PCOS Begins Earlier Than We Think
The In-Utero Origins of a Condition That Affects Millions
And What Women Can Do at Every Life Stage—For Themselves and Their Children
Polycystic Ovary Syndrome (PCOS) is one of the most common hormone and metabolic conditions affecting women today—and it’s also one of the most misunderstood. Too often, women are told PCOS is a weight issue, or a fertility issue, or simply “bad luck.”
The prevalence of Polycystic Ovary Syndrome (PCOS) among women of reproductive age is generally estimated in the following range:
According to the World Health Organization (WHO), PCOS affects about 6 % to 13 % of reproductive-aged women.
A recent meta-analysis found a global prevalence of approximately 9.2 % (95 % CI: 6.8-12.5 %) across many studies.
Other reviews report a broad range of 5 % to 18 %, depending on diagnostic criteria, population studied, and region.
So, in practical terms: roughly 1 in 10 women of reproductive age are estimated to have PCOS, though many cases go undiagnosed.
But emerging research tells a much deeper story.
PCOS doesn’t begin in the teenage years when cycles become irregular.
It doesn’t begin when weight becomes stubborn or acne spikes.
For many women, PCOS begins in the womb.
And understanding that changes everything—our compassion, the stigma, and most importantly, the solutions we turn to for healing.
This article explains:
How PCOS can begin during fetal development
What adult women with PCOS can do to heal and thrive
How women who suspect they have PCOS can start getting answers
How mothers can set their daughters up for a lifetime of hormonal success
The Developmental Roots of PCOS: What Happens in the Womb?
PCOS is not a single-gene disorder or a condition triggered by weight or lifestyle alone. It’s increasingly seen as a developmental condition, shaped by genetics and the prenatal environment.
Here’s what science shows:
1. Genetics Create Vulnerability—Epigenetics Pull the Switch
Researchers have identified several gene variants associated with PCOS, but none act alone. Instead, PCOS arises when genetic susceptibility meets environmental triggers—particularly during early development.
This is what scientists call the Developmental Origin of Health and Disease (DOHaD) model.
In simple language:
Your mother’s metabolic and hormonal environment influences how your ovaries, brain, and endocrine system develop.
This isn’t blame—it’s biology.
2. Prenatal Androgen Exposure Shapes the Fetal Endocrine System
One of the strongest findings:
Excess fetal exposure to androgens (male hormones) can affect the development of the female reproductive system, including:
ovarian follicle development
the hypothalamus and pituitary signaling (which controls ovulation)
insulin sensitivity
stress response (HPA axis)
fat storage patterns
Animal studies show that even brief exposure to excess testosterone in utero can cause PCOS-like traits in adulthood.
3. Maternal Metabolic Health Matters
The mother’s metabolic state is one of the most powerful shapers of the fetal hormonal environment.
Risk factors include:
gestational diabetes
maternal obesity
high maternal insulin levels
chronic inflammation
high cortisol (stress hormones)
These do not cause PCOS outright—but they increase the likelihood that fetal reproductive and metabolic systems develop in a way that resembles PCOS later.
4. The Role of AMH (Anti-Müllerian Hormone)
Women with PCOS often have higher AMH levels.
During pregnancy, elevated AMH can reduce placental aromatase, decreasing the conversion of testosterone into estrogen—and allowing more androgens to reach the fetus.
This may explain why PCOS can appear across generations.
5. “Two-Hit” Theory of PCOS
Scientists now describe PCOS as a two-step condition:
Hit One: Prenatal programming (genetics + in-utero environment)
Hit Two: Puberty, lifestyle, stress, environmental toxins, inflammation
If the second hit is strong enough, PCOS expresses itself.
This explains why some women with a PCOS-like mother never develop PCOS—while others struggle with severe symptoms.
So What Can Women With PCOS Actually Do?
Here’s where things get hopeful.
While you cannot change early developmental programming, you absolutely can optimize the systems PCOS affects: inflammation, insulin sensitivity, cortisol regulation, ovary function, and the nervous system.
Below are evidence-based, practical steps that truly move the needle.
1. Improve Metabolic Flexibility
Most women with PCOS have some level of insulin resistance—even the lean ones.
Support includes:
protein-forward meals (at least 30–40g per meal)
strength training 3–4 days/week
walks after meals
balancing carbs with protein + fat
supplements like inositol, NAC, berberine, magnesium
These stabilize insulin, which stabilizes ovulation.
2. Lower Systemic Inflammation
PCOS is strongly tied to chronic low-grade inflammation.
What helps:
omega-3 intake
curcumin
KPV, BPC-157, MOTS-c peptides lower systemic inflammation
contrast therapy
adequate sleep
removing inflammatory food triggers
gut repair (especially if MCAS or histamine issues are present)
When inflammation drops, hormones follow.
3. Regulate the Stress Response
Women with PCOS often have a more reactive HPA axis due to prenatal programming.
Tools:
morning sunlight
breathwork + HRV training
vagus nerve stimulation (Pulsetto-type tools)
boundaries around work
adaptogens (ashwagandha, rhodiola—adjust based on tolerance)
therapy or somatic work
structured nervous system rewiring
Calming the stress system improves ovulation and reduces androgens.
4. Support Healthy Ovulation
Ovarian health responds to consistency:
cyclic training that respects luteal fatigue
a multivitamin with adequate zinc, B6, B12, folate
Vitex (for some women)
supporting thyroid health
prioritizing sleep
gentle carb cycling around ovulation
reducing endocrine disruptor exposure
5. Work With a Provider Who Understands PCOS Beyond Weight
This includes:
full hormone panels
fasting insulin
inflammatory markers
thyroid function
adrenal profile
glucose tolerance
ultrasound only if needed (not required for diagnosis)
PCOS is metabolic, hormonal, inflammatory, and nervous-system driven—not a “you need to lose weight” condition.
What Women Who Suspect PCOS Can Do Right Now
If symptoms include:
irregular cycles
acne
hair loss
hair growth on chin/chest
stubborn belly fat
difficulty ovulating
blood sugar crashes
mood swings
low progesterone
infertility
…it’s smart to investigate.
Start with:
1. A complete PCOS panel
fasting insulin
glucose + A1c
LH, FSH
estradiol
progesterone (day 21)
testosterone (free + total)
DHEA-S
SHBG
AMH
thyroid panel
CRP
lipid panel
2. Track your cycles (even if irregular)
Apps can help, but body awareness is better:
cervical mucus
basal body temperature
ovulation predictor kits (if cycles aren’t too irregular)
3. Begin foundational metabolic support
Even before a diagnosis, the basics help:
walk after meals
protein first
reduce seed oils
strength train
manage stress
support gut healing
Diagnosis should empower—not shame.
How Moms Can Set Their Daughters Up for Hormonal Success
This is where the research becomes proactive instead of reactive.
There are powerful ways to reduce your daughter’s risk—even if PCOS runs in the family.
1. Support metabolic health during pregnancy
If or when you become pregnant again:
stabilize blood sugar
choose balanced meals
get daily movement
manage stress
prioritize omega-3s
manage inflammation
No perfection required—just awareness.
2. Encourage healthy blood sugar habits during childhood
Kids who learn:
protein first
balanced snacks
regular movement
stable meals
…are less likely to develop adolescent insulin resistance, a key trigger for PCOS expression.
3. Reduce endocrine disruptors
Teach your daughter to:
avoid heavily fragranced products
choose clean beauty where possible
avoid plastics with heat
use stainless steel or glass
Small habits make big hormonal differences.
4. Model healthy stress management
Children’s cortisol systems are heavily influenced by the home environment.
Show them:
boundaries
breathwork
communication
rest without guilt
nature time
You’re shaping their future HPA axis.
5. Normalize conversations about cycles
The earlier girls understand:
what ovulation is
how to track symptoms
that irregularity is a sign, not a flaw
…the more empowered they’ll be.
6. Watch for early signs
If your daughter experiences:
early pubic hair
severe acne
irregular cycles after age 15
elevated weight around the abdomen
darkened skin (acanthosis nigricans)
…it’s worth early evaluation—not fear, just awareness.
PCOS Is Not Your Fault—But Healing Is Within Your Control
Understanding the prenatal origins of PCOS removes the blame and brings in compassion.
You didn’t cause this.
Your body isn’t working against you.
And you’re not behind.
PCOS is deeply tied to inflammation, metabolism, stress, and nervous-system regulation—all things we can actively support. Women heal every day through a blend of lifestyle, functional medicine, targeted supplementation, and nervous-system repair.
And for future generations, we can shift the trajectory even earlier—through pregnancy health, stress resilience, metabolic support, and education.
You’re not stuck. You’re informed.
And informed women are powerful.
References
Mimouni, N. et al. "Understanding the developmental origins of PCOS." Human Reproduction Update (2021).
Dumesic, D. et al. "Developmental programming of PCOS: Prenatal androgen exposure and epigenetics." Endocrine Reviews (2019).
Abbott, D. H. et al. "Nonhuman primate models of PCOS." Seminars in Reproductive Medicine (2014).
Hart, R. et al. "Maternal obesity and risk of PCOS in daughters." Journal of Clinical Endocrinology & Metabolism (2018).
Tata, B. et al. "Elevated AMH and transgenerational transmission of PCOS traits." Nature Medicine (2018).
Rosenfield, R. "The two-hit hypothesis in PCOS." Fertility and Sterility (2020).
Azziz, R. et al. "Updated evidence-based PCOS guidelines." J Clin Endo & Metab (2022).
Sir-Petermann, T. et al. "Metabolic and endocrine features of PCOS daughters." Human Reproduction (2009).
Escobar-Morreale, H. "PCOS: The metabolic–reproductive syndrome." Nature Reviews Endocrinology (2018).