The answer lies in the regulation of glutathione metabolism and the critical role of Se-P, selenoprotein formation and function in the endocrine system.
Moreover, its depletion and the resulting lack of glutathione, and imbalances in the intregal neurochemistry: glutathione <--> GABA <---> glutamate <--->NMDA
coupled with a curious feedback loss to the gut, in the loss of the very bacteria responsible forB2, B6 and B12 uptake and metabolism. This occurs in patients who have low Se-P, low natural production of glutathione, and have excess glutamate activity AND sensitivity to its production in gut. There tends to be a natural proclivity towards this chemistry..BUT, it takes excess stress, a sedentary lifestyle, a higher fat and simple carb, lower protein diet ..to set these wheels in motion.
(Note that glutathione is also a sulfur protein. Sulfur and selenium are co-tgransported. There is a possibility that altered sulfur metabolism plays a role in reduced Se-P production and glutathione and GABA biosynthesis in liver.)
The answer, then, lies a series of simple lifestyle corrections:
improved daily exercise, focusing on cardiovascular condition and building muscle - in PCOS, excess androgen can be a problem, and the best way to reduce circulating levels that result from thecal cell (ovarian tissue) production of excess androgen from excess estrogen - is to control it via muscle cell feedback to liver and brain (thats back to pituitary and the hypothalamus).
To get the latter in tune: requires stress control / active management. Thats meditative walks, belly breathing, controlled relaxation with music, and avoidance of a lifestyle that encourages anxiety, anger, and depression.
That, in turn, requires dietary revision. Fresh vegetables, lots of whole protein PLUS whey (and brans), probiotics and avoidance of both saturated fats and omega-6 fats and simple carbohydrates. I would also use a digestive enzyme blend (Now Super Enzyme is OK).
Supplementation is straightforward and follows the biochemical pinchpoints:
A good multimineral/multivitamin. Short duration daily dosing with selenium methionate and molybendum chelate, zinc, vit C, and E. Extra B6, in the form of P5P (with B2, P5P usually has it in it, if not needs to be taken), and a little methylB12 (not much, don't need much, every other day is fine).
Omega-3 oil in a concentrate is good idea. NAC, in moderation, is also wise.
A little theanine, and a little magnesium and taurine are also wise additions.
I also encourage use of sam-e.
Treatment time: permanent, this condition is reversible, but will return if lifestyle/diet/exercise slack off. Time to resumption of normalized menses: 1-3 months. Time of reversal weight gain / hyperinsulinemia / acne hyperandrogenemia : approx 6-12 months.
Benefits: avoidance / reversal of thyroid and GI disease, resumption of normal ovulation, reduced breast, cervical and ovarian cancer. Resumption of normalized mood and sleep.