What Actually Causes PCOS? A Mechanistic Reading of Polycystic Ovary Syndrome — Frequently asked questions about PCOS

Is PCOS curable? Cure is the wrong framing. Substantial improvement and durable remission are realistic for most cases with the right mechanistic intervention. Many patients achieve regular cycles without hormonal contraception, normalized androgen levels, restored fertility, and sustained metabolic improvement. The genetic susceptibility that contributes to PCOS in many cases is not eliminated, but the active disease state can be substantially reversed when the upstream lesions are addressed. What about "lean PCOS"? Lean PCOS is one of the conditions most poorly served by the standard weight-loss-centered treatment paradigm. The framework explains lean PCOS as having the same upstream lesions (gut dysbiosis, inflammation, mitochondrial dysfunction) without the body weight that obese PCOS patients have superimposed. Treatment focuses on the upstream lesions rather than on weight loss. Many lean PCOS patients respond well to the framework's approach precisely because their underlying pathology has not been addressed by the standard approach. Should I take inositol? The evidence for inositol in PCOS is strong. Multiple randomized controlled trials have shown that myo-inositol and d-chiro-inositol in a 40:1 ratio at 4 grams daily improves cycle regularity, ovulation, insulin sensitivity, and metabolic parameters. The combination ratio matters; myo-inositol or d-chiro-inositol alon