PCOS symptoms often intensify after 30 due to compounding insulin resistance, adrenal stress patterns, and brain–ovary signaling changes. As estrogen and progesterone begin subtle shifts in the mid-30s, many women experience more anovulatory cycles, higher cortisol responses, and worsening androgen symptoms.
Dr. McCulloch explains how:
- Theca cells in the ovaries thicken under high LH and insulin, increasing testosterone production
- Adrenal-driven DHEA-S rises in women with stress-sensitive PCOS subtypes
- In-utero hormonal exposures (testosterone, insulin, maternal stress) flip epigenetic switches that set the stage for lifelong PCOS patterns
- Brain insulin resistance affects appetite, mood, cognition, and energy metabolism
- Exercise myths (like “PCOS women can’t do intense workouts”) prevent women from using one of the most effective therapies for insulin resistance
- New PCOS guidelines finally acknowledge weight stigma, ethnic variations, cultural nutrition models, and mental health burdens
- GLP-1 medications can benefit some patients—but dose, duration, and metabolic context matter
- Gut health plays a major role, with fungal overgrowth, microbiome depletion, and inflammation worsening metabolic dysfunction
- Neurodivergence links (ADHD, impulsivity, anxiety) reflect prenatal androgen exposure and metabolic effects on the brain
This episode takes a whole-system view of PCOS across the lifespan and reframes the condition not as a failure—but as a genetically programmed survival adaptation interacting with a modern environment that our biology wasn’t built for.
Listen to: Why your PCOS Got WORSE after 30 and How to FIX it | Dr. Fiona McCulloch
This Episode Is Brought to You By
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Links Mentioned in This Episode
- Fiona McCulloch’s Website: drfionand.com
- Fiona McCulloch’s Instagram: @drfionand
- Fiona McCulloch’s book: 8 Steps to Reverse Your PCOS
Articles:
- Connection Between PCOS and Menopause: Discover how PCOS symptoms evolve during menopause, why androgens may rise with age, and what women can do to protect their metabolic and hormonal health long-term.
- Adrenal PCOS: Holistic Strategies to Manage Stress and PCOS: Learn how adrenal-driven androgen excess develops, how stress physiology impacts PCOS, and the most effective lifestyle, nutrition, and supplement strategies to rebalance your HPA axis.
- Acne and Polycystic Ovary Syndrome: Hormone and Skin Care Treatment: Explore why PCOS acne happens, how hormonal imbalances fuel breakouts, and which evidence-based treatments—from skincare to supplements—can finally calm your skin.
- PCOS Hair Loss Explained: Common Patterns, Triggers, and Treatment Options: Understand the root causes of PCOS-related hair loss, how androgens disrupt the hair cycle, and the most effective medical and natural interventions to promote regrowth.
Episodes:
- PCOS Fertility Diet: Best Supplements to Boost Fertility Naturally | Cory Ruth: Cory Ruth breaks down the science of a PCOS-friendly fertility diet, plus the key nutrients and supplements shown to improve ovulation, egg quality, and conception rates naturally.
- The Truth About Insulin Resistance Treatment, Foods, and Labs in Perimenopause: Get a clear, science-backed guide to diagnosing insulin resistance in perimenopause and learn which foods, labs, and treatments truly move the needle for metabolic health.
FAQ: Why Your PCOS Got Worse After 30 and How to Fix It
Yes. Many women experience worsening symptoms due to increasing insulin resistance, changes in brain–ovary signaling, more anovulatory cycles, and shifting stress hormones.
Estrogen and progesterone become more erratic, which unmasks androgen dominance, increases inflammation, and worsens sleep, metabolism, and mood regulation.
No. While ovulation stops, adrenal-driven androgens often remain high, and insulin resistance can become more pronounced with age.
Androgens, genetics, brain insulin resistance, inflammation, gut dysbiosis, and prenatal programming all contribute—regardless of body size.
Not for everyone. Women with the MCAD genetic variant struggle to burn fat for fuel and can feel worse on keto. Some women need carbohydrates to support ovulation and cortisol balance.
Yes. PCOS is associated with higher rates of ADHD, impulsivity, and anxiety—likely due to prenatal androgen exposure and metabolic effects on the brain.
They can. GLP-1s may reduce inflammation, improve brain insulin resistance, normalize taste centers, regulate cycles, and support long-term metabolic healing when used thoughtfully.
Yes. Despite outdated myths, Vitex does not worsen high LH in PCOS when used appropriately. It can support prolactin balance and luteal phase hormones.
Because CGMs became trendy—but normal glucose rises after eating are healthy. The problem is chronic insulin resistance, not a single spike.
Absolutely. PCOS is associated with reduced microbial diversity, fungal overgrowth, and gut-driven inflammation, all of which worsen insulin resistance.
Strength training, adequate protein, balanced carbs, inositol, gut support, and individualized metabolic care significantly reduce long-term risks like diabetes and heart disease.
Men can carry the genes for PCOS, which may show up as insulin resistance, fatty liver, or early hair loss, even though they don’t have ovaries.