PCO vs PCOS: What’s the difference and how do I treat it?

This topic of PCO vs PCOS seems to be coming up a lot lately. Maybe it’s because many of you have managed to get your PCOS under control by following my Debunking PCOS guidelines, or maybe it’s because you have greater awareness around what your body and hormones actually need, leaving behind old habits and setting yourself up to thrive.

In any case, I want to answer this question to clear any confusion and, as always, broaden your knowledge bank.

What is Poly Cystic Ovarian Syndrome (PCOS)?

PCOS is typically characterised by elevated testosterone (male hormones/androgens) levels (confirmed via a blood test), alongside an internal ultrasound to confirm the presence of multiple follicles on the ovaries and other symptoms.

These symptoms are wide and varied but most commonly include amenorrhea or irregular cycles, weight gain, facial hair, acne, pelvic pain, thinning hair, and many more.

Typically women with PCOS will find they are insulin resistant. This is quite the vicious circle since adrenaline is triggered by fluctuating sugar levels causing the liver to produce glucose in expectation of the brain needing more fuel.

This forces insulin to be released, and when it isn’t fully utilised, it’s left to roam free in the blood. This will increase testosterone levels leading to the symptoms of PCOS.

What are Poly Cystic Ovaries (PCO)?

PCO is the presence of multiple follicles on the ovaries without the evidence of elevated androgens or other symptoms of PCOS.  This will be confirmed via an ultrasound and blood work.

Symptoms of PCO may be irregular or missing periods, because of the role the follicles play on the ovaries.

Each follicle is a work of art in itself.  It’s fairly normal that at any one time there may be up to 12 follicles sitting on the ovaries, typically in a string or ‘pearl necklace’ type arrangement.

Think of it like a little production line, each sitting there ready for ovulation, but ordinarily, only one (or sometimes two) eggs are released during the event.

In women with PCO, there are many follicles sitting on each ovary.  The ovaries are in constant communication via hormones with the brain (specifically called the hypothalamic-pituitary-gondal axis).

Basically, the hypothalamus tells the pituitary to release a hormone (follicle stimulating hormone or FSH) that stimulates the ovaries to release oestrogen and or progesterone for the follicles to grow.

But, if there are many follicles present on the ovaries this can cause all kinds of confusion as hormone regulation is disrupted since the cells of the follicles produce increased amounts of oestradiol and inhibin.

In turn, the hypothalamus and pituitary sense when there is enough of these hormones to lessen the release of gonadotrophin-releasing hormone or GNRH.

In a nutshell, the brain and the ovaries are always in communication. When there is enough of what the ovaries need, they tell the brain to back off. But, if there are many follicles sitting on the ovaries, then the brain is being told this ongoing, which can interfere with ovulation.

Understanding the difference between PCO vs PCOS

So how do I treat PCOS or PCO?

I outline this in great detail in my Debunking PCOS course (sorry to go on about it, but it’s all right there for you spread out over two hours of entertainment!)

Specifically, I outline my five steps to hormone balance, no matter what your situation – PCOS, PCO, Endometriosis, hormone imbalance, infertility – you name it.

No matter what, we still need to lay a solid foundation for our bodies to thrive.

Here are my top tips to get you started:

Heal your gut

The pill, medications, stress, sugar, gluten, modern living, you name it, it’s a culprit – all rob your body from essential flora and upset the gut’s ability to assimilate and absorb nutrients.  This is a key factor in hormone imbalance.  Starting here is a must.

Cleanse your liver, stat 

Your liver plays a huge role in ensuring your body is firing to its potential.  The liver also plays a role in the secretion of certain hormones that also stimulate the pituitary.

Many women who have been diagnosed with PCOS have used the pill to mask symptoms (or they may have been told the pill is treating the hormone issues, which sadly isn’t the case).

Due to the load this can place on the body, it’s essential to cleanse and remove toxins that the pill leaves behind.  My ebook Cleanse Yourself is a fabulous place to start.

Get your stress levels under control 

From a TCM viewpoint, emotional wellbeing is one of the largest influences of this hypothalamus-pituitary-gondotrophin axis.

In TCM, this is related to the heart and kidneys.  If the heart (affected so much by emotional distress of all varieties) can’t communicate with the kidneys via the meridian that exists through the midline of the body, ovulation can’t occur.

Now we know from a Western perspective this is that axis I’m referring to.  But this is why TCM works so well because it recognises the massive influence that stress and emotional upset can cause.  If you don’t know where to start, of course, I have an e-course for you too! Debunking Stress is yours for the viewing.

Sort out your oestrogen

Since the issue, for the most part, is hormone regulation, external influences that lead to increased oestrogen levels will make the condition worse. Toxins in our body products, cleaning products, haircare, washing detergent, water, all contain a ‘beep’ load of toxins that mimic oestrogen

Nourish through diet and lifestyle.  I’m not sure I can stress this enough.  Diet and lifestyle is the cornerstone of your health.  Fuel your body for wellness.  It’s that simple.

A few more Q and As on the topic:

Can the pill fix my PCOS or PCO?

Never.  The pill can’t, never has and will never be able to ‘fix’ your hormones.  In fact, it does the complete opposite of this.  Sadly, many women are finding this out the hard way.

If you are on the pill to ‘treat’ PCOS or the likes, the same steps apply in preparing your body transition off the pill and find yourself a long-term treatment solution.

It’s never too late and it certainly is possible.  I’d advise to do this alongside your natural fertility specialist, TCM Dr or Naturopath.  Do your research and understand your body.

I talk about this in detail in Well & Good.

Can I heal my PCOS or PCO?

Anyone, under the right circumstances and in the right environment, can set their body up to thrive no matter what.  This may mean for some they can completely get a handle on their hormone imbalance and for others, it may take longer or the symptoms may be well under control.

Healing to me is no clear sign of illness and this is what I’d always encourage my patients to move toward.

If I have PCOS/PCO am I infertile?

No! You may be momentarily, but as your body begins to heal and thrive, your cycles can return and your hormones start to fulfil their roles, your body can more towards its fertile state once again.

Need in-depth information to tackle your PCOS head on? My Debunking PCOS Masterclass is for you.  You’ll get the answers and the tools you need to overcome your PCOS/PCO here.


Get a deeper understanding of how to manage PCO vs PCOS in my Debunking PCOS Masterclass



  • March 4, 2015 By Tracey 11:14 pm

    Hi Nat. I have ovaries with a few more folls than usual – say 13 ea last time I was scanned. Ovaries are enlarged and can be painful esp around ovulation time. I also get a cycle every 26-29 days. I have been trying to conceive for 2.5 yrs with no success. I conceived our now 5 yo son immediately after stopping the pill. All bloods come back in normal ranges when recently tested! Laproscope showed no issues aside from enlarged slightly cystic ovaries – tubes clr and no endo at all. I was imbalanced when I went off pill this 2nd time. I even did ur cleanse about a yr ago. Must find discipline to do again. I see chinese dr for acupuncture and herbs this helps heaps. But still no pregnancy!! Do u have any thoughts aside from waiting??!!!! At times I feel completely heartbroken as we love our son so immensely we would love another and a sibling for him.

    • July 12, 2019 By Ali 5:06 am

      Hi Nat, I realize this is an older post- but I wanted to jump on. I have the same issue as Tracey above! Only we have not been able to conceive at all. I have never seen a positive test and we have been trying for over 5 years. We’ve seen multiple REs and are told we are unexplained. I am not sure if the “string of pearls” is hurting our chances or not, but it’s the only thing that isn’t normal. Even did the Laproscopy – all clear! Very normal regular cycles. Great sperm. We also have been receiving regular acupuncture. We are heartbroken and exhausted. There is not much information about PCO out there… just PCOS. Would you be willing to post more information about fertility with PCO (NOT PCOS)? Thank you!!

      • July 13, 2019 By Nat Kringoudis 11:30 am

        We treat it the same way to a degree – I talk about this in Debunking PCOS. Do you have the masterclass?

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