PCOS Explained: Beyond the Cysts

Woman doubled over from period cramps

When most people hear polycystic ovary syndrome (PCOS), they immediately think of cysts on the ovaries. But here’s the truth: PCOS is far more complex than that. In fact, the “cysts” in PCOS aren’t even true cysts — and understanding what’s really happening can help women feel less confused and more empowered in their care.

What PCOS Really Is

PCOS is a hormonal and metabolic condition, not just a reproductive one. While it affects the ovaries and menstrual cycle, the root issues often involve:

• Insulin resistance

• Androgen excess (elevated male-type hormones like testosterone)

• Disrupted ovulation

This combination can lead to irregular periods, acne, hair changes, weight struggles, fertility challenges, and more.

Why Insulin Resistance Happens

Insulin is the hormone that helps move sugar from your blood into your cells for energy. In PCOS, the body becomes resistant to insulin, meaning it doesn’t respond properly. To compensate, the pancreas pumps out even more insulin.

High insulin levels don’t just affect blood sugar — they also:

• Stimulate the ovaries to make more androgens

• Disrupt the signals that trigger ovulation

• Contribute to weight gain around the midsection

This is why blood sugar balance is such a key piece of PCOS management.

The Ovary’s “Cyst” Story

Each menstrual cycle, multiple follicles (tiny sacs containing immature eggs) start developing on the ovaries. Normally, one “takes the lead,” matures fully, and releases an egg during ovulation.

In PCOS, higher androgen levels and disrupted hormonal communication prevent this “selection process.” Instead of one follicle growing and releasing, many stay small and undeveloped. These appear as “cysts” on ultrasound — but really, they’re just immature follicles that didn’t get the chance to ovulate.

Why It’s More Than the Ovaries

This is why PCOS is often called a whole-body condition. It’s not just about the ovaries — it’s about how hormones, metabolism, and lifestyle factors interact. The ovaries are more like the “messengers” showing what’s going on inside the body.

Supporting Your Body with PCOS

Managing PCOS isn’t about “curing” it — it’s about finding balance. Strategies often include:

• Nutrition for blood sugar balance: Protein + fiber at every meal, limiting refined carbs, focusing on whole foods.

• Movement: Regular walking (20–30 minutes daily) improves insulin sensitivity.

• Stress management: Chronic stress worsens hormone imbalance.

• Sleep support: Poor sleep makes insulin resistance worse.

For some women, medications or supplements may be helpful — but lifestyle changes lay the foundation.

The Takeaway

PCOS is not just about cysts. It’s about hormones, insulin, and ovulation — and once you understand the “why” behind the symptoms, the condition makes a lot more sense.

If you’ve been diagnosed with PCOS (or suspect you might have it), remember: it’s not your fault, and there are effective ways to support your health. By looking beyond the cysts, you can start addressing the root causes and feeling more in control of your body.