Polycystic ovary syndrome (PCOS) extends far beyond the ovaries. It impacts hormones, metabolism, pelvic function, fertility, mental health, and the musculoskeletal system. Standard care often emphasises medication or diet, but overlooks gaps especially in movement, load adaptation and pelvic health.
At Embrace Physiotherapy, our women’s health physiotherapists, working closely with dietitians and gynecologists to offer an evidence‑based, whole‑body PCOS management approach. This blog explains how we combine clinical research and experience to provide comprehensive physiotherapy and nutrition support for hormonal balance, fertility, and long-term women’s health.>
Because PCOS touches multiple systems, its effects reach beyond reproductive years and can shape long-term health and quality of life.
What is PCOS: Beyond the Ovaries
PCOS is one of the most common hormonal disorders, affecting about 1 in 10 women of reproductive age. Although the “polycystic” name suggests ovarian cysts, the real picture is far broader.
Diagnostic Criteria
PCOS is diagnosed when two of the following are present:
- Oligo‑ or anovulation (irregular or absent menstrual cycles)
- Clinical or biochemical hyperandrogenism
- Polycystic ovarian morphology on ultrasound.
Because PCOS is a syndrome, women may present different combinations of symptoms. And newer guidelines are suggesting that a blood test assessing Antimuellarian Hormone (AMH) levels may be able to replace pelvic ultrasounds (Teede et al. 2023).
Systemic Consequences
PCOS has measurable effects across multiple systems in the body:
- Up to 70% of women with PCOS exhibit insulin resistance, which contributes to metabolic syndrome, type 2 diabetes risk, and cardiovascular disease (Singh et al. 2023; Teede, Deeks & Moran 2010).
- Structured exercise interventions have produced consistent improvements in insulin sensitivity, body composition, and menstrual regularity (Patten et al. 2020; Moran et al. 2011).
- PCOS is associated with chronic low-grade inflammation, affecting vascular and muscle function (Sadeghi et al. 2022).
- Women with PCOS have 3–4× greater risk of anxiety and depression relative to unaffected peers (Teede, Deeks & Moran 2010).
- In fertility and pregnancy, PCOS carries elevated risks of miscarriage, gestational diabetes, and obstetric complications.
Because PCOS affects multiple domains, any care plan that ignores movement, pelvic health, or musculoskeletal function leaves gaps. Physiotherapy for PCOS helps bridge those gaps, especially when combined with PCOS diet and lifestyle changes.
Watch: A conversation between a dietitian and a physio on PCOS
Can PCOS cause urinary incontinence or pelvic pain?
In clinical practice we find some women presenting with pelvic floor changes, often have a concurrent diagnosis of PCOS and or endometriosis/adenomyosis. So what does the research tell us?
- A case–control study of 368 women revealed that 37% of those with PCOS had pelvic floor dysfunction (PFD), compared with 6% in matched controls (Omar et al. 2023).
- Biomechanical research from 2025 demonstrated that hormonal milieu in PCOS alters pelvic floor resting tone, muscle length, and coordination (Kamal et al. 2025).
- Hyperandrogenic states may lead to thicker muscle bulk in pelvic floor muscles—but that does not guarantee coordination, control or symptom relief.
These findings suggest increased vulnerability to:
- Urinary incontinence (stress, urgency, mixed)
- Pelvic heaviness, pressure or pain
- Dyspareunia or sexual discomfort
- Bowel or defecatory dysfunction
These symptoms are frequently under‑assessed in standard PCOS care, but women’s health physiotherapists can help!
What pelvic floor physiotherapy treatments help with PCOS symptoms?
When a woman with PCOS presents to Embrace, to better understand her pelvic health status or desires management for her pelvic health concerns, assessment and management may include the following:
- Comprehensive pelvic floor assessment (internal + external)
– Identify resting tone, contractile ability, coordination, reflex integrity
– Evaluate voiding/defecation dynamics
– Palpate for trigger points or hypertonicity - Manual therapy / soft tissue release
– Myofascial release, tender/trigger point release
– Gentle connective tissue or perineal mobilisations - Breathing & intra‑abdominal pressure management
– Diaphragmatic coordination with pelvic control
– Thoracic mobility through stretches - Pelvic Floor Muscle Training (PFMT) with progression
– Where indicated focus on control, timing, endurance (not just strength) and/or downtraining and relaxation strategies
– Use feedback (tactile, ultrasound, electrical biofeedback) when needed - Symptom‑directed strategies
– Urinary: bladder retraining, timed voiding
– Bowel: teaching you how to poo, creating a bowel routine, downtraining pelvic floor strategies
– Dyspareunia: graded exposure, relaxation, desensitisation
Through these interventions in PCOS physiotherapy treatment, we monitor symptom changes over time and adjust progression based on your response.
What is the best type of exercise for managing PCOS?
Exercise for PCOS is a cornerstone of therapy. Seemingly well looking people don’t often think of seeing a women’s health physiotherapist for exercise prescription, however it can be a game changer and allow for a tailored whole person approach that respects your pelvic health, co-morbidities and your goals. So what does the research say?
- Patten et al. (2020) meta-analysis: aerobic, resistance or combined exercise improves insulin sensitivity, reduces waist circumference, and assists cycle regulation.
- Moran et al. (2011) Cochrane review: lifestyle interventions (diet + exercise) yield favorable metabolic and reproductive outcomes.
- Giallauria et al. (2008): 16-week supervised aerobic training improved autonomic balance and reduced inflammatory markers in women with PCOS.
- Mahindru, Patil & Agrawal (2023): physical activity supports mental health, mood, stress regulation in chronic conditions.
How this might look in clinic
- Baseline screening
– Strength, mobility, pain, postural and pelvic floor baseline
– Red‑flag screening - Low-impact initiation
– Walking, cycling, swimming — 3–5 × per week, 20–30 minutes
– Emphasis on adherence and bodily ease - Resistance training progression
– 2–3 sessions per week, 8–15 reps, moderate to high load
– Monitor pelvic signs (leakage, pressure, pain) and adjust - Interval (HIIT) work as tolerated
– Short bursts (30 s work / 1 min rest) phased in after foundational strength
– Align dose with pelvic and or cardio tolerance - Cycle‑aware modulation
– In phases of low energy or symptom flare, reduce volume or intensity
– Use “anchor workouts” you can reliably do in low-energy days - Functional integration
– Transition exercises into everyday movement patterns
– Help you move towards sustainable group based exercise classes
The TL;DR: we start where you are at and build connection and resilience over time in a progressive and sustainable manner.
Is pelvic floor physiotherapy useful for preconception care?
The short answer is YES! Szafarowska et al. (2024) observed that when adding physiotherapy to infertility care in PCOS improved quality of life and psychological metrics. While fertility treatment is medical in nature, physiotherapy helps to address mechanical infertility working towards comfortable and successful penetration over time.
Women with PCOS frequently report sexual dysfunction- pain, low desire or discomfort. Pelvic floor physiotherapy can help by:
- Evaluating pelvic floor tone, scar / trigger tissue
- Graded desensitisation and exposure, neuromodulation, manual releases
- Restoring muscle relaxation, control, confidence in intimacy
This is about physical function and body safety and trust.
Is pelvic floor function impacted by PCOS and gestational diabetes in pregnancy?
Gestational diabetes (GDM) is more common in PCOS sufferers; and GDM is associated with an increased incidence of pelvic floor dysfunction and urinary incontinence during pregnancy and after childbirth (Barbosa et al., 2011; Kim et al., 2008).
Typically, during pregnancy the deep pelvic floor muscles undergo hypertrophy (bulk up), and during labour, they must stretch (up to 300%) to allow fetal descent. However, in women with GDM the expected hypertrophy of the pelvic floor muscles and enlargement of the hiatal area did not occur; instead, there was a decrease in hiatal area and reduced muscle thickness between 24–28 weeks and 34–38 weeks of gestation. This suggests compromised adaptability under glucose dysregulation and may also be a reason for which GDM may contribute to the previously observed higher rates of labour dystocia and c-section in this cohort (Sartorão Filho et al., 2020).
Thus, in our antenatal planning we:
- Introduce modified pelvic floor conditioning and create length and distensibility
- Educate on load, core, birth‑mechanics- guide you on how to breath, position yourself and push for labour
- Offer perineal massage education demonstration and practice. Have you heard of our Birth Prep program?
Help you get ahead of your postpartum recovery including the core and floor and any other aches and pain that you may experience.
Can combining physiotherapy and diet improve PCOS symptoms?
PCOS management works best when diet and physiotherapy align. Dietitian-guided nutrition supports hormonal balance and reduces inflammation, while physiotherapy improves movement and stress regulation.
- Balanced macronutrients and glycaemic control
- Anti-inflammatory foods and mindful eating habits
- Monitoring of metabolic markers and progress
Together, physiotherapy and nutrition create multi-dimensional care—improving cycles, metabolism, and fertility outcomes.
Download the PCOS Diet + Exercise Cheatsheet
Let’s support your PCOS journey, together
At Embrace Physiotherapy, women’s health isn’t an afterthought—it’s our focus. From first period to fertility, pelvic pain to perimenopause, our care is designed by women, for women.
Located on Joo Chiat Road in Katong, our calm, private clinic supports women across Singapore’s East Coast and beyond. We’re one of the few clinics offering internal pelvic floor physiotherapy alongside PCOS-aware movement and metabolic care—all within a whole-person approach.
If you’re living with pelvic discomfort, unpredictable cycles, fertility concerns, or energy crashes, you’re not alone—and you don’t have to push through in silence.
Book a PCOS + Pelvic Health Assessment today and let’s co-create a plan that supports your symptoms, your goals, and your future.
References
Barbosa, A.M.P., Adriano Dias, G.M., Calderon, I.M.P., Rudge, I.M.V.C. and Witkin, S. (2011). Urinary incontinence and vaginal squeeze pressure two years post‐cesarean delivery in primiparous women with previous gestational diabetes mellitus. Clinics, 66(8), 1341–1345. https://doi.org/10.1590/S1807-59322011000800006
Giallauria, F., Palomba, S., Maresca, L., Vuolo, L., Tafuri, D., Lombardi, G., Colao, A., Vigorito, C., & Francesco, O. (2008). Exercise training improves autonomic function and inflammatory pattern in women with polycystic ovary syndrome (PCOS). Clinical Endocrinology, 69(5), 792–798. https://doi.org/10.1111/j.1365-2265.2008.03305.x
Kim, C., McEwen, L.N., Sarma, A.V., Piette, J.D. and Herman, W.H. (2008). Stress urinary incontinence in women with a history of gestational diabetes mellitus. Journal of Women’s Health, 17(5), 783–792. https://doi.org/10.1089/jwh.2007.0616
Mahindru, A., Patil, P., & Agrawal, V. (2023). Role of Physical Activity on Mental Health and Well-Being: A Review. Cureus, 15(1). https://doi.org/10.7759/cureus.33475
Moran, L. J., Hutchison, S. K., Norman, R. J., & Teede, H. J. (2011). Lifestyle changes in women with polycystic ovary syndrome. The Cochrane Database of Systematic Reviews, (2), CD007506. https://doi.org/10.1002/14651858.CD007506.pub2
Patten, R. K., Boyle, R. A., Moholdt, T., Kiel, I., Hopkins, W. G., Harrison, C. L., & Stepto, N. K. (2020). Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Frontiers in Physiology, 11. https://doi.org/10.3389/fphys.2020.00606
Sadeghi, H. M., Adeli, I., Calina, D., Docea, A. O., Mousavi, T., Daniali, M., Nikfar, S., Tsatsakis, A., & Abdollahi, M. (2022). Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Repurposing. International Journal of Molecular Sciences, 23(2). https://doi.org/10.3390/ijms23020583
Singh, S., Pal, N., Shubham, S., Sarma, D. K., Verma, V., Marotta, F., & Kumar, M. (2023). Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. Journal of Clinical Medicine, 12(4). https://doi.org/10.3390/jcm12041454
Szafarowska, M., Rosiński, M., Segiet-Święcicka, A., Jędrzejczyk, S., Jerzak, M., & Jerzak, M. (2024). Effect of physiotherapy on infertility treatment in polycystic ovary syndrome patients. Przegla̜d Menopauzalny = Menopause Review, 23(1), 14-20. https://doi.org/10.5114/pm.2024.136439
Sartorão Filho, C., Pinheiro, F., Prudencio, C., Nunes, S., Takano, L., Enriquez, E., Orlandi, M., Junginger, B., Rudge, M. and Barbosa, A. (2020). Impact of gestational diabetes on pelvic floor: A prospective cohort study with three‐dimensional ultrasound during two‐time points in pregnancy. Neurourology and Urodynamics. https://doi.org/10.1002/nau.24511
Teede, H., Deeks, A., & Moran, L. (2010). Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Medicine, 8, 41. https://doi.org/10.1186/1741-7015-8-41
Teede, H., Hashimoto, T., Laven, J., Misso, K., Souter, T., Bredenoord, A., et al. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Monash University. https://doi.org/10.26180/24003834.v1
