September is PCOS Awareness Month

What is PCOS?

PCOS stands for Polycystic Ovary Syndrome. It is a hormonal condition that affects about 1 in 10 people of reproductive age. The name comes from the fact that many people with PCOS have “polycystic ovaries,” which means their ovaries can look larger than normal and have many small fluid-filled sacs, or follicles. But the name can be a little misleading—PCOS is about much more than just ovaries.

Some common signs and symptoms of PCOS are:

• Irregular periods: periods that come late, are very far apart, or sometimes don’t come at all

• Problems with ovulation: the ovary may not release an egg regularly, which can make getting pregnant harder

• Higher levels of “male” hormones (androgens): this can cause acne, extra facial or body hair, or thinning hair on the scalp

• Metabolic issues: PCOS is linked with insulin resistance, weight gain, and higher risk for type 2 diabetes

• Mood changes: people with PCOS are more likely to experience depression or anxiety

Because symptoms vary so much, two people with PCOS may look very different from one another.

How Doctors Diagnose PCOS

The most widely used set of rules is called the Rotterdam Criteria, created in 2003. According to this system, a person is diagnosed with PCOS if they have two out of three features:

1. Irregular or missing ovulation (which leads to irregular periods)

2. High androgen levels (seen on lab tests or in physical signs like acne or hair growth)

3. Polycystic ovaries on ultrasound (20 or more follicles per ovary or ovaries that are larger than normal)

(Source: Current Guidelines for Diagnosing PCOS by Christ & Cedars, 2023)

Doctors also divide PCOS into different types, or phenotypes, based on which combination of these features is present. This helps guide treatment, since not everyone with PCOS has the same needs.

Many people with PCOS face delays in getting diagnosed. Studies show it can take two or more years from when symptoms first appear to when someone gets answers. That delay can add a lot of stress, confusion, and frustration.

What Genetics Teach Us About PCOS

One of the biggest questions researchers ask is: What causes PCOS?

In 2018, a huge international study looked at the DNA of over 10,000 women with PCOS and 100,000 without it. This kind of study is called a genome-wide association study (GWAS), and it searches for patterns in genes linked to certain conditions.

Here’s what the researchers found (Day et al., 2018):

• PCOS has a shared genetic background, no matter which diagnostic criteria are used (Rotterdam or others).

• They discovered new gene locations that are connected to PCOS, on top of confirming older ones.

• These genes overlap with traits like obesity, high insulin levels, type 2 diabetes, cholesterol problems, depression, and even male-pattern baldness.

  
  

What does this mean? PCOS isn’t caused by one single thing. Instead, it’s influenced by many small genetic differences that add up. These differences affect hormones, metabolism, and even mental health. This explains why PCOS looks so different in different people.

How Chinese Medicine Understands PCOS

While Western medicine uses lab tests, ultrasounds, and genetics, Traditional Chinese Medicine (TCM) looks at PCOS in a different way. Instead of focusing on one disease, TCM looks at patterns of imbalance in the body. A TCM practitioner will ask about your energy, emotions, digestion, sleep, and cycle history to understand the root cause.

According to Giovanni Maciocia, a well-known TCM author, PCOS often shows up in a few main patterns:

1. Kidney Yang Deficiency

   • Signs: feeling cold, fatigue, low sex drive, heavy or prolonged periods, infertility

   • Explanation: the body doesn’t have enough “Yang,” or warming energy, to support healthy cycles.

2. Liver Qi Stagnation with Phlegm-Damp

   • Signs: irregular cycles, bloating, weight gain, mood swings, fluid retention

   • Explanation: stress and emotions block the Liver’s energy, which causes dampness and phlegm that slow the system down.

3. Spleen Qi Deficiency with Dampness

   • Signs: fatigue, poor digestion, bloating, oily skin, acne, weight gain

   • Explanation: the Spleen isn’t transforming food and fluids properly, leading to damp buildup (sometimes compared to cysts).

4. Kidney Yin Deficiency with Empty Heat

   • Signs: night sweats, hot flashes, dry mouth, irritability, light or missing periods

   • Explanation: the body lacks cooling Yin, which lets too much heat rise and causes imbalance.

These patterns aren’t diseases in themselves—they’re ways of describing how the body’s systems are out of balance. A person with PCOS might fit into one of these, or a mix of them.

Acupuncture and Herbs for PCOS

Acupuncture

In TCM, acupuncture involves placing thin needles at specific points to restore balance. For PCOS, acupuncture may help:

• Regulate hormones by affecting the brain’s control of the ovaries (the hypothalamus-pituitary-ovarian axis)

• Encourage ovulation and improve menstrual cycle regularity

• Improve blood flow to the ovaries and uterus

• Reduce stress and balance mood, which is important since PCOS is linked to depression and anxiety

• Support metabolism and possibly improve insulin sensitivity

  
  

Herbal Medicine

Herbal formulas are another key tool. Common herbs used for PCOS include:

• Dang Gui (Angelica sinensis): nourishes the blood

• Shu Di Huang (Rehmannia root): strengthens Kidney Yin

• Fu Ling (Poria): drains dampness and supports digestion

• Chai Hu (Bupleurum): moves Liver Qi, reduces stress

• Gui Zhi (Cinnamon twig): warms Yang and improves circulation

The exact formula depends on the individual’s TCM pattern. A trained practitioner adjusts the recipe as symptoms change.

Putting It Together: East Meets West

Both Western medicine and TCM recognize that PCOS is complex and varied. Here’s how the two approaches connect:

• Western medicine talks about hormones, insulin, and genetics. TCM talks about Qi, Yin/Yang, and dampness. But both agree that PCOS affects many systems—reproductive, metabolic, and emotional.

• The genetic link between PCOS and mood issues like depression matches TCM’s focus on Liver Qi stagnation and emotional health.

• The connection with metabolism and diabetes matches TCM’s idea of Spleen Qi deficiency and dampness.

By combining approaches, patients can get more complete care. For example:

• A doctor may recommend lifestyle changes (like diet and exercise), medication for insulin resistance, and regular monitoring.

• A TCM practitioner may add acupuncture and herbs to regulate cycles, reduce stress, and improve overall balance.

Together, this can address both the physical and emotional sides of PCOS.

PCOS is a condition that affects millions of people worldwide. According to modern guidelines, it’s diagnosed based on irregular cycles, hormone levels, and ovarian appearance. Genetics research shows it’s not just about reproduction—it’s also connected to metabolism and mental health.

Traditional Chinese Medicine, through acupuncture and herbs, offers another way of understanding and treating PCOS. By looking at patterns of imbalance in the body, TCM provides individualized care that can help with periods, fertility, mood, and energy.

When combined, Western science and Chinese medicine can give a fuller picture and more options for people managing PCOS. While more studies are needed, many find that acupuncture and TCM are valuable tools alongside medical treatment.

If you think you might have PCOS, or if you already know you do, consider talking with both your healthcare provider and a licensed acupuncturist about options for management. Together, they can help you find the right balance for your body and your health. I've seen many cases of PCOS diagnosis over the years and no two are the same. Book a free 15 minute consultation appointment today if you have any questions!

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