Peach, red and pink drawing of the female reproductive organs with hands to represent care.

By: Molly Edwards, MPH, RD, LDN

 

“Everything suddenly made sense.”

That was my first thought when I was diagnosed with PCOS. After years of unpredictable periods, persistent fatigue, intense cravings and blood sugar crashes, and a slew of ever changing symptoms, I finally had a name for what was going on in my body and a framework that helped me understand why I had struggled the way I had.

Many of my clients share similar stories: complex symptoms, medical dismissal, a search for answers that leads to overwhelming (and often conflicting) advice about food, weight, and exercise.

Treating my own PCOS and making sense of all that noise is what inspired me to become a dietitian, offering weight inclusive PCOS care. I wanted to separate fact from fear, and help others feel less alone in their process. Most of all, I wanted to offer care that didn’t rely on restriction or weight loss to be effective. Because what finally helped me feel better wasn’t a perfect plan or a rigid diet. It was learning to trust my body again.

This article is for those navigating similar questions: Why is my period missing? Why do I feel so disconnected from my body? What does it actually look like to support PCOS in a way that is sustainable, evidence-based, and grounded in compassion?

What Is PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal condition that affects roughly 6–13% of women of reproductive age, though an estimated 70% go undiagnosed.1 Diagnosis is made using the Rotterdam criteria2, which requires any two of the following three features be present:

  • Irregular or absent ovulation, often presenting as missed, delayed, or unpredictable periods
  • Elevated androgens (testosterone or DHEA), which may appear as acne, excess facial/body hair, or scalp hair thinning
  • Polycystic-appearing ovaries, enlarged ovaries with multiple small follicles on ultrasound

Although not part of the diagnostic criteria, up to 80% of people with PCOS have insulin resistance3, a key feature in many cases. This occurs when the body’s cells don’t respond effectively to insulin, leading to elevated insulin levels that can disrupt hormone balance, increase appetite and cravings, and stimulate excess androgen production.

 

4 female friends hiking. They are dressed in workout clothes and have their arms around each other.

PCOS and Eating Disorders

The International Evidence-Based Guidelines for PCOS recommend that all individuals with PCOS be screened for eating and mood disorders.4 This is for good reason: people with PCOS have significantly higher rates of disordered eating behaviors, with 11% meeting the criteria for an eating disorder compared to 7.6% of those without PCOS.5 Recent 2024 research shows even higher rates, with women with PCOS having 53% higher odds of developing any eating disorder and more than double the risk for binge eating disorder.6

Why the link? PCOS creates both biological and emotional conditions that contribute to disordered eating. Insulin resistance and elevated androgens can increase appetite and carbohydrate cravings, making it harder to regulate hunger and satiety cues. Meanwhile, body image distress, weight stigma in medical care, and the frequent focus on weight loss as the primary treatment create psychological stress that can trigger restrict-binge cycles. Add in the emotional exhaustion of unpredictable symptoms, fertility concerns, visible changes that affect self-image, and the constant pressure to “manage” the condition, and it’s no wonder so many people with PCOS feel like their body is working against them. This cycle isn’t a failure of willpower. It’s a natural response to unmet needs and hormonal dysregulation, leading to a breakdown in body trust that can take time to rebuild.

When “Just Lose Weight” Makes Things Worse

Many people with PCOS are told to lose weight as a first step, sometimes the only step. Yet evidence shows that this approach is both incomplete and risky, particularly for individuals with disordered eating histories or a fragile relationship with food.6

Weight loss is not a behavior. It’s an outcome, and a complex one influenced by many factors outside of our control. Focusing on weight loss can push people toward chronic dieting, food restriction, weight cycling, or overexercise, which can trigger or worsen eating disorders and further disrupt hormone regulation, menstrual cycles, and PCOS symptoms.7

In fact, intentional weight loss is not required for improving PCOS symptoms and often exacerbates them. Studies show that sustainable behavior changes like improving nutrition quality, managing insulin resistance, and addressing stress can promote hormonal balance regardless of weight change.8

How Undereating Affects Your Period

When the body perceives an energy deficit, whether due to restrictive eating, overexercising, or even chronic stress, it may downregulate “nonessential” systems, like the reproductive system. This can lead to missed periods or a condition known as hypothalamic amenorrhea (HA).

Here’s where it gets tricky: people with PCOS can also develop HA, especially if they’re caught in a cycle of restriction or compulsive exercise in hopes of managing their PCOS. It’s not uncommon to see overlapping features of PCOS and HA in the same person, making it even more important to receive thoughtful, individualized care.

Given the complex relationship between PCOS, eating behaviors, and hormonal health, a one-size-fits-all approach often overlooks what people actually need. So what does truly supportive care look like?

What Weight Inclusive PCOS Support Looks Like:

What to Expect When Working With a Weight-Inclusive Dietitian for PCOS

At Lutz, Alexander & Associates Nutrition Therapy, we know how frustrating it is to receive conflicting advice, restrictive meal plans, or shame-based recommendations. That’s why a weight-inclusive, eating disorders-informed dietitian will take a different approach. Here’s what that may include:

Weight-Neutral, Personalized Approach

Along with your dietitian, you’ll explore your symptoms through a lens that respects your body’s needs and seeks to understand the why behind these experiences. That means no focus on weight loss or calorie counting. Instead, we’ll focus on how different approaches make you feel physically, emotionally, and mentally.

Exploring Body Image and Body Trust 

If PCOS has disrupted your trust in your body, we’ll work together to rebuild that connection through education, curiosity, and self-compassion.

Gentle Nutrition

Rather than eliminating foods (e.g., “cut all sugar”), we’ll explore adding in nutrients that support hormone balance and blood sugar regulation, and help break binge-restrict cycles by ensuring your body feels safe and adequately nourished.

Supportive Tools & Collaboration 

Based on your individual symptoms, values, and goals, we may explore supportive tools like supplements, medications, or comprehensive labs, and connect you with trusted providers including endocrinologists, pelvic floor physical therapists, or eating disorder-informed primary care providers and gynecologists who practice weight-neutral care. 

Whole-Person Treatment 

We’ll explore how movement, rest, sleep, and stress management can improve hormone health in ways that are sustainable and flexible, free of pressure and perfectionism.

Moving Forward Together

The Registered Dietitians of Lutz, Alexander & Associates are here to help. Recovery and healing with PCOS isn’t about perfection. It’s about progress, self-compassion, and finding what works for your unique body and life circumstances.

If you’re struggling with PCOS and your relationship with food, know that you’re not alone, and healing is possible. With the right support, you can learn to trust your body again, manage your symptoms effectively, and find peace with food.

Contact us today. 

In Case you missed it:

Read part 1 in our Period Talk series.

 

Citations

  1. Polycystic ovary syndrome. (2025, February 7). World Health Organization (WHO). Retrieved July 16, 2025, from https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
  2. Christ, J., & Cedars, M. (2023). Current Guidelines for Diagnosing PCOS. MDPI, 13(6), 113. PubMed. 10.3390/diagnostics13061113
  3. Amisi C. A. (2022). Markers of insulin resistance in Polycystic ovary syndrome women: An update. World journal of diabetes, 13(3), 129–149. https://doi.org/10.4239/wjd.v13.i3.129
  4. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Monash University.   https://doi.org/10.26180/24003834.v1
  5. Lalonde-Bester, S., Malik, M., Masoumi, R., Ng, K., Sidhu, S., Ghosh, M., & Vine, D. (2024). Prevalence and Etiology of Eating Disorders in Polycystic Ovary Syndrome: A Scoping Review. Advances in nutrition (Bethesda, Md.), 15(4), 100193. https://doi.org/10.1016/j.advnut.2024.100193
  6. Cooney, L. G., Gyorfi, K., Sanneh, A., Bui, L. M., Mousa, A., Tay, C. T., Teede, H., Stener-Victorin, E., & Brennan, L. (2024). Increased prevalence of binge eating disorder and bulimia nervosa in women with polycystic ovary syndrome: A systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism, 109(12), 3293–3305. https://doi.org/10.1210/clinem/dgae462
  7. Góral, A., Żywot, K., Zalewski, W., Jagodziński, A., & Murawski, M. (2025). Polycystic Ovary Syndrome and Eating Disorders—A Literature Review. Journal of Clinical Medicine, 14(1), 27. https://doi.org/10.3390/jcm14010027
  8. Gautam, R., Maan, P., Jyoti, A., Kumar, A., Malhotra, N., & Arora, T. (2025). The Role of Lifestyle Interventions in PCOS Management: A Systematic Review. Nutrients, 17(2), 310. https://doi.org/10.3390/nu17020310