Ovary-Acting? Not Quite: PCOS Is Not Just About Fertility or Weight

I let out a sigh of relief as I sat across from my doctor, the faint scent of antiseptic clinging to the small, white-walled clinic. Just the day before, I had gone in for an ultrasound after years of dismissing my irregular periods, stubborn acne, and rapid weight gain as nothing more than quirks of my body. 

When the results came back, I finally had a name for it: polycystic ovary syndrome or PCOS.

The advice was quick and familiar: lose weight, take the pill, and come back when I’m ready to conceive. I walked out with a prescription but without answers. What exactly was PCOS? Was it just a fertility problem, or something much bigger?

To dig deeper, I turned to OB-GYNs Lora Tansengco, MD of St. Luke’s Medical Center-Global City and Lyra Chua, MD, head of The Medical City’s Women’s Health Care Center. Both doctors were clear: PCOS is far more complicated than the shorthand advice women are usually given.

What PCOS really is

PCOS is a hormonal imbalance that disrupts how the ovaries work. It’s not a single disease, but a syndrome–a cluster of symptoms that can look different for every woman: irregular periods, excess male hormones or androgens, acne, weight gain, and sometimes, polycystic-appearing ovaries, which is when the ultrasound shows “many small, underdeveloped eggs or follicles in your ovaries.”

“It’s called a ‘syndrome’ because it’s a collection of symptoms that often appear together, rather than a single disease with a straightforward cause,” Dr. Tansengco tells Allure Philippines. “Think of it as your body’s hormones being a bit out of sync,” she continues, pointing to overlapping causes like genetics, insulin resistance, and environmental factors.

Dr. Chua describes it as “an abnormal state of the hormones responsible for normal menstrual cycles.”

And despite the name, PCOS doesn’t always involve cysts. Those so-called “cysts” are usually not actual cysts, Dr. Tansengco says, but are “tiny eggs, or follicles, that don’t mature (unlike in normal, ovulating, regularly menstruating women) and [have] been released because of the hormonal imbalances.”

According to Dr. Tansengco, polycystic-looking ovaries on an ultrasound are just one of three criteria doctors use to diagnose the condition. “You can absolutely have PCOS even if your ovaries don’t look ‘polycystic’ on a scan.”

The diagnosis, she explains, follows the Rotterdam criteria, established in a 2003 conference by 27 PCOS experts in Rotterdam, the Netherlands after a long debate about how to diagnose the condition. These guidelines broadened the understanding of PCOS, stating that a diagnosis can be made if  at least two of these three features are present: irregular or absent periods, excess androgens (clinically or through lab results), and polycystic ovaries on ultrasound.

More than a fertility issue

This is where women’s health often gets reduced to its narrowest frame: reproduction. But PCOS doesn’t only matter when you’re trying to have children. Its reach is lifelong.

“While it’s a leading cause of infertility, PCOS is a whole-body condition that impacts your long-term health, including risks for diabetes, heart disease, and mental health challenges,” Dr. Tansengco reiterates.

The emotional toll is heavy. Acne, weight fluctuations, excess hair, and unpredictable periods chip away at confidence, while fears about fertility amplify the distress. “Depression and anxiety are common upheavals in patients with PCOS,” Dr. Chua confirms. She points out that these struggles often stem from obesity, low self-esteem, and fears about infertility.

In fact, Dr. Chua goes as far as calling PCOS a “misnomer,” arguing that it should be recognized primarily as a condition linked to insulin resistance and excess androgens. “[The condition] should be rightly named ‘Hyperandrogenemia and Hyperinsulinemia,” she suggests.

And it’s not just about body size: “About 20 percent of women with PCOS are average weight or underweight,” Dr. Tansengco notes.

Why “just lose weight” isn’t enough

For many women, one of the most frustrating parts of managing PCOS is being told to “just lose weight” in clinics and online forums, leaving many women with more shame than solutions. While research shows that losing even five to ten percent of body weight can help improve symptoms, it oversimplifies a complex condition.

“It’s incredibly frustrating and often dismissive,” stresses Dr. Tansengco. “What’s often missed is that women with PCOS genuinely struggle with weight loss due to the underlying hormonal and metabolic factors of the condition.”

Both doctors emphasize that lifestyle changes–balanced nutrition, exercise tailored to the individual–can make a real difference.

Medication also plays a role. Beyond the pill, doctors may prescribe metformin to tackle insulin resistance or anti-androgens to manage symptoms like excess hair (hirsutism) and acne. The key is finding the right combination for each woman.

Living with PCOS

PCOS isn’t something you “cure”; it’s something you live with and learn to manage. That management goes beyond prescriptions. Stress, sleep, and mental health affect symptoms as much as food and movement do. Many women turn to therapy, support groups, or even journaling to cope with the emotional weight of the condition.

“Trust your instincts and be your own advocate,” urges Dr. Tansengco. “If you feel something isn’t right with your body, or if your concerns are dismissed, please don’t hesitate to ask questions, seek second opinions, and be persistent in finding answers.”

For women who’ve spent years searching for answers, a diagnosis can feel overwhelming. But as both doctors emphasize, knowledge is power, and so is compassion. “My greatest hope is that every woman with PCOS feels empowered, informed, and supported on her journey,” Dr. Tansengco says.

The bigger picture

When women are told to “just lose weight” or “take the pill,” they’re left without the tools to truly understand their own bodies.

PCOS is not a one-size-fits-all condition, and its care isn’t just about treating ovaries. It’s about treating women as whole people, with guidance, empathy, and individualized care.

“If left unattended and unmanaged, it could lead to the metabolic syndrome as the woman grows older: hypertension, diabetes, obesity with central fat distribution, heart problems, and cancers,” Dr. Chua warns.

For me, getting that diagnosis was only the beginning. The harder part has been figuring out how to live with PCOS. Not just with prescriptions, but with patience, knowledge, and a circle of care that goes beyond the clinic.

“Compassion and understanding are very important here, knowing that the woman already has a lot of self-imposed low esteem,” Dr. Chua says. “She has to be encouraged and motivated.”

And maybe that’s the real lesson PCOS keeps teaching me: that life with the condition isn’t only about managing symptoms. It’s also about learning to meet myself with grace and finally giving compassion to the same body I spent years blaming.