Maybe your story sounds something like this.
Your periods have always been irregular.
Or maybe they’re painful, unpredictable, or disappear for months at a time.
You’re dealing with acne that won’t go away, hair growing on your chin, thinning hair, difficulty losing weight, or challenges with fertility.
Eventually, you sit down with your doctor and hear:
“You have PCOS.” (Now PMOS or Polyendocrine Metabolic Ovarian Syndrome)
And maybe the next conversation is about birth control or metformin.
Those medications may have an appropriate place in your care.
But I don’t want the conversation to automatically end there.
If you’re sitting across from me and you tell me you have PCOS, I have questions.
What are your periods actually doing?
Are you ovulating?
How is your energy?
How do you feel after you eat?
What’s happening with your digestion?
What has already been tested?
What other symptoms have you been dealing with that may not have seemed connected?
Because PCOS tells me the name of the pattern you’ve been diagnosed with.
It doesn’t necessarily tell me everything contributing to that pattern in you.
Despite the name, PCOS isn’t simply about what’s happening in your ovaries.
PCOS Is About More Than Your Ovaries
PCOS is a complex condition that involves more than reproductive hormones. Metabolic health matters too, and insulin resistance can be an important part of the picture for many women.
But when I’m sitting with a woman who has PCOS, I’m also thinking about the whole picture and how all of these pieces may be connected.
Her hormones.
Her blood sugar.
Her thyroid.
Her digestion.
Inflammatory and immune signaling.
Her sleep, stress, nutrition, and lifestyle.
That doesn’t mean every symptom is connected or that every woman needs every test.
It means I’m willing to ask:
What else is happening in your body that may be worth investigating?
Depending on what I hear in your history, I may use bloodwork, hormone testing, stool testing, or other targeted labs to help answer the questions we’re asking.
Here are five areas I may consider based on what you’re experiencing—although they’re certainly not the only places we may look.
1. Your Gut: “What Does My Digestion Have to Do With PCOS?”
Maybe you tell me:
“I’ve been bloated for years.”
“I’m constantly constipated.”
Certain foods seem to make everything worse.
Your digestion changed after taking antibiotics.
You’ve tried probiotics, eliminated foods, or simply learned to live with feeling uncomfortable after you eat.
Now I have questions.
Not because I’m assuming your gut caused your PCOS.
But because your reproductive hormones and your gastrointestinal system aren’t operating in two completely separate bodies.
And we’re learning more about that connection.
Research has found differences in the gut microbiome of women with PCOS compared with women without PCOS. The gut also plays a role in processes that matter when we’re talking about PCOS—things like metabolism, immune and inflammatory signaling, and the way the body responds to insulin.
So when you tell me you have PCOS and you’re experiencing digestive symptoms, I want to understand those symptoms too.
What does your digestion actually look like?
Are you bloated after meals?
Are you constipated or experiencing loose stools?
Have you noticed food triggers?
Did something change after antibiotics, an illness, travel, or another event?
How long has this been going on?
Based on what you’re experiencing, a comprehensive stool test may be one tool I consider to help us better understand what’s happening in your gut.
Depending on the test, we may be able to look at things like digestive function, pancreatic elastase, fecal fat, inflammatory markers, short-chain fatty acids, intestinal immune markers, and patterns involving microorganisms.
Those results aren’t there to give us a simple answer like:
“Your gut caused your PCOS.”
They’re helping us ask a more useful question:
“Is there something happening with your digestive health that deserves our attention too?”
2. Your Hormones: “But They Already Checked Those.”
I hear this one often:
“My hormones were checked. They said everything was normal.”
Okay.
But which hormones? And when were they tested?
Because “your hormones are normal” can mean a lot of different things.
Maybe testosterone was tested.
Maybe estradiol was checked once.
Maybe progesterone was measured without considering where you were in your menstrual cycle.
And maybe every number came back within the laboratory’s reference range.
That’s useful information—but it doesn’t necessarily answer every question I have.
A reference range tells me whether your result falls within the laboratory’s expected range. I still have to interpret that number in the context of you.
Where were you in your cycle when it was tested?
Are you ovulating?
What symptoms are you experiencing?
What do your other hormone markers look like?
Maybe you tell me:
“My periods are 45 days apart.”
“I spot for days before my period.”
“My acne gets horrible around my cycle.”
“I have facial hair even though I was told my testosterone was normal.”
“My sleep is terrible.”
“I wake up exhausted but feel wired at night.”
Now I’m curious.
Because I don’t want to look at one hormone value—or even several hormone values—and assume that tells me everything about what’s happening with your hormones.
Looking at Hormones From Another Angle
Depending on your symptoms, cycle, history, and what has already been tested, one tool I may consider is DUTCH Complete testing.
DUTCH stands for Dried Urine Test for Comprehensive Hormones. One of the reasons I may use it is that it allows me to look at your hormones from another angle—including how your body is processing certain hormones.
That’s where hormone metabolites come in.
Think of a metabolite as something that’s created as your body processes a hormone.
So rather than only asking:
“How much estrogen are we seeing?”
I can also gather information about some of the metabolites created as your body processes estrogen.
Depending on what we’re investigating, this type of testing can give us additional information about how certain hormones are being metabolized, along with cortisol and cortisone patterns throughout the day.
It’s not that one type of testing is automatically “better” than another.
It gives me a different type of information—and sometimes that’s exactly what I’m looking for.
3. Your Blood Sugar and Metabolic Health: “But My Glucose Was Normal.”
Maybe you tell me:
“They already checked my glucose. It was normal.”
Great. That’s useful information.
But my next question is:
What else did they check?
Because a normal fasting glucose doesn’t necessarily give me the whole picture of what’s happening with your blood sugar and insulin.
Insulin is a hormone that helps move glucose out of your bloodstream so it can be used or stored by your body.
When your cells become less responsive to insulin, your body may compensate by producing more of it to help maintain blood glucose levels.
That’s especially relevant in PCOS because insulin resistance is an important part of the picture for many women.
This Isn’t Just About Weight
Metabolic health can sometimes get reduced to a conversation about someone’s weight.
But that’s not how I want to look at it.
Women with PCOS can experience blood sugar and metabolic concerns at different body sizes.
So I’m not deciding whether to pay attention to your metabolic health simply by looking at your weight.
Maybe you tell me:
“I crash after I eat.”
“I crave sugar all the time.”
“I get shaky if I go too long without eating.”
“I feel like I’m starving again shortly after a meal.”
“I’ve noticed changes in my weight that I can’t explain.”
“I have a strong family history of diabetes.”
And I also want to know about how you’re eating.
What does breakfast typically look like?
Are you getting enough protein?
Are you skipping meals and then ravenous by dinner?
What kinds of carbohydrates are you eating, and what are you eating with them?
How much fiber are you getting?
I’m not asking these questions so I can hand you a generic “PCOS diet.”
I want to understand how you’re currently fueling your body and how that may relate to the symptoms and patterns we’re seeing.
So What Might I Look At?
Depending on your history and symptoms, I may consider fasting glucose, HbA1c, fasting insulin, and lipid markers to help me better understand your metabolic picture.
I’m not looking for one number to give me the entire answer.
I’m looking at the pattern and interpreting those results alongside your symptoms, family history, eating patterns, and the other information we’ve gathered.
If blood sugar regulation or insulin appears to be an important part of your picture, nutrition is going to be part of our conversation. We may look at things like meal composition, protein and fiber intake, carbohydrate choices, meal timing, and other dietary or lifestyle changes based on what makes sense for you.
Not because every woman with PCOS needs to eat the same way.
Because I want your recommendations to match what we’re actually seeing in your body.
4. Your Thyroid: “They Checked That Too.”
Maybe you tell me:
“They already checked my thyroid. They said it was normal.”
My next question is usually:
What did they check?
Because sometimes when someone tells me their “thyroid was checked,” they’re referring to one marker—usually TSH.
TSH can give us useful information. But depending on your symptoms and history, I may want to look at more of the thyroid picture.
Maybe you’re also telling me:
“My hair is thinning.”
“I’m exhausted all the time.”
“I’m always cold.”
“My digestion has slowed down.”
“My periods are irregular.”
“I feel like my body has changed and I don’t understand why.”
Some of those symptoms can overlap with symptoms women experience with PCOS, which is exactly why I don’t want to automatically assume every symptom you’re experiencing is coming from PCOS.
Looking Beyond One Thyroid Marker
Depending on what you’ve already had tested and what I’m seeing in your history, I may consider a broader thyroid panel that includes markers such as:
- TSH
- Free T4
- Free T3
- Reverse T3
- Thyroid peroxidase (TPO) antibodies
- Thyroglobulin antibodies
These markers can provide different pieces of information about thyroid function, while thyroid antibodies can help identify evidence of thyroid autoimmunity.
That’s worth being aware of in the PCOS conversation because research has found a higher prevalence of autoimmune thyroid disease and thyroid antibodies in women with PCOS compared with women without PCOS.
That doesn’t mean every woman with PCOS has a thyroid problem.
But if your symptoms or history make me curious, I want to know what was actually evaluated before assuming there’s nothing else here worth looking at.
Another area I may consider is inflammation.
Inflammation is a normal part of how your body responds to things like injury, illness, and infection. Research has also found higher levels of certain inflammatory markers, including C-reactive protein (CRP), in women with PCOS compared with women without PCOS.
One marker I may consider is C-reactive protein (CRP).
If CRP comes back elevated, that gives me information—but it doesn’t tell me why inflammation may be elevated or point to one specific cause.
And that’s where I start asking more questions.
Have you recently been sick or injured?
What’s happening with your blood sugar and metabolic health?
What does your diet look like?
How are you sleeping?
Are there digestive symptoms we’ve already identified?
Is there something in your health history that deserves further attention?
This is also where you can start to see why I don’t want to look at each area of your health in isolation.
Your gut, hormones, blood sugar, thyroid, immune system, sleep, nutrition, stress, and lifestyle are all happening in the same body.
And now that we’ve looked at these five areas, there’s an important question we need to answer: Does every woman with PCOS need the same testing?
No.
And that’s exactly the point.
Do You Need All Five of These Tests?
No.
Two women can walk into my office with the same PCOS diagnosis and have two very different stories.
One may be dealing with digestive symptoms.
Another may have no digestive complaints but is struggling with blood sugar regulation, fatigue, and intense cravings.
Another may have a family history of thyroid disease along with thinning hair, constipation, and constantly feeling cold.
Same diagnosis. Different woman. Different questions.
That’s why the goal isn’t to run every possible test on every woman with PCOS.
The testing should come from the questions we’re trying to answer.
Your symptoms matter.
Your history matters.
Your previous lab work matters.
Your goals matter.
Those things help determine where it makes sense to look next.
Testing Is Only the Beginning
And this is where all of this really matters.
The goal isn’t the testing. The goal is what we can do with the information.
I don’t want to run a long list of labs, hand you a stack of results, and leave you with more information but no idea what to do next.
Once we have the information we need, I’m putting it together with your symptoms, health history, menstrual cycle, nutrition, lifestyle, and goals.
Then we use those pieces to build your plan of care.
Depending on what we find, your plan may include dietary changes, targeted supplementation, lifestyle changes, chiropractic care when appropriate, and other recommendations within my scope of practice.
And if something we uncover needs evaluation or treatment outside of my scope, that may mean collaborating with or referring you to the appropriate healthcare provider.
This is also why two women with PCOS may leave my office with very different plans.
If blood sugar regulation appears to be an important part of your picture, we may put more attention on nutrition and metabolic health.
If digestive symptoms and testing identify areas that deserve attention, that may influence the dietary, lifestyle, or supplemental support we consider.
If hormone testing provides useful information, we interpret that alongside your symptoms, menstrual cycle, and the other things we’ve learned about your health.
I’m not trying to create the same “PCOS protocol” for every woman who walks through the door.
I’m trying to understand what’s happening with you, determine what deserves our attention, and use that information to create a plan that makes sense for you.
If You Have PCOS and Still Have Questions
A PCOS diagnosis can be an important piece of information.
But it doesn’t have to be the end of the conversation.
Maybe you’ve already tried birth control or metformin.
Maybe you’ve made dietary changes.
Maybe you’ve been told your labs are normal, but you’re still experiencing symptoms you don’t understand.
If you were sitting across from me in my office, I wouldn’t just ask:
“Do you have PCOS?”
I’d want to know:
“What’s happening in your body—and what haven’t we looked at yet?”
Because that’s where we can start deciding what information may actually be useful, what deserves our attention, and what your next steps could look like.
A Different Kind of Conversation About PCOS
At The Wellness Way–Lake Forest, this is how I approach conversations with women who come to me looking for more answers about their health.
As a chiropractor, my role isn’t to replace your gynecologist or other medical providers. My role is to look at your health history, symptoms, lifestyle, previous testing, and the different areas we’ve talked about here and ask:
What else might be worth investigating?
When appropriate, I use additional testing to help answer those questions and create an individualized plan of care that may include nutrition, targeted supplementation, lifestyle changes, chiropractic care, and collaboration with other healthcare providers when needed.
My goal isn’t to give every woman with PCOS the same protocol.
It’s to understand the woman sitting in front of me and determine what makes sense for her.
Still Have Questions About Your PCOS?
If you’ve been diagnosed with PCOS but still feel like you don’t fully understand what’s happening in your body, this is the kind of conversation we can have together.
We’ll start with your symptoms, your history, the testing you’ve already had, what you’ve already tried, and what you want to improve.
From there, we can decide what makes sense to investigate—and what your next steps may look like.
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