PCOS is an Epiphenomenon

Polycystic Ovary Syndrome (PCOS), the commonest endocrine disorder in women, affects fertility, metabolism, & quality of life. It is portrayed as a primary disease of the ovaries, where follicles do not mature, ovulation becomes irregular, & multiple cysts appear on ultrasound. Is this the full story?

Our research over the past decade challenges this traditional view. We asked a simple question: Is PCOS the problem, or is it a downstream effect — an epiphenomenon — of something deeper?

Weight Gain Comes First

In our retrospective study of over 170 women with infertility, we noticed that more than 97% of women with PCOS had gained at least 4-5% of their body weight after adolescence before developing PCOS symptoms.

This weight gain was not limited to women who were overweight or obese. Even women with normal BMI developed PCOS when their weight crept up. Absolute number on the scale mattered less than shift in weight.

Why is this important? This suggests that weight gain may be the precipitating factor for PCOS. The ovaries, are not inherently diseased. Rather, they are responding to metabolic signals from rest of the body.

The Domino Effect: From Weight to Hormones to Ovaries

Biology supports this. Here is what happens when weight gain accumulates:

• More fat tissue increases leptin, which alters hypothalamic-pituitary-ovarian (HPO) axis.

• Rising blood sugar triggers insulin release & compensatory hyperinsulinemia.

• High insulin lowers sex hormone–binding globulin (SHBG), increasing the amount of free testosterone.

• Elevated free testosterone disrupts follicle development, leading to anovulation.

A Protective Checkpoint?

In a Perspective, we proposed that PCOS might serve as a biological checkpoint. By halting ovulation in a hormonally hostile environment, body may be protecting itself from high-risk pregnancies.

This reframes PCOS not just as a disorder, but as an adaptive response gone awry in the modern context of rapid weight gain & lifestyle change.

Pregnancy Complications: Blaming PCOS or BMI?

It is believed that women with PCOS are at higher risk for complications during pregnancy. Our 2017 study examined over 100 PCOS pregnancies compared to controls. The results were revealing:

• The only significant complication was gestational diabetes mellitus (GDM).

• Risk of GDM rose not because of PCOS itself, but in proportion to BMI.

• PCOS women with normal BMI had similar outcomes to non-PCOS controls.

Conclusion: PCOS is not an independent culprit. It is weight gain & metabolic status that drive both PCOS & its associated pregnancy risks.

Rethinking PCOS Management

If PCOS is an epiphenomenon of weight gain & metabolic dysfunction, then treatment strategies should shift focus:

• Instead of forcing ovulation through medications, we should address the root causes — weight management, insulin sensitivity,& lifestyle modification.

• By correcting upstream imbalance, downstream reproductive effects may resolve naturally..

Take-Home Message

PCOS may not be a disease of the ovaries. It may be the body’s way of signaling that something is off balance — a metabolic alarm bell ringing through the reproductive system.

When we ask, “Is PCOS an Epiphenomenon?” the evidence increasingly points to Yes. The shift in perspective could change the way we diagnose, counsel, & treat millions of women worldwide

• Disclaimer: This opinion article is for educational purposes only & does not constitute medical advice. Readers should consult their healthcare providers before making any decisions about diagnosis or treatment.

This is not medical advice. This is food for thought. Please discuss with your doctor before making any change in your food & lifestyle.

The escalating global incidence of Type 2 Diabetes Mellitus (T2DM) over the past five decades directly correlates with the parallel rise in overweight and obesity, forming an intertwined epidemic termed "diabesity." This review argues that the primary driver of this crisis is the pervasive consumption of "inappropriate food," particularly refined carbohydrates and ultra-processed foods, which disrupt metabolic homeostasis and promote weight gain. We propose that "appropriate food"—defined as whole, fresh, local, plant-based, minimally processed, or unprocessed foods, consumed in appropriate amounts and at appropriate times, and complemented by age-specific exercise—constitutes the fundamental and most effective intervention for T2DM prevention, management, and even remission. This lifestyle-centric approach, supported by emerging insights into the gut microbiome and personalized monitoring via continuous glucose monitors, often renders long-term pharmacotherapy unnecessary and potentially harmful. We critically examine the conventional reliance on chronic drug therapy, highlighting its significant side effects and questionable long-term morbidity/mortality benefits, advocating instead for its judicious use primarily in acute medical emergencies. This paper calls for a paradigm shift in T2DM management, prioritizing sustainable, food-based lifestyle interventions over a drug-centric model.

Disclaimer: This is an opinion article for educational purposes only & does not constitute medical advice.Readers should consult their healthcare providers before making any decisions about diagnosis or treatment.