PCOS in Female Athletes: Performance, Health, and Management

Polycystic ovary syndrome (PCOS) in female athletes often goes unrecognized because the condition can present atypically in athletic populations. Identifying and managing the syndrome is critical, as it requires a multidisciplinary approach to protect both the long-term health of the athlete and their competitive performance.

The intersection of PCOS and athletics is complex, involving a balance between hormonal advantages in physical performance and the health barriers created by the syndrome. While some hormonal characteristics associated with PCOS may align with athletic strengths, the overall condition can impede an athlete’s ability to reach their full potential.

The Role of Testosterone and Athletic Performance

Research published on March 20, 2020, in Endocr Connect indicates that testosterone levels within the normal female range are related to muscle mass and athletic performance in female athletes. Testosterone is noted for its ability to increase muscle mass and strength, stimulate erythropoiesis, and promote competitive behavior.

Among female athletes, there is an elevated prevalence of hyperandrogenic conditions, which include both PCOS and rare differences or disorders of sex development (DSD) that can significantly increase testosterone production. In women with PCOS, testosterone levels typically remain within the upper part of the normal range.

These findings have led to the proposal that essential hyperandrogenism is beneficial for athletic performance and may play a role in the choice made by some women to compete in athletic activities.

PCOS as a Performance Barrier

Despite the potential performance advantages of higher testosterone, PCOS can also serve as a significant hindrance. According to materials from NSCA Coach, PCOS is identified as a barrier that can prevent female athletes from reaching their full potential.

While athletes are frequently reminded to manage stress, nutrition, training, and sleep to optimize their performance, hormonal factors like PCOS are often overlooked or inadequately addressed in athletic training environments.

Hormonal Pathways and Exercise

Exercise has a direct influence on various hormonal pathways that are impacted by PCOS. Understanding these interactions is essential for strength and conditioning coaches to support the health and performance of athletes with the syndrome.

The specific hormonal pathways affected by PCOS and influenced by exercise include:

• Insulin resistance
• Cortisol
• Testosterone
• Follicle-stimulating hormone (FSH)
• Luteinizing hormone (LH)

Clinical Management and Diagnosis

The diagnosis of PCOS in athletes is frequently delayed or missed due to atypical presentations. Because the physical manifestations of the syndrome may be masked or altered by high levels of athletic activity, careful differentiation is required by clinicians.

Effective management of the condition requires an individualized approach. Because PCOS affects multiple systems—including metabolic and reproductive health—a multidisciplinary team is necessary to ensure that clinical management supports the athlete’s performance goals without compromising their long-term health.