PCOS + Performance: Why Standard PCOS Advice Fails Active Women

PCOS affects up to 1 in 10 women, but the majority of our clinical guidance is developed from sedentary populations.

Not runners.

Not lifters.

Not hybrid athletes.

Not women engaging in 5–10 hours of training per week.

This creates a major clinical gap:

Active women are told to follow low-carb, weight-focused guidelines that directly conflict with the metabolic demands of their training.

The result?

We see women who are:

• Training 4–6x/week

• Eating “clean”

• Restricting carbohydrates

• Pushing harder because they think they’re “lazy”

  
  

  …yet experiencing every sign of under-fuelling and RED-S.

Fatigue.

Brain fog.

No menstrual cycle.

Hair thinning.

Heavy legs.

Mid-session crashes.

Stalled performance.

It presents as “PCOS symptoms,” but more often it’s chronic low energy availability due to mismatched nutrition guidance.

High-intensity and endurance training requires carbohydrate availability.

PCOS doesn’t override basic physiology.

When we pull carbs away from athletes, cortisol rises, glucose becomes erratic, and recovery suffers.

What actually works?

Carb periodisation:

– Pre-training fuel

– Carbs during long/intense sessions

– Protein + carbs post-session

– Higher protein/fat meals outside training windows

This protects metabolic health and supports hormonal regulation — especially for women trying to regain cycles while training.

We can (and must) do better as practitioners by recognising that:

Active women with PCOS are not the same as sedentary populations. When we fuel them like athletes, their performance, cycles, and well-being improve dramatically.

If you’d like the PCOS Performance Cheat Sheet I give my athletes, feel free to reach out. Or listen to my fueled female podcast here.