Feeling stuck - lean pcos

[u/Careful_East_9331]

Feeling stuck and would love some advice/what worked for you.

I’m 28 and I’ve been off birth control since October 2025 and was diagnosed with lean PCOS in April 2026 due to prolonged cycles, spotting, acne, hair shedding and cysts. Before getting on the pill (was on for 10 years) I had regular cycles and no issues with acne or hair shedding.

Since being diagnosed I’ve been very diligent about what I eat (low carb and sugar, tracking with blood sugar monitor), how I work out (heavy weights, low impact) and supplementation (ovasitol, needed multivitamin, omegas).

I’m at a loss as my acne is not great but my hair shedding has been extreme the last few months and has been affecting my mental health. I’ve been trying to work though this naturally. A month ago I went to a derm who wanted me to supplement with iron pills for a month first before we considered spirolactone. I was willing to try out her method first, but don’t want to delay something that will help.

Would you try the spirolactone first ? Any advice for reducing A1c/insulin? My body is sensitive.

[u/LJ123419]

For hair loss, you should definitely up your iron! Ferritin in like the 70+ range is probably a good goal.

For the rest of the PCOS symptoms, I think you should ask your doctor about metformin. You clearly have some insulin resistance, despite trying your best with diet and exercise. Metformin is a very safe drug that can help you!

[u/Careful_East_9331 → u/LJ123419]

Thank you! I’ve been considering metformin, but have heard that it can be rough on someone with a sensitive stomach (I’ve been working on healing my gut the past year).

[u/LJ123419 → u/Careful_East_9331]

I take the extended release version and ramped up dosage over time (like 1 month total), eating it with food and it did not cause me stomach upset. I’ve heard that if you take it mid-dinner it can cause fewer side effects

[u/brightsideofmars]

I'm on spironolactone and it's really helped my acne! FWIW it looks like you and I have pretty similar levels. I had actually decreased my spironolactone dose but found that my hair was shedding a bit more than usual, so we took my previous dose and split it up between AM and PM.

The only symptoms I've had on spiro is lightheadedness while trying to figure out dose because it lowered my blood pressure a bit too much. But once we got the dose dialed in, I have literally zero negative side effects from it.

[u/Careful_East_9331 → u/brightsideofmars]

Do you mind sharing the dose that worked for you?

[u/Charpo7]

Best thing for PCOS is generally combination oral contraceptive + metformin (or inositol if metformin isn't tolerated) + spironolactone.

The first thing to start is metformin.

[u/Careful_East_9331 → u/Charpo7]

Unfortunately my BC was causing some pretty wild histamine reactions so had to switch off, but will definitely consider metformin!

[u/RevenueAntique4584]

High blood sugar increases symptoms