Beyond Birth Control: New and Evolving Treatments for Patients With PCOS

by Karis Sarkisian and Jennifer R. Berman, MD

Almost all our polycystic ovary syndrome (PCOS) patients share the same frustration:
they were handed a birth control prescription and sent on their way. While hormonal
stability offered by the pill can be helpful, it’s not always the right fit for every patient
with PCOS. Individuals with conditions like migraines, diabetes, or clotting disorders, for
example, may not be ideal candidates.

Fortunately, the understanding that PCOS is a full-body condition has become more
mainstream. Still, many are surprised to learn that PCOS can impact sleep, mood, gut
health, and cardiovascular health. While regulating menstrual cycles is important, greater
long-term benefit often comes from targeting the non-reproductive symptoms of PCOS
directly.

Although there is no “cure” for PCOS—and that’s not a failure of medicine, but a
reflection of the condition’s complexity and research still ongoing. PCOS is classified as
a heterogeneous endocrine-metabolic disorder, meaning it manifests differently from
person to person. Its causes are multifactorial: genetic predisposition, epigenetic changes,
environmental exposures, and developmental influences (like in utero androgen
exposure) may all play a role.

Some patients primarily deal with insulin resistance. Others are impacted by adrenal
androgen excess, inflammatory cytokines, or disruptions in hypothalamic signaling.
Often, these mechanisms overlap. Because these variabilities, no one-size-fits-all
treatment exists—which is why Dr. Jennifer Berman’s personalized approach to PCOS is
so effective.

What’s New in PCOS Management?

In recent years, the conversation around PCOS has expanded far beyond birth control and
metformin. As science continues to unravel the complex physiology behind this
condition, exciting new therapeutic options are emerging.

Dr. Berman’s comprehensive, integrative approach goes beyond conventional medical
care to address metabolic dysfunction, inflammation, and hormonal imbalance. Here is a
look at some of her latest advances in PCOS treatment that are transforming care.

GLP-1 Agonists: Changing the Game for PCOS Patients

Originally developed for diabetes and weight management, GLP-1 receptor agonists are
now gaining traction as a metabolic therapy for PCOS. These medications help regulate
blood sugar, reduce inflammation, and improve insulin sensitivity—key challenges for
many PCOS patients. They are also helping to break the cycle of weight gain and
hormonal imbalance.

Patients frequently ask, “What role do GLP-1 agonists play in PCOS care?” These
medications—such as semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound,
Mounjaro)—are especially helpful for those struggling with insulin resistance, weight
gain, or poor muscle mass. They help regulate appetite, promote weight loss, and
improve insulin signaling.

GLP-1 agonists are part of a broader category of peptide therapies, which use naturally occurring proteins to support key systems in the body.

Peptides: Targeted for Decreasing Inflammation

Peptides like CJC-1295/ipamorelin and BPC-157 are being used to:

  • Enhance lean muscle mass
  • Promote restorative sleep
  • Improve insulin sensitivity
  • Accelerate healing from chronic inflammation

CJC-1295 + Ipamorelin: These growth hormone secretagogues stimulate natural GH
and IGF-1 production. The result? Improved sleep, body composition, recovery, and
muscle mass—all of which enhance insulin sensitivity and decrease inflammation
without the risk.

BPC-157: Originally studied for gut and musculoskeletal healing, BPC-157 is gaining
traction in PCOS for its ability to support inflammation recovery, joint health, and gut
permeability—factors often overlooked in endocrine disorders.

These therapies help optimize the body’s natural hormone rhythm without the risks
associated with synthetic hormone treatments.

Nutraceuticals and Supplements:

Many patients prefer more natural or food-derived compounds. Here are some standouts
in PCOS care:

  • Berberine: A plant alkaloid that activates AMPK (an energy-regulating enzyme),
    berberine improves insulin sensitivity and reduces inflammation. Some studies
    show its effects rival those of metformin, with the added benefit of microbiome
    support.

 

  • DIM (Diindolylmethane): Found in cruciferous vegetables, DIM promotes healthy estrogen metabolism and may help reduce symptoms of estrogen dominance like breast tenderness, bloating, or hormonal acne—common in PCOS.

 

  • Inositols (Myo- & D-Chiro): These compounds act as insulin sensitizers and
    secondary messengers in ovarian function. They’ve been shown to improve
    ovulation, insulin signaling, and androgen levels—and may be a side-effect-free
    alternative to metformin for some.

Pregnenolone: A New Frontier in Neurohormonal Balance in PCOS Patients

Pregnenolone, a neuro-steroid and precursor to progesterone, is now under study for its
role in mood, cognition, inflammation, and adrenal regulation. Emerging research
suggests that pregnenolone supplementation may help improve progesterone levels,
stabilize the hypothalamus/pituitary axis, and reduce anxiety or mood swings—issues
that are common but under-addressed in PCOS care.

Microbiome-Targeted Therapies

The gut microbiome is increasingly recognized as a key player in metabolic health and
hormone regulation. Probiotic therapy, prebiotic supplementation, and targeted dietary
strategies are now being used to reduce insulin resistance, systemic inflammation, and
estrogen dominance in PCOS patients.

Genetic and Epigenetic Testing

Precision medicine is making its way into PCOS care. Genetic SNP testing and hormone
metabolism profiles (via DUTCH or Genova Diagnostics) are helping providers like Dr. Berman tailor treatments based on individual risk factors and pathways—whether metabolic, adrenal, or inflammatory.

A New Lens for PCOS in Midlife

PCOS doesn’t disappear at perimenopause or menopause—it evolves, and symptoms can
even worsen. Many women with a history of PCOS continue to struggle with metabolic
symptoms, androgen excess, or estrogen imbalance into their 40s, 50s, and beyond. Dr.
Berman’s Menopause Biotype test is an emerging tool designed to help map a woman’s
unique hormonal landscape during this transition.

Using advanced biomarker analysis and symptom profiling, the Menopause Biotype test can
identify:
• Estrogen dominance, androgen persistence, or adrenal-driven patterns
• Progesterone decline affecting mood, sleep, or cycle irregularity
• Poor hormone detoxification linked to fibroids, acne, or PMS

For women with PCOS entering perimenopause or menopause, this test provides clarity and guides targeted treatment—whether it’s bioidentical hormone therapy (BHRT), adrenal
support, or detox strategies. Dr. Berman uses the Menopause Biotype to personalize
treatment protocols for her PCOS patients with:
• Persistent PCOS symptoms in midlife
• Unexplained weight gain or fatigue
• Mood swings unresponsive to conventional medications
• Low libido or postmenopausal sexual dysfunction

This precision-medicine approach ensures women with PCOS aren’t left guessing—or given
blanket hormone therapies that miss the mark.

What This Means for You

If you’ve felt dismissed, unheard, or stuck with limited options, you’re not alone.
There are more tools than ever before to help you navigate PCOS—ones that can be
tailored to your unique physiology and goals. These PCOS therapies signal a shift
from symptom suppression to true root-cause healing. Whether you’re struggling
with fertility, weight gain, mood instability, or chronic inflammation, there are more
options than ever to help you thrive—not just manage. If you're interested in a
personalized PCOS treatment plan, Dr. Berman’s integrative approach combines
the best of traditional and cutting-edge therapies to help you feel like yourself again.