PCOS / PMOS
PCOS and sport
Exercise, elite sport and androgens
Exercise is important for women with polycystic ovary syndrome (PCOS/PMOS). It improves insulin sensitivity, metabolism, fitness and mood, even without weight loss. The 2023 international guideline recommends 150 to 300 minutes of moderate or 75 to 150 minutes of vigorous activity per week, plus strength training on two days a week. The best form of exercise is the one a woman enjoys and keeps up.
Beyond the importance of exercise for the well-being of women with PCOS, however, these women also have an indirect relationship with sport and elite sport.
Why is PCOS common in female athletes?
Androgens have an anabolic effect. They increase muscle mass and strength, strengthen the bones and shape body composition. Women with PCOS usually have mildly raised androgens, and their effect is visible outside sport as well. In one study, women with PCOS who did not do sport had greater muscle strength than women without PCOS, regardless of body composition, and strength rose with testosterone levels.
In elite sport this link becomes even clearer. In a Swedish study of 90 Olympic athletes, about 27% of athletes who did not use hormonal contraception had cycle disorders, mostly in endurance sports. The most common cause was not a lack of energy, as one might expect, but PCOS. Bone density in these athletes was high, and none had osteopenia. Another Swedish study in endurance athletes showed that athletes with PCOS had a higher aerobic capacity (VO2max), more muscle mass and a higher bone density than athletes of the same weight without PCOS. Androgen levels were linked to aerobic capacity and muscle mass. In Olympic athletes, other androgens, dihydrotestosterone and DHEA, were also linked to performance.
The link is therefore indirect. Sport does not cause PCOS. Women with PCOS, however, often have physical features that favor performance, and for this reason they reach elite sport more often. Androgens also seem to protect their bones, even when periods are rare.
Androgens and performance
Olympic athletes, Sweden
Cycle disorders in 27%. Most common cause PCOS. High bone density.
Endurance athletes with PCOS
Higher VO2max, more muscle mass, higher bone density.
Middle-distance events
2 to 3% better performance with the highest testosterone. The data are disputed.
Women with PCOS who do not do sport
Greater muscle strength, depending on testosterone.
Are raised androgens doping?
No. The World Anti-Doping Agency (WADA) prohibits only the administration of androgens as medicines. Androgens that the body of a woman with PCOS produces itself are not doping.
The question of whether naturally high androgens give an unfair advantage has, however, occupied sport for years. Among female track athletes, those with the highest testosterone levels performed 2 to 3% better in middle-distance events. Other researchers question these data. On this basis, World Athletics introduced rules in 2018 for athletes with certain differences of sex development (DSD), such as 5-alpha-reductase deficiency or partial androgen insensitivity. In these conditions, testosterone reaches male levels. Since 2023, these athletes must keep their testosterone below 2.5 nmol/L for at least 24 months to compete in the female category.
The rules state explicitly, however, that they do not apply to PCOS or to congenital adrenal hyperplasia. In PCOS, androgens are mildly raised and stay far below male levels. An athlete with PCOS therefore competes without any restriction.
There is, however, a practical point about treatment. Some medicines used in PCOS are on the WADA Prohibited List for 2026. Spironolactone is a diuretic and is prohibited at all times, in and out of competition. Letrozole and clomiphene, which are used to induce ovulation, are also prohibited at all times. An athlete who is subject to doping controls and needs these medicines must apply for a Therapeutic Use Exemption (TUE) before treatment. The contraceptive pill, metformin, GLP-1 receptor agonists and inositol are not on the list.
PCOS medicines and the WADA list 2026
Not prohibited
Prohibited at all times, TUE needed
What if periods stop?
Female athletes often have cycle disorders, and PCOS is not the only reason. A lack of energy can cause functional hypothalamic amenorrhea, a condition with an opposite mechanism that often looks like PCOS in tests. The two conditions can also exist together. More in the article PCOS and functional hypothalamic amenorrhea.
The practice's approach
The doctor encourages every woman with PCOS to exercise regularly, in a form that fits her life.
The practice supports the needs of women with PCOS in competitive sport and makes sure they stay safe. With every cycle disorder, the doctor also checks for functional hypothalamic amenorrhea. The aim of the practice is for the woman to do sport safely, in good health and without worry.
Sources: International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (Monash University, ESHRE, ASRM, 2023); Teede HJ et al., Human Reproduction 2023. Hagmar M et al., Hyperandrogenism may explain reproductive dysfunction in Olympic athletes, Medicine & Science in Sports & Exercise 2009. Rickenlund A et al., Hyperandrogenicity is an alternative mechanism underlying oligomenorrhea or amenorrhea in female athletes and may improve physical performance, Fertility and Sterility 2003. Eklund E et al., Serum androgen profile and physical performance in women Olympic athletes, British Journal of Sports Medicine 2017. Kogure GS et al., Women with polycystic ovary syndrome have greater muscle strength irrespective of body composition, Fertility and Sterility 2015. Bermon S, Garnier PY, Serum androgen levels and their relation to performance in track and field: mass spectrometry results from 2127 observations in male and female elite athletes, British Journal of Sports Medicine 2017. Hirschberg AL, Female hyperandrogenism and elite sport, Endocrine Connections 2020. Hirschberg AL, Hyperandrogenism in female athletes, Journal of Clinical Endocrinology and Metabolism 2019. World Athletics, Eligibility Regulations for the Female Classification (Athletes with Differences of Sex Development), 2023. World Anti-Doping Agency, Prohibited List 2026.