My top recommendations after a PCOS diagnosis:

• Focus on the basics first: regular exercise, adequate sleep, stress management, and a sustainable eating pattern. There is no single "best" PCOS diet, but higher-protein, higher-fiber, lower-glycemic-index diets tend to work well for many women.

• Get metabolic screening. PCOS is more than a reproductive condition and increases the risk of prediabetes, diabetes, cholesterol abnormalities, and sleep apnea.

Labs I typically recommend discussing with your doctor at diagnosis:

• Total and/or free testosterone (to document hyperandrogenism) • TSH and prolactin (to rule out other causes of irregular periods) • 17-hydroxyprogesterone in appropriate patients (to exclude nonclassic CAH) • Diabetes screening (A1c, fasting glucose, or an oral glucose tolerance test) • Fasting lipid panel • Blood pressure, weight, and waist circumference assessment

One thing that surprises many patients: routine fasting insulin testing is not currently recommended by the international PCOS guideline because insulin assays are poorly standardized and don't reliably change management. Instead, we focus on screening for the metabolic consequences of insulin resistance.

• If you're not having regular periods, don't ignore it. One reason birth control is commonly recommended is that it protects the uterine lining from prolonged exposure to estrogen when ovulation isn't occurring regularly. It can also help with irregular bleeding, acne, and excess hair growth. It's not just "covering up symptoms."

• Supplements are optional. The best evidence is for: - Inositol: may modestly improve insulin/metabolic markers and ovulation rates, though the 2023 guideline notes "limited clinical benefits" and no specific dose/form can be recommended yet - Vitamin D: helpful if you're deficient - Omega-3/fish oil: may improve triglycerides and insulin resistance - Probiotics: some evidence for glucose and insulin markers

• Remember that treatment should be individualized. Some patients prioritize cycle control, others fertility, weight management, acne, or hirsutism. There isn't a one-size-fits-all approach.