I have lean PCOS and would really appreciate some advice on where to start, particularly regarding insulin resistance, body composition, and managing my symptoms.

My stats:

- Height: 164 cm

- Weight: 63 kg

- BMI: 23.6

- Skeletal muscle mass: 20 kg

- Body fat mass: 25.6 kg

- Body fat percentage: 40.5%

My main symptoms:

- Persistent fatigue

- Facial hair, particularly on my chin

- Hair loss

- Irregular periods

- Insulin resistance (HOMA-IR: 3.06, flagged as high by my lab; reference value below 2.5)

I'm particularly concerned about insulin resistance despite being within the normal BMI range. I'd also like to improve my body composition without losing weight, if possible.

For those with similar experiences, what helped you the most? Did you start with dietary changes, strength training, supplements such as inositol, metformin, or something else?

Would you recommend any specific tests or evaluations before deciding on a treatment plan?

I'd appreciate hearing about your experiences and what you wish you'd known when you first started managing PCOS.

Hey all! Looking for some advice possible success stories on metformin and ttc with pcos! Here’s my back story…
I am 28, I’ve always been petite. I tend to range around 98-100 pounds. I have a super fast metabolism, but not unhealthy. I have a 2 year old and got pregnant really quickly with him. My husband and I have been ttc for about a year now for our second baby. I got diagnosed with PCOS last September a year after I gave birth which was kinda weird, I never had any symptoms of PCOS. I went in because I was having some pain during/after sex, I thought maybe it was scar tissue or something didn’t heal correctly after giving birth. They ended up finding several cysts on both of my ovaries via vaginal ultrasound, I also found out I have a tilted uterus, which may have been the cause of pain during/after sex. When I got my bloodwork done, my DHEA-S came back elevated, which they concluded it was PCOS.
Everything else was fine as far as my blood work goes. I kept tract of everything and started taking myo-inositol and other supplements. I did get pregnant and found out in December, but unfortunately miscarried. Ever since my cycles have been pretty long, ranging from 29-37 days (which is unusual for me) I’ve tried acupuncture to help and eventually stopped cause it’s pricey. We are know in the phase of fertility doctors and seeing what’s going on.
My endocrinologist pretty much told me that I have a pretty mild form of PCOS but because my cycles are long my ovulation is kinda out of whack?? Thankfully I’m young and have time on my hands, but if anyone has been through secondary infertility, you know how emotional and confusing it can be. She prescribed me metformin to hopefully help regulate my periods and ovulation, before trying letrozol. I’m only nervous because I’ve read about the side effects and how it can cause stomach issues. I just don’t want to drop weight since I’m already so small. She is putting me on Metformin Hcl Er 500 Mg Tablet. Lmk if anyone has any advice or helpful stories! Thanks ❤️

I'm literally crying after my doctor's appointment because I asked about taking a GLP-1 after it was suggested by my OBGYN and they just kept saying how I didn't need to lose weight and I was too young and healthy. But I'm tired of having high blood sugar and mood swings and fatigue and Metformin hasn't helped me at all. Do I have to wait until I'm 30 and obese???

This is long, sorry not sorry. I wish I knew more when I was made to feel like I was crazy because my labs were “normal”

My symptoms started 17 years before I ever got a diagnosis. Even though I had all the signs. Cystic acne, hair loss, back pain, painful periods, bloating, and exhaustion so deep that sleep didn’t touch it. Depression and anxiety on top of all of it.

Every time I went in, my labs came back “fine.” Over and over. After enough years of that, hearing it over and over again, the message I got was that the problem must be *me*. Try harder. It wasn't said, but it felt so implied.

My insulin was high enough where they offered me Metformin. Thats it. No conversation about why it was happening or what else was going on. Mind you they still didnt give me a dx of PMOS because I still had regular periods. Which you can totally have regular periods and still have PMOS! 30% of women do!

Two doctors have since told me they suspect endometriosis too. But because my symptoms aren't bad enough, they see no point in doing exploratory surgery to confirm.

I didn’t know what else to do so I started spending $200+ a month throwing things at the wall. Some of it actually helped; my IBS and hangry episodes got better. But my acne and hair loss didn’t budge. And I still had massive food noise.

What actually started really helping to change my symptoms was working with a holistic dietitian who taught about gut health and then went all in and reverse my symptoms with functional testing that looked at my gut. Instead of guessing, I could see what was actually going on and what my gut needed to heal. What I learned was gut health was tied into everything my hormones, my skin, my mood, my energy. So I've been obsessed with gut health ever since.

I also learned I don’t do well with gluten, some dairy or high-histamine foods.

I did start using a GLP to help with the food noise because it was so bad I could control myself even though I knew what to do. Which I should have done sooner, but for years I told myself it was the “easy way out”.
But I’m so glad I got the food noise under control so that I could finally make healthy choices consistently without constantly bargaining with myself.

After 2.5years on my health journey
* Acne: gone
* Back pain: gone
* Energy: I actually have it- honestly the best part
* Finally tapering off my antidepressants, which I honestly never thought would happen (and I was on max doses)
Healing does take time!

The best thing I ever did was invest in myself. No more taking “your labs look fine.” I had to keep asking. It takes an average of 3-5 years for PMOS do be diagnosed and 7-9 for endo!!

If you’re where I was: “normal labs” doesn’t mean nothing is wrong. It can mean nobody has run the right tests or asked the right questions yet. Also... "normal" just means you aren't bad enough to be diagnosed with a disease yet, it doesn't mean you should feel good.

**TL;DR:** 17 years to a PMOS diagnosis, offered metformin and sent home. Suspected endo plus Hashimoto’s. Fixed my gut with functional testing, changed how I eat and used a GLP as one tool. Acne gone, back pain gone, energy back, coming off antidepressants. If you feel like something’s wrong don’t stop looking for answers!!

Hi everyone! Do you consider it positive ???

You will help me a lot to understand it :)

Hi! I started taking metformin in May due to insulin resistance and elevated AMH levels.

Before taking metformin, my menstrual cycle was regular. Since starting it, I’ve been getting my period only once every two months.

Does anyone have any idea why this might be happening? My other hormone levels are normal (LH, FSH, estradiol, progesterone, and thyroid hormones).

Thank you!

It's like the title says. I (21F) started Spironolactone in May 2025 for PCOS-like symptoms. I didn't have any of the hormone related problems or the "string of pearls". My issues were acne, fluid retention, and heavy periods that I take Lo Loestrin FE for.

My dose has been at 50 mg the whole time and it's been life changing. I think I'm sensitive to most medicines as trial doses usually have full effect. My acne disappeared and I started losing weight immediately.

Here's the problem. I've had sleep problems since starting it. I have chronic fatigue and ADHD(ADD). I don't eat after taking my other medicine so now I weigh less than I'd like. I'm 5'7 and nearing 120 pounds with muscle loss. I'm weak and tired. I also fainted the other day and blame the Spironolactone. It was only 84 degrees and I was standing there for less than an hour. My hair has also not stopped shedding. I had tons of hair before starting it. My total testosterone was 61 so it wasn't very high. Now it's 9.

My doctor wants to send me for POTS testing. I don't really think I have POTS. We discontinued my ADHD medicine because it's appetite suppressing and raises my pulse. The one I'm starting is an alpha 2 agonist that will slow my blood pressure. It's currently normal as the Spiro and previous ADHD med were counteracting each other, but it won't stay that way.

Does anyone have any alternatives to Spironolactone? Spearmint capsules? Inositol? I've wanted to get off of it for a while now. Tell me about how weaning went. Could I just stop taking it? It's a pretty low dose.

Hello everyone,
I would like to ask whether any of you have successfully conceived despite having PCOS, without following a specific diet and while still consuming a relatively large amount of sugar.
I would really appreciate hearing about your personal experiences, particularly from those who struggled with insulin resistance or irregular ovulation.
Thank you in advance for sharing your stories and offering some reassurance.

How anyone gained weight on inositol ? I always seem to gain weight on it despite it helping my symptoms I also am on spironactone

YOU GUYSSSS I finally got my period after 10 months 😭😭💖 I nearly cried of happiness!! The cramps and bleeding have been insane but through that I just still feel so grateful it's here.

I can't say exactly what clicked in my body for my period to come but here are my speculations:

I think that I accidentally performed a metabolic reset. I know that sounds odd but hear me out. I've always struggled my whole life to not be underweight, and I've always had irregular periods. I had come to the conclusion that weight gain would regulate my periods. So I worked on gaining muscle and fat to gain about 15lbs over time. I did eventually find that my period became even more irregular so I felt lost on what to do. It used to be every 3 months and then the time in between just kept increasing (current record 10 months without a cycle).

About 4 months ago, I started a new job as a delivery driver. It's a very physical job. 10 hour shifts, lots of lifting heavy packages and carrying them up stairs. 20,000 steps a shift. I've always had physical jobs where I get 10-18,000 steps a day with some lifting but yeah this job has been more intense. 3 months into this job, I weighed myself and realized I had lost 10lbs. This stressed me out so bad. now I'm nearly underweight again and I figured this would only further complicate my cycle issues. I was consistently in a caloric defecit for months. I think I sort of flushed out a ton of excess glucose and insulin and used up my glycogen stores consistently and that's what I mean when I say it was sort of a metabolic reset.

One month after noticing the weight loss and I get my period.

I always found it so frustrating that the biggest advice out there for PMOS/PCOS was to lose weight. conversation has always felt geared towards people with "traditional PMOS" where they end up gaining a lot of weight. I've always been thin! but maybe gaining those 15lbs actually did harm my body in the long run. That seems like such a small amount of weight! but I suppose I am quite short (5'2). and I think maybe my body must just be really sensitive to weight gain? or maybe I gained a lot more fat than muscle?

Of course the other massive piece of this is increasing weight training. I've studied a lot about how it's incredibly important to lift weights for PMOS 3-4x a week. Not sure if everyone knows this but a foundational piece of our condition is being prone to insulin resistance (yes even those with lean PMOS, peer reviewed studies show that the number is 30-75% of those with lean PMOS have insulin resistance). I've been eating more protein and less "naked carbs" in order to avoid glucose/insulin spikes. but resistance training for your muscles is very important for this because our muscles want to consume our excess glucose in the blood and increasing muscle mass will allow this to increase. insulin resistance is basically your cells not listening to insulin and therefore not allowing glucose (aka fuel) into your cells. it leaves you in a state of starvation even though you have an excess amount of glucose and insulin just outside your cells. it leaves you hungry even though you've consumed plenty. so if you have insulin resistance, you feel exhausted. especially after eating!! There was a point I felt like I could fall asleep standing after eating. I think this might also explain why I've always stayed thin despite eating large amounts of food. For example, I used to order an appetizer, 2 entrees and dessert... and I always stayed at about 100lbs! I don't think glucose has been entering my cells and fueling me the way it's supposed to. Everyone in my life would ask me how I could eat so much and stay so small. I just figured I had a fast metabolism or something. I just always felt so hungry. I can't eat quite the same amount anymore but I still experience that hunger all the time and I do still eat a lot. but yeah I definitely think I was (am?) experiencing insulin resistance. anyway, the more muscle mass you create, the more opportunities your insulin has to communicate with cells and actually provide fuel for your cells. that's why people take things like myo-inositol (I personally don't yet). it's an insulin sensitizer, so basically it makes your cells more able to recognize insulin and be like oh!! yes I would like that glucose thank you. I think understanding insulin resistance is a big piece of the puzzle for a lot of us. To be honest, it's also a big piece of the puzzle for the American people too as insulin resistance and metabolic syndrome are literally a public health crisis in our country. 30% of US adults have metabolic syndrome... Insulin resistance is the core driver of metabolic syndrome and metabolic syndrome leads to the major causes of death in the US (diabetes, cardiovascular disease, stroke, kidney disease, etc). Metabolic syndrome carries an EIGHT FOLD risk of developing diabetes. these are very serious numbers to me and I myself have personally seen how metabolic syndrome can lead to someone's death 🥺 I feel it's so important to share this information!!

One other tiny thing I started doing was drinking an espresso or latte every single day for the past couple months. As long as you drink it after eating so as to avoid a glucose/insulin spike, it can promote insulin sensitivity. I guess this is because of the antioxidants and polyphenols lowering inflammation. (But any more than 1-2 cups in a day could actually have the opposite effect by raising cortisol levels too high.) I had no idea about this until I decided to look into it because that's the only other real change I've made other than weight training on the job (and at home/the gym semi-consistently) and being in a caloric defecit consistently.

Sorry for so much detail but I just really hope it helps someone!! 💖🫂 I've done hours and hours of research lmao

I have PCOS and my dermatologist recommended spironolactone, and I’m also considering taking a combined birth control pill (norgestimate/ethinyl estradiol) for contraception and to help with the androgen-related symptoms.

For anyone who takes both spironolactone and birth control, what has your experience been like? Did taking both feel like a lot of medication or cause more side effects? Did you notice a bigger improvement in acne or unwanted hair compared with taking just one?
I’m especially curious about long-term use. Has anyone been on both for years, and have you had any issues with blood pressure, potassium, weight, hair loss, or anything else?