Reviewed by Stephanie Paver, MS, RD

What is PCOS CausesSymptomsPCOS DietTreatment Weight LossFor Coaches

cne, hair in weird places, weight gain, wonky periods, and fertility struggles.

Those are just some of the symptoms of polycystic ovary syndrome (PCOS), a hormonal problem that affects up to 20 percent of women worldwide.1, 2

Because of its varied symptoms along with the lack of a clear diagnostic test, some women must wait years—and see multiple health professionals—before they get an accurate diagnosis.3

Even with good advice, women with PCOS may struggle to do what they know is good for them:

If fatigue is an issue, exercise can feel as appealing as hauling garbage on a hot day.

If sleep is elusive, appetite might intensify, making processed foods seem all the more irresistible.

If mental health is suffering, everything might seem harder.

Also frustrating: Trying to find consistent, evidence-based PCOS advice on the Internet. Seriously. Ugh.

That’s why we wrote this article—so coaches and people with PCOS can find trusted advice that actually works.

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What is polycystic ovary syndrome (PCOS)?

Physicians diagnose PCOS when someone exhibits at least two of the following:

✓ Irregular periods: They may be shorter than 21 days, longer than 35 days, or completely absent.

✓ “Cysts” in the ovaries: Confirmed by an ultrasound, these growths aren’t true cysts, but rather a build-up of egg follicles.

✓ High androgen levels, like testosterone: This is confirmed by a blood test or visible signs like facial hair, acne, or male pattern baldness.

Though not a diagnostic criteria, high insulin levels and a reduced ability to tolerate carbohydrates are also common.

Biology lesson: The PCOS hormonal cascade

PCOS likely originates in the hypothalamus, a small region in the brain which—among other things—is in charge of regulating hormones.

In a normal menstrual cycle, the hypothalamus releases a hormone called gonadotropin-releasing hormone (GnRH) in regular pulses, triggering the pituitary gland to release two other hormones:

follicle-stimulating hormone (FSH)luteinizing hormone (LH)

FSH and LH travel to the ovary, prompting the release of estrogens, androgens, and progesterones. The right ratio of these hormones stimulates ovulation, or the release of an egg.

In PCOS, the hypothalamus releases GnRH at a higher frequency.

Faster and longer GnRH pulses disrupt the normal ratio of LH and FSH. Many (though not all) women with PCOS will have higher levels of LH. More LH triggers the production of more androgens—like testosterone—and inhibits ovulation.

High insulin—a common feature of PCOS—can further contribute to androgen production as well as decrease another hormone called sex hormone binding globulin (SHBG), which can lead to even higher amounts of circulating free testosterone.

Women may also have dysregulated thyroid and adrenal function.

Just like the ovaries, the thyroid and adrenal glands depend on normal hypothalamic and pituitary function.

It’s this hormonal circus that causes the grab-bag of symptoms that appear across various systems of the body.

What causes PCOS?

PCOS arises from a combination of four main influences.

Genetics

Multiple genes contribute to an increased risk of PCOS, although carrying a specific gene variant doesn’t guarantee you’ll exhibit symptoms.4, 5, 6

The fetal environment

If your mother has higher levels of testosterone during her pregnancy with you, your risk of developing PCOS goes up.7, 8

Childhood trauma

Chronic stress early in life can result in changes in the brain that alter hormone regulation, and increase the risk of many diseases, such as immune, metabolic, cardiovascular, and psychiatric disorders.9, 10

Women with PCOS are twice as likely to have experienced childhood trauma.11

Lifestyle habits

A sedentary lifestyle, poor nutrition, and obesity contribute to insulin resistance and excess inflammation.

This makes PCOS more likely, as well as worsens symptoms.

Getting adequate movement, good nutrition, and managing weight won’t cure you if you have PCOS, but they can improve symptoms, quality of life, and future health outcomes.12

Several environmental pollutants have been linked to PCOS, too.13

These include brominated diphenyl ethers, polychlorinated biphenyls, organochlorine pesticides, perfluorinated compounds, phthalates, and bisphenol A (BPA). Major hormone disruptors, these chemicals are found in air, water, soil, and food, as well as in household cleaning supplies, food containers, and beauty products.

PCOS symptoms

Hormonal imbalances produce a constellation of symptoms, which vary from person to person and range from very mild to severe.

Menstrual irregularities: In addition to being longer or shorter than usual, periods may also be super heavy or very light.

Infertility / anovulation: High levels of androgens stop the release of an egg, inhibiting ovulation.

Ovarian “cysts” / follicles: Many—but not all—women with PCOS have a build-up of immature ovarian follicles (often erroneously called “cysts”).

Changes in hair growth: High androgen levels can cause coarse hair to develop on the face, chest, belly, or back, a symptom known as hirsutism. Meanwhile, hair at the crown and frontline of the head may begin to thin.

Weight gain and / or stubborn weight loss: Weight can stick around like a stubborn barnacle, possibly due to the combination of high androgens, high blood sugar and insulin, unregulated inflammation, and/or a sluggish thyroid.

Acne: High androgen and insulin levels may contribute to oily skin and stubborn acne—especially around the chin, but also on other parts of the face, back, or chest. Painful, longer-lasting cysts can also appear around the underarms, under the breasts, or around the groin, a condition called hidradenitis suppurativa or acne inversa.

Dark skin patches: Also known as acanthosis nigricans, high insulin levels can cause darkened, thickened, velvety skin in the creases of the body, particularly around the armpits, neck, and groin.

Low energy and carb cravings: Some women with PCOS have a reduced ability to tolerate processed carbs. Translation: 15 minutes after you’ve eaten that scone, you’ve dozed off and your face is molding to your keyboard.

Increased risk of diabetes: Compared to the general population, women with unmanaged PCOS are more than four times more likely to develop type 2 diabetes, and nearly three times more likely to develop gestational diabetes.14

Blood lipid imbalances: High blood sugar and insulin can contribute to low levels of high-density lipoprotein (the “good” cholesterol), high triglycerides, and a higher risk of cardiovascular disease.

Sleep issues: PCOS is linked to sleep apnea, which is when breathing periodically stops during sleep.15

Mood swings, anxiety, and depression: PCOS can increase the likelihood of mood swings, anxiety, and depression.16 Because many women with PCOS struggle with their weight, they’re also at an increased risk of disordered eating.

Both the visible and invisible symptoms of PCOS can be incredibly distressing, taking a toll on self-esteem.

Thankfully, there’s help.

PCOS and Hashimoto’s thyroiditis.

Women with Hashimoto’s thyroiditis—an autoimmune condition of the thyroid—are more than three times as likely to have PCOS, compared to the regular population.17, 18

Why are the two related? It’s still unclear.

What we do know:

Both PCOS and Hashimoto’s thyroiditis have a strong genetic component. A handful of genes (FBN, GNRHR and CYP1B1) have been linked to both, although researchers aren’t confident these genes fully explain their association.19Women with PCOS have a higher estrogen to progesterone ratio, which can increase immune activity. This is bad news for autoimmune conditions like Hashimoto’s, which are characterized by an already overactive immune system.Women with PCOS may have less gut microbiome diversity.20, 21 This can further compromise the immune system.

This landscape in is like adding gasoline to an autoimmune fire, increasing the likelihood of Hashimoto’s.22

PCOS treatment

Out there on the Internet, you’ll find PCOS treatment plans that list dozens of “never eat” foods and sweat-til-you-drop fitness regimens.

You won’t find that here. In our experience of working with over 100,000 clients, we know one thing for sure: It takes a rare person to consistently stick to an extreme diet and fitness plan.

The good news: Most people see massive improvements with just three tiny and much-more-realistic lifestyle changes.

The PCOS diet: Be smart with carbs

To manage energy and blood sugar, you don’t need to (and probably shouldn’t) avoid carbs altogether, but some research shows that lower carb—and possibly low dairy—diets can be helpful.23

The advice

Put the focus on what to eat rather than what not to eat. Aim for about 10 grams of fiber and 20-30 grams of protein (roughly one palm-sized portion) per meal by building plates around these nutrient-rich foods.

Lean proteins: meat and poultry, fish and shellfish, eggs, tofu and tempehColorful non-starchy vegetables: cruciferous veggies (think: broccoli, cabbage, and kale), lettuces, cucumber, celery, summer squash, tomatoes, mushrooms, peppers, and asparagusLow-sugar fruits: berries, apples, oranges, and plumsHealthy fats: avocado, olives, nuts and seeds, and oils (olive and coconut)

With the above taking up the most space, fill out your plate with smaller amounts of dairy, starchy veggies, or whole grains.

For help making more nutritious food choices, check out this visual guide: ‘What should I eat?!’

And for more specific nutrition recommendations tailored to your body, lifestyle, and goals—including portion suggestions for the above food groups—see: The Precision Nutrition Calculator.

re there any supplements that help PCOS?

Below is a list of the most effective, evidence-based supplements used to manage PCOS.

If you’re a coach, encourage your client to first talk to their doctor.

NutrientMechanism of actionLevel of evidenceRecommended doseInositolHelps regulate hormone levels and menstrual cycles, as well as improve insulin sensitivity, egg quality, and fertility. 24, 25, 26Very highTwo forms are most effective: Myo-inositol (4,000 mg/day) and D-chiro-inositol (100 mg/day)ZincZinc deficiency is more common in women with PCOS,27 and supplementation may regulate hair growth and improve skin quality.28Moderate30-50 mg/day for 8 weeks, with a meal (can cause nausea on an empty stomach)Vitamin DPlays a role in ovarian follicle development and progesterone production, both important for maintaining a healthy menstrual cycle and fertility.29ModerateIf a blood test confirms a deficiency, 1,000-2,000 IU/day can help normalize levelsMagnesiumHelps regulate blood sugar, estrogen, and progesterone production, and supports the nervous system.Moderate200-400 mg/dayChromiumImproves insulin sensitivity, and may help lower high blood sugar.30Moderate200-1,000 mcg/day (at the higher range, separate doses into two or more)

PCOS exercise: Find joyful movement

Most beings benefit from regular movement. (Even pet hamsters are happier with a running wheel in their cage.)

In women with PCOS, exercise can:

Improve ovulation and menstrual regularity31Improve insulin sensitivityDecrease androgensDecrease risk of cardiovascular diseaseImprove mental health32, 33

These benefits show up with or without additional changes in diet and regardless of weight changes. Meaning: Exercise is a superpowered tool.

The advice

Aim for at least 120 minutes of moderate-intensity exercise per week.34 That translates to about four 30-minute sessions, with (ideally) half of those sessions devoted to resistance training.

But start wherever you are.

If you’re a regular gym go-er, keep at it. Resistance training may be especially beneficial, because it helps improve insulin sensitivity and the ratio of fat to lean mass.35 (Plus, lifting heavy things feels badass.)

If you get your movement mostly from errands, like carrying your groceries or walking to the bus stop, try adding a little more. Consider tracking your steps to get a baseline, then set a goal for a higher number. Or, add a once or twice weekly online or in-person exercise class or workout. (For a zero-equipment, 10-minute workout see: How to stay in shape when you’re busy.)

If the word “exercise” makes you want to wash your mouth with soap, just start anywhere. Even a five-minute walk or a dance party counts. (Wagging your finger and saying, “Nuh-uh,” doesn’t. Nice try though.)

What’s most important: Find something that you actually enjoy doing, because you’ll be more likely to keep at it.

Choose the exercise flavor that most appeals to you. As you get comfortable and consistent with more movement, reassess, and add a little more if that aligns with your abilities and goals.

PCOS: Two different types?

Women with PCOS may have slightly different hormonal profiles (and symptoms) depending on whether they also have excess body fat. Recognizing the two subpopulations, experts use these terms36:

The reproductive type (sometimes referred to as “lean PCOS”) tends to have a lower BMI and less insulin resistance, but higher luteinizing hormone (LH) and sex hormone binding globulin (SHBG).37The metabolic type tends to have a higher BMI, more glucose and insulin dysregulation, and lower LH and SHBG levels.

With the exception of weight loss, the lifestyle recommendations we suggest in this article still apply to both groups.

Stress management: Self-kindness is the new cool

With PCOS, it can be easy to fall into self-criticism and pessimistic thinking. That’s why, as you do your best to make healthy changes in your life, also bring in an abundance of self-compassion.

The advice

Pay attention to your thoughts, and when you notice yourself being unkind or overly critical, practice speaking to yourself as you would your best friend.

Acknowledgethat your condition can be a real struggle sometimes.

And while it’s not your fault, it is your responsibility to take care of yourself in the best and kindest way you can.

It may help to remember that many other women are dealing with PCOS too. Joining a PCOS support group, or even just thinking about the other women who are “in this” with you can be helpful.

In addition to a self-compassionate mindset, make sure to prioritize those stress-busting basics.

Get adequate sleep. Good sleep helps balance hormones and mood, makes it easier to regulate weight and appetite, and reduces the chance of “Tiredzilla” coming out to torment your friends and family. (For tips on how to improve sleep, read: The power of sleep.)

Include daily stress-relieving activities. Meditation, walks in nature, time with loved ones, and creative hobbies are stress-busting superstars. For even more stress reducers, read: Feel like you’re failing at self care? 3 solutions that can actually help.

Be mindful of how you frame your PCOS story. Are you a helpless PCOS victim? Or, can PCOS be an opportunity to learn more about your health and take better care of yourself? Which story feels better? Which story motivates you to take empowering action?

Of course, sometimes you can “do everything right” and still feel completely overwhelmed, maybe even hopeless. If that’s the case, reach out. Talk to a trusted loved one, your doctor, or a mental health professional.

Sometimes just knowing someone else is on your team can make the difference between “I’m in a black hole and I can’t get out” and “I see some light at the end of the tunnel.”

PCOS and weight loss

The truth is: It can be harder to lose weight when you have PCOS.

That’s one reason why it’s better to focus on the lifestyle habits we mentioned in the previous section. After all, what you eat and how you move has a bigger influence on your health and symptoms than does your weight on the scale.

In many cases, fat loss will happen as a natural side effect of better overall health. But if it doesn’t, you’ll still be eating, moving, feeling, and living better.

dvice for coaches

As a coach, it’s easy to feel out of your realm, wondering: “Am I really qualified to help someone with PCOS?”

And while coaches can’t diagnose or treat PCOS, you absolutely can support them—no special certifications required.

Keep in mind: Your client likely has access to healthcare experts who know the latest PCOS research and treatments.

What’s missing from your client’s life: Someone who can help them put what their doctor recommends into practice.

Most likely, their doctor will recommend strategies that are quite similar to the strategies you’ve already used with other clients: exercise, healthy eating, and stress relief, all of which can improve symptoms of PCOS tremendously.

Stay within your scope, and be the best cheerleader you can.

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Deswal, Ritu, Vinay Narwal, Amita Dang, and Chandra S. Pundir. 2020. “The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review.” Journal of Human Reproductive Sciences 13 (4): 261–71.Sirmans, Susan M., and Kristen A. Pate. 2013. “Epidemiology, Diagnosis, and Management of Polycystic Ovary Syndrome.” Clinical Epidemiology 6 (December): 1–13.Tomlinson, Julie A., Jonathan H. Pinkney, Phil Evans, Ann Millward, and Elizabeth Stenhouse. 2013. “Screening for Diabetes and Cardiometabolic Disease in Women with Polycystic Ovary Syndrome.” Diabetes & Vascular Disease Research: Official Journal of the International Society of Diabetes and Vascular Disease 13 (3): 115–23.Crespo, Raiane P., Tania A. S. S. Bachega, Berenice B. Mendonça, and Larissa G. Gomes. 2018. “An Update of Genetic Basis of PCOS Pathogenesis.” Archives of Endocrinology and Metabolism 62 (3): 352–61.Dunaif, Andrea. 2016. “Perspectives in Polycystic Ovary Syndrome: From Hair to Eternity.” The Journal of Clinical Endocrinology and Metabolism 101 (3): 759–68.Vink, J. M., S. Sadrzadeh, C. B. Lambalk, and D. I. Boomsma. 2006. “Heritability of Polycystic Ovary Syndrome in a Dutch Twin-Family Study.” The Journal of Clinical Endocrinology and Metabolism 91 (6): 2100–2104.Dumesic, Daniel A., David H. Abbott, and Vasantha Padmanabhan. 2007. “Polycystic Ovary Syndrome and Its Developmental Origins.” Reviews in Endocrine & Metabolic Disorders 8 (2): 127–41.Tata, Brooke, Nour El Houda Mimouni, Anne-Laure Barbotin, Samuel A. Malone, Anne Loyens, Pascal Pigny, Didier Dewailly, et al. 2018. “Elevated Prenatal Anti-Müllerian Hormone Reprograms the Fetus and Induces Polycystic Ovary Syndrome in Adulthood.” Nature Medicine 24 (6): 834–46.Kuras, Yuliya I., Naomi Assaf, Myriam V. Thoma, Danielle Gianferante, Luke Hanlin, Xuejie Chen, Alexander Fiksdal, and Nicolas Rohleder. 2017. “Blunted Diurnal Cortisol Activity in Healthy Adults with Childhood Adversity.” Frontiers in Human Neuroscience 11 (November): 574.Felitti, V. J., R. F. Anda, D. Nordenberg, D. F. Williamson, A. M. Spitz, V. Edwards, M. P. Koss, and J. S. Marks. 1998. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. The Adverse Childhood Experiences (ACE) Study.” American Journal of Preventive Medicine 14 (4): 245–58.Tay, Chau Thien, Helena J. Teede, Deborah Loxton, Jayashri Kulkarni, and Anju E. Joham. 2020. “Psychiatric Comorbidities and Adverse Childhood Experiences in Women with Self-Reported Polycystic Ovary Syndrome: An Australian Population-Based Study.” Psychoneuroendocrinology 116 (June): 104678.Merkin, Sharon Stein, Jennifer L. Phy, Cynthia K. Sites, and Dongzi Yang. 2016. “Environmental Determinants of Polycystic Ovary Syndrome.” Fertility and Sterility 106 (1): 16–24.Vagi, Sara J., Eduardo Azziz-Baumgartner, Andreas Sjödin, Antonia M. Calafat, Daniel Dumesic, Leonardo Gonzalez, Kayoko Kato, Manori J. Silva, Xiaoyun Ye, and Ricardo Azziz. 2014. “Exploring the Potential Association between Brominated Diphenyl Ethers, Polychlorinated Biphenyls, Organochlorine Pesticides, Perfluorinated Compounds, Phthalates, and Bisphenol A in Polycystic Ovary Syndrome: A Case-Control Study.” BMC Endocrine Disorders 14 (October): 86.Joham, A. E., S. Ranasinha, S. Zoungas, L. Moran, and H. J. Teede. 2014. “Gestational Diabetes and Type 2 Diabetes in Reproductive-Aged Women with Polycystic Ovary Syndrome.” The Journal of Clinical Endocrinology and Metabolism 99 (3): E447–52.Ehrmann, David A. 2012. “Metabolic Dysfunction in Pcos: Relationship to Obstructive Sleep Apnea.” Steroids 77 (4): 290–94.Zehravi, Mehrukh, Mudasir Maqbool, and Irfat Ara. 2021. “Depression and Anxiety in Women with Polycystic Ovarian Syndrome: A Literature Survey.” International Journal of Adolescent Medicine and Health, August. https://doi.org/10.1515/ijamh-2021-0092.Kowalczyk, K., G. Franik, D. Kowalczyk, D. Pluta, Ł. Blukacz, and P. Madej. 2017. “Thyroid Disorders in Polycystic Ovary Syndrome.” European Review for Medical and Pharmacological Sciences 21 (2): 346–60.Ulrich, Jan, Julia Goerges, Christoph Keck, Dirk Müller-Wieland, Sven Diederich, and Onno Eilard Janssen. 2018. “Impact of Autoimmune Thyroiditis on Reproductive and Metabolic Parameters in Patients with Polycystic Ovary Syndrome.” Experimental and Clinical Endocrinology & Diabetes: Official Journal, German Society of Endocrinology [and] German Diabetes Association 126 (4): 198–204.Gaberšček, Simona, Katja Zaletel, Verena Schwetz, Thomas Pieber, Barbara Obermayer-Pietsch, and Elisabeth Lerchbaum. 2015. “Mechanisms in Endocrinology: Thyroid and Polycystic Ovary Syndrome.” European Journal of Endocrinology / European Federation of Endocrine Societies 172 (1): R9–21.Wang, Lan, Jing Zhou, Hans-Jürgen Gober, Wing Ting Leung, Zengshu Huang, Xinyao Pan, Chuyu Li, Na Zhang, and Ling Wang. 2021. “Alterations in the Intestinal Microbiome Associated with PCOS Affect the Clinical Phenotype.” Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie 133 (January): 110958.Lindheim, Lisa, Mina Bashir, Julia Münzker, Christian Trummer, Verena Zachhuber, Bettina Leber, Angela Horvath, et al. 2017. “Alterations in Gut Microbiome Composition and Barrier Function Are Associated with Reproductive and Metabolic Defects in Women with Polycystic Ovary Syndrome (PCOS): A Pilot Study.” PloS One 12 (1): e0168390.Arduc, Ayse, Bercem Aycicek Dogan, Sevgi Bilmez, Narin Imga Nasiroglu, Mazhar Muslum Tuna, Serhat Isik, Dilek Berker, and Serdar Guler. 2015. “High Prevalence of Hashimoto’s Thyroiditis in Patients with Polycystic Ovary Syndrome: Does the Imbalance between Estradiol and Progesterone Play a Role?” Endocrine Research 40 (4): 204–10.Phy, Jennifer L., Ali M. Pohlmeier, Jamie A. Cooper, Phillip Watkins, Julian Spallholz, Kitty S. Harris, Abbey B. Berenson, and Mallory Boylan. 2015. “Low Starch/Low Dairy Diet Results in Successful Treatment of Obesity and Co-Morbidities Linked to Polycystic Ovary Syndrome (PCOS).” Journal of Obesity & Weight Loss Therapy 5 (2). https://doi.org/10.4172/2165-7904.1000259.Monastra, Giovanni, Vittorio Unfer, Abdel Halim Harrath, and Mariano Bizzarri. 2017. “Combining Treatment with Myo-Inositol and D-Chiro-Inositol (40:1) Is Effective in Restoring Ovary Function and Metabolic Balance in PCOS Patients.” Gynecological Endocrinology: The Official Journal of the International Society of Gynecological Endocrinology 33 (1): 1–9.Kamenov, Zdravko, and Antoaneta Gateva. 2020. “Inositols in PCOS.” Molecules 25 (23). https://doi.org/10.3390/molecules25235566.Laganà, Antonio Simone, Simone Garzon, Jvan Casarin, Massimo Franchi, and Fabio Ghezzi. 2018. “Inositol in Polycystic Ovary Syndrome: Restoring Fertility through a Pathophysiology-Based Approach.” Trends in Endocrinology and Metabolism: TEM 29 (11): 768–80.Abedini, Maryam, Ehsan Ghaedi, Amir Hadi, Hamed Mohammadi, and Reza Amani. 2019. “Zinc Status and Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis.” Journal of Trace Elements in Medicine and Biology: Organ of the Society for Minerals and Trace Elements 52 (March): 216–21.Jamilian, Mehri, Fatemeh Foroozanfard, Fereshteh Bahmani, Rezvan Talaee, Mahshid Monavari, and Zatollah Asemi. 2016. “Effects of Zinc Supplementation on Endocrine Outcomes in Women with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial.” Biological Trace Element Research 170 (2): 271–78.Lin, Ming-Wei, and Meng-Hsing Wu. 2015. “The Role of Vitamin D in Polycystic Ovary Syndrome.” The Indian Journal of Medical Research 142 (3): 238–40.Fazelian, Siavash, Mohamad H. Rouhani, Sahar Saraf Bank, and Reza Amani. 2017. “Chromium Supplementation and Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.” Journal of Trace Elements in Medicine and Biology: Organ of the Society for Minerals and Trace Elements 42 (July): 92–96.Mikkelsen, Kathleen, Lily Stojanovska, Momir Polenakovic, Marijan Bosevski, and Vasso Apostolopoulos. 2017. “Exercise and Mental Health.” Maturitas 106 (December): 48–56.Guszkowska, Monika. 2004. “[Effects of exercise on anxiety, depression and mood].” Psychiatria polska 38 (4): 611–20.Harrison, Cheryce L., Catherine B. Lombard, Lisa J. Moran, and Helena J. Teede. 2011. “Exercise Therapy in Polycystic Ovary Syndrome: A Systematic Review.” Human Reproduction Update 17 (2): 171–83.Patten, Rhiannon K., Russell A. Boyle, Trine Moholdt, Ida Kiel, William G. Hopkins, Cheryce L. Harrison, and Nigel K. Stepto. 2020. “Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.” Frontiers in Physiology 11 (July): 606.Picchi Ramos, Fabiene K., Lúcia Alves da Silva Lara, Gislaine Satyko Kogure, Rafael Costa Silva, Rui Alberto Ferriani, Marcos Felipe Silva de Sá, and Rosana Maria dos Reis. 2016. “Quality of Life in Women with Polycystic Ovary Syndrome after a Program of Resistance Exercise Training.” Revista Brasileira de Ginecologia E Obstetrícia / RBGO Gynecology and Obstetrics 38 (07): 340–47.Dapas, Matthew, Frederick T. J. Lin, Girish N. Nadkarni, Ryan Sisk, Richard S. Legro, Margrit Urbanek, M. Geoffrey Hayes, and Andrea Dunaif. 2020. “Distinct Subtypes of Polycystic Ovary Syndrome with Novel Genetic Associations: An Unsupervised, Phenotypic Clustering Analysis.” PLoS Medicine 17 (6): e1003132.Toosy, Sehar, Ravinder Sodi, and Joseph M. Pappachan. 2018. “Lean Polycystic Ovary Syndrome (PCOS): An Evidence-Based Practical Approach.” Journal of Diabetes and Metabolic Disorders 17 (2): 277–85.

Precision Nutrition Level 1 Certification. The next group kicks off shortly.

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If you’re a coach, or you want to be…

Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes—in a way that’s personalized for their unique body, preferences, and circumstances—is both an art and a science.

If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certification.

Precision Nutrition Level 1 Certification.

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“Is it burnout, or am I just being a baby?”

Burnout is gaining recognition in the work and wellness worlds. This makes sense, as self-reported stress levels are higher than ever.1 (And global pandemic, you’re really not helping.2)

But, like many health conditions, especially those related to mental health, there’s still a fair bit of stigma around burnout.

Some people hear the term “burnout” and say:

“This wasn’t a thing when I grew up. When did people become allergic to hard work?!” (As they take a big gulp of their mid-morning bourbon.)

Truth is, burnout is nothing new.

It’s been around as a clinical concept since the 1970s, and it surely existed before we slapped a formal name on it.3

But in 2019, the World Health Organization officially recognized it as a workplace phenomenon, and are currently working on developing tools to help recognize, treat, and most importantly, prevent burnout in workplaces.4

That’s good news because: Knowing you’re burned out also means you can recover from it sooner—and better.

Plus, preventing burnout usually means improving overall wellbeing.

In this article, we put together a handy quiz to help you spot the signs of burnout—either in yourself or in clients. (If you want to jump to it, click here.)

After that, we’ll share three ways to counteract burnout—even if you can’t make stress “go away.”

Ready? Let’s dig in.

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What is burnout?

Burnout, also known as burnout syndrome, is a state of mental, emotional, and physical exhaustion that can happen when the demands in our lives consistently and chronically outweigh what we’re able to do or produce.5,6,7

It’s not a single bad day—or even week—at work. Rather, it’s an ongoing, long standing pattern of feeling like you’re trying and failing, without success, support, recognition, or recovery.

In most countries, burnout isn’t considered a medical condition, but rather an occupational (workplace) phenomenon.

That said, some places (hi, Sweden and the Netherlands), do recognize burnout as a medical diagnosis that requires time off from work.

Folks most at risk for burnout have jobs where:

Actual demands are high (fast-paced work, high stakes, lots of decisions, significant consequences for mistakes)Perceived demands are high (it feels rushed, overwhelming, urgent, and busy—especially for people who care about “doing a good job” or “being a team player”)Ideals are high (people have high personal standards and strongly believe in the value and importance of their work)Resources are low (such as time, money, support, and rest)

When you think of this combination, you might already be imagining who feels it most: service jobs like health care, first response, teaching, or coaching are prime examples of occupations with high rates of burnout.

But burnout can affect people in any career. And even though it stems from work, burnout’s shockwaves can impact all areas of your life.

Luckily, recovery can also come from many areas of your life. We’ll get to that part in just a minute.

Burnout test: Are you showing signs of burnout?

For each statement that sounds like something you experience relatively often, tick the box.

At the end of the quiz, you’ll get a score.

In general, the more signs you experience, the more likely you are to be on the road to burnout. (Check out the tips we offer at the end of this article.)

Important: This is not a clinical diagnostic test.

If you’re noticing more than a few of the below, even if it doesn’t feel like a “big deal,” consider consulting a healthcare professional.

Sleep, fatigue, and energy levels

Trouble falling or staying asleep – 1 pointPoor quality sleep (e.g., restless, wake up often) – 1 pointTired (so, so tired); run down and drained – 1 pointWired… can’t sleep! Running on an invisible hamster wheel! – 1 pointRely on caffeine for alertness through the day (e.g., coffee, black tea, energy drinks, caffeine tablets) – 1 pointBody feels heavy or sluggish – 1 point

Physical symptoms

Heart palpitations, racing heart – 1 pointTightness in chest or trouble breathing – 1 pointStomach upset, digestive issues (e.g., heartburn, gas, irritable bowel) – 1 pointHeadaches, migraines – 1 pointJaw pain/tightness; tooth grinding (dentist might notice this if you don’t) – 1 pointJumpy, startle easily – 1 pointChronic aches and pains (e.g., muscle aches, inflamed joints, back or neck pain) – 1 pointIrregular, painful, and/or absent menstrual cycles (if you have a uterus and would typically be menstruating) – 1 pointFeeling spaced-out or dizzy – 1 pointHunger and food cravings; emotional eating – 1 pointLack of appetite – 1 pointPoor immunity—you seem to get every bug going around or just feel kind of “off” much of the time – 1 pointPoor recovery—takes longer to recover from workouts, injuries don’t heal as well, seems hard to bounce back – 1 pointInflamed (e.g., flare-ups of allergies, skin issues, joint pain, sinusitis) – 1 pointHair falling out – 1 point

Cognitive / mental symptoms

Forgetful or often worry about forgetting things – 1 pointHard to concentrate or focus – 1 pointFeel anxious and/or worry a lot – 1 pointFeel overwhelmed, and/or frazzled—so much to do/juggle! – 1 pointProcrastinate and/or avoid tasks – 1 pointHard to prioritize tasks or choose what is important to do next – 1 point

One or more of these thoughts seem familiar:

“Everyone else is the problem. They’re so unmotivated/stubborn/lazy/crazy.” – 1 point“My boss/workplace is the problem.” – 1 point“Everything around me is broken. Nothing works right. I hate ____.” – 1 point“This is all out of my control. So many things need to be fixed, but it’s not my job to do it.” – 1 point“I just keep trying and trying, but it’s like being on a hamster wheel. I never get anywhere.” – 1 point“I’m fine. This is fine. It’s all fine. I’ll just handle it like I always handle it. Fine. Fine. I’m totally fine.” – 1 point“AAAAAAAAAAAAAHHHHH!!!!” – 1 point

Emotional symptoms

Feel “blank”, emotionless, numb – 1 pointFeel sad or “down” – 1 pointFeel trapped and stuck, out of options – 1 pointFeel pessimistic, discouraged, hopeless, “what’s the point” – 1 pointFeel resentful, irritable, short-tempered – 1 pointFeel chronically frustrated; everything around you sucks and people are jerks – 1 pointFeel disconnected, alienated, alone – 1 pointFeel like nobody recognizes or appreciates you and/or your work – 1 pointFeels like nothing you do or are is good enough – 1 pointSeems like nearly every day is a hard day – 1 pointFeels like you need something to cope (e.g., drugs, alcohol, eating/not eating, shopping) – 1 pointOften focused on your shortcomings (e.g., not fit enough, not good enough, not smart enough, not organized enough) – 1 pointFeel out of control – 1 pointTrying very hard to control other things—like your body, other people, your routine—but it feels like you’re failing – 1 point

Relationship symptoms

Can’t relate to or connect with other people, such as family, friends, coworkers, clients, etc. – 1 pointAvoid others (e.g., procrastinate contacting clients, keep office door closed to other people, such as family, friends, coworkers, or clients) – 1 pointFeel like you can’t depend on or trust other people (they screw things up or let you down) – 1 pointActive conflicts with others at work, home, school, etc. – 1 point

Your burnout score:

Score: 3 or less

Sounds like you’re doing alright. You may have an occasional bad day, but you recover from it, and move on.

Score: 4 to 8

Hmm. You might benefit from a little more recovery and self-care. Consider consulting a qualified mental health professional, even just for a chat.

Score: 9 to 13

Be careful—you’re at risk of burnout, particularly if you feel several of these intensely and often. Consider consulting a qualified mental health professional.

Score: 14 to 18

You are at severe risk of burnout. Do something about this urgently. Seek help and support from a qualified professional.

Score: 19 or more

You are at very severe risk of burnout. It’s time to take action and seek help and support from a qualified professional.

3 ways to counteract burnout syndrome

Whether you scored high and are looking for a solution, or you’re curious what to do if you’re concerned about burnout creeping up on you in the future, here’s what can help.

(And if you’re working with a client showing burnout symptoms, you’ll definitely want to share these strategies with them.)

#1: Protect your time, space, and emotional investment with good boundaries.

Boundaries, or the lack of them, are a key factor in burnout.8

This can be boundaries between:

Home and work (for instance, struggling when working remotely, finding yourself doing work outside of work hours… or in your bed)Personal and professional identities (accidentally venting about personal stuff to a client, or being asked to do work that’s outside the scope of your job)

Conversely, having clear, strong, and well-defined boundaries can alleviate burnout by:

Helping you switch “work mode” on and offProtecting time with friends and loved ones.Reducing the amount of emotional labor you’re doing.

(Emotional labor means managing other people’s feelings, as well as controlling your own emotional response to them. Learn more: Invisible stressors: Are they sucking the life out of your health?)

How do you maintain good boundaries? Here are a few ideas.

Identify what you can and can’t control. Try our Sphere of Control Worksheet.

Implement a “focus filter.” Consciously tell yourself, ‘I’m choosing to focus on THIS right now.’ This applies to work—you don’t do housework or counsel your mother-in-law while you’re trying to do your job—but it can also look like spending time with your partner without thinking about work as you gaze across a candlelit table.

Be intentional about your environment. If remote working muddles your work-life boundaries, set up a separate space for work-related duties—even if it’s a specific corner of your kitchen table or the middle seat of your couch.

Because as fun as it is to take conference calls from bed in your housecoat, creating separation between “work” and “home” will make turning off “work mode” and getting into “rest mode” at the end of the day feel much easier.

(Plus, if you can go somewhere and shut a door, it might—slightly—reduce your “on-call” status for other family members. Cue: “MOM!! Billy is touching my Tonka truck with his Lego!!”)

Clarify your boundaries—what you’re saying “yes” and “no” to at a given time. Maybe you tell yourself you want to say “yes” to family time (or plain old sanity time for yourself), so you’re no longer checking emails after 6 pm.

You could uphold that boundary by putting your phone on mute, so you don’t hear emails pinging as they come in.

Communicate your boundaries clearly to others, and enforce them as needed. Tell others what your boundaries are. Be explicit and clear. Don’t expect folks to “just know.” (As Brené Brown says, “clear is kind.”)

It can be uncomfortable to advocate for your needs, but it’s kinder to yourself—and the other person—to be honest about what you can and can’t sustain. In our work email situation, that might mean putting on an auto-responder that lists your office hours, so people know when to expect to hear back from you.

Remember, it’s not just about the “no.” It’s also about the “yes.” As in, what have you consciously decided is worth your time, energy, and attention?

What activities are aligned with your values? What do you want to do and feel more of? What needs to be cleared, constrained, or revised so that you can prioritize better, and “replenish your tank” more effectively?

#2: Cultivate engagement by spending more time on what you love doing, with people you love working with.

The flip side of burnout is engagement.9,10

Engagement means you’re thriving in your work role. You’re energized by your work, and the people around you support you and respect your boundaries.

Rates of burnout are lower in workplaces that focus on the following six engagement-promoting components:11

Appropriate workloadsControl over work (at least a little)Rewards, including simple appreciation and recognitionCommunity and genuine, supportive social connectionsFairness and equityValues that feel meaningful

Of course, if you’re an employee, you may not have control over whether or not your job has all these components. But you can:

Talk to your manager about workload, what you want to work on, and how you’d like to receive feedback. Rather than trying to do all the things like a hero, ask for help prioritizing, if needed.

Build strong connections. Invest time in relationships that feel genuine and supportive. If possible, connect with colleagues… and also have relationships that have nothing to do with work.

Consider your values. What matters to you? Think about what your personal values are, and how they align with the work you’re doing. Have your values changed? Or do you just need more help finding a match between job demands and what you truly feel is important?

Model productive, collegial, and growth-oriented behavior. Many teams bond over a shared hatred of workloads, clients, bosses, or the general day-to-day BS.12 In some ways, this is practical and realistic. However, research suggests that only venting—without productive and positive action—doesn’t make us feel better.13,14 In fact, focusing all our attention on awfulness tends to make us feel worse. So, if your coworker had a crap day, instead of complaining about how horrible the job is, buy them a coffee or suggest you both sneak out for a walk in the park.

Consider constraining the complaints. Some psychologists suggest using a “complaint window” during which you specifically allot time and energy to complaining. Outside of that time, you don’t. For instance, “I’m going to devote the next ten minutes to saying all the things I hate about work, then that’s it for the day.” (The same principle works for a “worry window”—establishing a set period of time to worry about things.)

Practice compassion. Sure, some customers might just suck, and some bosses are just grouchy tyrants. But many people are under pressure themselves, or struggling with stress they don’t know how to manage. Unless it’s clear you work with a sadistic sociopath, try to find the human underneath, and consider what they might be going through. If you can’t find compassion, that can be a sign of compassion fatigue. Try our Compassionate Coaching Worksheet.

If you don’t have a boss or manager (maybe you’re a self-employed coach or you’re a caregiver to a family member), consider how you might implement these ideas into your work situation.

That might mean delegating or outsourcing tasks to manage your workload, saying no to things you really don’t want or have time to do, or finding a mentor to provide advice and social connection. (A mentor can skyrocket your potential. See: How to find a mentor, and why mentorship is so important for you—and your clients.)

#3: Focus on deep recovery.

There are going to be times when you can’t lower your demands.

What happens then?

Increasing recovery can help offset increased stress.

By pumping up your recovery practices, you may find you’re better able to handle workplace (and everyday life) stress.

Recovery isn’t just sleep and taking days off from the gym. The best kind of recovery addresses multiple aspects of your health—your physical health, yes, but also your emotional health, your social health, and more.

We call this “deep recovery.”

With burnout, the mental, emotional, and existential pieces are particularly important. However, many people might experience these as physical issues too. For instance, you might not consciously feel angry… but your jaw muscles are grinding like a wood chipper. You might not consciously feel hopeless… you just feel exhausted.

Having a professional as an ally to work through those areas—especially one you like who you feel understands you—can help you get better results and feel less alone.

Consider reaching out to your primary care physician or a therapist (or encouraging clients struggling to do so).

And remember:

Asking for help is a sign of strength, not weakness. (Even The Rock needs a spotter when he benches 900 pounds.)

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References

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Heinemann LV, Heinemann T. Burnout Research: Emergence and Scientific Investigation of a Contested Diagnosis. SAGE Open. 2017 Jan 1;7(1):2158244017697154.American Psychological Association (2017). Stress in America: Coping with Change. Stress in America SurveyAmerican Psychological Association (2021). Stress in America: One Year Later, A New Wave of Pandemic Health Concerns. Stress in America SurveyBurn-out an “occupational phenomenon”: International Classification of Diseases [Internet]. [cited 2021 Sep 29].Danhof-Pont MB, van Veen T, Zitman FG. Biomarkers in burnout: a systematic review. – PubMed – NCBI. J Psychosom Res. 2011;70:505–24.Sabo B. Reflecting on the concept of compassion fatigue. Online J Issues Nurs. 2011 Jan;16(1):1.Gazelle G, Liebschutz JM, Riess H. Physician burnout: coaching a way out. J Gen Intern Med. 2015 Apr;30(4):508–13.Demerouti E. Strategies used by individuals to prevent burnout. Eur J Clin Invest. 2015 Oct;45(10):1106–12.Leiter MP, Maslach C. Burnout and engagement: Contributions to a new vision. Burnout Research. 2017 Apr;5:55–7.Leiter MP. Assessment of workplace social encounters: Social profiles, burnout, and engagement. Int J Environ Res Public Health [Internet]. 2021 Mar 29;18(7).Maslach C, Leiter MP. The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It. John Wiley & Sons; 2008. 202 p.Pouthier, Vanessa. 2017. Griping and Joking as Identification Rituals and Tools for Engagement in Cross-Boundary Team Meetings. Organization Studies 38 (6): 753–74.Bushman, Brad J., Roy F. Baumeister, and Angela D. Stack. 1999. Catharsis, Aggression, and Persuasive Influence: Self-Fulfilling or Self-Defeating Prophecies? Journal of Personality and Social Psychology 76 (3): 367–76.Bastin, Margot, Patricia Bijttebier, Filip Raes, and Michael W. Vasey. 2014. Brooding and Reflecting in an Interpersonal Context. Personality and Individual Differences 63 (June): 100–105.

If you’re a health and fitness coach…

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It helps clients get “unstuck” and makes everything else easier—whether they want to eat better, move more, lose weight, or reclaim their health.

And for coaches: It gives you a rarified skill that will set you apart as an elite change maker.

The brand-new PN Level 1 Sleep, Stress Management, and Recovery Coaching Certification will show you how.

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