PCOS - Wokingham, Berkshire

1. What is PCOS?

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders affecting women of reproductive age. It is characterised by a combination of hormonal imbalances, disrupted ovulation and, in many cases, the presence of multiple small follicles (sometimes called cysts) on the ovaries — though the name is somewhat misleading, as these are not true cysts but undeveloped follicles that have failed to mature and release an egg.

The European (Rotterdam) diagnostic criteria for PCOS requires the presence of at least two of the following three features: elevated androgen levels (particularly testosterone); oligo-ovulation or anovulation (irregular or absent ovulation); and polycystic ovarian morphology on ultrasound (12 or more follicles measuring 2–9mm per ovary, or an ovarian volume greater than 10ml). In the United States, some diagnostic frameworks do not require polycystic ovarian morphology, which is worth noting if you encounter different definitions elsewhere.

PCOS is not a single, uniform condition — it presents very differently between individuals, and the dominant hormonal pattern varies considerably depending on a woman's body type, diet, lifestyle and genetic background. Effective treatment therefore requires a thorough individual assessment rather than a one-size-fits-all approach.

I have extensive experience treating PCOS using acupuncture and Chinese herbal medicine, helping women to regulate their cycles, restore ovulation, improve their hormonal profile and conceive. I practise at clinics in Wokingham, Berkshire, and offer online herbal consultations for patients who cannot attend in person.

2. Symptoms of PCOS

PCOS symptoms typically begin at or around puberty and can vary considerably in severity from woman to woman. Women with polycystic ovarian syndrome may experience some or many of the following:

Irregular periods — cycles that are longer than 35 days, highly variable in length, or absent altogether (amenorrhoea)
Anovulation — failure to ovulate regularly, which is the primary cause of PCOS-related infertility
Elevated testosterone and androgens — higher than normal levels of male hormones including testosterone, androstenedione and DHEAS
Hirsutism — excess hair growth on the face, chest, abdomen or back due to elevated androgens
Alopecia — male-pattern hair thinning or loss on the scalp
Acne — particularly along the jawline and chin, driven by elevated androgens
Insulin resistance — the body's cells becoming less responsive to insulin, leading to elevated blood glucose and compensatory high insulin levels
Weight gain or difficulty losing weight — particularly around the abdomen; present in approximately 40–50% of women with PCOS
Elevated LH levels — present in around 40% of women with PCOS, particularly those who are lean
Reduced SHBG levels — sex hormone-binding globulin, which normally binds testosterone and reduces its activity, is lower in women with PCOS
Elevated prolactin — higher than normal prolactin levels are found in some women with PCOS
Elevated AMH levels — anti-Müllerian hormone is typically elevated in PCOS because of the large number of small antral follicles present
Anxiety and depression — significantly more common in women with PCOS than in the general population
Dysmenorrhoea — painful periods when they do occur
Reduced blood flow to the uterus — impacting endometrial receptivity and fertility
High blood pressure — more common in women with PCOS, particularly those with insulin resistance

3. How is PCOS diagnosed?

PCOS is diagnosed based on clinical history, blood tests and pelvic ultrasound. Because of the variation in how PCOS presents, diagnosis requires careful assessment rather than relying on a single test result.

The main investigations used to diagnose PCOS include:

Pelvic ultrasound — used to visualise the ovaries and assess for polycystic morphology (multiple small follicles). An MRI provides a more detailed image and is considered more accurate than ultrasound in difficult cases. If follicles are smaller than 5cm in diameter, surgery is generally not recommended; larger cysts that obstruct fertility may require removal.
Blood tests for hormones — measuring levels of testosterone, androstenedione, SHBG, LH, FSH, AMH, prolactin and insulin-like growth factor (IGF)-I. In lean women with PCOS, elevated LH (above 10 IU/L, measured around day 8 of the cycle) is commonly found. In overweight women, elevated insulin (hyperinsulinaemia) and testosterone are more characteristic. Insulin resistance can also be assessed through a fasting insulin test or an HOMA-IR score.
Progesterone blood test — a progesterone level measured seven days before the expected end of the cycle (typically day 21 of a 28-day cycle) can confirm whether ovulation has occurred. A low progesterone level suggests anovulation.
Mid-cycle ultrasound — tracking follicular development by ultrasound can confirm whether a dominant follicle is developing and whether ovulation is occurring.

4. How common is PCOS?

PCOS is the most common endocrine disorder in women of reproductive age, affecting approximately 5–15% of women worldwide depending on the diagnostic criteria used. In the UK, it is estimated to affect around one in five women.

Among women presenting for fertility treatment, the prevalence is considerably higher. Approximately 34% of women undergoing IVF are found to have polycystic ovaries (PCO) — the presence of multiple follicles on the ovaries, which may or may not be accompanied by the hormonal abnormalities that define full PCOS. These multiple follicles are mainly undeveloped follicles that have failed to mature and release an egg.

In women who do not ovulate, PCOS accounts for approximately 50% of all cases of anovulation. Asian women have a higher prevalence of PCOS and insulin resistance than women of European descent, and often present with a leaner phenotype despite significant metabolic dysfunction.

5. What causes PCOS?

The precise cause of PCOS is not fully understood in western medicine, and it is likely that the condition arises from an interaction between genetic predisposition and environmental and lifestyle factors. The two main hormonal mechanisms that drive PCOS are hyperandrogenaemia (elevated androgens) and hyperinsulinaemia (elevated insulin), and these are interconnected.

In lean women with PCOS, elevated LH is often the primary driver — high LH stimulates the ovarian theca cells to produce excess androgens (particularly testosterone and androstenedione), which impairs follicular development and prevents the dominant follicle from maturing and ovulating. In overweight or obese women, insulin resistance is more commonly the primary mechanism. High insulin levels stimulate the ovaries to produce excess androgens independently of LH, and also reduce hepatic production of SHBG, further increasing the level of biologically active free testosterone.

Western medicine also recognises that excess meat consumption can increase levels of insulin-like growth factor (IGF)-I, which further stimulates androgen production and follicular proliferation. It is not advisable for women with PCOS to take DHEA supplements, as DHEA is a precursor to testosterone and can worsen the androgenic component of the condition.

In traditional Chinese medicine, the causes of PCOS are understood as follows:

Poor diet — excessive consumption of damp and phlegm-producing foods (refined carbohydrates, sugar, dairy, processed foods) leading to the accumulation of damp and phlegm in the body
Lack of exercise — sedentary lifestyle increases the accumulation of damp and phlegm
Emotional stress — causing Liver qi stagnation and disruption of the smooth flow of qi and blood
Overwork — depleting Kidney yin and overall constitution
Long-term oral contraceptive pill use — which in TCM can cause yin excess and suppression of the natural hormonal cycle
Excessive consumption of red and white meat — increasing damp-heat and androgen-like excess within the body

6. Health risks associated with PCOS

PCOS is not only a reproductive condition — it is associated with a range of significant long-term health risks that go beyond fertility, and these should be discussed with a GP or specialist as part of ongoing management.

Type 2 diabetes — women with PCOS and insulin resistance are at significantly increased risk of developing type 2 diabetes, particularly if overweight. Regular monitoring of blood glucose and insulin levels is important.
Cardiovascular disease — elevated androgens, insulin resistance, dyslipidaemia and hypertension all contribute to an increased cardiovascular risk profile in women with PCOS.
Endometrial hyperplasia and cancer — chronic anovulation means the uterine lining is continually exposed to oestrogen without the protective effect of progesterone (which is only produced following ovulation). Over time, this can lead to overgrowth of the endometrium and, in some cases, endometrial cancer.
Miscarriage — women with PCOS have an increased risk of spontaneous miscarriage. In TCM, this increased risk is attributed to the obstruction of qi and blood to the uterus caused by damp and blood stasis — the same underlying pathology that drives PCOS itself.
Sleep apnoea — more common in women with PCOS, particularly those who are overweight.
Mental health — anxiety, depression and reduced quality of life are significantly more prevalent in women with PCOS than in the general population, and should be actively addressed as part of a comprehensive treatment plan.
Increased risk of autism in offspring — research has shown that children born to mothers with PCOS have a higher incidence of autism spectrum disorder, which has been linked to higher than normal testosterone levels during pregnancy. These elevated testosterone levels are also associated with decreased oxytocin levels, which is implicated in the social communication difficulties seen in autism.

7. PCOS in traditional Chinese medicine

In traditional Chinese medicine (TCM), PCOS is primarily understood as a condition of damp and phlegm accumulation combined with qi and blood stagnation, often with an underlying Kidney deficiency and Liver qi stagnation. The multiple undeveloped follicles characteristic of PCOS correspond in TCM to an accumulation of phlegm and damp in the lower jiao (the lower abdominal region), which obstructs the free development and release of the egg from the ovary.

In TCM, excess testosterone is understood as too much yang — an excessive activating and heat-generating force — which causes accelerated, uncontrolled follicular growth rather than the orderly development of a single dominant follicle. The excessive oestrogen produced by the multiple follicles corresponds in TCM to an excess of yin substance accumulating in the uterus, which over time can overstimulate and over-enlarge the uterine lining.

Most women with PCOS present with a combination of the following TCM patterns:

Kidney yang deficiency with damp-phlegm — insufficient warming energy in the reproductive system leads to the accumulation of cold damp and phlegm, which obstructs ovulation. This pattern is more common in women with oligomenorrhoea (infrequent periods), a tendency to feel cold, fatigue, weight gain and pale complexion.
Liver qi stagnation with blood stasis — stress and emotional tension cause stagnation of Liver qi, which in turn leads to blood stasis in the uterus and impairs the smooth regulation of the menstrual cycle and ovulation. This pattern is more common in women who experience significant premenstrual tension, breast tenderness, irritability and irregular cycles.
Damp-heat accumulation — dietary excess of damp and heat-producing foods leads to the accumulation of damp-heat in the lower jiao, driving androgen excess and follicular proliferation. This pattern is more common in women with acne, hirsutism, heavier body build and a tendency to excess heat.
Spleen and Kidney deficiency — weakness of the Spleen's transformative function (often driven by poor diet and overwork) leads to the accumulation of damp, while Kidney deficiency underlies the constitutional weakness of reproductive function. This is often the root pattern beneath more complex presentations.

8. Acupuncture for PCOS

Acupuncture is an effective treatment for PCOS, with a substantial body of research supporting its use — much of it conducted by the internationally recognised researcher Dr Elisabet Stener-Victorin and her team at the Karolinska Institute in Sweden. Acupuncture addresses PCOS through several well-documented mechanisms.

Regulating the hormonal axis

Acupuncture stimulates specific points that influence the hypothalamic-pituitary-ovarian (HPO) axis — the hormonal cascade that governs the menstrual cycle. It promotes the release of beta-endorphin in the brain, which modulates the release of GnRH (gonadotropin-releasing hormone) from the hypothalamus, FSH and LH from the pituitary gland, and oestrogen and progesterone from the ovary. This regulatory effect helps to restore more normal hormonal balance, reducing the LH:FSH ratio that is often elevated in PCOS and lowering excess testosterone levels.

Reducing sympathetic nervous system activity

Research has shown that PCOS is associated with increased sympathetic nervous system tone, which contributes to elevated androgen production in the ovaries. Both needle acupuncture and electroacupuncture have been shown to significantly reduce sympathetic nerve activity, thereby reducing ovarian androgen production and improving the hormonal environment for ovulation.

Improving insulin sensitivity

Research has demonstrated that acupuncture can improve insulin sensitivity and reduce fasting insulin levels in women with PCOS. By regulating insulin, acupuncture reduces the insulin-driven stimulation of ovarian androgen production — one of the primary hormonal drivers of the condition — thereby improving the overall PCOS hormonal profile without the gastrointestinal side effects associated with metformin.

Restoring ovulation

By reducing sympathetic nerve activity, regulating the HPO axis and improving insulin and androgen levels, acupuncture has been shown in clinical trials to stimulate ovulation in women with PCOS. Research by Stener-Victorin and colleagues demonstrated that women who received electro-acupuncture had significantly improved ovulation rates and were more likely to conceive compared with control groups. Acupuncture has also been shown to reduce the number of ovarian cysts, regulate the menstrual cycle and improve blastocyst implantation rates.

Regulating AMH levels

In women with PCOS, AMH levels are typically elevated above the normal range because of the large number of small antral follicles. Research has shown that acupuncture can reduce AMH levels in women with PCOS, normalising ovarian function and improving the hormonal environment for ovulation and conception.

Improving blood flow to the uterus

Acupuncture has been shown to increase blood flow to the uterus and ovaries, improving endometrial receptivity and supporting implantation. This is particularly relevant for women with PCOS undergoing IVF, where endometrial quality and receptivity are critical factors in treatment success.

Supporting weight management

For women with PCOS who are overweight, weight loss of even 5–10% of body weight can significantly improve hormonal balance, restore ovulation and improve fertility. Acupuncture supports weight management by improving metabolism, reducing stress-related eating and improving digestive function. Research has also shown that acupuncture can reduce leptin levels and modify appetite regulation, supporting sustainable weight management alongside dietary changes.

9. Chinese herbal medicine for PCOS

Chinese herbal medicine used in conjunction with acupuncture is more effective for PCOS than acupuncture alone, as herbs can directly address the accumulation of damp, phlegm and blood stasis that drives the condition at a deeper level. I prescribe bespoke herbal formulas for each patient based on their individual pattern of imbalance.

Herbal formulas for PCOS typically combine herbs that resolve damp and phlegm — directly addressing the undeveloped follicles — with herbs that invigorate blood and regulate qi, and herbs that tonify the Kidney and Spleen to address the underlying constitutional weakness. The specific formula varies considerably depending on whether the dominant pattern is damp-phlegm with Kidney yang deficiency, damp-heat with androgen excess, or Liver qi stagnation with blood stasis.

The classical Chinese herbal formula Wen Jing Tang has been studied in research and shown to improve ovarian function and regulate hormonal levels in women with PCOS. Research by Ushiroyama et al. (2006) found that women with PCOS who switched to Wen Jing Tang after not responding to other herbal formulas experienced significant improvements in endocrinological status and ovulation induction.

Research by Gui et al. (1997) demonstrated that kidney-tonifying herbs can regulate the pituitary-ovarian-adrenal axis in women with androgen-driven ovarian dysfunction — directly addressing one of the core hormonal mechanisms of PCOS.

In addition to herbal formulas, nutritional supplementation can complement treatment. Biotin supports insulin regulation; myo-inositol (a B-complex vitamin) has been shown in research to improve egg maturation and insulin sensitivity in women with PCOS and is a valuable addition to treatment. I discuss supplementation at the initial consultation based on each patient's specific profile.

10. PCOS and fertility

PCOS is one of the most common causes of female infertility, primarily through its disruption of regular ovulation. However, it is also one of the most treatable — many women with PCOS conceive with relatively straightforward interventions, particularly when the condition is caught early and managed comprehensively.

The key fertility goals in TCM treatment of PCOS are:

Restoring regular ovulation — the primary barrier to conception in most women with PCOS
Regulating the menstrual cycle and improving the quality of the follicular and luteal phases
Improving egg quality — which is often compromised by the abnormal hormonal environment of PCOS
Reducing elevated AMH and normalising ovarian function
Improving endometrial receptivity and blood flow to the uterus
Reducing the risk of miscarriage, which is elevated in women with PCOS

For women with PCOS undergoing IVF, acupuncture is particularly important in managing the risk of ovarian hyperstimulation syndrome (OHSS) — a potentially serious complication of ovarian stimulation that is more common in women with PCOS due to their high antral follicle count. Research has shown that acupuncture can reduce the risk of OHSS. I recommend beginning treatment at least three months before a planned IVF cycle to optimise the ovarian environment and reduce the OHSS risk.

You can read more about improving fertility with PCOS in my book My Fertility Guide, available as a paperback, Kindle and audiobook.

11. Diet and lifestyle for PCOS

Diet and lifestyle are foundational to the management of PCOS and should form the basis of treatment alongside acupuncture and Chinese herbal medicine. In both western and TCM medicine, improving diet and increasing physical activity are essential first steps.

Reduce insulin-spiking foods

For women with insulin-resistant PCOS, reducing the dietary factors that drive insulin elevation is the most important nutritional intervention. This means significantly reducing refined carbohydrates (white bread, white rice, pasta, pastries, sugary drinks), processed foods and foods with a high glycaemic index. Replacing these with low-GI carbohydrates, plenty of non-starchy vegetables, lean protein and healthy fats helps to stabilise blood glucose and reduce the insulin-driven androgen production that perpetuates PCOS.

Reduce damp and phlegm-producing foods

In TCM, PCOS is driven in part by an excess of damp and phlegm — and many of the foods that produce these pathological substances in the body are the same ones that worsen insulin resistance in western terms. Dairy products, excessive sugar and refined carbohydrates, fried foods, cold or raw foods in excess and alcohol all increase damp and phlegm accumulation and should be reduced. Foods that support the Spleen's transformative function — including warm, cooked foods, whole grains, legumes and root vegetables — are encouraged.

Reduce red and white meat consumption

Consumption of both red and white meat has been shown to increase levels of insulin-like growth factor (IGF)-I, which stimulates ovarian androgen production and can worsen PCOS. Reducing meat consumption and replacing it with plant-based protein sources (legumes, tofu, nuts) can meaningfully reduce the androgenic drive in PCOS.

Exercise regularly

Regular physical activity is one of the most effective interventions for PCOS. Exercise improves insulin sensitivity, reduces androgen levels, supports weight management, reduces stress and improves mood. Both aerobic exercise and resistance training are beneficial; a combination of the two is ideal. Even modest increases in activity — such as 30 minutes of brisk walking most days — can produce measurable improvements in hormonal balance and ovulation rates.

Manage stress

Chronic stress worsens PCOS by elevating cortisol levels, which further stimulates androgen production and impairs insulin sensitivity. In TCM terms, stress causes Liver qi stagnation, which directly disrupts the smooth regulation of the menstrual cycle and ovulation. Stress management through whatever means works for the individual — whether yoga, mindfulness, adequate sleep or reducing workload — is an important component of PCOS treatment.

12. Commonly asked questions about PCOS

Can acupuncture cure PCOS?

Acupuncture cannot cure PCOS in the sense of eliminating the underlying genetic predisposition, but it can very effectively manage the condition — regulating the menstrual cycle, restoring ovulation, reducing androgen levels, improving insulin sensitivity and supporting fertility. For many women, regular acupuncture combined with Chinese herbal medicine and dietary changes produces better long-term symptom control and fertility outcomes than pharmaceutical management alone, without the side effects associated with Clomid or metformin.

How long does acupuncture take to improve PCOS?

Most women begin to notice improvements in their menstrual cycle within two to three cycles of weekly acupuncture. Hormonal changes — reductions in testosterone, improvements in LH:FSH ratio and changes in AMH — typically take three to six months of consistent treatment to become measurable. I recommend a minimum of three months of treatment before reviewing hormonal markers, as this aligns with the timeframe in which the ovaries respond to consistent therapeutic input.

Can I take Chinese herbs alongside Clomid or metformin?

In most cases, yes. Many of my patients with PCOS use Chinese herbal medicine alongside prescribed medication. I always ask about all medications at the initial consultation and formulate the herbal prescription accordingly, taking any potential interactions into account. Some women find that Chinese herbal treatment over three to six months allows them to achieve ovulation without needing pharmaceutical ovulation induction — this is something to discuss with both your herbalist and your GP.

Does PCOS get better after pregnancy?

For some women, PCOS symptoms improve after pregnancy, particularly if significant weight loss is achieved during the postpartum period and healthy dietary and lifestyle habits are maintained. However, PCOS does not typically resolve permanently after pregnancy and ongoing management remains important. Women with PCOS who have conceived should continue to be monitored for insulin resistance, cardiovascular risk factors and endometrial health.

Is PCOS the same as polycystic ovaries?

No — polycystic ovaries (PCO) and polycystic ovary syndrome (PCOS) are related but distinct. Polycystic ovaries refers simply to the presence of multiple small follicles on the ovaries on ultrasound, which is found in approximately one in three women of reproductive age and does not in itself indicate a hormonal or metabolic problem. PCOS requires the additional presence of at least one of the other criteria — elevated androgens or irregular/absent ovulation. Many women with PCO on ultrasound have no other symptoms and no fertility difficulties.

References

Gui et al. (1997) Experimental study of effect on tonifying kidney herbs in pituitary ovary adrenal gland of androgen sterilized rats. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih, 17(12):735–8 (ISSN: 1003–5370).

Gerhard et al. (1992) Auricular Acupuncture in the Treatment of Female Infertility. Gynecol. Endocrinol. 6, 171–181.

Jedel et al. (2011) Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab 300: E37–E45.

Mannerås et al. (2008) Low-Frequency Electro-Acupuncture and Physical Exercise Improve Metabolic Disturbances and Modulate Gene Expression in Adipose Tissue in Rats with Dihydrotestosterone-Induced Polycystic Ovary Syndrome. Endocrinology 149: 3559–3568.

Qu et al. (2016) The effects of acupuncture on polycystic ovary syndrome: A systematic review and meta-analysis. European Journal of Integrative Medicine, Volume 8, Issue 1, February 2016, 12–18.

Qin et al. (2016) Effect of acupoint catgut embedding therapy combined with Chinese medicine for nourishing the kidneys and promoting blood circulation and improving blood glucose and lipid levels as well as the pregnancy rate in obese PCOS patients with infertility. Exp Ther Med, Nov;12(5):2909–2914.

Stener-Victorin et al. (2000) Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand, Mar;79(3):180–8.

Stener-Victorin et al. (2004) Effect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetized rats with steroid-induced polycystic ovaries. Reproductive Biology and Endocrinology, 2.

Stener-Victorin et al. (2007) Acupuncture in Polycystic Ovary Syndrome: Current Experimental and Clinical Evidence. Journal of Neuroendocrinology 20 (3), 290–298. doi: 10.1111/j.1365-2826.2007.01634.x.

Tugrul Cabioglu et al. (2006) Changes in Serum Leptin and Beta Endorphin Levels with Weight Loss by Electroacupuncture and Diet Restriction in Obesity Treatment. The American Journal of Chinese Medicine, Vol. 34, No. 1, 1–11.

Ushiroyama et al. (2006) Effects of Switching to Wen-Jing-Tang (Unkei-To) from Preceding Herbal Preparations Selected by Eight-Principle Pattern Identification on Endocrinological Status and Ovulatory Induction in Women with Polycystic Ovary Syndrome. The American Journal of Chinese Medicine, Vol. 34, No. 2, 177–187.