PCOS Part 2: Everything Your Doctor Never Told You

Make sure you listen to PCOS Part 1 before jumping into this one. In this episode, Coach Cate is talking directly to the woman who tracks her food, is in the gym, preps her meals, takes her supplements, and takes her health so seriously - but her body isn't responding the way it should. Trainers + Doctors tell you that you need more discipline, but that isn't the problem. The problem is that you have incomplete information - and this episode will change your life. 

Transcript

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Hey, hey, welcome back to Healthy Period. I'm Coach Kate, and if you're new here, welcome. I'm a nutritional therapist and movement coach with a mission to help every woman that enters my world understand her body, how it works, why she experiences the symptoms that she does, despite her laps being normal, and align her body with what it's been screaming for. And this episode is for the woman who has been trying everything and has PCOS. So I'm speaking directly to the woman who tracks your food, goes to the gym consistently, preps your meals, takes your supplements, does your research, you take your health seriously, and yet you feel like your body doesn't respond the way it should. You're doing everything right but spinning your wheels. Every trainer, doctor, or coach you've worked with has made you feel like the problem is you, like you need more discipline, like you're missing something, like your body is working against you. And I want you to hear this clearly: you are not the problem. You have never been the problem. You have been given incomplete information. And today I'm gonna change that. So this is PCOS part two. And if you haven't listened to part one yet, go back and start there because today I'm going deeper. And I want to start with how PCOS actually is diagnosed. Now, there are three criteria that doctors look at that are called the Rotterdam criteria, but you do not need all three diagnostic criteria to be diagnosed with PCOS. You only need two out of the three. So, number one, irregular or absent ovulation, cycles that are longer than 35 days, very unpredictable or absent altogether. Hyperandrogym, elevated antigens, either on labs or clinically, meaning symptoms like acne, hair thinning, or excess facial and body hair. And polycystic ovarian morphology, so the appearance of multiple follicles on the ovaries on an ultrasound. So you only need two out of the three. That's it. And this matters because you can have PCOS without cysts on your ovaries, you can have PCOS without a positive ultrasound, and you can have PCOS with a regular-ish cycle. But here's where it gets complicated. Even when women meet the criteria, the conversation often stops at a diagnosis. There's rarely a conversation about what type of PCOS you have, what's driving it, why is your body doing this, and what is the root cause of your PCOS. A diagnosis without context is just a label, and labels without understanding doesn't help you heal. Let's zoom out for a second because before we go deeper into the physiology, I think we need to have an honest conversation about why PCOS is so prevalent. PCOS is now one of the most common hormonal conditions affecting women of reproductive age. One in five. One in five women have PCOS, and it's not one in ten anymore. And I want to ask a question that doesn't get asked enough. Why? Why are so many women's hormones dysregulated? Why are so many women's cycles irregular? Why are so many women's bodies producing excess antigens? Why are so many women insulin resistant? Because here's what I know to be true. Hormones don't just choose to act with violence randomly. Your hormones are not betraying you, they're not broken, they're not your enemy. Your hormones are doing exactly what your brain told them to do. They're responding precisely and intelligently to the inputs that they've been given. And when we look at the inputs most women have been given for the last 10, 15, 20 years, it makes complete sense that their hormones are dysregulated. I want to briefly touch on the four types of PCOS. I talked about this in the first PCOS episode, but I want to just roll through it again really fast. Because PCOS is not a one size fits all. And treating every woman with PCOS in the same way is one of the reasons why so many women aren't getting better. So, type one, we're gonna go real deep into insulin-resistant PCOS today because 70% of PCOS cases are insulin-resistant PCOS cases. And this is driven by high insulin signaling the ovaries to overproduce antigens. It's strongly linked to blood sugar dysregulation, chronic dieting, and metabolic stress. And again, this is the type that we're gonna go deep on today. But type two is post-pill PCOS. So that occurs after coming off of hormonal birth control. The pill suppresses ovulation. So when it's removed, the brain ovary communication needs time to reestablish. It's temporary, but it feels very real and it's very scary. And frequently it's misdiagnosed as a true PCOS when it may resolve with support. Type three is inflammatory PCOS, and that's driven by chronic inflammation, often presents with fatigue, headaches, skin issues, and joint pain. So gut health, food sensitivities, and immune dysregulation are often the central drivers here. And androgens rise as a response to inflammation. Androgens rising is not the root cause. And then the fourth type is adrenal PCOS. So this is driven by adrenal androgen excess. So it's often linked to chronic stress, HPA access dysregulation, and nervous system overload. So women who normally have insulin levels that are normal, which is why standard PCOS advice doesn't always work for people with adrenal PCOS. So why does this matter? Because the root cause of each different type is different. The support each type needs is different. And if you're treating insulin-resistant PCOS with the same approach as adrenal PCOS, you're gonna get incomplete results at best. Let's talk about why so many women have PCOS, because it's not a coincidence. We're born into a world that told us be the smallest version of yourself, never miss a workout, push through your period, push through being sick, rest is lazy, hunger is weakness. If you're not losing weight, you're not trying hard enough. Eat less, cut carbs, try keto, try intermittent fasting, shrink yourself, perform. We were handed this messaging at 13, 14, 15 years old before we even understood what hormones were, before we knew what our bodies needed, before anyone told us that rest was biological, not optional. And we absorbed it because we didn't know what we didn't know. And for the fitness industry, because it does have a lot to answer for here. And I was in it. I became a personal trainer when I was 18 years old, which was 11 years ago. And I adopted so many things from my mentors and I pushed these messages out to my clients. And if that was you, I am so sorry, but I am so happy that I have dove headfirst into the work that I do now. So no more women fall victim of the crappy messaging of the fitness world. That messaging has been never skip a leg day, push through the pain, no days off. You're only as good as your last workout, sweat more and eat less. And if you're not losing weight, you're not in a big enough deficit. And women believed it. Because why wouldn't they? It was everywhere. It was celebrated, it was marketed as strength. But here's the truth: chronologically, over-exercising and chronically undereating is not strength. It's metabolic stress. And metabolic stress, sustained over years, dysregulates cortisol, insulin, thyroid hormones, reproductive hormones, and the entire HPA axis. The fitness industry was never taught about hormonal adaptations. So when a woman with PCOS wasn't losing weight despite eating 1200 calories, doing HIT five days a week, cutting carbs, and tracking everything, she was told, you must be eating more than you think, you need to push harder, try cutting another 200 calories. And she believed it, and she tried harder, and her body held on tighter. Because that's what survival biology does. And it goes even deeper than fitness, because so many women, the over-exercising and the under-eating, it wasn't just about their body, it was about their worth. Maybe you grew up in a home where productivity was praised above everything. Maybe rest felt unsafe, like if you stopped moving, you'd fall behind. Maybe you learned early that your value was tied to what you produced. Maybe you associated rest with laziness, laziness with failure, and failure with being unworthy of love. So you performed. You became the woman who never said no, always showed up, pushed through everything, never let anyone see her struggle, and was always fine. And your body, your brilliant, adaptive, and intelligent body, responded to 15 years of performance mode by activating every survival mechanism it had. Ovulation became inconsistent, androgens rose, the cycle became irregular, the weight became harder to manage, and eventually a doctor handed her a diagnosis, PCOS. And instead of someone saying, Your body has been in survival mode for 15 years and this makes complete sense, she was told lose weight and come back. And here's what I want to get very honest about because it's very complicated. There is a real psychological relationship between body weight and insulin resistance in PCOS. And I'm not going to pretend that it doesn't exist because dismissing it does not help you. But here's what's true: excess adipose tissue, particularly visceral fat, produces inflammatory signals that worsen insulin resistance. So insulin resistance drives androgen excess. Androgen excess disrupts ovulation. Disrupted ovulation perpetuates PCOS symptoms. So, yes, for some women, weight loss can improve PCOS symptoms. But here's where conventional medicine gets it completely wrong. Telling a woman with PCOS to just lose weight without addressing the insulin resistance and metabolic dysfunction that is making weight loss physiologically harder is like telling someone to run faster while their shoelaces are tied together. The weight is often a symptom of insulin resistance, not just a cause of it. And the methods most women use to lose weight, severe caloric restriction, excessive cardio, chronic stress, under-eating, these methods worsen insulin resistance. They worsen cortisol, they worsen the hormonal environment, which makes weight loss harder, which creates more restriction, which creates more hormonal dysfunction. It is a cycle and is not your fault that you've been stuck in it. And then there's the fertility piece, because so many women, the PCOS diagnosis doesn't land hardest at the weight conversation. It lands hardest when someone says, getting pregnant may be difficult for you. And I want to speak to that woman directly. Because she has been through years of irregular cycles, years of being put on the pill, years of dieting, years of trying, years of feeling like her body was working against her. And now she's sitting in a doctor's office being told she may need IBF and she feels like she's failed, but she didn't fail. She was failed by a system that managed her symptoms without ever addressing the root cause. PCOS does not automatically mean infertility. It means ovulation is inconsistent, not impossible. And when the underlying drivers are addressed, insulin resistance improves, inflammation decreases, the hormonal environment shifts, ovulation can return. This is not a guarantee, but it is a possibility that women deserve to know about. And it starts with understanding what is actually driving your PCOS, not just what label you've been given. Your hormones didn't betray you. They responded, again, intelligently and precisely to every input they were given, to the restriction, to the over-exercise, to the stress, to the performance, to the years of telling your body it wasn't safe to rest. And they did exactly what they were designed to do. And now the work is not about punishing your body into compliance, it's about changing the inputs. It's about creating an environment where your hormones don't need to be in survival mode anymore. That's root-cause work, and that's what we're gonna go deep on, and that's what your body has been waiting for. So let's talk about insulin-resistant PCOS because, again, this is the most common type and it's the most misunderstood. So, first, what is insulin resistance? Insulin is a hormone your pancreas produces in response to glucose in your bloodstream. So its job is to signal your cells to absorb glucose for energy, keep blood sugar stable, prevent glucose from staying in your bloodstream for too long. Insulin resistance means that your cells have stopped responding to insulin signal effectively. So your pancreas compensates by producing more insulin. And excess insulin stimulates the ovaries to produce more androgens, which is testosterone, disrupts the signaling between the brain and the ovaries, suppresses ovulation, promotes fat storage, particularly around the abdomen or your belly, and drives inflammation. So when a woman with insulin-resistant PCOS struggles to lose weight, gains weight easily, has cravings, experiences energy crashes, irregular cycles, and has acne or hair thinning, it's not a willpower issue. This is a metabolic and hormonal issue that requires a completely different approach than eat less and move more. And this is where the conventional advice fails women with PCOS completely. You've probably been told to lose weight, eat less, move more, try a lower calorie diet. But here's the functional truth: chronic caloric restriction raises cortisol, increases insulin sensitivity initially, but then dysregulates it, slows metabolic rate, signals the body to hold on to fat stores, suppresses thyroid function, and further disrupts ovulation. So the very thing you are told to do makes the hormonal dysfunction worse. It's not a theory, it's physiology. So let's talk about the most common treatment women with PCOS are offered, the birth control pill. Now, I want to be very clear here. I am not anti-medication and I am not anti-birth control, but I am pro-informed consent. And most women with PCOS are never told the full story. Here's what the pill does for PCOS symptoms. It does suppress androgen production, which can improve your acne and your hair symptoms. It does create a quote unquote regular cycle, though this is a withdrawal bleed, it's not a true period. It can reduce ovarian cyst formation temporarily. But here's what it doesn't do: it does not fix insulin resistance, it does not address the root of what's going on with your PCOS, it doesn't restore ovulation, it does not regulate your hormones, it suppresses them. And then here's what happens when women come off the pill. Your symptoms return, often worse than before. The root cause was never addressed, it was paused. Nutrient depletions from long-term pill use, so B vitamin, zinc, magnesium, are now compounding your hormonal dysfunction. This is why so many women say, I came off the pill and everything fell apart. Because the pill didn't treat the PCOS, it just made your symptoms bearable. And in the meantime, insulin resistance continued, inflammation continued, and the underlying hormonal dysfunction continued under the surface, quietly, for as many years as you were on the pill. So let me paint a picture here for you. Because behind every PCOS diagnosis is a woman who has been navigating her body in the dark for most of her life. And her story usually goes something like this. She's 13 or 14, her periods are irregular from the start, painful, unpredictable, and heavy. She's told this is normal and that her body is just adjusting. But by 14 or 15, she's put on the pill. Not because anyone fully explained what was happening in her body, but because it was the easiest solution. Her periods regulated, her acne improves, and the conversation just ended there. Now she's 16, she starts experiencing anxiety, maybe depression, she feels disconnected from herself, from her body, and she's put on antidepressants. No one connects this to her hormones. No one asks about her gut health, her sleep, her stress load, or what the pill might be doing to her nutrient levels. Then, fast forward to her in her early 20s, she comes off the pill, maybe because she wants to try for a baby someday, or because she wants to see what her body does on its own. And everything unravels. Her cycle disappears or becomes wildly irregular, her skin breaks out, her hair starts thinning, she gains weight despite eating normally. She goes back to the doctor. And finally, at 22, 23, maybe even 24, she gets a diagnosis, PCOS. And instead of feeling relieved, she feels terrified. Because the conversation that follows includes you'll need to lose weight, you should go back on the pill. Getting pregnant might be difficult. You may need IVF. And she walks out of that office feeling like her body has completely failed her. But here's what I want to say to that girl. Your body has not failed you. Your body has been adapting to years of suppression, undernourishment, stress, and incomplete information. PCOS is not a life sentence, it's a metabolic and hormonal pattern that responds to the right support. And you deserved that information from the very beginning. So let's talk about something that doesn't get addressed enough in the fitness and wellness space. Personal trainers and group fitness coaches are not taught about hormonal adaptations. They are taught calories in versus calories out, progressive overload, macros, body composition. And those frameworks work for a hormonally healthy body. But for a woman with insulin-resistant PCOS who has been in a caloric deficit for 10 years, that framework doesn't just fail, it makes the problem worse. And here's what actually happens: when a woman with PCOS has been chronically under-eating, her metabolic rate adapts downward. Her body becomes more efficient at storing fat, her cortisol rises, her thyroid downregulates, her hunger and fullness hormones become dysregulated. Her body is in survival mode and it has been for years. So when your trainer says you just need to be in a bigger deficit, your body here keeps surviving and it holds on tighter. So what happens on the weekends? Because I know this story too. You've been restricting all week, you've been good, you've been tracking, and then Friday night hits and something shifts. You can't stop eating, you eat past the fullness, you feel like you're out of control, and then you feel shame. And then on Monday, you restrict harder. That's not a character flaw. That is a physiological response to chronic underfueling. So when the body is chronically deprived, your hunger hormone rises, your fullness hormone drops, dopamine drives reward-seeking behavior around food, cortisol amplifies cravings, the binge is not the problem, the restriction is. And no amount of willpower overrides survival biology. And I want to honor this woman specifically because she is everywhere in the PCOS community. She's loyal to her group fitness classes, she's consistent in the gym, meal prepping on Sundays, taking her supplements, doing everything she's been told. And she's spinning her wheels. Not because she's not working hard enough, but because her metabolic rate has adapted to years of restriction. Her hormones are calibrated to survival mode. Her cortisol from intense exercise is amplifying your insulin resistance. Her body doesn't feel safe enough to release the weight. Trying harder in this context doesn't create better results. It creates more stress on an already stressed system. This is why PCOS requires a completely different lens. And this is where the work begins. So I want to be very clear: this is not a protocol, it's a framework. Because every woman with PCOS has a different history, a different stress load, and a different starting point. But the foundations look like this. One, stabilize blood sugar consistently. Eat regularly, prioritize protein at every meal, pair carbohydrates with a fat and a protein. Stop skipping meals. Your iced coffee on your drive to work is not a meal. Please stop skipping meals and stop fasting. Fasting is a good tool. I do like to use fasting at some points, but for a metabolically challenged system, fasting, especially first thing in the morning, is not going to do you any good. So, number two, reduce the body stress load. This includes physical stress, over-exercising. It includes emotional stress, metabolic stress, which is under-eating, and your body needs to feel safe before it regulates. You also need to support your liver and your gut. Estrogen and androgen metabolism depends on your liver and your gut systems. Gut inflammation worsens insulin resistance, and constipation recirculates your hormones. You also need to replenish what's been depleted. Years of restriction and pill use deplete magnesium, zinc, B vitamins, and iron. These are foundational for hormone production and insulin sensitivity. And you need to move in a way that supports Supports your body, not depletes it. So strength training improves your insulin sensitivity, but chronic hit raises your cortisol. Walking is underrated and very powerful in this situation. And recovery is not optional. And everything I've talked about today: the insulin resistance, the pill, the metabolic adaptation, the years of trying harder and getting nowhere. This is exactly what we're going to do even deeper into my upcoming masterclass. PCOS, everything your doctor never told you. This masterclass is for the women who has a PCOS diagnosis and still doesn't understand what's driving it, has been on the pill and wonders what it actually did, has been dieting and exercising and not seeing results, wants to understand her body, not just manage her symptoms, and is ready for real answers. In this masterclass, I'm going to cover the types of PCOS and how to identify yours, just kind of like we did today, but a little bit deeper. What's actually driving your symptoms? What conventional advice fails women with PCOS? What functional support actually looks like, and what you can start doing differently right now. And registration is open. This masterclass is going to be on April 20th, which is a Monday at 12 p.m. Eastern time. The link is in the show notes. So make sure you download that or the link in my bio on my Instagram. And if you're confused on how to get the registration link, just message me PCOS on Instagram and I'll send it directly to your DMs. And if this episode resonated with you, share it with a woman who you know that has been struggling with PCOS because she deserves to hear these answers too. So thanks for listening to Healthy Period. I'll see you in the masterclass.