplements and it turns out that Omega 3 and Flaxseed break me out further. I tried Berberine but it paced up my heartbeat so I had to leave it out. I am not zinc deficient (as I had a test) so not sure if this would help. My periods are regular too.

    Can you suggest anything for persistent acne ? It has been very traumatic and after trying so many things, I feel lost. Is it even possible to treat acne?

    I will be looking forward to your reply. Thanks !

  53. This was a good read. I’ve been a type 2 diabetic since I was 12. I got diagnosed with PCOS at 17, I’m now 22. All this time I NEVER knew their was a specific type of PCOS. They say I’m insulin resistant, my body makes too much insulin. I’ve been taking metaformin since I was 12 years old. 2000mg a day.

    Was told me being overweight I would only have a 10% chance of having a kid, but they included that if I was to lose weight and get to where I should be that then the PCOS will just go away.

    Doesn’t seem to be that way…

  54. Thank you for this article! I think I have had PCOS for many years. (I am now officially diagnosed with PCOS). I gained about ten pounds in high school, at 16, then my periods became much more painful. At the time, I did not have the understanding to potentially tie the weight gain to painful periods. My periods were about every 4 weeks, very regular. Looking back, I believe that’s when my PCOS kind of started though. Fast forward 12 years and I start taking the pill, at 28 years old. Then everything changes. My obgyn says that my symptoms are not due to the pill, but I felt very strongly that they were. My period started coming on painfully and lightly while I was still taking the hormone, then it would come on heavier than ever when it was the non-hormone days. So basically, my period came more often and heavier while on the pill. This was my first experience with irregular periods. My skin also became less elastic. I gained weight. (Which was, admittedly, partially due to my poor eating choices when newly married and trying to cook yummy meals for my new little family…). My skin started breaking out with cystic acne. Ugghhhh
    So, I came off of the pill 1 year later. I am still suffering from those symptoms 6 years later. My doctor diagnosed me with PCOS sometime between when I went off of the pill and now. I ate healthy and exercised and journaled. I did the things that most healthy people do that keeps them at a healthy weight, but I still gained. I have spoken with my primary and my obgyn many times. Blood tests have shown that I am insulin resistant.
    So, since the regular healthy eating did nothing to help me (though my obgyn felt very strongly that my body would reset it’s insulin resistant if I followed the healthy, Mediterranean style diet), I decided to take his advice and do the Mediterranean, but also go very low carb. (I struggled with this decision, as I do not promote low carb for most people. We live off carbs; they are what our body needs. But I do NOT want diabetes). I finally lost 16 pounds. It took me 3 months. During that time, I lost weight, but my periods started happening more often, and I became more depressed and more crabby. My skin was the worst it had ever been. So I ate less red meat and added other protein sources like chicken without antibiotics. This helped a smidge. So I then had to go back to eating some carbs. At that point, I still lost a little weight, which was a positive sign!. But still, I felt like I had to choose between my health and my happiness. I absolutely do not want to develop diabetes. It’s a horrible disease that kills you one piece at a time. However, i struggle to find the balance of less insulin resistance, vs other hormonal balance.

    I believe I have insulin resistant PCOS that was exacerbated by the pill and weight gain. My question is, does that sound correct? What are your thoughts on my experience? Thank you again so much for this information and your many articles and knowledge.

    • Also, I forgot to mention that after coming off the pill my period came, full on, every two weeks. Painful and heavy. I didn’t want to do pill again. Obgyn put me on just progesterone. My period then became regular again. I went through the progesterone process two separate times to regulate, and have had a regular period ever since, EXcEPT for when I did the very low carb. Thanks.

  55. Dr Briden, can you let me know if you think I might have PCOS and if so, is it post-pill (1 depo shot one year ago); or adrenal in nature?
    Free Testosterone 2.2 (1.3-9.2)
    Testosterone 33 (9-55)
    Progesterone 0.4 (1.2-15.9)- taken on day 14 of 19 day cycle
    Estradiol 518 (48-309)
    DHEAS 380 (75-410)
    Free T4 0.8 (0.76-1.44)
    rT3 9.1 (9.0-27.0)
    T3 free 2.2 (2.4-4.2)

    I have not had insulin testing. I have not ovulated since depo, and I have developed hirsuitism. I assume I need to have LH and FSH tested. Any other labs you’d reccomend? I have been taking vitex (prescribed by an ND) for 3 weeks. How long would I need to stop that so that it wouldn’t affect the LH lab?

    Thank you so much for you work!

  56. Hi Lara,
    After ttc for 2 years, I got pregnant but it ended in a miscarriage at 6 weeks. It is now 6 months later and I’m taking vitex to regulate my cycle. I have pcos, probably from adrenal and thyroid problems as well as high lh. My cholesterol is slightly elevated (probably thyroid) and I have hair loss, increased hirsutism, lower belly spare tire and low blood sugar if I don’t eat regularly. I used to have long cycles 30-50 days, but vitex has reduced them considerably. They’re now from 30-35 days which is great!
    I did a cd14 blood test and ultrasound today to check for ovulation and my results are as follows:
    Estradiol 143.38 PMOL/L LH 12.37 MIU/ML Progesterone 1.54 NMOL/L. My biggest follicle is 13mm and my lining was 5.6. I’m worried that my estrogen is too low and that’s why ovulation is taking it’s time. My estrogen has been low the past few months as well. I was wondering if you know of anything to help with increasing estrogen that’s not hormonal because I have a small uterine polyp also. Thank you for this amazing blog; it’s so helpful!

  57. Hi Laura. I have been off the Pill for 16 months and my cycles are still highly irregular, other than the Follicular phase is 30-45 days long and the LP is no longer than 9-10 days. They were normal before the pill, but I was on it for 15 years. The longest cycle since quitting the pill I’ve had is 66 days, the shortest 38. I’ve tried Vitex and Peony and licorice with out a lasting result. I also developed Acalculous cholecystitis, so badly that I’ve been having lukemoid reactions. My Gastro says this may be why my cycles are so wonky and he doesn’t see me ever conceiving until i get this taken care of (as in removed). Its frustrating because I’m 35, and 5’4″ and 118 lbs, eat a healthy diet (just coming off a pescitarian diet after reading your posts on eating more animal proteins. that) , exercise regularly and my insulin levels are within normal limits. But I do have a long family hx of gallbladder disease. Last hormone test on 7-5-2017 was taken right in the middle of a long Follicular phase and was 8.4 FSH and 7.6 LH. Cholesterol is normal. I have not had a fasting blood glucose test. My question is (and i know I’ve not provided all my info) so in your opinion, could this gallbladder disease be causing the inflammation that might be making my cycles so irritatingly irregular and so long in the FP and so short in the LP? I’ve read that gallbladder disease my be results of high estrogen, so could lit be the hormones are effecting the gallbladder or the gallbladder effecting the hormones? I’m so frustrated.

    • There are lots of reasons for cholecystitis. The 15 years on the pill would have increased your risk but it’s difficult to say exactly why it is happening.

  58. Hi. I have anovulatory PCOS and my period lasts for almost 11-14 days in length and comes every 2 weeks. Which means every half a month I will get a period. My bloods show elevated LH and testosterone. I am thin and have no physical signs of PCOS other than a few hairs on the chin (very little)

    I want to start the white peony and licorice treatment. I know the effective dose for pcos is 5000 mg a day (2500 peony + 2500 licorice)

    I need to know when to start? And when to stop? And for how many months?

    As I perscibed, my periods are prolonged and very frequent. Which means no lutheal phase!
    So.. I was wondering.. can I start just at anytime and keep taking the herbs everyday?

    By the way, I want and hope to ovulate naturally.


  59. Hi. I have been diagnosed with pcos many years ago. I have hirsuitism and am overweight but have normal insulin levels but high testosterone. However, I never missed a period, am regular as clockwork, and never had a cramp in my life. As I’m not sexually active I have an iud in place to lower my iron yet a year on I still have light periods. Do I have pcos? I have just started taking vitex to see if this helps balance things out. Do you have any thoughts?

  60. Thanks for this–I wasn’t aware of the other PCOS types. You forgot one, though. The genetic condition congenital adrenal hyperplasia very often causes PCOS, and that can be the way that someone with mild CAH finds out that she has it, because late-onset CAH may not display symptoms bad enough for the woman to go get diagnosed. They screen for CAH in newborns now but certain types don’t show up on the screen and women born before the mid-80s probably didn’t get screened.

    • Thanks for such a helpful comment. Yes, adrenal hyperplasia is a reasonably common reason for androgen excess. I discuss the adrenal type of PCOS in my new book.

  61. Hi Dr. Briden, I am considering metformin and berberine for my insulin resistant POCS. My GTT done 2 yrs ago showed I was very insulin resistant. Also I started taking T3 over a year ago and now my period is like clock work. However, I only bleed for two days of late so I wonder if I ovulate.
    I am wondering why not take metformin which is more easily available and quite cheap compared to berberine. After all wasn’t metformin first isolated from a plant too? A study says that berberine is not great if TTC.

  62. Hi Lara, can you please tell me what blood tests you recommend for PCOS possible diagnosis? I have only been diagnosed via ultrasound

      • I do not understand how you are building the bridge between PCOS and a vegetarian diet. You are stating in your article that a vegetarian diet causes a zinc deficiency, but there are plenty plant based zinc sources out there. I would even question that humans are supposed to eat meat in general but we do not even have to go that far. Is there any other relation you have researched other than zinc?

  63. Hi Lara,
    I hope you don’t mind me commenting here to ask you about my own situation. I’m on the waiting list for an appointment with you in Sydney but you’re a very in-demand woman! 🙂
    I came off the Pill four years ago and didn’t get my period for 7 months. During that time I was diagnosed with PCOS, however I’m not insulin resistant and I’ve never had elevated androgens on blood tests. Prolactin levels, thyroid and DHEAS are also normal. I initially had high LH but it has now seemed to stabilise. My cycle has continued to be fairly irregular with a short luteal phase, around 10 days, but in the last 3 months it has decreased to only 7 days. My husband and I are now trying for a baby and I’m worried as it seems I may have a progesterone deficiency. Any ideas what may be causing my irregular cycles, and what could help with a luteal phase defect?
    Thanks so much!

  64. Hi Lara,
    My name is Erin i recently in may was diagnosed with PCOS, i had two miscarriages last year. My OB/GYN started me on glucaphage 500 mg bid (i tried metformin and it made me very sick). I came across your page and im very interested in berberine. Im just wondering can they be taking together ? Also started vit d – my level was 30 – so i will try the magnesium as well.
    Thank you so much

  65. Hello,
    I wanted to know if there are any other things that could cause PCOS, or long cycles plus elevated testosterone, since I can’t identify with any of the causes which you have listed here. Also I don’t have any symptoms of gluten sensitivity, but could I be sensitive to it anyway, without noticing it?
    I haven’t been tested for adrenal hyperplasia but I don’t really have any male-like characteristics on my body. Only a little bit acne and maybe a little more body hair, but it’s not a male-like pattern. Also, I do ovulate, but only every few months. Besides, the length of my cycles have increased since last year. They always were like 50-70 days, but now they’re more like 100-120 days.

    • It’s probably worth doing a blood test for prolactin, adrenal hyperplasia and also gluten or “gliadin antibodies.” Sometimes menstrual irregularity is the only symptom of gluten sensitivity.

      Beyond that, it’s difficult to say without knowing all your medical history. Was there ever a time when you had regular cycles?

      • Do you know what kind of doctor I would have to ask about these blood tests? I’m asking because my ob-gyn hasn’t tested me for these as far as I know.

        No, I’ve never had regular cycles. I’m only 21 but they’ve always been very long and irregular. Sometimes there was a shorter cycle of like 40 days in between, but mostly they were about 60 days long. And as I said, since last year or so they’ve become even longer, which I find very strange because I didn’t have any major changes in my life style.

  66. Thank you so much for your information and sharing your knowledge I want to ask you what dosage would you recommend of peony and licorice your data states the patients used a 7.5 g dosage for 24 weeks,??

  67. Your article states. “Best supplements for insulin resistance are magnesium, lipoic acid, inositol, and berberine. “ What dosages should these supplements taken in?

  68. Hi Laura,
    I have a question in regards to being diagnosed with PCOS. I’m 28, I have regular periods every month, approx every 26 days from day 1 to day 1 (never been on any form of hormonal birth control) they are a bit clotted and somewhat heavy but usually last around 4 days, I have spotting for a day or two in the beginning. I was tested for estradoil, lh, fsh, and progesterone on my first or second day of my luteal phase. LH- 12.3 mIU/ML, FSH- 4.2 mIU/ML, Progesterone- 2.8ng/ML, and estradoil- 151.5 pg/ML. This was a follow up test after a scary ER visit for extreme pain in my pelvis for 4 hours and vomiting during my mensus earlier that cycle. I was also given two ultrasounds looking for signs of cysts that came back clear (one, two weeks before that painful cycle, and one in the ER after pain medication was administered). I have not been tested for androgens yet or allergies. My fasting glucose and thyroid were fine. I suffer from a vaginal ph imbalance which results itchy discomfort and frequent infections (when I do not use a ph balancing lube everyday), very painful periods, and cyclical cystic acne. My LH is 3 times more than my FSH and my progesterone is low Is this enough to diagnose PCOS off of? If not PCOS what is this? Would you recommend any more specific tests? Thank you so much for your help! It’s been so frustrating as nearly every doctor I’ve had has been dismissive of my pain and discomfort. I so look forward to hearing any insights you might have, I am reading your book right now 🙂

  69. Hi there! I just bought Vital Nutrients Multi-Nutrients 2 which contains 112.5mcg Iodine (as potasium iodide) and 100mcg Selenium (as selenomethionine). Shouls I not take the Violet?? Or find a different bottle of Vital Nutrients that doesn’t contain those 2 ingredients? Or can I take both together?

  70. I’m quite sure my type is from insulin resistance. Over a year ago I was diagnosed with hypothyroidism. Since this was most likely an issue after the PCOS, do I need to eliminate gluten as well as sugar?

  71. Hi Lara

    I’m wondering if it’s better to take vitex or licorice / peony.
    I’ve been diagnosed with PCOS 5 month after stopping the pill. I think it is pill-induced POCS, but we’ll test insulin resitance next week. My lab results showed, that my androstendion is to high. Everything else (inculing LH and Prolactin) is normal (LH 8 U/L, Prolactin 157 mU/l).
    In your book you wrote, that Vitex can worsen PCOS. But my LH is fine, just androstendion is too high. You also wrote, that in a trial peony and licorice reduced serum testosterone, what about androstendion?

    Can’t wait to hear from you,


  72. If you have had supplements like lipo acid and NAC for e.g. a year, is it suggestable that you take a break from them? For how long and can you continue after that?

  73. Hi Lara! I’ve read your book an read a lot of scientific research on d-chiro-inositol and myo-inositol. I began taking the 40:1 ratio everybody is recommending. I’ve dealt with acne for about 10 years. But after I just startes taking DCI alone my acne vanished. Is it dangerous to only take dci alone? Could it set my body of balance? I take 600mg every morning.

  74. “I think it’s important that we remember women are not small men.”
    I love that LINE & am going to use it in my thinking when I visit my doctors. It is a profound idea that is so simple yet so complex.
    I have type 1 diabetes (30 years) & hypothyroidism (diagnosed 3 years past) as well as PCOS. I am thin & active. I take excellent care of my diabetes & eat well. I am very insulin sensitive & receive about 30 units humalog a day between basal & bolus by pump. I was diagnosed during a period of infertility by blood work, symptoms & ultrasound.
    My doc prescribed metformin 500mg. I have a friend who was on 1000mg. When I asked my doc why we were prescribed different amounts as we are similar in size, she upped my dose to 1000mg. I never understood why. My facial hair growth & acne slowed to almost nothing while pregnant with my son & during the first year nursing but has returned with a vengeance.
    How is dosing figured? What classification do you guess I would be. I know you can’t diagnose over the internet 😉 I have an appointment with my endocrinologist in a couple weeks. I’d like to go in with better questions

  75. Hey there Lara!

    I have a question for you that will hopefully ease my mind. I was dx with PCOS when I was 19 (currently 27). They dx me via ultrasound. I had just gotten off the pill and stopped having my periods. I’ve been on 500mg Metformin ever since and in the last 4-5 months started changing my diet (no dairy, gluten, or soy). My question is this, I just had labs done and everything came back normal except my prolactin (around 44). All my labs last year were completely normal, including prolactin. Why do they keep saying I have PCOS if I do not have high testosterone, high glucose, etc.? They are redrawing the prolactin in a few weeks and will refer to endocrine if it’s still high. Thanks for you help, I just don’t feel like I’m getting the information I want/need!


  76. Hello Laura,

    I first want to thank you for your work and this article. it has helped me tremendously. I’m 27 years old 5’5” and weigh about 210 lbs (my heaviest). The symptoms I’ve noticed since high school have been: irregulars periods (about 8 or 9 per year) and they usually last about 10 days (light/med); I have excess body hair on my face, nipples, happy trail, and everywhere from hips down, I suspect i have an allergy to dairy and sugar; I have yeast infections probably 6-8 times per year ( and I notice them when I at more sugar than usual, among other things); I have been diagnosed recently with seborrehic dermatitis on the scalp. I weighed 160 in 2007 (which steadily increased), I don’t exercise regularly, I have normal blood pressure and no diabetes or prediabetes. I take no medication or birth control pills. I have had no pregnancies. I recently received my blood test results:
    TSH .56 mIU/L
    FSH 5.3 mIU/L
    LH 19.2 mIU/L
    PROLACTIN 7.1ng/mL
    In your opinion, does this sound like an inflammatory PCOS? Thank you so much!

  77. Is there a type of PCO with low level of testosterone??? I started taking de pill when I was 16 to treat PCOs (I’m 32 now), 2 years ago I decided to quit, but never had a period again. Went to many doctors, tryed differrent medications, but nothing worked yet… my testosterone level is not high, Im not insulin resistent and my cholesterol got incredibly high after I quit the pill… dont know what to do…

  78. I have 35 day cycles and use daysy which says I am ovulating around day 24. Could I still have pcos if I ovulate each month? (I have elevated androgens and acne/hair growth)(the hair growth only started in pregnancy and didn’t go away).

  79. Hi Lara,

    Question in regards to soy (isoflav) – I have noticed its in many of our practitioner supplements (Naturopathy) now and I am so confused when to use it , if at all – I understand how the studies demonstrate it works by occupying the oestrogen receptors but i have always had the belief that soy exacerbates symptoms (and it did for me when i ate it).
    Thank you

      • Hi Lara – Thank you for your response. After switching to a vegetarian diet and heavily soy based my periods continued to cease (as they had already not came back after the pill), i soon got diagnosed with hypothyroidism and gained 7kg within a few months and i had severe cystic acne (most of which you have mentioned above) and all of which has subsided over the years with naturopathic treatment. I just find it odd that many of the practitioner supplements have it in it considering only small amounts are generally recommended.

        Thank you 🙂

        • Yes, that’s pretty typical of soy (loss of periods and underactive thyroid). I don’t prescribe products that contain a lot of soy. I don’t worry if they have a little bit of soy lecithin. It’s all about quantity. Even without soy, a vegetarian diet has high content of phytoestrogens in all the other legumes.

    • Hi Sarah. I think I experienced PCOS after a surgery and have the MTHFR mutation and was wondering if it was a factor, since I am not over 60 (although over 50). Welcome your thoughts about the relationship between these two.

  80. Hi Lara,

    This website is such a great resource for women with PCOS. I am 22 years old got diagnosed in December as my testosterone was only slightly elevated it was 1.7 and the cut off was 1.6. I have been checked and am not insulin resistant. I have started taking vitex recently I’m not sure it it is helping yet- my prolactin is high/normal and my LH FSH ratio is normal so hopefully this will be okay. I think my PCOS might be either pill induced or due to inflammation as I have had digestive issues for a few years now (bouts of stomach ulcers, IBS, gastritis). After following a gluten free, dairy free diet, alcohol free diet since December my skin is slowly starting to clear up and I am now having regular periods! I also have no digestive pain or issues anymore! Huray! What I was wondering was what markers would you give to say that my PCOS has completely gone- or does it always stay with you and can come back? I am thinking of following a vegan diet as I have heard this can be beneficial for some women with PCOS- what do you think to this?

    Any help would be really greatly appreciated..


  81. Dear Lara!
    I’m so glad about finding your wonderful website about 4 reasons for PCOS! I’m a woman from Austria and I have searched for the cause of PCOS for the last 8 years. Only a few persons know about the association
    between chronic inflammation and PCOS,
    but now I do – because I have read your fascinating, great text! My lymphnodes in
    the neck are chronically swollen and my
    gland is suffering of hashimoto, but
    anybody of the doctors understood the
    association, that pcos actually were
    caused by chronically inflammation in
    some cases! I was diagnosed in
    reactivated Epstein Barr Virus.
    My LH is chronically too high, but now
    I make an experiment to take
    bioflavonoides, coenzym q10, selen,
    vitamin d, opc and such other supplements.
    My testosteron, androstendion and LH
    is too high since I was a teenager,
    although I always used to be slim and
    there is no insulin resistance!

    Could you tell me, what nutrient I
    can also take to damp inflammation?!

    I thank you from my heart, that you have
    written this wonderful text and I have
    found it!!!

    Yours sincerely,


  82. Would anyone here suggest PROTEIN POWDER im their daily eating with a PCOS insulin restistance diagnose I am interested finding an alternative for breakfast e.g. Is it a bad idea?

  83. I am wondering if you have any helpful information for women, like myself, who are 42 and had a partial hysterectomy(uterus removed) and still suffer with the symptoms of PCOS. I live in Canada and I’m having a hard time even finding a doctor who understands PCOS. I have been on metformin serval different times and end up with fatty liver and quite sick after 6 weeks of being on this medication. I am very frustrated because every website seems to be about trying to get pregnant and I don’t need that! I have been following a whole food diet and taking many supplements, yet I’m still dealing with symptoms and side effects. Please point me in the right direction.

  84. Thanks so much for this article. I’m 21 years old and I’ve been suffering from PCOS since the age of 15. I am not overweight or insulin resistant and I believe it is caused by inflammation as I was a picky eater who mainly ate pasta and sandwiches growing up. I still find it difficult giving up gluten. I have nearly constant bleeding. My vitamin D is very low and my testosterone is 200. It has been 6 months now since I’ve come off the pill. I’m eager to get to the root of the issue and help my body to heal. I’m anxious to feel better, but I understand that it will take time. What do you recommend?

  85. Which is best way trying start ovulation ?..With topical progestetone or Peony and Licorices ? Does anyone havet a good brand to suggest?
    Dont dare to tre Vitex may harm because of elevated LH

      • Yes insulin resistans is the cause for sure. The belly fat is still permanent and since cycles are so long for her ovulation is not happening I think. Looking for the next step to after almost a year of good diet and exercise.

  86. Hello, I just came here because I have pcos. Also, I just found out I have thyroid antibodies. Doctors never wanted to test me for it even though I’ve gain weight, have anxiety, unable to exercise, cold, hair loss. I was hoping you had something on hashimoto’s. I’m going to follow your advice on 3 and 4. Im going my doc tomorrow and she if she’ll treat me for the antibodies.

  87. Hi i think my pcos is so to serious im worried having this but the doctor just gave me pills now that i saw that there is types of pcos i dont know which type i am.. I get confused most of the time its every 3months that my period is gone and base on what i experience the longest was 7mons. Its gets worst when i came here in canada can u help me about this thanks

  88. I started taking peony and licorice two months ago and since then I have seen great improvement in my prolactin levels (I had it quite above the average… Now, It’s become “normal”…) I hope it will do the same with my LH…

    • I had been taking peony and licorice for three months (periods became more regular, LH was back in normal range, although prolactin went high again) but I stopped because I wasn’t sure about my potassium levels… I am trying to be careful and listen to what my body is telling me… What is your view on peony and licorice’s effect on potassium in the body? Can I repeat another 3-6mts cycle of peony and licorice if the symptoms come back? Thank you very much for your reply!

      • I’m careful with licorice because of its effect on potassium and blood pressure. The simplest thing is to monitor blood pressure and to take breaks from the herb.

  89. Hi Lara

    I’m just wondering what the best way to take Peony and Licorice is . All the formulations I have found say to take a certain dose 2-3 times a day. However, in your book you recommend taking it in the morning when the pituitary gland is most receptive. Does this mean it is best to take the equivalent of all 2-3 doses at once in the morning? Or do I just take one dose in the morning and don’t take any more? Or should I follow the dosing instructions on the bottle but make sure I get at least one dose during the morning?

    Any help with this is much appreciated.

      • I would like to know the same as well! And can you combine it with the other supplement you are taking e,g. NAC ,alpha Lipoic.. if you dont have an ovulation or dont know when it is happening ..How to determine when to start…?

      • So to clarify, does that mean I should stop taking the 8 pills, 3 times daily as it suggests on the bottle and change to 4 pills, once daily in the morning?

        • I can’t responsibly give advice that specific online. Can you find a local herbalist or naturopath to help you? Remember, you need to be careful with licorice, as it can cause high blood pressure.

  90. Hello,

    How do you know if you have pcos? I’ve been having period problems since my son was born and I never previously had them. I had my hormones tested and here are the results…

    Prolactin 7.6 no/mL
    SHBG 89.0 nail/l
    Testosterone % free + weakly bound 6.7%
    Testosterone free+w bound 3.6 ng/dl
    Testosterone total LC/MS 54.0ng/dL

    All of the results are in range but the testosterone total is at the very top of the in range results. im not sure if my testosterone would be considered high or not?

    Thanks love your page!

  91. Hello Dr Lara!
    I have insulin resistance PCOS and being on the way to quit sugar. And I wonder that is it OK to eat bananas. It is my favorite and can not pick some when in supermarkets for the glossary. I’m afraid high fructose in bananas make insulin resistance worser.
    Please let me know the fact about it.

  92. Hi Lara,
    I’m sure I have post pill pcos and am planning to buy my peony and licorice supplements next week following reading your book. Thank you. I note that you have written that periods should return within approx 4 months if this is the right herb. Will everything rebalance hormone wise if this is the right herb? My skin is bad and all this s*%t with not having a period for 8 months makes me feel generally unwell inside and out. I’m hoping to plan my wedding once this issue is dealt with and just want to know if this is going to be enough.
    Thanks in advance

  93. I really enjoyed your book and I’m hoping you can help me with a problem. I was having a hard time conceiving despite having nothing wrong with me or my husband. I’ve always had regular periods (between 27-29 days). So I started charted and after charting for a while, I suspected I might have a slow rise/progesterone deficiency. My MD did not listen to me, so I found an online program (based off of traditional Chinese medicine) which claimed to helped women improve their cycles. I thought this would help me progesterone issue. I was on the program for almost 2 months and was taking daily tinctures of herbal supplements based on what was going on with my cycles. Some of the tinctures had peony and licorice. I noticed that my periods started to become highly erratic and irregular. Now my past several cycles have lasted 43 days, 49 days, etc. and I don’t think I’m ovulating (or I’m ovulating very late). It seems that I have “pill induced PCOS” even though I did not take birth control pills. I’m still trying to conceive a baby, but now my cycles are completely messed up. Peony and licorice did not work for me. What should I do? My periods have been messed up for over 3 months now and I feel lost.

      • These were the supplements. Sometimes I would take the “Unwind” formula before the “Enrich”
        Taken on cycle days 1-3: Release: Water, Cane Alcohol (17% ABV), Glycerin, Cooked Rehmannia root, Angelica root, White peony root, Red peony root, Sichuan lovage rhizome, Peach seed, Safflower flower, Lycium fruit, Motherwort herb, Motherwort seed

        Taken on cycle days 4-14: Enrich: Water, Cane Alcohol (17% ABV), Glycerin, Tortoise Plastron, Cooked Rehmannia Root, Angelica Root, White Peony Root, Lycium Fruit, Common Yam Rhizome, Poria, Medicinal Cornel Fruit, Tree Peony Bark, Sichuan Lovage Rhizome, Oriental Water Plantain Rhizome

        Taken on cycle days 15-28: Unwind: Water, Cane Alcohol (17% ABV), Glycerin, Angelica Root, White Peony Root, Poria, Albizia Bark, Valerian Root, Siberian Milkwort Root, Bupleurum Root, Red Peony Root, Baikal Skullcap Root, Cyperus Rhizome, White Atractylodes, Turmeric Tuber Root, Tree Peony Bark, Mint, Honey Fried Licorice

        • I just want to add that I thought taking these herbal supplements were harmless but they totally ruined my periods. Caused me to go from life-long, regular periods to very long, irregular periods in a few months. These supplements are dangerous and I’m hoping Lara can shed some light on what I can do.

  94. Hello,
    I’m a 23year old from India .I was first told by my doctor when 17 that I had pcos (he considered my ultrasound report). I’ve had all symptoms like cystic acne, weight gain that was difficult to lose even till date, thinning hair and hair loss, facial hair growth, high melanin production with darkening at various odd areas and most importantly irregular menses. There was a time when my periods skipped for 6-8 months as well. But since last one year I was with a nutritionist who significantly brought into my diet high fiber foods and limited sugar and junk to the least. And I lost 7-8kgs. My menses started to fall into place but I’ve now become overly conscious and scared I might fall into trap again.
    I’ve consulted many doctors ever since but haven’t found one who could clearly tell me how it could be tackled. One doctor also told me that due to doing abs at the gym I have gotten Pcos and asked to strictly refrain from doing it in the future too!
    I’ve tried all medicines from allopathic to homeopathic. Surprisingly ayurvedic medicines helped me slightly giving me some hope..
    I’m 154cm and 61kgs, still 10 kgs over which I’m now finding really difficult to lose as I’ve hit a plateau.
    Looking forward to your reply and help.
    Smridhh Kaur

      • Also don’t stop exercising. That doctor is a liar, all the evidence suggests a healthy diet and regular exercise helps with PCOS symptoms. Weight training and cardio mixed is best.. do half an hour each day 🙂

  95. Dear Francesca
    I am fighting for my daughter . Your testimony gave me hope
    This herbal medicine you got from a certain doctor ..Where is he /she located? Did you have visit in person ?

  96. Dear Lara,
    Thank you so much for your work on PCOS. Your blog has helped me a lot understanding about PCOS.
    I have irregular menstruation since I was 15 years old. I was diagnosed with PCOS when I was 25 due to high testosterone and DHEA-S. My testosterone used to be higher 90 to 110, and DHEA-S is higher 500s.

    I have been taking Spironolactone 100mg for months, and birth control (I am trying to come out of it). I had low D3 since I don’t go out in the sun much, and regularly take Vit D3 supplement.

    My recent blood result below has high DHEA-S. Do I have INFLAMMATORY PCOS?

    Thank you so much.

    TSH 1.61 uIU/mL 0.27 – 4.20 uIU/mL
    DHEA Sulfate 634 ug/dL 99 – 340 ug/dL
    Hemoglobin A1C 4.9 % 4.0 – 6.0 %
    Insulin 11.5 uIU/mL 3 – 25uIU/mL
    Testosterone,LC-MS/MS 49 ng/dL 8 – 60 ng/dL
    TESTOSTERONE,FREE 0.64 ng/dL 0.06 – 1.03 ng/dL
    25-OH Vit Total 50 ng/mL 30 – 60 ng/mL

    • Elevated DHEAS but normal testosterone suggests adrenal androgen excess. Please see my androgen excess post.

      But is your testosterone normal because you were on Spiro and birth control at the time of that test? Mind you, I would have expected that to also suppress your DHEA.

      • Dear Lara,
        Before I started taking Spiro and Birth control (Microgestin Fe 1/ 20 estrogen and progestin), my Testosterone was 109 ng/dl. The level dropped after I started Spiro and birth control at the same time, but DHEA-S never dropped.

        Does that mean I have ovarian androgen excess? or it is adrenal androgen excess as you said since my DHEA-S is not controlled?
        I will try the supplements you have mentioned in your blog. Do you suggest coming off the birth control will help me?

        Thank you so much, Lara.

  97. My fasting bloodtests always is 4,9 or 5. Is this too low to have insulin pcos? I’ve had acne for years and meet many of the criteria for pcos.

    • The test for insulin resistance is not blood glucose, but rather: “fasting insulin” or glucose tolerance test with insulin. Insulin is the hormone.

    • The test for insulin resistance is “fasting insulin” or glucose tolerance with insulin. (you’re quoting a test for fasting glucose, which is not the same thing)

  98. I was very regular and didnt have period issues until i took the depo provera shot for birth control. I did that for about a year then went off because of side effects. 4 months later my period came back and then they were irregular for the next 18 months. Cycles 40-55 days sometimes. Then i had a miscarriage and a month later got pregnent again and now that baby is 3 months. Im interested to see how my periods will be when they come back (currently breastfeeding) i always thought it was that shot that screwed everything up but i didnt think anyone woild believe that…

    • yes, I would believe it was the depo shot that messed up your hormones. But glad you had a happy outcome. Your periods could be normal again after pregnancy.

  99. Hello,

    I am 30 years old and went off birth control in January. Prior to birth control I was very irregular. I would say I have been on bc for roughly 10 years. Since coming off the pill I had very irregular periods (66, 12, 82, 40 and 50 day cycles). In hopes of starting a family, my ob induced a period with provera and did blood work on day 4. I was diagnosed yesterday with PCOS via u/s. I was told by the Dr. that blood work wise my androgens were normal and insulin was low. My FSH/LH levels were consistent with PCOS and the u/s clearly showed PCOS ovaries. The OB suggested my next steps would be clomid to help ovulate and TTC or a combo of provera/clomid. Im not quite sure which category of PCOS I would fall into above. Do you recommend taking vitex to help ovulate?

    Thank you in advance for your help!

  100. Hello! I have been treated for hypothyroidism for the last 10 yrs. I have been trying to conceive for the past year, that’s why I took some hormonal lab tests. They revealed high prolactin and high LH (4th and 5th day of period). I’m in good shape :), I eat quite healthy, I also eliminated wheat and dairy products… What do you think my tests show and what should I do to raise my chances to conceive? I will be very grateful for any reply…


  101. Hi Lara,
    Recently I stumbled upon the idea of using proteolytic enzymes, in particular serrapeptase or Wobenzym, to treat PCOS and other reproductive issues. Do you have any experience or knowledge on this treatment? Thanks so much!

  102. I have some questions …Considering using Vitex.. Must the LH test be taken a special day in the cycle in order to get a right test result? What is the difference between a glucose test and an insulin test ? Glucose test is something you can test by your self as a diabetic e.g.?

    • Day 2 or 3 is the best day to measure FSH and LH.
      An insulin test is a measure of the hormone insulin. It can be a simple fasting insulin or done as part of a 2 hour glucose tolerance test.

  103. Hi Doc

    My symptoms are I haven’t had my period for 6 months and I have acne around my chin. Would you say I have post pill PCOS?

    My progestone, oestrogen and testosterone are still within ‘normal’ range, but testosterone is towards the higher end (Estrodial 59 pg/ml, Progestone .4 ng/ml, Testosterone .60 ng/ml). My LH is elevated, FSH:LH ratio 3:1. My cholesterol is slightly elevated. Cholesterol 5.72 mmol/L, Triglycerides .78 mmol/L, HDL 1.3 mmol/L and LDL 4.07 mmol/L. My insulin, fasting glucose, A1c, DHEA, SHBG, Prolactin, TSH, T3, T4, FT3 are normal.

    Thank you…

  104. IF the menstrual cycle is always short -21 days – plus insulin resistance and bad acne can you say that PCOS is present? This is what I have thought for a long time -but you say nothing in your blogs about short regular cycles?

  105. hi lara
    i have pcos.intially i have only symptoms of irregular periods.later i used high progestorne pills.after stopping that i got hairloss,acne and sleep distrubences.later for one month i have used peony and stoped and used spironolactone and acne hairloss every thing i stopped spiro then i got everything.then i started spiro but i didn’t get stopped.when i am using natural progestrone i noticed more now i am using peony& it ok to take both .last time after stopping pills first 4 months i have used metformin and later started peonyfor 1 month then started after using natural progestorne cream i started immidiately with peony and spironolactone.i didn’t see any long it will take?

    please reply ,i am waiting for ur reply.

  106. Thank you so very much for your work. My 17-year-old was diagnosed is PCOS this year after trying to discover the cause of her daily migraine headaches and missed periods. We were informed there was no link between the two.

    Now, after listening to your podcast on PCOS Diva, I am very curious to determine which type of PCOS my daughter may have. Would you be willing to give me your opinion? The GYN has her on a progesterone only pill and the neurologist has her on Topomax for her migraines. The headaches continue to no avail. Her acne is worse, and we no longer discuss her hirsutism. I found you searching the internet for supplements as I really do not want to add spironolactone to her daily regimen.

    We were told her thyroid was normal. She does NOT have diabetes mellitus. Test results: Hydroxyprogesterone is 43 ng/dL, Sex hormone binding globulin is 21 nmol/L (Tanner stages 7-17), DHEA 326 mcg/dL, FSH 4.7 mIU/mL, LH 5.0 mIU/mL, Prolactin 8.6 mg/mL, LH 5.0, Estradiol 25, Testosterone 26, Free Testosterone 4.4

    My daughter refuses to exercise. She carries extra weight. Diet changes are a hard topic to bring up.

    Thank you again for your work. I am excited to get your book for my daughter. She already dreams of having children so I have been praying for a miracle. Maybe you are that miracle?

    • I’m no expert but based on your message I would say it’s probably not IR or post pill. First try cutting down on carbs and sugar and see if that helps. Can you go for a walk, aqua jogging or a bike with your daughter? Find a sport her friends are doing? Or together you could do the couch to 5k but turn it into a competition, bet her ($$ or not) that you can beat her. When I was a teenager I wasn’t responsible for the supermarket shopping so I ate what was available. Sure she might be able to buy her own snacks, but if you don’t have chips, biscuits etc in the house, it makes it more difficult for her to eat them. Heaps of fruit and vegetables, make your own hummus, boiled eggs, etc. Good luck 🙂

    • Alyssa, those results do not look like a whole lot of androgen excess. Her LH is not elevated, her testosterone looks in the normal range (although you didn’t provide units or lab reference ranges). Her SHBG is low, I think it is the free that is high not the overall. Did they do DHEA-S? did they run Androdiestone? Her estrodial may also be low depending upon the cycle day it was run. Maybe not if it was early in the cycle. I would work on boosting the SHBG. Before she was on the pill, did you do any basal charting to see if she was ovulating?

      Did they run A1C and fasting insulin and glucose tests for you? they should would help you to know how to approach things if it was insulin related or not.

      Was she colicky as a baby? does she have allergies and food intolerances? Lookup Migraine and DAO enzyme. Try it. If you can get the migraines and inflammation under control it may help.

      • Thank you for your reply. I will seek the answers to the questions you posed and wish I had known of your work before we started the pill. I am tempted to stop the pill and start over again with diagnosis. In the mean time, any suggesting for getting her SHBG up? DHEA-S was 326 mcg/dL with range of 37-307.

        RE migraines: She wasn’t colicky. Naturopath didn’t find anything major other than a reaction to chocolate and coffee. Did find excess copper and bacteria, but she had been to Brazil recently. Looking into natural source for DAO. Thanks for the advice. I am hopeful I can find a working solution that doesn’t involve meds.

  107. Hi Lara

    This post has been very helpful for me.

    I got diagnosed with PCOS 2 days ago. I also have an underactive thyroid.

    I have started taking iodine (nascent), and I feel very exhausted after taking even just one drop (400mcg). Is this okay?

    Also I have been taking estroblock (DIM) for the last 1.5 years to help with acne. But as it suppresses estrogen, maybe this isn’t the best choice?

    Thank you. Looking forward to reading your book!

  108. Hi Lara,

    I am so very grateful to have found your blog and Period Repair Manual. They have been invaluable resources on my journey toward healing my cycle. I hope you don’t mind if I tell you a little bit about my story and how you’ve helped me.

    I stopped menstruating at 16 due to a hard to diagnose androgen secreting sertoli leydig cell tumor of the ovary. I presented with extremely(!) elevated testosterone, amennorhea… basically PCOS type symptoms. After about a year of going from doctor to doctor, I ended up having a unilateral salpingo-oophorectomy, confirming my diagnosis. Strangely, after the tumor was completely removed, my androgens stayed elevated – not astronomically high as before, but at levels that still caused amenorrhea, hair growth, acne, etc.

    My gyn-endocrinologist diagnosed me with PCOS and put me on birth control to “regulate” my cycle. This diagnosis perplexed me, as it seemed too bizarre of a coincidence that I should have 2 different maladies with the very same symptoms, seemingly back to back. I asked my doctor if there could be some other explanation, as I did not fit the typical profile of a PCOS patient. Could it be possible that my hormones had become stuck in a pcos-like cycle from my long exposure to high levels of testosterone secreted by my the tumor? This idea was struck down and I was resigned to the “facts” my doctor told me: there is no cure for PCOS, it is something I will have to deal with for the rest of my life and when it came time to have children, it would be a struggle involving lots of medications and doctor’s visits. This terrified me. I basically ignored my diagnosis after this. I pushed it to the back of my mind and just treated my symptoms.

    Throughout the years I had several short stints on birth control, but mostly stayed off it due to nasty side affects and preference. Then two years ago, frustrated and still dealing with amenorrhea, acne and hirsutism, I went on spironolactone. While it was effective at treating my acne, I always had a bad feeling about this medication. As my acne cleared up and hair lessened, I struggled with side effects from dizzy spells to seemingly constant dehydration. I knew that I could not stay on spironolactone forever and that I had to find a solution to regain my period and resolve my PCOS symptoms. This search for hope and answers led me to your blog (this very post, actually) and Period Repair Manual. I quickly devoured your brilliant book and felt completely empowered with newly gained knowledge. It was a revelation to learn that polycystic ovaries are just a symptom of one (or a combination) of many causes. While I wasn’t sure of my exact “type” of PCOS, I knew that I could make some easy changes to remedy any factors that could be contributing to my situation as laid out in your book. My outlook on my diagnosis shifted; I worked to tweak my diet, started taking a few supplements and slowly started to taper off my spironolactone dosage. I noticed I felt better and shockingly, I started to see signs my body was responding to these changes.

    Then it happened! One day about a month ago, I woke up to my first natural period in about 10 years. I could hardly believe it! Now I have started my period for the second time (!!!) and I know that it is not a fluke. I’m sure it will take a while to settle into a regular cycle but to see such unmistakably clear evidence of my efforts is so gratifying. Your work has had such an impact on how I understand my body. I honestly cannot thank you enough! Please keep spreading your message! It is so important for women to understand their cycles and to know all of their options when something is not quite right.


    Chelsea 🙂

  109. Hi, Lara!
    Could please help me determine what type of PCOS i have?
    These are my hormones results:
    Estradiol, Prolactine, Progesterone, FSh, Cortizol, Free testosterone, SHBG, DHESO4, DHEA-S , T3 , T4 and TSH are on normal range.
    LH is elevated (Fsh/LH =1/3)

    The blood tests were done on the 7th day that I got my period( folicular phase).
    My cycle has been always irregular, I have normal body weigh now but I used to be underweight. I have hirsutism too. My ovaries are polycystic.

      • Does glucose measure insulin?
        I had done fasting glucose, normal range was 3.8- 6.1 , my glucose was 5.1 . Before this it was 4.5.
        My cholesterol and tryglycerides were on nirmal range.
        Maybe it’s worth mentioning that my estradiol measures at the start of normal range. Also my endocrinologist told to do a RM of sella turcica years ago, and it showed hypersygnals in neurohypophysis which could mean calcification might be present.

        I haven’t been using any drugs for 2 years. My doctor used to switch druggs to see which one would work better, I had used Dianette, metfirmin and dexamethasone.
        They would regultae my period but my hisrutism never decreased.

  110. Thank you so much! This was eye opening for me. It seems that I have the inflammatory kind, what type of zinc should I get? I saw that there are different types like picolinate and chelated. Thank you!

  111. “Know when it’s time to let go of your PCOS Diagnosis. In most cases, PCOS is not a permanent condition. With the right diagnosis and the right treatment, PCOS can become a thing of the past.” You have brought hope to so many who have been told there is no cure, you can only manage it but you cant get rid of it.

  112. I was diagnosed when I was 22, I’m now 49. I don’t fit into any of the 4 categories. My blood tests always come back perfect. Even though diabetes runs in my family and thyroid deficiency, my results are always in the excellent range. Even my hormones are being produced properly. Going by tests alone, I am a perfectly normal, healthy woman. Yet, I am extremely overweight. Until this year, my periods were 3-4 a year if I was lucky. Now I get them every month, but I believe I have entered perimenopause and my body is responding to that.

    I’ve tried cutting down on excessive carbs, but if I do it too much my body craves them and I lose all my energy, almost sleeping or listless all day. I want to lose weight because it interferes with my mechanical body functions I’m really at a loss as to what I can do to rebalance my hormones so I naturally lose the weight.

  113. I am really confused. I got told I had pcos in 2011 from and ultrasound and from all of a sudden having cystic acne for a long time that wouldn’t go away. I was 30 years old at this point. To give you my story. I always suffered with acne as a teenager and up til i was aboit 18. My skin cleared quite well but would always get the odd spots around my time of the month mostly. Been on pill since was 15…… various types because at 21 started suffering from headaches which at about 24 said was migraines. Always thought i had hairy forearms and then from mid twenties i had the hair on my tummy where belly button is….. where men get it! Have hair on my toes and a couple of strays on top of foot….. again where men do and also hairs on chin a few are black but always had hairy face….. the fine hair. Didnt know until someone picked up on it in a close up professional photo. Anyway I was diagnosed 2011. The Dr. Said to stop smoking and lose weight. Forgot to mention have never missed a period since they began at 11 years old. Some of the various pills was on stopped them but always returned no problem. My weight had always been normal for my height. Then it seems as soon as I was diagnosed and quit smoking going gym for little time I did was making me worse. Slowly the weight kept piling on. My hairyness got worse I was losing hair on top of head near temple. I didn’t get it. I had an appointment at hospital and at that point I mentioned children and she said because I had a period every month it was hopeful for me. I dreaded getting pregnant though for fear of more weight gain and not being able to lose it and hair thinning or thickening. It thickened a little but then lost it in clumps after baby was born. Got told I had gestational diabetes but knew I hadn’t as I didn’t change my diet after this and blood tests I had to do were all in normal range. It annoyed me because had to be induced and had very horrendous Labour and delivery. Anyway since giving birth a year ago spots have come back, the weight no better. Am not on pill at all now because of migraines and I hate myself. It’s the weight gain I hate. I must admit I love my sugary foods and all the wrong foods and with a baby you grab the first and quickest thing you can but before I was pregnant which happened within 3 months of trying i had gone since diagnosis….. 55kg up to 70kg and at present I am 78kg. I look awful because I am small in height. So after reading your article I don’t know if I even have pcos but I do have all the symptoms for it. The only thing I didn’t have a problem with is ovulating which I got told can happen. So I don’t get it. Don’t know what other tests to ask for as my normal regular check up other than bloods but I know you are meant to find out what type you have to get the right treatment as everyone is different. My ovulation since being pregnant has not been quite the same. I have missed a couple of months…. not in succession and my cycle now is around 30 to 3w days where it used to be 28 days so not sure if that’s because of being pregnant and what that does to your body or pcos only now affecting it. Sorry its long but what do you think

  114. My daughter has been struggling with possible PCOS for one year and has come a long way. Is it possible to have a period and yet not ovulate? We have had her hormones tested 3 times and all come back with low to non existent progesterone (which she was supplementing and now is not at the advice of her endocrinologist). Her thyroid is now normal with a low dose of Synthroid. She was at 27 fasting insulin and is now 8 uU/ml. How long does it take to start ovulating after your insulin comes back down? Her cholesterol was high and has improved to normal along with her crp. She has come so far!! But, is she ovulating? It doesn’t seem like it.
    She has about 35 day cycles and occasionally skips a period once a year or, at the most twice.
    By the way, she is 19.
    So basically,
    If you have a monthly period do you always ovulate?
    and, once you normalize your insulin, how long does it take for monthly ovulation to occur again?

    Thank you!

    • Yes, it is possible to have a period, but not ovulate. That is called an anovulatory cycle, and is common with PCOS.
      But the progesterone blood test is only accurate if it was down about seven days before her period. Is that when the tests were done?

      • No, her draw was day 21 of her period, but that month ended up being a 36 day cycle. That is part of the problem, her periods have become irregular. I have never heard to test 7 days before her period which would have been day 28 of that month. We did get her results back on her pelvic scan and no enlarged ovaries or more than 12 cysts per ovary. (I believe she had about 5 or 6 per ovary which we are told is normal.) Radiologist said scan negative for PCOS.
        So, that is good news. The only real symptom of PCOS she has currently is slightly elevated testosterone (55.3 reference range 8.4-48.1) although her free testosterone is on the lower side. (2.0 with reference range 0-6)

        How do you test accurately for progesterone with an irregular cycle? The month before that she skipped a period, although that has only happened two other times in her life.

        She is only 19 an not interested in pregnancy. Since we have resolved her insulin, glucose, weight (she has lost 45 pounds) and cholesterol levels, How important is it for us to pursue this progesterone mystery? (This is the third low progesterone test in 18 months)
        Or, should we wait until she is interested in becoming pregnant which is probably at least 5 years away.

        By the way, she is also hypothyroid and takes 25 mg of Synthroid 6 days a week. Thyroid tests all in the normal range, however I am trying to get her Free T3 levels up which I have read can help with ovulation. Hers are on the lower end of normal and I think we want her in the upper end. So we are upping her zinc and Vitamin C. She does not currently take T3 medicine as I am really hoping to resolve this naturally. She is mostly GF and I think that helps her more than she wants to admit. 🙂

        Thank you so much for your input!!! I really appreciate your help!

        • Ann, have you done basal body temp charting? it is not completely foolproof, but it may give you some information. Get a really good basal thermometer. One which records a temp down to the second decimal place….so 98.63 for example. During the follicular phase you would expect a lower temperature, 97 to 98 range, and then a slight maybe two tenths of a degree dip the day of or before ovulation, and then a temp spike of between .5 (half a degree) to a full degree after the ovulatory dip. The temp should then remain roughly that elevated until you get your period. If you do not see that shift in temperature (increase caused by progesterone) then it was probably a non-ovulatory cycle.

        • Progesterone testing is only meaningful if it’s measured in the 10-14 days BEFORE the period. Its normal for progesterone to be low (close to zero) for a big part of the cycle.

          For example, with a 35 day cycle, there won’t be ANY progesterone until at least day 21. Progesterone will then be highest on day 28.

          The way I do it with my patients is to wait for sign of ovulation (mucus and temperatures), and then count 5 or 6 days, and THEN test.

          And I agree with Maddy about using temperatures. Have you read my book?

          • Thanks for the information. I plan on reading your book soon. Next time we test I will definitely do it after signs of ovulation and I will try my best to get her temperatures. Since she has corrected her insulin resistance do you think that will help her normalize her period? Does that take some time to happen?

  115. Hi Lara

    I have pill-induced pcos.. I was on yasmin for about 8 years and came off with irregular periods, and really bad acne. It has been about to years since diagnosis now and my periods have been regular for the past year or so but I am still getting the acne and I am unsure what to do about it.. I use a topical gel from the doctor to keep it at bay but it is still quite persistent. It is honestly so emotionally exhausting as my skin is already scarred and ruined from the intense breakout I had and the breakouts I continue to have.
    Thanks for your advice 🙂

    • Dear Friend.
      I have been where you are. In my younger days. I think I had inflammatory PCOS. Cystic acne followed me a couple of years. I had no cure no information, nor did any doctor. So I just had to put up with it. My best advice to you is to be patient. The healing will come but in order to get the healing there are several steps to implement in daily life. In Laras book you can read all about it. Order it if you haven’t already done it. I did even though my worse. PCOS days are behind me .
      Don’t loose hope PCOS and acne can be reversed but it is hard work.

    • I wouldn’t give that study much attention. It’s from 1986. As I describe in the article, PCOS is a condition of anovulation that can be caused by many different things.

  116. I am 23, virgin,.I always had irregular periods since menarche…I consulted gynaecologist 4 years ago….i had usg and thyroid hormone assay whicch came back normal …he put me on pills …I took it for 18 months… then I didnt as I was fed up of that…I had withdrawl bleeding the following month then next month I had menses…then no periods for 4 months…and….now its been 4 months…and no periods…he said again I have to be on pills…he said I have pcos… but he didnt do any hormone assay…how can he make the diagnosis. ..what do I do…I really dont wanna be on pills until I know its the only resort…

  117. Is it possible to start out as a one and it progress to another? I believe mine was pill induced but since I couldn’t get answers or figure out what was going on (even after my initial dx) I believe I’ve changed to insulin resistant/diabetic.

    Its a relief to read about the pill induced because for years I’ve said if I had not gone on the pill I wouldn’t have these issues. Everything was fine until then.

  118. Hi Lara,

    I’m wondering how long after eliminating soy from my diet I would start to notice changes and improvements in my hormone levels.

    I have ‘lean’ PCOS (not overweight, no typical external features, not insulin-resistant), which was diagnosed when I was 17 years old (I’m now 28). This has been confirmed with multiple ultrasounds and extremely irregular menstrual cycles/anovulation.

    I’m a vegetarian and consumed A LOT of soy products (e.g. soy milk on cereal, soy lattes, tofu, soy beans – all on a daily basis), and have recently stopped eating all soy products in a bid to help my hormone levels as I haven’t menstruated in 6 months.

    I’m wondering how long it might take before I start to see some improvements in my hormone levels.

    Thanks 🙂


  119. Hi Lara,

    Just wondering if there is any link between PCOS flare ups and change in weather? My symptoms seem to significantly worsen every year when summer hits.

    Thanks for your time!

  120. I can’t seems to identify which category I fall under… I was recently diagnose with pcos and my FSH 5.5, LH 12.7, progesterone 0.6ng/ml , prolactin 17.73ng. Would vitex be a good option?

  121. hello lara…were to begin>i am 30 years old and been diagnsed with pcos from my octor during an ultrasound and said he sees he small cysts but my ovaries were god in size..he put me on metformin and told me to diet.after month of diet .was eating chicken and veggies and salads and walking daily ..i got pregnant ..after one month had a misscarraige…that was 4 years ago …now im dieting gain..doing the cambridge diet and i started with 136.9kg and i am now 122.4 kg….after two months still dieting..menstruation came back but im spotting a little almost daily pinkish and then nothing the whole day..what should do..i didnt see myself in any of the four tyes..just irregular bleeding…and nt ovulating and migraines…no excess hair nothing or thining hair…what should i do next..te problem is i ust moved to a new country and i dnt have a dctor yet

    • now i just checked my last results and it says that my prolactin was 21.5mg ml …my lh was 27 and fsh was 15.7…what does this all mean? confused

    • Are you sure you’re not insulin-resistant? It seems likely that you are if the doctor prescribed metformin.

  122. Hello. I was diagnosed PCOS last year. I stopped using pills given by my doctor. I have change brand of pills twice, I suffer many side effects and then I stopped taking it. I’m searching for alternative treatment like herbal supplements. Do you think berberine can be helpful with my case? It’s been months since I haven’t had my period. I suffer acne in my jaw line and I have gain weight. my BMI results says I’m overweight. Thank you for your advise. 🙂

    • The big question is whether you suffer insulin resistance, or not. Your doctor should be able to tell you. If you do suffer insulin resistance, then your best strategy is to fix that. Please see my insulin resistance post.

  123. Hi Lara,

    I guess I’m a combination of Type One and Type Two. I was on the pill for 8 years (before that I had regular cycles) and after I stopped taking the pill, I had my period only in first two months and then it stopped. It’s been 18 months now with no period and I’m really worried. I am 27, ultrasound of my ovaries showed cysts but blood tests showed all my hormone levels are normal. The only thing that is not OK is my insulin level (I did 2 hour insulin and glucose test and my insulin after two hours is three times higher then normal). I expected my endocrinologist from my home country to put me on metformin, but she said I shouldn’t worry about insulin and that my period stopped because I was underweight (she thinks the pill was artificially making it happen for 8 years). She advised me to gain some weight, which I did, my weight is completely normal now but nothing is happening.
    I would appreciate your advice, I feel so hopeless. I’ll go to another endocrinologist here in US soon. Thanks!

  124. Ok so my progesteron was normal, my androstenedione too high (5.2 on the scale of 0.3-3.3 ng).. My estradiol was normal.
    My periods are normal, I also ovulate cause I check my temperature and such.

    The only thing I have is excess hair growoth on my body and my hair seems to be thinning a bit also its very thick still but its on the front of my hair line… Maybe because I am low on ferritine tho.

    It is just so weird… They also did a scan in the hospital and my ovaries looked fine.

    So why do I have these high androgens :/ I dont get it. I tried natural stoppers ike maca, spearmint, licorice… didnt lower it.

    • Have you been checked for zinc deficiency (most vegetarians are deficient in zinc and it’s important because zinc is a key androgen-blocker)

      • Thank you so much for replying 🙂
        And yes, I got tested last year and my zinc was really good.
        The only thing I have been low in is ferritine(this was also before I was vegan) and vitamind D(also before I was vegan since a lot of people in my country are deficient in it).

  125. Nothing has helped me :/ I tried all natural things and my androgens stay high. I have no clue what to do. They did an ultrasound on my ovaries and everything looked fine with no cysts. I eat a healthy vegan diet and am skinny. I dont think I have insulin problems either cause I had an insulin test done at the hospital once and my body responded perfectly.

    • Oh and btw I use the ladycomp so I dont use the pill; and in my temperature chart is shows I have a perefct cycle with ovulation around day 12-13 and a cycle of on average 27 days. Im pretty regular as well;I do have increased hairgrowth on my body, some pimples on my back but not full blown acne, and it seems my hair is thinning in the front but I also had low iron levels a bit for a while which I have had since starting puberty tho;
      My androstenedione was 5.2 and the scale they used went from 0.3 -3.3 ng :/

      • Andro is adrenal hormone. did they test DHEA and DHEA-S for you as well? Did you have adrenal ultrasound? Ask them to run 17-OH-Progesteroe and 17-OH-Pregnenelone also. And cortisol.

        do you have allergies, migraine or food intolerances? IBS or GERD?

  126. If Lara can not answer maybe some of my PCOS sisters can tell me a name on a good organic BERBERINE supplemnet? I live in Europe

    • Hi Shana
      Below is a reply I found from Lara to your question when she guest posted on a different blog.
      “There a number of supplement companies that make a berberine capsule, including Thorne and Douglas Labs. Also, the herb goldenseal (hydrastis) is berberine, but that herb is endangered in the wild”
      I’m in NZ and couldn’t find any companies that stock the mentioned supplements but did find the herb goldenseal so will give that a go.
      You might have better luck with stockists in Europe. Good luck ☺

  127. Hi
    You’re the first person I have come across that actually seems to know what they are talking about. Thank you heaps for writing this blog!!
    I am 27 and stopped taking the contraceptive pill 10 months ago and haven’t had a period or any signs of a period since. Only acne that seems to be getting worse. I had my doctor run bloods and my LH level is 11.3 which shows up as normal. After reading your blog and looking at the results again. Isn’t this slightly high for no period? Should I try Peony? I see that you are in Chch I’m in Nelson NZ. .could you recommend a naturopath here that could help??
    Any advice would be greatly appreciated.

      • Doesn’t the LH level vary by cycle day? So early in the cycle it should be approximately close to FSH level, near 1:1 ratio, but during the window immediately surrounding ovulation – the LH surge you would expect LH to be a fair amount higher than FSH. ???

        • Absolutely. LH goes very high during its pre-ovulation spike. Up to 20 or 30. But it’s only for a day. Rare to see it on blood test.

  128. Could you please suggest what would be the right causes and treatment for such type? Lean PCOS, high LH (LH:FSH=2,7). Other hormones is in balance. Normal testosterone, but hirsutism. No IR, glucose normal. Age 27. Never had normal periods, irregular very long and heavy, but no pain. Half of the year taking inositol, less carbs and sugar. Seems nothing is working. Age 27

  129. Hey thanks for a wonderful blog that gave me hope
    If one is a classic PCOS which tablets should eat after you started with healthy eating and regular exercise? Feels like it a lot but I’m willing to do whatever is necessary. Shall I start to begin with magnesium and berberine.? The doctors give no better alternative and I think Lara is right when she says that it’s about to get started with ovulation and getting the hormones in balance

  130. Not sure which kind of PCOS I have – policystic ovaries yes, no periods since stopped pill 6 months ago, had regular periods before pill, acne (before pill, cleared up on pill, now back), not insulin-resistant with TSH 0.96 / Free T4 15.7 / LH 4.1 / FSH 6.2 / estradiol 27 / progesterone 1 / prolactin 18 / SHBG 105 / total testosterone 46 / free testosterone 0.4. Age 33. Follow your advice on diet- non-inflammatory. Why do I not have periods?!

  131. Hi Lara ,last summer my daughter stopped having periods for few month,she was diagnosed with pcos,she had flax seeds grounded at home together with cenamon for 3weeks,and topped dairies for 2 wks and the period came(her tests results showed low class allergy to cows milk)
    Then she started spearmint (2cups per day)and decreased milk intake and the period came after month and a half ,she continued and it came 22 days later
    I thought to share her experience

    Thank you very much

  132. Hi Dr.Briden
    i have ovarian cysts and irregular periods and DHEA & DHEAS are high.
    i thought it was adrenal form pcos ,but i read some where if ovarian cysts are there it is not adrenal form
    is it true?because all other hormones are fine.acne,hirsutism r there.what type of pcos is this?

    • The ovaries can have a polycystic appearance with adrenal androgen excess (adrenal PCOS). In fact, the ovaries can have a polycystic appearance with perfectly normal hormones. The polycstic appearance simply means that ovulation is not happening that month.

  133. Hi Dr.lara
    i don’t know which type of pcos i am in.i have elevated DHEA levels but high end normal DHEAS.
    and all the other hormones are normal ,and iam not insuline resistance.My testosterone,androsterodine
    is normal. i am 37 years loss and irregular periods are main symptoms.
    initially they did bloodwork after my lunch that time my DHEAS is slightly elevated,but after 10 days did blood work in morning DHEAS is high end normal.later i used sprinolactone then DHEAS is reduced
    bit more but DHEA is mildly elevated.
    can u please suggest me what type of pcos is it ?ovarian / androgen ?

      • Thanq Dr.Lara
        For adressing it is androgenic type pcos.but 5 years back when i got pcos i am having only irregular periods .once in a while i used pills.after one and half year back i used different kind of pills
        for 3 months(don’t know brand)then i stopped it immediately i got severe acne and hair loss which is continue still now. so i am little bit confused about this.when i have only irregular periods doctor never tested my blood work.after hair loss started checked my blood levels.
        so i am confused ,can u please detailed it.

  134. Dear Dr Briden,

    Thank you for your blog & book – such great and much needed resources.

    I am a bit unclear on my type of PCOS (which may in fact be the other type of amenorrhea you mention in your book).

    I went on the pill (first Dianette, then Yasmin) at 19, because of acne, and stayed on it for over 10 years. Early last year I stopped taking the pill (mid-chart) and I did not have a period for 9 months (not even a withdrawal bleed). I went back on the pill in October-time (still not having had a period) as my acne flared up again and my gynaecologist and GP both thought it was a good idea to address the “PCOS”. This was before I found your blog & book!

    I now want to find an alternative way of dealing with the lack of periods and acne. I am not trying to conceive at this time, but pregnancy is in the mid-term plan. At the same time, I desperately want to be free of acne. And having read your book, I now understand ovulation is a sign of health, so I want my monthly report card. 🙂

    Before starting the pill at 19, I can’t recall what my periods were like. I think they were quite long (6-7 days?) and that I had a long-ish, but fairly regular cycle (35 days?), but I can’t quite remember. I couldn’t say whether I ovulated or not. When I first got my period, in my early teens, my cycle certainly wasn’t regular, but I understand that’s quite normal and also I was fairly skinny and very physically active.

    After having stopped the pill last year and not having had a period for some time I sought advice from a gynaecologist/endocrinologist – he did an ultrasound and saw that I had polycystic ovaries. As my acne was slowly starting to come back (around my jawline and on my back), he diagnosed me with PCOS and suggested I take an artificial hormone for 10 days (brand name “Duphaston”) to induce a bleed, before going back on the pill. The Duphaston did not induce a bleed. The gynaecologist therefore sent me for hormonal tests (twice, with 6 weeks or so in between), which, according to him, showed no signs of abnormalities. I have the results, but am not writing them down, as this post is already very long!

    A few days after the second batch of hormonal tests, I started taking the pill, as by that time the acne was getting bad and I also needed a method of contraception (though in terms of contraception, I would LOVE to do the natural method described in your book and my partner is very supportive of using condoms until that can be done). Having taken my first chart, the withdrawal bleed came as if on cue.

    Having then discovered your blog and book, I asked my GP for a number of further tests: insulin resistance (the full drink-a-disgusting-drink test), gluten intolerance, vitamin D and thyroid. My GP thought I was a bit crazy, but she is fairly wonderful, so happily agreed to the tests. All of the tests came back normal. I am normal weight (BMI approx. 20), I eat reasonably healthily and have been for a long time (organic; lots of fruit & veg; I limit, but don’t exclude, dairy, sugar and gluten), I do have a somewhat stressful job, but the older I get the better I get at handling the work stress and I do both yoga and meditate; I do exercise a fair bit (as I love it), but nothing in the extreme range.

    The pill has improved my acne (but may also be making my skin incredibly dry – face and arms) and I am very reluctant to stop taking it before figuring out a plan to deal with the acne, but I do really want to come off the pill. This time, though, I guess I want a plan. The problem is that I’m unclear on what steps to take, as I can’t quite figure this out on my own or what causes it. I do seem to have some form of PCOS (polycystic ovaries, and while no heightened levels of testosterone show on the blood tests, there is the acne, which goes away when fed artificial female hormones), but it’s (i) not caused by insulin resistance, (ii) it doesn’t seem to be JUST pill-induced (as I’m not sure I ovulated before and I certainly had bad acne before), (iii) I’m not showing signs of inflammatory PCOS, though I guess it could still be that, (iv) I don’t eat soy and I don’t have a vegetarian diet.

    Or could the acne and post-pill amenorrhea be unrelated and should be treated separately?

    Apologies for the long post. I’d so appreciate your guidance here. Either by way of a blog reply, or, if you have the chance, I would love to have a Skype/telephone consultation (I live in Europe). I’d come see you in a heart beet were I living in New Zealand! I’d be very happy to send you my full hormone and other tests results and supply any further information you might need.

    Thank you and thank you again for your wonderful blog & book.

  135. Hi, I have a question about PCOS diagnosis. I have irregular cycles, very mild acne/hirutism but none of the typical diagnostic lab work is abnormal. Most recent U/S was also normal. But I do have high AMH (14.9). Is this enough to diagnose PCOS? I keep reading that high AMH is very indicative of PCOS. Thanks!

        • Hi Megan, yes, an AMH at that level is “highly suggestive” of PCOS. 🙂 I know you’ve heard that already. Is your LH elevated?

          • No, that is the odd thing. LH is very normal. All other bloodwork checks out, besides having low progesterone. I had an ultrasound taken shortly after my AMH results that showed only a primary follicle, no cysts/immature follicles. After well over 2 years of trying to conceive, I am going to an RE next month, so we’ll see what they have to say. I worked very hard on regulating my cycles with my ND & acupuncturist for over a year, and while they had appeared to regulate for a few cycles, they are back to being very long (and very frustrating) again. Thought it is tough to hand over control of my body after all the my hard work & sacrifice, I feel like it’s time. At least I know I am much healthier than I was at the beginning of this process, hopefully at a better place to be receptive to treatments. Thank you for your input Lara!

  136. Hi Dr. Lara,

    Can you have normal insulin levels and still have insulin resistance? My fasting insulin was 8 on a blood test, but I still think I have IR because I have a bigger belly (I’m 5’3, 110 pounds, cut all sugar from my diet and I STILL have a belly!!). Should I get a glucose tolerance test instead? Or is abdominal obesity enough to determine that I have insulin resistance? I don’t fit any other type of PCOS and really want to make sure I’m treating the correct cause. I’m already doing everything you outline in your book to fight IR, but I was thrown off by my insulin blood test coming back normal.

    Thank you so much! I love your book and have read every article on your site.

    • Hi Stephanie, Is it abdominal obesity? You have a BMI of only 20. Could it actually be digestive bloating or distension?
      In that case, you want to switch gears and treat digestion (see Chapter 10 of my book). Finally, on what was your PCOS diagnosis based?
      Do you have high androgens?

      • Thank you! I was diagnosed based on very irregular cycles (only about 4 per year) and a very high AMH level (51). They said my androgens were “in the normal range,” but I do think they are high (my DHEAS was 261.9 ug/dL and testosterone is 52.5 ng/dL). I also have oily skin and mild acne (but no hirsutism).

        I think it’s more likely to be IR than inflammatory PCOS because I ate an extremely high sugar diet for 20 years (I’m 31 now). I was seriously addicted to sugar and only cut it out 4.5 months ago. I don’t have any symptoms of digestive issues (never get headaches, no joint pain, no skin conditions). I lost a lot of the belly when I cut sugar (lost 16 pounds total), but it hasn’t gone away completely and still is pretty big. That’s why I think I have IR – I just didn’t understand why my fasting insulin level was normal. Maybe it’s okay in a fasting state but still spikes too high after meals?

  137. Hi, What about low estrogen PCOS. What method of treatment do you recommend I go about fir this. I just got off the the pill a week ago and did my bloodwork. All other hormones seem normal and estrogen is reduced at 12.83. My LH level is at 3.85? Is that still low?
    Do I still take the DI to get rid of the excess xenoestrogens from my system?

    • Most PCOS-sufferers are deficient in estradiol (the estrogen your doctor tested). You make estradiol by ovulating, so again it comes back to my key message for PCOS and all period problems, which is to promote healthy ovulation. Please see my Estrogen Deficiency post.

  138. Hi Dr. Lara,

    I was diagnosed with pcos and have been under treatment off and on since 2014. After taking a blood test for hormone levels two months ago, my gyn said that I am inheriting it because my hormone levels were normal. I was prescribed metformin for thirty days along with a diabetic tablet to regulate insulin. My periods were normal for two months. Now that I have stopped taking the medicine I have not got my period this month, it’s a week overdue. I am not sure if it will take some more time to regulate. And I am also planning to start a family in another month or two. I would like to wait till my ovulation and period are regulated. Please advise.


  139. Hi Lara
    My 17 years old daughter stopped having periods 7 month ago
    3and a half month ago her doctor diagnosed her with pcos ,he described her premolot nor for 15 days , and the period was induced
    A month and4 days ago she had a natural period on the third day she had tests
    Her tests results are

    Hemoglobin:12,9. Rbcs :5,51

    Bl glucose:77. TT3:109

    FSH:2,0. Lh:1,6

    Insulin fasting :3,7. Vit d:20,62

    Serum zinc86,9

    Her gluten sensitvety test result was normal

    Her tests for food allergy were normal except for cows milk that was :0.,38

    Could that be the cause of pcos?

    Should she stop dairies?

    Nb:she is slim ,normal weight ,has no facial hair but excessive hair in the central line of the abdomen
    Eats healthy ,and doesn’t eat soy and eats enough starch

  140. Hi Lara

    I am 30 and was diagnosed with PCOS last September when I went to fertility specialist. I was tested for insulin resistance and my HOMA score was 2.8 (fasting glucose 83 Insulin 13.5). My day 3 test showed

    estradiol 21.49
    FSH 5.8
    Prolactin 27.8
    TSH 2.4
    Vitamin D 17.1

    I have been on Metformin 500mg twice daily since Sept and have dropped 15lbs to 124lbs (Current BMI is 21). I am trying to maintain a low carb diet having eliminated sugar and diary and am also consuming ACV/cinnamon to help as well. I am a vegetarian so I am not sure if I have zinc or magnesium deficiency .

    My last three cycles have been around 32 to 35 days due to the Metformin, but after reading your blog I am confused if I am Type 1 as well as Type 3 (since I had low Vitamin D, mild hirutism ) . I am trying spearmint tea to help reduce the androgen levels but could you advice me how else to lower my androgen/testosterone levels and ovulate naturally

  141. Hi Dr Lara,

    I was diagnosed as having PCOS last February. I had stopped taking my contraceptive pill in July 2014 as I had decided to start a family. I went to my GP last January as my periods had not yet returned to ‘normal’ (cycles were between 6 and 10 weeks long, rather than the 4 weeks I was used to prior to starting the pill). I had taken various different pills and had the depot provera jab for a period and this spanned 10 years between initially starting on oral contraception and coming off it in the July.

    Initial blood tests though were apparently fairly normal and didn’t indicate that I had PCOS but I was sent for an ultrasound. I was told that the ultrasound did show I had PCOS. My periods continued to be quite erratic. Bleeds have been fairly normal in length though aside from one episode where the bleed went on for over 6 weeks but found that was the result of an incomplete miscarriage.

    However the past 3-4 months I have returned to a more normal 4 week cycle. Is it possible that I could have been misdiagnosed and it has just been continued effects from taking the pill?

    • An ultrasound cannot diagnose PCOS, so if you have normal cycles now, and normal hormones on blood test, then you don’t have PCOS. Quite likely, if you were to repeat the ultrasound, it would look normal.

  142. Do you recommend a combination of the magnesium and the inositol etc. I have been put on metformin before and it destroys my stomach. I and PCOS-Insulin Resistant. I’m just searching for answers, I have the hair growth with no menses and no ovulation. I am also taking progesterone every month just to have a cycle.

  143. Hi Dr. Lara,

    My daughter always had irregular periods. Her periods were rare. At 16 she had still normal testosterone and her doctor suggested but did not require to use pill. As an alternative she recommended to take Provera every 3 months to induce period as a precaution against cancer, which we did. She has a little of acne and hirsutism but very manageable. She was not skinny but not nearly overweight. Then when she was 17 blood test showed that she has increased testosterone(71) and prolactin(23.7) and normal LH(9.78) and no insulin resistance. She got a diagnosis of PCOS and doctor pretty much ordered to start pill. Her main argument was that if my daughter does not start pill she will have physical non reversible changes with enlarged clitoris. We tried homeopathy and acupuncture for 4 month but since there were no results and we were scared about enlarged clitoris we started pill. She is taking it for 4 months now and she gained a lot (more than 15 pounds) weight. Cannot be completely sure that it is because of the pill because she also went to college at the same time.
    I started to research and came across of your blog and the book which I just finished reading.
    I could not find any reference to enlarged clitoris. Is this something that we really need to worry about if she stops taking the pill?
    Also another questions, if she stops taking the pill and goes back to Provera (every 3 month) to decrease cancer chance and also tries some remedies from your book, is there any way for us to know that those remedies are helping?
    She does not meet criteria of any of 4 PCOS types so it might take a while to figure out what is causing it. She was tested in the past for thyroid problems but after reading your book I will ask to test her again.
    Also do you provide private consultations via Skype?

    Thanks in advance,

    • Your daughter’s testosterone is only slightly elevated at 71 (reference range for a woman is 15-70 ng/dL). Also, her prolactin is normal (reference < 24 ng/mL). My experience with young women in a similar situation is that it should be fairly easy to get her periods going naturally once you can identify the underlying issue. Ask her doctor to test thyroid again (and look at optimal range), serum zinc, celiac serology (gluten sensitivity), and some of the other tests that I list in Chapter 7. I have to say something about Provera. It's a horrible drug, and it wouldn't surprise me if it is what raised her testosterone. Many of the young women that come to me have gone 1-2 years without a period, and their GYNs had not prescribed Provera (thank goodness!). The doctors were usually more concerned about bones--and Provera is bad for bones. Yes, there there is a slight lifetime risk of endometrial cancer with true PCOS, that’s over a lifetime — decades of exposure to unopposed estrogen. There is no substantial cancer risk in a young women going 6 – 12 months without a period, and anyway she’s likely to have regular periods once you can find the right natural treatment.

      Finally, what is her BMI?

      Please send me a private message.

  144. Hello from Poland 🙂

    I was diagnosed with PCOS and I didn’t agree, so I started my research and found your amazing page which gave me hope that I have pill inducted PCOS than can be managed without pills.
    I’ve been taking the contraceptive pill for 14 months, then stopped in February and haven’t had a period since. Before the pill, I had regular cycles and only some acne (I didn’t worry so much about it).

    After stopping the pill my face started to look like pizza, my hair started falling off. I was going from one gynecologist to another, no one mentioned PCOS beside one, the last one.

    These are my blood tests:
    progesterone 0,52 ng/ml
    estradiol 41,15 pg/ml
    TSH 1,5000 uIU/ml
    LH 14,46 mIU/ml.

    I had prolactin, testosterone and FSH tested in July:
    prolactin was 9,60 pg/ml
    testosterone was 45,18 ng/dl
    FSH was 7,12 mIU/ml.

    After reading articles on your page last week I ordered supplements and I started taking magnesium (citrate), chromium, zinc, B complex, D complex, evening primrose oil, and I drink peppermint tea twice a day. I am vegan, my blood levels are great, cholesterol and iron perfect as my doctor said. I testes glucose and it was fine, but Insuline resistance test is so expensive… But I don’t have any sytptoms of it.

    The problem is that I cannot find peony and licorice anywhere and I think I can’t take vitex (I assume my LH is high, am I wrong? Vitex is available to buy here in Poland, so it would make it easier if I could take it).
    What do you think, dr. Briden? Is it pill inducted PCOS? How else can I treat it?

    Thank you for what you’re doing!

  145. Hi Dr Lara,

    I have read your book a couple of times (specifically the PCOS chapter!) and I am currently trying to determine what ‘type’ I have so I can progress with the appropriate cause of treatment. My doctor is dead set that an anti-androgenic BCP and Metformin are mandatory and I’m really doing my best to resist being forced in to taking BCP. My details are as follows: 23 years old, BMI 18.7, diagnosed with PCOS at 16, had an irregular cycle but started BCP so young I can’t tell if it ever had a chance to regulate, PCOS symptoms have flared up (hair loss/hair growth/oily skin) in the last 12 months when I moved countries and stopped BCP about a half year before that.

    Blood work (day 3 of period) as follows:
    FSH: 5.6 mIU/ml
    LH: 14.3 mIU/ml
    Prolactin: 285.2 mIU/L
    Estradiol: 246.6
    Testosterone: 0.99 nmol/L
    AMH: 123 pmol/L
    DHEAS: 146.4 ug/dl
    TSH: 1.5 uIU/ml
    FT4: 17.4 pmol/L
    FT3: 4.6 pmol/L
    Anti Tg: 301 IU/ml
    Anti TPO: 23.9 IU/ml

    Also a couple of months ago my general blood work came normal and vitamins etc as follows:
    Ferritin: 62 ng/mL
    Vit B12: 301pmol/L
    Vit D (25-OH): 63 nmol/L

    I am being told by my gyno that he is positive it is insulin related, and dismisses the possibility my thyroid plays any part in this. My thyroid hormones are ‘normal’ but with a high presence of anti TG (I also have goiter), could there be an underlying relation between this and my PCOS? I understand the sensitivity with offering medical advice online, but if you had a patient with similar levels would you consider this a Type 3 case? I’m desperate to avoid BCP and more importantly treat the actual imbalance. If you would prefer I message you privately please let me know, thank you in advance!

  146. Dear Dr. Lara,
    In your book I read that too much insulin make more LH and reduce SHBG and thereby free testosterone can be increased.
    My LH is actually low and SHBG is in the higher end in the normal range, free testosterone is also normal. I was told I have mild insulin resistance (my HOMA index is perfect(1,3) but the 2.hour reading higher than the 1.hour). So I don’t really understand why the reverse is happening in my case.

    I was on pill for years because I have hirsutism. I have regular period but not sure if I ovulate.
    My DHEA’S is also in the normal range in the higher end and I am still waiting for the androstenedione.
    Well, looks like that all the androgens are ok. Can the IR cause the unwanted hairs even with normal androgens?
    Dr. Fiona’s blog mentions some anti-androgen herbs, like reishi mushroom. Would it be ok to try it with normal androgens? I would also like to take the suggested supplements for IR.
    I feel my case is complicated any help would be appreciated.
    Thank you very much in advance. Loved your book.

    • When did you stop the Pill? When were the LH and SHBG readings taken? (Because SHBG is elevated by the Pill, and can stay abnormally elevated for many months after stopping.)

      • I stopped the pill 8 months ago and the I did the blood test only 1 week ago. So could it be elevated because of the pill?
        If my total and free testosterone are normal, but SHBG and DHEA-S are a little bit elevated still in the normal range (androstendione reading is not ready yet) then does that mean I have high androgens? Can this cause the hirsutism?
        Thanks a lot.

        • SHBG is essentially an anti-androgen. It is a protein that binds to androgens and takes them out of circulation. So higher SHBG would generally mean less hirsutism.

          With a HOMA index of 1.3, I really doubt you’re insulin resistant. If you were my patient, I would look at other underlying causes of androgen sensitivity such as inflammation. The first thing is to figure out if you ovulate or not. You can do that by tracking temperatures or having luteal phase blood test.

          Progesterone is the best hormone for improving hirsutism (and you can only make progesterone with ovulation).

        • Dear Jane

          I know it is a very old post. I hope you don’t mind me reaching out to you!
          My blood readings are the exact same as yours, except that I have high Androstendione as well. (What are yours?) Have you found out your type of PCOS or Problem? Any help or answer would be very much appreciated. I am so lost. Thank you so much!

          Hugs and many thanks,


  147. Hi Lara,

    Thank you so much for making this blog. I’m a bit stumped on my situation and was hoping you could maybe offer some advice. I’m a thin Type 1 insulin dependent diabetic who has always had regular periods, but I’ve struggled with hirsutism since I was a teenager.

    I had my hormones tested a couple years ago and my testosterone and DHEA levels came back very high. My DHEA was 580 (lab range for normal is 35-430) and my testosterone level was 118 (reference range 15-80) My then doctor put me on the pill, which lowered my testosterone to just a few points above the normal range, but I didn’t see a noticeable difference in hair growth so I stopped taking it after about a year. Interestingly, she only tested my LH and prolactin levels while I was on the pill, so I don’t know if these numbers are useful to you or not but my LH was 4.8 and prolactin 6.8. Since stopping the pill, I’ve been trying DIM-Plus and Spearmint, which seems to be helping a little at slowing the excess hair growth, but I’m not 100% certain.

    What type of PCOS do you think I have and are there other supplements that might be better options for me than what I’m currently trying?

    I’m hesitant to bring up the subject with my current endocrinologist because I know her reaction will be to immediately prescribe Sprio + birth control, and frankly, the side effects of those medications worry me and I don’t think are good options for long-term use.

    Any insight you can offer would be so appreciated!

    • I’ve worked with a number of Type 1 diabetics, and many of them have a similar problem with elevated androgens. It is essentially the classic type of insulin-resistant PCOS. High insulin causes high androgens. The difference is that your insulin comes from an external source.

      Many of my Type 1 diabetic patients work to carefully reduce their insulin requirement by reducing carbohydrate intake. Please see the amazing new review article about the safety and appropriateness of a low carb diet for both types of diabetics:

      Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base.

      Of course, this must be done under medical supervision. I hope you can find an endocrinologist who is willing to help you with this. (Just to clarify: By “reduce insulin requirement”, I mean reduce, not stop. Of course, you’ll always need to take insulin.)

      • Thank you. I’ve actually had high androgen levels since I was a young teen but didn’t develop T1 Diabetes until many years later as an adult. While I don’t necessarily think that insulin resistance is the sole cause in my case, particularly since my daily insulin requirement is already quite low, I do appreciate your response Dr. Lara, and will definitely read the article as cutting out a few excess carbs certainly couldn’t hurt!

        • Since your hirsutism predates your diabetes, there may be other factors. Possibly the inflammation-induced “androgen sensitivity” I discuss in my latest androgen post. You know you have inflammation (immune activation) because you have an autoimmune disease (type 1 diabetes). If you were my patient, I would seriously think about cutting dairy and gluten.

  148. I have pcos and fibroids. I’ve been trying to conceive but haven’t had any success.. What could I do to improve my chances of getting pregnant.. Thank you

  149. Dear Dr. Lara,

    Thank you so much for this blog and for your amazing book. I read it in one day and finally I feel like I’ll be on the right track. I am gonna get the blood tests done next week and I’ve already started a sugarfree, dairy-free, gluten-free diet.
    I’m 34 and been suffering from hirsutism for a decade. I went on and off pill Diane, it helped a lot but I stopped taking it half year ago.
    I think I have progesteron deficiency, I’ve got few of the symptoms. I also think I have IR, but next week I will make sure of that.
    So my question is if I have both of them, can I take vitex or peony (depends on my LH) to boost my progesterone plus inositol, bereberine and magnesium for the insulin? Are they ok together or is that too much?
    Your book is quite informative, I love it but i’m a little bit confused because you are saying that the point is to look deep and find the underlying issues but in that case if I have IR now, but the the cause of my hirsutism was not the insulin problem 9 years ago when my first symtomps appeared how I can know what is the right treatment now?
    I had been taking pill in my early twenties for 2 years then I stopped it and then 1 year later I noticed more hair, so it could have been post-pill PCOS ( my period was always regular before and after the pill, too and according to my doctor my blood test was normal) he couldn’t suggest any solution, but the pill Diane and stupidly I started it. So here I am now and I have no idea how to find out the main cause. What is your opinion?
    Thank you so much in advance.

    • Hi Jane, great question about what was the original cause of your hirsutism. Are you certain you weren’t insulin resistant back when you were 24? It’s possible because you’d already been on the Pill for a few years, and the Pill causes insulin resistance.

      Generally, I find if there is insulin resistance, then it’s most important to treat that. And reverse that. Then look at whether androgens are still high.

      As for whether Vitex or not, Yes, depends on your day 2 LH. ? And remember, if you are insulin resistant, then that’s why your progesterone is low. Reverse insulin resistance, and your progesterone will naturally come up. You may not need a progesterone-boosting herb specifically.

  150. Hi Lara,

    I am 33 today. I was diagnosed with PCOS in my early 20’s. Blood test showed I had the hormone imbalance. The ultrasound didnt show any cysts. However, I was not insulin resistant or really overweight. The problem for me is extremely coarse hair growth. I was put on spironolactone, Metformin, and birth control. I also had periods maybe 3 times a year. The Metformin made me feel really weak like I always had to eat. The doctor took me off it. I stayed on the spironolactone and birth control for a year or a bit longer. I changed my eating habits and lost weight on my own. I also cut a lot of carbs. I am now about 50 pounds lighter. This was about 4 years ago since the weight loss. At that time, doctor took me off all medication. Ever since then, I have normal periods every month. My blood test now shows that my hormones are normal. I even had my thyroid tested, bc my biological mother has thyroid issues and diabetes is heavy as well in her family. Everything seems fine. My question for you is why do I still get the hair growth on my face? Do I REALLY have PCOS?

    Thank you

    • The hormone imbalance of PCOS is usually reversible (as you’ve found). But even once hormones are normal, the symptom of hirsutism (body hair) can persist for months or even longer. That’s because the hair follicles have a very long memory.

      • That makes sense now. I just didn’the think it would grow back as much or even years later.

        When hormones are back to normal, does that mean ovulation is as well?

  151. I am type 4. All my blood work came back normal (blood sugar, cholesterol, testosterone, and any others that go along with PCOS). . I am on thyroid medication because my T4 was high a year ago, but it is within normal limits now. I am on the IUD without hormones. My ultrasound came back with 12+ cysts in each over and swollen. I do have acne that I am being treated with Spironolactone and a little bit of body hair. My uterus is good. My cycles are usually every 6 weeks, but extremely light (1-2 days) now with the IUD. I would like to find away that will lower my cyst count naturally, so I can have normal cycles.

  152. Hi Lara,
    I’m not sure if I fit under type 2 or type 4 and am lost as to what to do. At 17 I went on bcp as I hadn’t yet got my period. Back then a gyn examined me and said that everything was normal I was just a late developer.
    10 years later I came off the pill and waited for.a period which still hasn’t come (6months). A full set of hormone tests all came back normal but I have 30+ cysts on each ovary (and obviously not ovulating) so was diagnosed with PCOS. I don’t have any other symptoms, am normal weight range, no family history and have a very healthy lifestyle.
    My fs wasn’t worried about my primary amenorrhea and put me on clomid. Last month 25mg, this month 50mg.
    I’m worried that clomid isn’t going to work as my hormone levels are normal and wondering if chaste berry might help ‘kick start’ my cycles.
    Any advise you have would be really helpful! Many thanks, Sarah

  153. HI Lara–my question is this. I have been told I possibly have PCOS. My period comes regularly every 28-30 days, however it does not appear I am ovulating(?) At one point in my normal cycles I was ovulating, however as I achieved pregnancy in 2012. Following this I was briefly on birth control but stopped it as I did not want to continue artificial hormones. Again normal cycles since that time.
    We recently, unsuccessfully, began trying to conceive.
    My reproductive endocrinologist checked levels:
    Day 3–Estradiol 44, FSH-8.4, LH 5.7, testosterone 48 (top normal) Normal pelvic US
    However, following charting my cycles and failing to see a strong elevation in BBT, and OPKs that turn positive around day 13 but then remain positive for 6-7 days, I question the fact that I am ovulating at all.
    My mid cycle levels (day 17) were LH-10.7, FSH- 4.7, testosterone – 80.
    My Dr. feels this indicates my LH is normal at the start of my cycle but then following the surge to trigger ovulation continues to remain elevated in an attempt to encourage ovulation which for some reason is failing. My assumption is these elevated levels of LH in the 2nd half of my cycle are also causing my testosterone to rise.
    Additional info on thyroid
    TSH= 2.36, Free T4 =1.1, Free T3=3.3 (was told these are normal?-although 2.36 seems higher than it should be?
    I am not insulin resistant (fasting insulin 2.0, blood sugar 73) and have no signs of inflammatory PCOS.

    My question is this–What is your opinion on why I may not be ovulating? Does this seem more consistent with post pill PCOS or possibly hidden cause related to thyroid (I should mention no symptoms of hypothyroid), despite the fact that my period is still fairly regular?

    Thanks so much for your input!

    • I should also mention the birth control I took for a short period back in early 2013 was Loestrin, which I have read has a high androgen index–is it possible this has thrown off my hormonal levels, and now ovulation and I am stuck in a vicious cycle?

    • Your insulin is actually quite low. You’re not on a low carb diet, are you? Have you had a luteal phase progesterone reading?

      • No low carb here.
        Fasting insulin the month prior was 5.0 which was low normal
        This past cycle I did have what I thought was day 21 progesterone of 6.8. I assumed this meant no ovulation. However my period came 4 days later only 25 day cycle( I assumed slightly short due to stressing so much about all this ha!) so I am not sure if that can be accurately interpreted? What are your thoughts on the cause of this? Your input is so greatly appreciated!! Thank you so much!

        • Fasting insulin of 5 is perfect, and I’m glad you’re having some starch.

          A luteal progesterone of 6 ng/mL means you did ovulate last cycle. (were the units ng/mL?).

          But yes, the sustained LH surge is a bit of a problem. Did your doctor say anything about your thyroid readings?

      • My fasting insulin is also low (2.7) and blood glucose is 73. I am on a low carb diet. Do you not recommend low carb diets for women with such readings?

        • I’m cautious with a low-carb diet for any woman because we need starch to ovulate. On the other hand, I highly recommend a no-sugar diet.

  154. Hi Lara,

    Your posts have been incredibly helpful in my PCOS journey and I really appreciate all the information that you share. I have a question about taking supplements and herbs.

    I am currently taking Maca powder, Ashwagandha, Gotu Kola, Vitex, Inositol and Gymnema. I take a lot of supplements though and want to reduce what I can and I am starting to think I don’t need all of the ones I listed which I’m taking specifically for PCOS-related issues.

    I was trying to find specific information if Inositol and Gymnema do the same things or have the same effect when it comes to insulin resistance. I would like to only take one of them, if possible, but don’t know which one is best. I only plan to be on Vitex for another 2 months and then will take a break. And I want to continue with Maca powder long term.

    Do you have any recommendations on what would be good to keep taking or if I’m taking things that do the same?

    Thanks so much, Lara. I also really appreciate all the time you dedicate to responding to comments as I have learned so much from just the comment section!

      • I actually don’t know Lara. I have an appointment with my gynecologist in a few weeks and will have a more thorough discussion with him. I was diagnosed over 10 years ago at age 18, but he was never very specific about type and I never really looked into it much. He basically put me on birth control at that moment and that was his only treatment recommendation over the last decade. I have gone on and off the pill as I felt necessary and to regulate my periods, but I never did much more than that.

        I am very serious about regulating my hormones naturally at this point just for general wellness and health. I’ve been off the pill for a few years and want to get things balanced before I try to conceive in hopefully a year or so. I have always been about 15 lbs overweight and carry much of my excess weight in my middle region. I will have regular cycles for some time and then they’ll become irregular again. That’s the usual pattern. I haven’t really had thinning hair or excess hair growth, but do suffer from hormonal jaw line acne. I always felt my PCOS symptoms were pretty mild compared to such terrible things other girls and women go through- irregular cycles have always been the biggest issue for me.

  155. Dr. Lara

    I am pretty sure I have post pill PCOS (diagnosed after reading your book). Would PCOS improve with no suplements? How long should I wait to see normal DHT levels with no suplement or herbs?

    • My experience is that Yes, post-pill PCOS can sometimes improve on its own with time. As long as other parts of underlying health are good.

  156. very clear and interesting explanations. Would really, really appreciate your recommendation as to which treatment options I might try? (apologies in advance for the incredibly long read below)

    I have pcos (for the last 8-10 years) and have tried several conventional (the pill for 2 years, and later metformin) and alternative (homeopathy) approaches.

    my mom is diabetic and my dad has hypothyroid.

    I am not overweight, and not suffering from hypo/hyper Thyroid (as far as the doctors are able to tell from traditional tests). My other symptoms are painful acne (had a sudden burst 2 years ago which still persists. prior to that I have had perfect skin always. now I get 3-4 painful cystic pimples a month), painful periods (specially day one of the 7day cycle), lots of hair loss, eczema, dandruff. Last year I moved from a very moist climate to a very dry one, after my wedding.

    My homeopath had me tested for a bunch of things in which the following was evident (tests in Q4 2014 and Q1 2015):

    – Vit D, 25 Hydroxy -> deficient ( 50.95. range 75.00 – 250.00 nmol/L)
    – Low levels of serum ferritin ( 9ng/ml)
    – low-ish B12 ( 298 pg/ml)
    – cholesterol = borderline high (total 203. HDL C- 76. Direct LDL – 107)
    – zinc 87.12 ug/dL
    – T3, reverse = 23ng/ml
    – FT3 Serum 5.20 pmol/L
    – FREE T4 Serum 19.38 pmol/l
    – TSH Serum 1.87 uIU/ml
    – FSH 6.0 mIU/mL
    – LH 21.03 mIU/mL

    For the last 2-3 months I have thus been taking these supplements intermittently:
    – Vitamin D3 (1000 IU)
    – Multivitamin (Solgar V2000
    – Vitamin B12 (1000 IU)
    – Proactive regimen for skin, alternate days
    – recently (this week) shifted to A2 milk, though I dont drink much milk anyway

    Things are slightly better for me now, though not ideal. My cycle variates between 4-6 weeks. I feel like the year homeopathic treatment has not resolved my issues, though it has made them slightly better.

    I am now looking to add more supplements to my regimen as I stop the homeopathy. could you help recommend which supplements I might try? I have read on your website regarding myo-inositol, berberine, femaprin (vitex), magnesium, zinc.

    There are just so many options (!), I am really overwhelmed and confused about which I should choose for my specific scenario. I want to add things that will help me, but in the simplest way possible. I really don’t want to become a pill popper at such an early age (turning 29). Would greatly appreciate any guidance you could provide 🙂 Thank you so much in advance!

    • Forgot to add a couple of things:

      1) the Thyroid Antibodies result (ref range: 0.00 to 60 IU/ml for both):

      Anti- TPO, (Autoantibodies against thyroid peroxidase) = 28.00 IU/mL
      Anti- Thyroglobulin (Autoantibodies against thyroglobulin) = 15.00 IU/mL

      2) I also have fairly dry skin.

      3) I have recently also added organic dairy Kefir milk, 200ml, to my daily diet (Lifeway brand). I will soon start making my own with A2 milk to surpass the dairy issue.

      4) I am from India (incase it makes a difference to your interpretation of the results 🙂 )

    • Your LH is elevated which is typical of insulin resistant PCOS. You need a test for insulin resistance, if you haven’t done that already (fasting insulin or HOMA-IR index).
      Please have a look at Chapter 7 in my book Period Repair Manual. It explains the role of insulin resistance in PCOS.

      • Thanks Lara. I would like to have a consult with you via skype if possible to discuss the way forward. Prior to this I’d like to get the relevant tests (if any) done so we can discuss as needed.

        I am justing starting to read your book. Meanwhile aside from the fasting insulin (I had this done about 5 years back when my PCOS was worse, where the the result post second glucose was very marginally showing resistance. But I’ll get a one done now again as you suggested, to get a fresh guage). I am getting the pelvic ultrasound done as well.

        So aside from these lab tests is there anything else I should get tested?

        I’am travelling to India and Singapore the coming month so will get all the testing done there. If there is any chance you’re visiting these two places during this time, it would be ideal to chat in-person too, if you have the time 🙂

          • Hello Lara,

            I had emailed you earlier on the address provided on this website. Am doing so again now – if you could kindly respond and confirm receipt please.

            If there’s another way to p.message you, kindly also let me know.


  157. Hi , really informative article. I’m dealing with PCOS from 10 years ego when I was 20 and during this time I was on Diane35. Recently I tried to stop taking the pills and go on low carbs diet but it didn’t work for me. all PCOS symptoms came back immediately(Severe acne , hair loss , etc). My doctor says I’m not insulin resistance due to the test result and I’m really slender as well. PCOS type 2 and 3 also doesn’t seems to fit me. I am wondering which type really I am and how can I reverse this condition naturally??

    I have iron and vitamin D deficiency and I always take supplements. I also have really high cortisol level which the doctor say is due to diane35 that I take.

    • Are you sure you actually have PCOS? Have you read Chapter 7 in my book? (it’s all about proper PCOS diagnosis)
      Because acne and hair loss can be caused by other things.

      • Hi again and thanks for your response. I also have lots of small cysts on my ovaries , irregular periods excessive hair and acne … and doctors diagnosed this as PCOS .

        • PCOS cannot be diagnosed by ultrasound because polycystic ovaries are common in normal women. But excessive body hair is a pretty clear sign. Without knowing all the details of your case, I cannot make specific recommendations. Please have a look at my book .

          • Thanks for your answer and the information. Reading your blog motivated me to do more research and started a gluten free diet. I also try to stick with low carb diet at the same time. I feel really better now after 5 days on gluten free diet but still too soon to judge. I am suspicious about having sensitivity to gluten.

  158. Dear Dr Lara,

    Thank you very much for this blog and for your book (which I am currently reading). I have been looking for years for this kind of naturopathic approach concerning PCOS.

    I am trying to understand which type of PCOS I am and would have a question. (Later, I would like to ask you for a skype consultation if possible, but think I might need to do some more tests before).

    I guess maybe I am insulin resistant type, but did not do fasting insulin test yet (my doctor thought it was not necessary, as my FSH and LH levels clearly indicated, in his opinion, I am insulin resistant). Below are my symptoms. Could you please advise if I should still ask for the fasting insulin test?

    I am 36 and have PCOS since I am 16 (with irregular cycles and hirsutism). Started to change my diet since 2008, cycles improved a lot (before, it happened I had no cycles for 4 to 6 months, and now I have about 10 or 11 per year), but hirsutism remains.
    My weight is 65 kg for 1,69 m. Fasting glucose is normal. CRP normal (low?): 2 mm in 1st hour. I have digestion problems since adolescence (chronic cholecystitis, etc.). Have done IgG test recently: according to it I am highly sensitive to diary, gluten, nuts and eggs. In my childhood, I suffered from otitis and chronic tonsillitis.
    And I have also low vitamin D.

    My hormones:
    FSH: 6,7 UI/L (2,5 ug/L)
    LH: 21,4 UI/L (5,8 ug/L)
    Testosterone: 1,04 ng/mL (3,61 nmol/L).

    My doctors say all they can offer is the Pill + Androcur (cyproterone acetate). I’ve read that Androcur is prohibited in many counties. And anyway it does not address the root of the problem… And I was never convinced by the Pill. So I have not taken these drugs and still hope there is a natural solution for my situation.

    So, as mentioned previously, my question is: should I still ask for a fasting insulin test?

    Thank you very much for your attention,

    • Yes, you need to test for insulin resistance. Your elevated LH may mean insulin problem but it might be something else. Natural treatment works very well for PCOS. Send me a private message.

  159. Hey there…

    I cant stress enough how informative this article is!!

    Been suffering from all sorts of probs for like 2 years… n somehow this (type 3) makes all kinds of sense…

    Been suffering from pcos.. then fibromyalgia .. doctor said depression too… extreme vitamin d deficiency.. insomnia… n the list goes on…

    Saw the article when researching herbal meds.. ( fertility meds for a year kinda destroyed my life)

    I’m currently on saw palmetto… it’s helping… (however I think I’m gaining too much in the middle!)
    I’ll try the magnesium too..

    Thankx. . N keep up the good work!!!!

  160. Hi Lara,
    I really love your website and thank you for all the information that you share with us.

    I am having some issues that I want to share.

    I am 30, 5″3 and 125lbs. I have high testosterone of 109ng/dl and low vitamin D of 22ng/ml.

    My GP said I have PCOS since I lose a lot of hair and grows facial hair.
    I am on 50mg/day of spironolatone for the past couple of months, and 50,000 DU/week of Vitamin D2.

    I have been feeling lightheaded, nausea and fatigue even before I started the medication for the past 6-8 months and it has never gone away. My GP is not sure why I am having the symptoms. My other blood tests, ultrasound is normal. The frustrated part is I am still loosing hair and almost getting bald on the crown area.
    Your thoughts would be really appreciated.


  161. Hi lara,
    I have been having some serious problems since February. On feb. 17 I felt very light headed and hotttt n my heart started racing…I went to lay down and passed out. For about 10-15 seconds. This was the first of many episodes but the only one where I passed out. I have seen 2 neurologists, a cardiologist, an endocrinologist and of course my regular doctor. And I did see a naturopath/ homeopath one time….the only things that they have found is a deficiency in vitamin d and b12. Recently I got a call from my regular doc saying that I have pcos. Everything that I’ve searched suggest that this can’t be responsible for all of my symptoms alone. But I have recently read a couple of articles that link server hormone imbalances to pcos. And I have almost every symptom on the list for hormone imbalances. A while back my regular doc did a sugar test n said that my sugar is bottoming out 3 hours after I eat but I test regularly at home (especially during episodes n have always been in a normal range). I feel that my doc is not willing to do any further testing n I’m at a loss for wat to do. I do have an appointment to see the naturopath again. Any thoughts yu have are appreciated.

    P.s. I’m 26 yrs old with two kids and a tubal ligation. If need more info I’m happy to give it to yu….my list of symptoms seems a mile long

    • hi Brooke, PCOS would not be the cause of your heart racing. The vitamin B12 deficiency is important. Are you vegetarian? Do you restrict eating in any other way?

  162. Hello Dr Lara- I want to thank you for your website and posts. I have recently found your blog and have found it extremely insightful. I work in health care as a physician assistant and am hoping you can help direct me somewhat in my own condition and would really appreciate your help. First I will give you some history- I am 30 years old, have always had normal cycles since I first started menses at age 12- typical every 28-30 days, almost to the hour in the past several years. The only time I did not get my period was a year and a half period from age 17-18 when I had issues with restrictive eating and lost 20 lbs in only 3 months. I am assuming this was my body shutting down ovulation due to low body weight. Since my period returned it again had always been normal. I was on birth control from 2007-2010 with Alesse but stopped when I decided I didn’t like putting artificial hormones into my body. Again after stopping, my period immediately returned to clockwork so I never imagined there may be an ovulation issue. Additionally I did become pregnant in 2012 so at some point I must have been ovulating.

    Recently, I have been feeling as though my hair was thinning and I have always had extremely thick hair. I have a few stray hairs on my chin, which I cannot recall when those started appearing. I have no acne. I am now a normal weight at 5’5 125 lbs. I work out with running, spinning, HIIT 4-5 days per week and typically eat a very healthy diet with low sugar and carb intake, wine 2-3 times per week. I had labs done due to hair loss and was found to have elevated total testosterone of 63.5 ng/dL, labs done around mid cycle I believe. Given this finding, I then had more labs repeated as follows again I was around mid cycle
    Total testosterone- 80.7 ng/dL
    Free testosterone -4.0 pg/dL
    Androstenedione – 185 ng/dL
    Estradiol-648.2 pg/mL
    Progesterone- 2.2ng/mL
    SHBG- 162.5 nmol/L
    Insulin- 5.1 uU/mL
    Prolactin 16.3 ng/mL
    Glucose – 80 mg/dL
    Vitamin d slightly low at 23.8 so started supplementing
    Thyroid levels all normal with TSH, t3, t4 and tpo antibodies
    As this was all very confusing to me I ended up seeing a reproductive endocrinologist who recommended repeating all levels day 3 of menses for more accurate readings.
    Repeat levels-
    Total testosterone – 48ng/dL ( now high normal)
    Free testosterone – 3.9 pg/dL
    DHEA sulfate- 165 ug/dL
    HgB A1c – 5.1
    Prolactin 12.3
    17 -oh progesterone – 30 ng/dL
    insulin- 2.0 (low?)
    Estradiol- 53.1
    FSH- 8.65
    LH- 7.38
    2 normal pelvic US- was told I didn’t have PCOS given normal periods and normal US findings,. But never given explanation for my high testosterone and thinning hair. My husband and I are now going to try to conceive and I am wondering if now maybe I am not ovulating? Even though I have normal cycles? And why this has now occurred? i assume with my normal insulin levels I do not have insulin resistant PCOS so what’s my best course of action for fixing my imbalance, improving my hair, and hopefully conceiving a healthy baby? Sorry for the long post but thought the details were important?
    thank you in advance for your wisdom!!!!

    • Hi Kate, I wouldn’t read too much into that one high testosterone reading, especially since it was then normal. If you really want to know if you’re ovulating, then you’ll want to have mid-luteal progesterone test (one week before your period)
      As for your hair loss, can I ask how low-carb you are? Going too low starch almost always causes hair loss.

      • Thank you for your response!! I actually had 2 high testosterone readings- 63.5 and 80, done about 1 month apart then one top normal at 48. I think I will try to have a day 21 progesterone done this month to answer he ovulation question. As for diet I still eat starches with sweet potatoes, carrots, corn almost daily just mostly try to avoid bread, pasta, rice.

  163. I am pretty sure I am not ovulating due to low vitamin D (50nmol/L last time I had it checked) and to support this theory the only time I have ovulated in 1.5 years is 2 days after returning from a sunny vacation (happened 2 days later from both vacations I took). I chart my bbt to know when I have ovulated and those are the only 2 times I had my period. My question is that I do supplement daily with liquid D3 so why is that not helping restore ovulation? I take 5,000IU a day, what else can I do??

    • When D deficiency doesn’t respond to supplementation, it’s usually a problem with underlying chronic inflammation. Do you have any other signs of inflammation? Fatigue, joint pain, headaches, skin problems, digestive issues?

        • Lara, when there is inflammation present and you don’t want to take lots of supplements, would you recommend anti-inflammatory supplements like turmeric or a multi with D & magnesium?

          • I do routinely prescribe turmeric. But I also work to correct the underlying source of chronic inflammation– usually inflammatory foods and gut dysfunction.

        • Find a solution for your IBS and eczema, and you’ll have found a way to support healthy, regular ovulation. Digestive health affects hormone health. I discuss that in my book.

  164. I have inflammatory PCOS and I was thinking about taking Turmeric, Ginger, Garlic Supplements, but I had a IgE and IgG4 and I reacted to all three (Turmeric, Ginger, Garlic) though in the “Low” scale, but some were pretty close to the Moderate line. Would taking these still help my inflammation or bad idea?

  165. Lara, would you recommend supplements like turmeric or ginger for inflammatory PCOS?

    Also, up to how much magnesium is safe in a day? Thanks.

  166. I was diagnosed with Insulin Resistant PCOS 6 years ago b/c of my unexplainable weight gain and infertility. I was eventually able to get pregnant through diet and metformin but by doctor was never able to explain what was happening to my body. This blog is amazing and I actually cried a little bit when i stumbled upon it. I am now a devotee!

  167. I missed my periods for 4yrs nw .it started when i was 32 and my doc said my ovaries are not working so tell me what to do now to bring back my period

  168. Hello Lara,

    I am so happy that I found your website! So many doctors in the US will not admit that post-pill syndrome is something that could actually happen and I have yet to find a doctor who was willing to help me find a way to treat my PCOS without the pill. I came across this page because I always felt that going off birth control triggered my PCOS. If you can give me any advice I would sincerely appreciate it.

    Prior to going on the pill I had a regular period and no acne, then I went on the pill as treatment for terrible cramps. Upon taking the pill I had really bad side effects specifically migraines as a result my doctor had me try about SIX different birth controls within a single year, until I finally said I refuse to take the pill. After stopping the pill I developed terrible acne on the left side of my face (much worse than what I had on the pill) my doctors (endocrinologist, general practitioner, gynecologist, dermatologist) all told me to get back on the pill, which I again refused. I started to look for answers on my own and found PCOS. I went to the endocrinologist and got a blood test which showed elevated LH and DHEA-Sulfate everything else came back normal (ie insulin, glucose, leptin, testosterone, prolactin, urinary iodine etc.). She diagnosed me with PCOS officially. However I do not have an irregular cycle, am not over or under weight, and I do not have abnormal hair growth.

    It always struck me that my only noticeable symptom: acne came after I stopped taking birth control, however it has been about 2 and a half years since I have gotten off the pill: is it possible that this is still post-pill syndrome? Should I try the licorice and peony combination? and is this herbal remedy something that should be taken as a pill or brewed as a tea?

    Thank you so much,

  169. Hello laura how are you??? I know that I need to quit the sugar but honestly I am addicted maybe its due to my insulin resistance? And pcos? I dont know but I was wondering what do.I do to get off the sugar because its becoming overwhelming….

  170. Hi I’m angle. About a month ago I had my appendix removed, then about a week ago I visited a gynecologist (super un-professional.) I had told her when I was younger, I am 18 now. So a few years ago, a private doctor told me something about a hormonal imbalance. I didn’t remember much, but she then told me it could probably be PCOS. I had a pelvic and normal ultrasound done, and she practically threw the birth control pills at me and said to take them if I did have PCOS. I never had an irregular period, only when I first got it, which was when I was 11. But after a year I got it regularly. She explains to me that the pill was going to help regulate, which I kept repeating I GET IT REGULARLY! She calls me today and says the ultrasound was good, and then I ask about the PCOS and she goes well it seems positive for it but you’re already on the pill so.. And I tell her I’m not taking it. She wants me to go in for a blood test. I don’t have any symptoms, I’m probably like 5 pounds over my weight. I can’t seem to find a good gyno, help!!!!!

    With love,

    • Hi Angie, thanks for sharing your story. What took you to the gynecologist in the first place? Was it the pelvic pain that turned out to be appendicitis? If you have no symptoms, and your periods are regular, then probably no reason to go back.

  171. Looking for successful pcos stories with permanent birth control or if hormone replacement is necessary after a hysterectomy combined worth pcos? Thank you

  172. Hi, Lara, I have polycystic ovaries but did not identify any in my case, I can not hit the treatment, I do not have insulin problems, thyroid, my testosterone is not above the allowed since took the medicine duphaston with progesterone and will start cicloprimogyna to take my regular menstruation. that is unregulated from adolescencia.I take contraceptive pill for many years, when I stopped no longer had the polycystic ovaries, but returned the exams. Now I want to get pregnant, Please, Could you give me some suggestion or opinion about my case? You think I should take ovulation-inducing?