A third of women with PCOS wait more than four years for a diagnosis. Up to 70 per cent never get one at all.
Last September, a parliamentary inquiry confirmed what most women with the condition already knew: there is no national diagnostic protocol, no consistent care pathway, and PCOS receives minimal attention in GP training.
The inquiry also called for something that is long overdue: a formal reclassification of PCOS as a metabolic condition, not just a reproductive one.
For anyone who's spent time in this space, that's not a revelation. But the fact that it needs saying at parliamentary level tells you something about how far behind the clinical conversation is.
The thing medicine keeps missing
PCOS is driven, in large part, by insulin resistance. Understanding that changes how you approach it. Not in every case — around one in five women with PCOS have normal insulin function, and for them the picture is more complex. But for the majority, it's the mechanism that connects the symptoms that otherwise seem unrelated, and understanding that changes how you approach it.
When the body's insulin system starts to struggle — through long-term blood glucose spikes and crashes, poor sleep, chronic stress, too little movement and other factors — cells become less sensitive to insulin's signal. The pancreas produces more to compensate. Blood tests can miss what's going on for years because glucose stays roughly normal. But chronically elevated insulin directly signals the ovaries to produce excess androgens. That's where the irregular cycles, acne, hair changes, and weight that won't shift actually come from. Not separate problems but the same problem, expressed differently.
Research published last year called for a significant shift: treating insulin resistance as the central mechanism in PCOS rather than a secondary complication.
What can actually change insulin resistance
Insulin resistance is reversible. It responds to diet — specifically reducing how often and how sharply blood glucose spikes. It responds to sleep quality, because even a few disrupted nights measurably increases insulin resistance the following day. It responds to stress, because cortisol raises blood glucose even when nothing has been eaten. And it responds to movement timed well after meals, when muscles can absorb incoming glucose directly.
None of that is new information. What's been missing is personalising it and acting on it — knowing which factors matter most for your body, in what order, and being able to see the evidence that they're working.
What changes when you have the right data
Many Nico members come to us because of PCOS or suspected insulin resistance. Not for a diagnosis — we're a wellness platform, not a clinical service, and only blood tests can confirm what's happening metabolically. But for something most women with PCOS haven't been given: a continuous picture of what their glucose is doing across the day. Because that's what drives insulin.
The metric we focus on is glucose variability — the shape of the line rather than individual spikes. When you reduce variability consistently over time, you start to reduce insulin resistance.
Nico ties your glucose data to a journal of what you actually did that day: what you ate, when you moved, how you slept. Cause and effect stops being abstract when you can see your own evidence alongside the biodata. Add expert feedback on what those patterns mean for your specific situation, and you have something the standard PCOS care pathway has never offered: a way to understand what's happening in your body before it's been years in the making.
Sources: APPG on PCOS Inquiry, September 2025; Verity PCOS Diagnosis Survey 2025; Parker et al., Journal of Clinical Medicine, June 2025.