The Core Issue

PCOS (recently renamed polyendocrine metabolic ovarian syndrome, or PMOS) is tied to gut bacteria imbalance, and doctors have been throwing probiotics, prebiotics, and synbiotics (a combo of both) at it for years with mixed and often conflicting results.

The Finding

Researchers pooled 14 randomized controlled trials covering 755 women with PCOS and, for the first time, split out which of the three interventions actually worked. When taken alone, prebiotic fiber (like inulin, the kind of fiber that feeds good gut bacteria without adding new bacteria) dropped total testosterone by an average of 31 ng/mL and cut hirsutism scores (excess hair growth) by over 2 points. Probiotics and synbiotics, tested the same way, showed no significant hormone benefit at all.

Why it Matters

If you have PCOS and have been taking a probiotic hoping it would help your hormones specifically, this suggests it might not be doing much on that front, even if it helps digestion generally. Plain fiber supplements may be the more promising lever.

Limitations of Study

Only 2 of the 14 trials tested prebiotics by themselves, so this headline result rests on a small slice of the total data. Nearly every outcome also showed high statistical variation between studies, and all 14 trials came from just two countries, Iran and Poland, with every participant already overweight or obese going in.

Conflicting Interests

None reported. The researchers stated no funding and no conflicts of interest.

Interesting Statistics

- 14 randomized controlled trials, 755 women total, run between 2015 and 2025

- Prebiotics alone: testosterone down 31 ng/mL, hirsutism score down 2.02 points, SHBG (a protein that mops up excess testosterone) up 11.43 nmol/L

- All three interventions combined: fasting insulin down 2.07 μIU/mL, triglycerides down 12.22 mg/dL, HDL ("good") cholesterol up 2.13 mg/dL

- Baseline BMI was 24 or higher in every single trial included

TL;DR

Plain prebiotic fiber, not probiotics or combo synbiotics, showed the clearest hormone benefit for PCOS in a pooled analysis of 14 trials, but it is based on only 2 prebiotic-only studies so far.

I got this from u/Electronic-Lie-4547 and I thought it would be helpful to a lot of us here.

https://biomesci.com/prebiotics-outperform-probiotics-pcos-pmos/

My wife’s menstrual cycles range from 38 to 60 days. Her thyroid and prolactin levels are normal, she’s at a healthy weight, and she exercises three times a week, yet her cycles are still irregular.

I can imagine how difficult it must be to struggle with weight due to PCOS, and I so sorry for that. However, in all the PCOS subreddits we’ve looked through, most of the posts seem to be from people struggling with their weight or having difficulty losing it.

We rarely come across people with PCOS whose main issue is irregular periods or not getting their period at all. Is anyone else here dealing with PCOS where the primary symptom is an irregular or absent menstrual cycle rather than weight-related issues? What did you do to improve your menstrual cycle?

I (26F) take one scoop of inositol daily before breakfast and it has helped but lately I feel like it hasn’t as much. Maybe the effects are wearing off. My period has become more regularized and it did help with my mental health but honestly I feel like my hormones are wacky again and I’m constantly tired and anxious. I was bad then good and now and again. I did loose like 5-7 lbs while on inositol so that’s another plus but I am curious about trying a GLP-1.

I’ve been on metformin before and spirolactone but stopped. Spiralactone was kinda cool bc I do feel like it made me more feminine.

What are your thoughts and experiences on a GLP-1? Did it improve ur life? Erase PCOS? Let me know because I’m seriously considering. Yeah the weight loss will be cool (my weight is good, I’m fit and I go to the gym). It took me forever to lose weight and I know the GLP1 will make me shred fat much faster without even trying now. I heard many felt improved energy levels too amongst many things like eliminating their insulin resistance and reducing testosterone levels. My doctor actually had prescribed me a GLP1 years ago before it was popular.

im 20F and i’ve been diagnosed with PCOS a couple of months ago. i take meds and go to check-ups so everything so far is stabilised. my real concern is that i’ve seen that PCOS usually affects fertility and even in some cases causes infertility which is my biggest fear because my one dream in the world is to become a mother. how did it affect you? i kind of need reassurance lol

I’ve suspected I had adhd for a while, as long as I can remember… I’ve shown symptoms since childhood. I only showed pcos symptoms later in life, when I got to my mid to late teens. So idk, I felt like my psych was being a bit.. dismissive? by implying that i don’t have “real” adhd and only adhd-like symptoms that are being caused by pcos. The results of the assessment have a strong indication that I do have adhd, so he still prescribed me meds, but I honestly feel a bit uneasy with what he implied.

It’s like as soon as i said I have pcos, his entire tone changed, and he started talking about how as soon as I fix my diet, my adhd symptoms will disappear. He went off a tangent to give me advice (which I already know) about cutting carbs, prioritizing protein/veggies, etc. It felt like all the struggles I felt my entire life with adhd was being invalidated. I mean, being unmedicated quite literally ruined my life. I don’t understand how I can’t possibly have both pcos and adhd. But obviously, he’s the doctor, and I’m not, so it’s probably not my place to question it. I don’t want to sound like that one person who pretends they know more than actual professionals.

Sorry, I know this isn’t the adhd sub but I’d rather hear from people who have pcos lol… what do you guys think? it seems there is a lot of correlation with adhd and pcos, and I know a lot of you guys have both. Is what my psych said really true? Did “reversing” pcos make your adhd symptoms disappear?

So my doctor is recommending Zepbound in combination with Metformin because she believes we can reverse my insulin resistance. Can I hear the pro's and cons? Please tell me about your experience. I'm scared and feeling like a failure.

CW: fertility, pregnancy, loss, postpartum, pet death

Got diagnosed with PCOS in 2021 after wanting to conceive but not having a period for a year to even start tracking my cycle. Was also diagnosed with sleep apnoea and high blood pressure and got on Metformin, BP meds, supplements for vit d and iron deficiency, and started CPAP therapy. I had some improvement in my symptoms but a couple of years later I was diagnosed with MAFLD after an unsuccessful four rounds of ovulation induction. I changed my diet and ramped up my strength training and lost 13 kg before plateauing, at which time I went on a low dose of GLP-1 and lost another 8 kg. My MAFLD reversed in that time, my blood pressure meds were working properly, my sleep apnoea numbers were almost nonexistent, the inflammation in my hands disappeared. After a year on the GLP-1 I accidentally became pregnant (I was actually tapering off my dose to start IVF), but it was a chemical pregnancy we lost at 5 weeks. My OB said that a lot of his patients had luck conceiving after a loss because of the hormonal state they were in at that time, so I stopped my incompatible meds and tried again. We were lucky enough to be able to see that pregnancy through and my son is now 10 weeks old.

Pregnancy was a magical time for me. My health was perfect, probably because of the placenta taking over my hormone regulation. I was off all meds except Metformin and that wasn’t even clinically needed, I just stayed on it in the hopes I wouldn’t develop gestational diabetes, which I didn’t, luckily. I only gained the expected amount of weight, my baby was perfectly average in size, I had a vaginal birth that needed forceps and an episiotomy but recovery was quick and relatively painless. I’m breastfeeding, which I wasn’t sure I’d be able to do with PMOS, and I’ve lost the weight I gained.

Unfortunately, postpartum life has been hard. My dog was diagnosed with a malignant tumour the day before I went into labour and quickly declined, passing away in three weeks. My husband got shingles from the grief and stress pretty much the day after I gave birth, so he wasn’t able to be as hands on with the baby as we were planning for six weeks. We have no friends or family nearby, so we dealt with it all alone, and on top of that, I had to go no contact with my mentally ill mother in late pregnancy and she started harassing me a few weeks into PP, so I finally blocked her. I don’t know if it’s the stress or if it was always going to happen this way but my symptoms are coming back with a vengeance. My blood pressure was 150/110 the first time I went to the doctor PP and I can’t be on my normal meds while breastfeeding, so I’m on two less effective ones, one of which is making my feet swell, my skin turn red, and my head spin when I get up too quickly. My doctor just called me today to tell me my liver enzymes are elevated again, so my MAFLD might be back. My weight is the same as when I’d reversed it, I’m getting back into exercise, and my diet is pretty good, I’m just eating a higher volume because I’m breastfeeding, so it seems like it’s not just a matter of weight or macro intake. I’m so upset, it seems like I’m going to have to stop breastfeeding earlier than I wanted to so I can go back to the medication regimen that worked for me.

Most of the time I’m pretty accepting of the hand I was dealt. I know it’s not fair and it isn’t my fault that I have PMOS so it would be easy to give into the temptation to wallow in that, but I’m pretty good at just keeping my head down and tackling what problems are in my control. But now I’m so angry and sad and I just really need to vent and get this out: why can’t I just do all the right things for my health and, you know, be healthy?

Hello! I was diagnosed with PCOS in June after fighting for years, and today I was given a prescription for Metformin starting with 500mg in the morning and 500mg at night.

Of course with this comes lifestyle changes, which is fine, I’m just struggling to find resources for how to plan meals/know what I can eat easily and how to apply this to my life. I have an eating disorder and I’m neurodivergent, so leaving my comfortable foods full of refined sugar and carbs feels very scary. Add to this that I have deformities in my feet, and asthma, which makes exercise very difficult. I have custom orthotics on the way and take my inhaler, but I’m stuck with changing just eating till the orthotics come and my pain is less severe.

Does anyone have some resources on healthy eating and how to apply it in a practical way?

I just got metformin but I haven’t start taking it yet. The thing is I really like to party… and I made a quick google searches and a lot told me that I basically can’t drink on it? My doctor dint mention anything only that “don’t take it if your sick”

is it safe?

Can i just not take it that day and be fine?

Do any or you know how it works with alcohol?

What are your experiences on Inositol vs Metformin?
Got diagnosed with PCOS yesterday and been TTC for 6 months. They were going to put me on Metformin but due to my IBS/IBD/Colitis they told me I should do Inositol instead. Hoping it’ll give me a better chance at getting pregnant!

Long time PCOS-er here. I've tried a bunch of things over the years but cannot get control of my bloating, specifically in my stomach and my face.

Does anyone have anything that they swear by that helps significantly? Like even if it's short term solutions that I can take or do daily (especially if I have a beach trip coming up).

THANKS!!

After a four year battle with my GP - I finally got my PCOS diagnosis today.

I changed GP and found one that listened and heard me and wanted to work with me not against me.

I feel so many different emotions today, happy to finally have some answers, scared of what’s to come, angry that it’s taken four years to get to this point and a bit of everything else in between.

My GP has recommended metformin which I start tomorrow, and honestly I’m terrified.

I’ve tried to avoid the horror stories and just focus on what it can do for me - i.e. hopefully help with ovulation and TTC.

I’m not eligible right now for any help in the way of ovulation meds like clomid and the like as my BMI is too high so I’m hoping the metformin might help with this alongside calorie counting and exercise.

Does anyone have any success stories with PCOS/metformin/TTC and everything else as I don’t have anyone else to talk to and never had any experience with PCOS so just looking for some tips tricks and a friendly face to talk through it all with!

how do you actually keep track of what is happening?

If one cycle is 35 days, the next is 60, and another period disappears for months, a normal period app can feel almost useless. Do you track dates only, symptoms, spotting, discharge, mood, pain, or anything else?

I’m curious whether anyone has found a simple way to look back and understand their own pattern instead of constantly wondering when the next period is going to show up.

I’m so sick of not knowing. My next doctors appointment is in a month, and I’m only 16. My periods are so bad, heat packs don’t help and ibuprofen does little to nothing. I can go for months without one. My hips hurt like hell, I snap at everyone including my little brother over the smallest things. I’m just so sick of being told it’s nothing, or I might have this and that without any action actually being taken. I just want to know what’s wrong with me. My mom blames my hip pain on my walking pattern, my mood swings are just me being dramatic, and the horrible cramps on “just a normal part of life”. She insists they’ll get better but they’ve only gotten worse. I hate it. What do I even do at this point. I have to take pain killers almost every day before my sports practice just to get through it because my hips hurt so bad. Help.

So other then electrolysis or laser what are some at home things bonus points for brands or items you use to keep it under control?

I usually shave but I'm getting tired of it coming back in a few hours. I'm leaning towards waxing because I'd be there plucking for 3 days with the amount that I have. I just don't know anything about waxing to even know what products are even good to use.

Hi friends! So I was recently diagnosed with PMOS and I have definitely been struggling with nutrition. For some context I have been struggling with an ED for about 10 years, in the past I have done heavy restricting, purging, mostly binging so just a lot to deal with.

I also struggle so heavily on low energy days. The last thing I want to do is get off the couch and cook anything, even preparing small plates of food can be difficult when my energy levels are so low and my ED brain is like "oh just don't eat then." I don't want to restrict food because it just leads to a binge which makes all my symptoms 10x worse

I know carbs and sugar cravings can be common with PMOS which I definitely experience. Sometimes I feel so ravenous and when I don't wanna cook food I just turn to foods which are definitely not giving me what I need (I try to refrain from calling foods good and bad and use more neutral language around food)

Anyways I'm wondering if anyone with PMOS also deals with this and has any quick and easy food tips for low energy days. I know nutrition is really important with PMOS but I am also actively in ED recovery and I want to honor that so I don't trigger past behaviors.

Thank you 🩷

hey everyone!

i've waxed before, but i used a kmart brand and another no brand one it was pretty shit, i'm wondering if anyone (particularly any that are easy access to aussie's) have any recs for good hard wax + wax pots that worked for you?

just wondering if there are any in-store options, or even amazon or somewhere that ships to australia if you aren't in aus!

for context i have thick, course black hair and need something strong enough to grip thick stubborn leg / arm hair. pls help!

I am currently 23 & my husband and I have been TTC for 6 months now. Today I got my PCOS diagnosis after getting labs back, and to be honest I truly never thought I had it. The only thing I ever thought I knew about PCOS was the stereotypical talk that in order to have it you must have cysts on your ovaries and lots of thick course body hair. I have also had girls my age tell me PCOS is way worse than endo and I should be lucky I don’t have it. Ultimately making me feel invalidated in my struggles.
I still don’t know much about what PCOS is or how this changes things for me. I heard it’s now called PMOS?
Doctor wants to start me on Metformin (which I know nothing about) in hopes my body will try and regulate/ovulate so we can get pregnant. I feel really lonely & confused. Angry, sad, unsure of myself, and scared for the future. I have had my endometriosis diagnosis since I was 13 and it has taken a long time to understand it, and feel at peace with it.

If anyone has any good education, or who is in a similar situation I would love to connect and hear your story!

How has metformin helped you? How has your body changed since being on it? Has anyone had success with getting pregnant on it?

I have PMOS and HS, both since my teenage years. Back then, I was a healthier weight and tried so many treatments for HS.

Thankfully, although my weight increased dramatically due to bout of bad mental health my HS has been really great the last year, and I have managed to get my periods back from every 200 days, to a cycle between 28 & 35 days for the last 6 months. This was mainly due to having to reduce my stress as it was causing me to be extremely ill.

Since getting back on track I decided to talk to my GP about weightloss, I know GLP1s are an option and for personal reasons I don't want to go down that route right now, but she suggested a new pill (can't remember the name) or metformin which I had been on before.

I started the metformin about 3/4 weeks ago, and since then my HS has significantly worsened. I have flares in areas that I hadn't experienced in years.

Now when I think back, I am almost sure that all my bad experiences with HS were around when I had tried metformin.

I otherwise have found metformin decent, not incredible, but certainly not bad and had no GI issues.

Has anyone else with PCOS experienced this?

I'm going on a multi day trip and hoping to avoid sugar crashes as well as stay energized enough to hike for the full day. I know people say to "carb up" before the trip but I've learned that PCOS means we don't use the carbs as efficiently. Just wondering if anybody had something that worked for them in terms of what you ate before and during a trip.

Hello, hello.

I wouldn't mind an extra pair of brains to help me out, since I am struggling to think. I am literally fighting brain fog as we speak. There have been some things on my mind. Something I am really fighting and wanting help with is my brain fog. Lets go over context first.

First, I recently ended my investigation to check if I had NCAH. My endocrinologist said I was insulin resistant (Insulin levels were abnormal at endocrinologist but upper normal at PCP), had high androgens (upper 300 to low 400 from labwork done with PCP and endo clinic), upper-normal testosterone, and 5.7 A1C (first percentage for prediabetes). The ACTH stim test showed 177 ng/dL for 17-OHP, which had my endocrinologist determine I did not have NCAH. Also, my base cortisol at the PCP and endo was normal range. Therefore, I got a diagnosis of PMOS despite only meeting 1 out of the 3 criteria, since I have regular periods and have normal ovaries. My ovary scans were not done recently. They were done during my teenage years, if I am not misremembering having them done at all.

I've been struggling with brain fog and fatigue since covid began circulating. I recall experiencing a very odd and difficult respiratory illness before covid was announced around the world, but It did not compare to when I got diagnosed with covid about two years ago. Anyways, I did lose weight and treated my sleep apnea, which did not improve my symptoms. Recently, about 2-3 months ago, I finally did improve my symptoms. I have been on adderall (15mg. Got on it because I questioned if my adhd was the problem and it worked for the first few months) and walking for 30min after breakfast and maybe lunch. Now, fast forward to about 2-3 weeks ago. I have been feeling good and wanted to go down a dose after being without the medicine for \~5 days (prescription refill mishap and other things too wordy for now). I was still doing great with my usual routine and then about a day before my period, my mental clarity falls. Then a week after, I am sick and my brain fog is almost back to the worst I have felt. Me being medicated and walking does nothing. I am taking metformin and spironolactone too. When I test my glucose, it is in the green (usually \~123 after eating breakfast. Fasting sugars before have told me 110s, so I am assuming that is where my base is). So now I know my brain fog is not about my glucose at the moment. I do wonder if it has to do with illness or something, since I could have been incubating the virus (assumingly a cold) the week before exhibiting symptoms?

But seriously, I need this brain fog cut out of my life. Not only does it significantly reduce my quality of life to the point I feel emotionally and mentally blunted (i don't feel depressed and I am on an ssri that has a highly positive history for me), but the intensity of this brain fog actually worries me a lot. It has gotten me in dangerous and reckless scenarios a few times before and I can't let that happen as I am a parent and I also need to drive to get things I need. Especially in this god damn economy.

A few other questions I have is if I need to revisit any labwork and advocate for myself to re-examine anything. Idk... otherwise, I am open to other guidance or general support. Thank you for listening and being here.

Edit to add: some more recent changes to me is that I have lost ~8 lbs since starting spironolactone and metformin. My sleep hasn't been great the past week because of my illness, but it was fine the week before. I also haven't been eating as much as before because of medication and food noise receding, but I wouldn't say I am eating too little at all. I have at least 2-3 meals a day. The dietician also said my meals sound rather balanced and confused her as to why I felt the way I did. Can't say I have been eating the best recently though, because of my illness. But I try to be fiber and carb/sugar conscious with my meals or daily eating.

A few other contextual notes: school for kid started ~3 weeks ago, my blood pressure before adderall and on new dose is low 100s/60 and low 100s/70 during 15mg, I haven't been sick since probably winter time, and I haven't ever been evaluated for long covid.

Hii, I recently bought some tea for pcos symptoms but i’m not sure how to prepare it without a lot of sugar. i’m from the south and sweet tea is my favorite drink but i know excess sugar isn’t good for me with pcos (and type 2 diabetes) does anyone have any like sweetening methods? simple syrup is just boiled sugar and water.. so i really dont want to do that.

thank youuu

18 F

Ok so i have been noticing extremely hairfall since past year (i can literally see my hairline receed), and i got diagnosed with pcos a month back and i am currently on birth control. Will it make it worse? Will it help me?

Please if someone knows ...help me

I don't wanna go on minoxodil but the stress everytimee i brush my hair is killing me.

Hi all,

I’ve been on 500 mg of metformin ER since August 17. However I’ve started to notice that I am increasingly anxious, fatigued, and irritable in the afternoons.

I do have ADHD so I guess it could be related to my stimulants (40mg Vyvanse at 7:30pm and 5mg dextroamphetamine around 1:30pm to prevent the Vyvanse Crash) but regardless….i feel great until about an hour after my afternoon snack at 3:00pm. My anxiety starts to get worse and worse. I’m fatigued and can’t think straight, but also anxious. I can’t do much more work by 4:15pm.

By the time my boyfriend picks me up at 4:30pm, I am panicky and irritable. Today, I had a full-on panic attack and crying fit once we got home. This has happened quite a few times in the weeks since beginning metformin…

Anyways, just wondering if anyone has experienced this. I guess it could be normal, but I really hope not. Lol

Ugh struggling mentally going through alot this past year been trying for 3 years for a baby, I finnaly got a period, in June with progesterone, its mentally exhausting and now im in grieving I lost my fur baby , the only reason I had to be called a mom it hurts , ontop of this I went no contact in June as my mother caused me trauma. , I posted my frustrations and a Facebook friend commented on a post I made how I lost 9 pounds since January bassically saying thats it, and how she has pcos and all you need to do is eat correctly and drink water and exercise, then you will lose weight, saying pcos doesnt effect weight loss

..this is mentally draining