PCOS Symptom Audit Checklist

Not all PCOS is the same

PCOS is diagnosed by the Rotterdam criteria (2 of 3: irregular periods, elevated androgens, polycystic ovaries on ultrasound) but the root cause varies significantly between individuals. Using the same dietary approach for all PCOS subtypes is one of the most common reasons women don't see results. There are four root-cause profiles — your dominant one determines your nutrition strategy.

The 4 PCOS root-cause profiles

1. Insulin-Resistant PCOS (most common — ~70%)

Elevated insulin drives the ovaries to produce excess androgens. Signs: weight gain around the abdomen, skin tags, darkening of neck/armpits/groin (acanthosis nigricans), strong sugar and carbohydrate cravings, diagnosed with high fasting insulin or elevated HOMA-IR, history of gestational diabetes or strong family history of T2D. Diet focus: low glycaemic, high protein (1.6g/kg body weight), drastically reduce refined carbohydrates.

2. Inflammatory PCOS

Chronic low-grade inflammation drives androgen excess. Signs: chronic fatigue, joint pain or headaches, skin issues (rashes, eczema), elevated hsCRP or ESR on blood tests, autoimmune history (thyroid antibodies, IBS, rheumatoid conditions), symptoms worsen with certain foods (gluten, dairy, seed oils). Diet focus: anti-inflammatory Mediterranean-Indian hybrid diet, elimination approach, omega-3 priority (2g EPA+DHA daily).

3. Adrenal PCOS

The adrenal glands — not the ovaries — are the primary androgen source. Signs: elevated DHEA-S on blood test with normal or borderline DHEA and testosterone, symptoms worsen significantly with stress or poor sleep, anxiety, insomnia, normal or near-normal insulin levels, relatively lean body type. Diet focus: cortisol regulation via regular meals (never skip breakfast), magnesium-rich foods, adaptogens (ashwagandha has the strongest evidence in PCOS).

4. Post-Pill PCOS

Hormonal contraception suppresses ovulation; after stopping, some women's cycles take months to resume. Signs: regular cycles before contraception, irregularity only after stopping the pill, relatively new onset (within 6–12 months of stopping), no strong insulin resistance markers. Diet focus: often temporary. Support with zinc (pumpkin seeds, sesame), B6 (sunflower seeds, walnuts, bananas), and vitex (chasteberry) if confirmed with a practitioner.

Symptom audit — tick what applies to you

The following checklist covers the most diagnostically useful markers. Tally your scores by category after completion.

Metabolic / Insulin

Weight gain concentrated at the abdomen and waist · Difficulty losing weight despite diet and exercise · Strong cravings for sugar and carbohydrates · Energy crashes 1–2 hours after eating · Skin tags at neck, underarms, or groin · Darkened skin patches at neck, underarms, or groin · Fasting insulin above 10 mIU/L · HOMA-IR above 2.0

Inflammatory

Persistent fatigue not explained by sleep · Joint pain without injury · Frequent headaches · Skin rashes, eczema, or unexplained breakouts · Bloating and digestive issues after meals · Known autoimmune condition · hsCRP above 1.0 mg/L on blood test · Symptoms worsen after gluten or dairy

Adrenal / Stress

Symptoms noticeably worse during periods of high stress · Difficulty falling or staying asleep · Anxiety or feeling of overwhelm · Elevated DHEA-S on blood test · Normal testosterone and insulin levels · Hair loss at temples (adrenal pattern) · Wired but tired feeling in evenings

Post-Pill

Cycles were regular before hormonal contraception · Irregularity started within 6 months of stopping the pill · No significant weight changes · Mild or absent metabolic symptoms · Relatively recent PCOS diagnosis

Universal PCOS nutrition rules

Regardless of subtype, the following principles apply to every PCOS case:

• ·Eat within 1 hour of waking — never skip breakfast. Cortisol peaks in the morning; a protein-rich breakfast within 1 hour significantly reduces morning androgen production.
• ·Minimum 30g protein at every meal — targets 1.4–1.6g protein per kg body weight daily.
• ·Every carbohydrate must be paired with protein + fat + fibre — no naked carbs.
• ·Spearmint tea: 2 cups daily — the strongest dietary intervention for reducing free testosterone, supported by two RCTs.
• ·Cinnamon: ½ tsp daily in food or water — insulin sensitiser with specific PCOS evidence.
• ·Ground flaxseed: 2 tbsp daily — lignans modulate oestrogen metabolism and improve menstrual regularity.
• ·Seed cycling: Days 1–14 of cycle add ground flaxseed + pumpkin seeds; Days 15–28 add sesame + sunflower seeds.
• ·Limit dairy if symptoms suggest inflammatory subtype — casein A1 in standard Indian dairy is a common inflammatory trigger.
• ·Prioritise sleep as a clinical intervention — chronic sleep deprivation directly worsens PCOS markers.

What to test before designing your plan

• ·Fasting insulin and HOMA-IR (not just fasting glucose — this is the most commonly missed test in PCOS)
• ·Free testosterone and DHEA-S (distinguishes ovarian from adrenal androgen source)
• ·hsCRP (inflammatory marker)
• ·Thyroid panel: TSH, Free T3, Free T4, TPO antibodies (Hashimoto's co-occurs in 25–30% of PCOS cases)
• ·Vitamin D (deficiency worsens insulin resistance — supplement to 50–80 ng/mL)
• ·Vitamin B12 (especially if on metformin, which depletes B12)
• ·AMH (anti-Müllerian hormone — useful for tracking ovarian reserve over time)